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20/47 Interventions to Improve the Uptake of the Influenza Vaccination in Carers


Deadline for submission: 17 November 2020, 1pm

Research question(s)

This research brief was prepared before the advent of the Covid-19 viral pandemic. It addresses an issue that remains important, but is arguably now even more pertinent as a result of Covid-19. A vaccine for Covid-19 presently does not exist, but the learning from research commissioned under this brief will likely be of added importance in relation to Covid-19 in the future.

We are interested in proposals for the evaluation of the effectiveness and cost-effectiveness of interventions that aim to improve the uptake of influenza vaccination. The recipients we are interested in are those involved in the care of vulnerable groups. Recipients could be non-NHS nursing and care staff and carers who work in institutions, or in the homes of those in vulnerable groups. This includes unpaid informal carers. Of particular interest are all staff employed in residential or care homes who may be health, social care or domestic staff.

The primary outcome of the research should be uptake of the influenza vaccination and an assessment of the active elements of interventions. Secondary outcomes might also include vaccine recipient acceptability; cost-effectiveness; and impact on healthcare and social care. Applicants should clearly define and justify the choice of intervention, the choice of setting and study design, and choice of outcome measures. Researchers will need to specify how short, medium and long term impacts will be evaluated.

Applicants should explain how the research will fit into the remit of the PHR programme. Epidemiology or exploratory studies are not usually eligible for PHR programme funding but primary research (including pilot, feasibility, randomised and observational studies), modelling studies and evidence syntheses will be considered where these directly inform policy or future intervention evaluation. For this call the PHR programme is not interested in research that aims to develop new interventions, there must be some proof of efficacy. This call is not about increasing uptake in members of vulnerable groups or in NHS staff. However, applicants should familiarise themselves with evidence on maximising vaccine uptake among NHS staff.

Examples of topics of interest include, but are not limited to: promotion, engagement, removing barriers to cultural health beliefs, targeting or improving accessibility (e.g. places or times of delivery) and how to tailor messages to individuals or communities working at a population level.

Inequality of uptake between groups of staff and carers with different characteristics (e.g. ethnicity, socio-economic etc.) is of particular interest. Consideration should be given to external factors that may affect the uptake of the vaccine, such as relevant media activity during the research period, staff contractual requirements and staff turnover.
This is not a call for primary research into the efficacy of the influenza vaccination or national policy change. Researchers should be aware of and draw upon other relevant NIHR and Public Health England funded research.

There are a number of patient and population groups deemed by UK policy as being ‘at risk’ of contracting or having serious complications from influenza. In order to further protect these vulnerable groups, those who care for them can be considered as eligible for influenza vaccination, and the NHS encourages staff to be vaccinated.

However, not all eligible staff or carers take up the free influenza vaccination. There are already some simple interventions that are used in different parts of the UK to promote uptake of the influenza vaccination among these groups, such as marketing campaigns and reminder systems, or workplace vaccination clinics. However, given the relatively low rates of uptake, effective interventions are necessary.

Recent NICE guidance (PH96) has drawn attention to the lack of research evaluating interventions in increasing flu vaccination uptake. Therefore, the PHR programme wishes to commission research into the effectiveness and cost-effectiveness of such interventions, taking into account ongoing initiatives in this field.

Studies should generate evidence to inform the implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation, evidence syntheses + modelling).  Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.

The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered.  Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.

The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - are also of interest. 

For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.

Representatives of policy or practice communities relevant to the project should be directly engaged or involved with the development and delivery of PHR research because this produces research that is more closely grounded in, and reflective of, their concerns and makes the subsequent uptake and application of research findings more likely. By policy or practice, we mean any organisation that is involved in shaping policy or delivering public health services relevant to the research, whether at local or national levels. This might include local authorities, charities, voluntary organisations, professional bodies, commercial organisations, governmental and arms-length bodies.
We welcome proposals in which appropriate professionals (e.g. a director of public health or chief executive of a charity) are formally part of the project team as a co-applicant, and in which they play a defined role in the project. Their contribution may be to facilitate or enable research access to organisations, to be directly involved in research fieldwork, to contribute to interpretation of emerging findings, and to be involved in dissemination activity. The time of policy or practice representatives as co-applicants can be costed into the proposal, as part of the Research Costs. As with all members of a project team, an individual's equipoise should be considered before they are proposed as co-applicant of a research project. Their involvement and associated costs should be fully justified, in the same way as for academic applicants.

There are other ways in which policy or practice representative support for the proposed research can be demonstrated, such as co-opting on to a project advisory or steering group, or the inclusion of a letter or statement of support from a senior policy or practice partner from relevant organisations.

Remit of call

All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) programme. Please go to for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream -

General notes

The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.

The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.

Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.

Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The NIHR PHR programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.

The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the NIHR PHR programme is unable to fund intervention costs.

The NIHR PHR programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at with details of your proposal and the other funder prior to submission.

All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.

Notes to applicants

The NIHR PHR programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.

Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications.

The NIHR Clinical Research Network (CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.

Clinical Trials Units are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.

Transparency agenda

In line with the government’s transparency agenda, any contract resulting from this tender may be published in its entirety to the general public. Further information on the transparency agenda is at: /