The Flu Bee Game is a digital quiz-style game designed to improve vaccination rates by engaging, educating and encouraging staff to get vaccinated. The game presents flu facts, busts vaccine myths and tells players where and how they can get vaccinated in their organisation. The game's content is based on challenging the top reasons that staff give for not getting vaccinated.
The Flu Bee Game is an HTML5 web app with a supporting website. The game works on any device through a web browser and only takes a few minutes to play. Players answer questions about flu and vaccination. If they get enough questions right and dodge the flu bugs, they build a ‘honeycomb path’ that leads them to ‘Queen Bee’ status. Players are also offered practical advice about where and when to get the vaccine in their organisation.
In the NHS and social care, it is vital that staff get their seasonal flu vaccination to protect themselves, family, colleagues and patients from the virus. In England, the target for NHS trusts in the coming season is to achieve 80% uptake of the vaccine among staff. However, many trusts have not achieved this level of uptake in previous seasons, which suggests that their campaigns need to be more effective at persuading staff to get vaccinated.
Some staff have doubts about the severity of flu and/or have concerns about the vaccine itself. These doubts and concerns are sometimes based on myths and misconceptions and employers must try to persuade these individuals to change their minds and get vaccinated.
Some staff may intend to get vaccinated but do not do so for practical reasons, such as not knowing when or where the vaccine will be administered. These individuals need some simple facts, instructions and a reminder.
All of these myths, misconceptions and practicalities are relatively easy to address, if employers have the right plan, resources and tools in place.
Engaging staff and getting their attention is the starting point for any flu vaccination campaign. Employers cannot address myths and misconceptions about flu unless they can engage staff for long enough to present their messages about flu and the vaccine. Those messages must then be presented in a manner that is easy to understand and likely to effect a change in attitude, leading to vaccination.
The game harnesses the power of ‘serious’ games and gamification. Players can share their success on the game's leader board and invite colleagues to play and compete via social media. The objective is to create a local, regional and national ‘buzz’ through social media and word-of-mouth that raises awareness and increases uptake of the vaccine.
The game was inspired by Joan Pons Laplana. In 2017, Joan was leading the Flu Campaign at James Paget University Hospitals NHS Foundation Trust. In 2016, the uptake for the flu vaccine had reached only 39%, putting the Trust near the bottom of national rankings and so Joan's team were looking for more effective ways to raise awareness about the flu jab.
‘Employers cannot address myths and misconceptions about f lu unless they can engage staff for long enough to present their messages about f lu and the vaccine’
After seeing an online Sepsis Game developed by Focus Games Ltd, Joan approached the company and suggested creating an online game about flu. She explained:
‘Last year, staff used a variety of excuses for not getting vaccinated. These were common myths, so we wanted to raise awareness and to bust these misconceptions. We also wanted to provide facts and evidence to encourage staff to get vaccinated. It had to be fun. I approached Focus Games and the Flu Bee Game was born.’
The game was launched in 2017 and was used by the Trust, as well as 11 other NHS trusts and a large care home group. In 2017-2018 the Trust achieved 71% staff uptake and is now one of the most improved trusts in the UK: it sits near the top of national rankings, a remarkable transformation in under 2 years.
Several other organisations using Flu Bee have seen a significant increase in flu vaccine uptake among staff. A clear example is Frimley Health NHS Foundation Trust. Last year, it was recognised by NHS Employers as having delivered the most improved flu fighter campaign in England after it nearly doubled its vaccination uptake from 38% in 2016–2017 to 72% in 2017–2018 following the introduction of Flu Bee.
Focus Games and Joan assessed the feedback from employers who used the game and individuals who played the game and used this information to create a new version for the 2018–2019 season. This version offered employers more practical support to integrate the Flu Bee Game into their wider campaign and improve promotional activities. A user survey was also added to the game so that feedback could be provided more easily.
In the 2018–2019 season, more than 25 NHS trusts used the game and the Scottish Government supported a trial and study of the game in all Scottish NHS boards. Queen's University Belfast also ran a study of the game with its nursing students and a French version of the game has been produced.
During the 2018–2019 season, players of the game were asked to complete a survey. Between October and December 2018 1801 NHS employees working in a range of clinical and support roles answered the following question: ‘Has the Flu Bee Game changed your perception of flu vaccination?’ Twenty-eight per cent of respondents claimed that they felt ‘more positive’ about flu vaccination after playing the game.
Initial analysis of the survey data from nursing students at Queen's University Belfast suggest that the game was able to change perceptions about the flu and the vaccine, and increase intentions to get vaccinated.
In a survey completed at the time of playing the Flu Bee Game, 425 the Belfast students responded to these questions:
The students were then asked to complete a second survey to find out whether they did get vaccinated. Their responses cannot be independently corroborated and these claims are therefore self-reported.
The initial survey results had identified a cohort of students that could be considered to be ‘confirmed doubters’ who:
These students then played the Flu Bee Game and 26% of these ‘confirmed doubters’:
This preliminary analysis suggests that the Flu Bee Game helped to persuade 26% of students who had not intended to get vaccinated to do so. A further 19% who had claimed they intended to get vaccinated did not for practical reasons such as lack of time or money.
This is a significant cohort of people who could be considered ‘hard-to-reach’ in any vaccine education programme. Further investigation would help establish the efficacy of the Flu Bee Game as a vaccine education tool that prompts behavioural change leading to increased vaccination rates.