Knowledge, attitude, and practices and influencing factors related to seasonal influenza vaccination among health-care workers in Qingdao, China, 2013–14: a prospective cohort study Hao Xiaoning Ph.D Jun. 17th , Roma

Background Method Result Suggestion 2018/4/21

Background Seasonal influenza vaccination among health-care workers(HCWs) can prevent influenza infection among patients in health-care settings. We investigated the HCWs’ awareness and knowledge of seasonal influenza and the influenza vaccine ,and analyzed factors affecting vaccination to formulate targeted strategies to increase vaccination. 2018/4/21

Methods Cluster sampling was used to select eight health institutions in Qingdao, China. A prospective cohort study was conducted in November, 2013 and the random follow-up survey was in June, 2014. Eligible HCWs were full-time employees providing direct patient care. We applied χ²-test and logistic regression to analyze factors influencing vaccination. 2018/4/21

Demographic characteristics of HCWs Results Demographic characteristics of HCWs In the baseline survey, 1852 pre-flu-season questionnaires were distributed to eligible HCWs, 1670 questionnaires were collected and 1521 were finished. In the follow-up survey, 1301 HCWs of those who finished the pre-flu-season questionnaire finished the post-flu-season questionnaire. The average age was 36.6 (SD: 9.2). The characteristics of HCWs in cohort were shown in Table 1 as follow.

Knowledge We set up 4 basic questions to access HCWs’ mastery degree of the knowledge regarding flu and flu vaccine in the questionnaire.

Knowledge We set up 4 basic questions to access HCWs’ mastery degree of the knowledge regarding flu and flu vaccine in the questionnaire.

Among all the health care workers, only 6 Among all the health care workers, only 6.8% (89/1301) HCWs knew the correct answers to all 4 basic questions about flu and flu vaccine. Generally, they can answer 2 questions of 4 correctly (38.5%, 501/1301).

Attitude We chose 9 items to understand HCWs’ attitude toward flu and flu vaccine.

Attitude The vaccination rate was higher in those who thought the vaccine was safe (P<0.01). The vaccination rate was lower in those who concerned about side-effects from the influenza vaccine (P<0.01). Those who concerned about getting flu during flu season had higher vaccination rate. Those who thought they would feel very vulnerable to the flu without flu vaccination and who thought they would regret without getting a flu vaccination and end up getting the flu were both had higher vaccination rate.

For the pre-season flu vaccination intention, 883 (67 For the pre-season flu vaccination intention, 883 (67.9%) HCWs responded there were small chance (including almost zero chance, very small chance and small chance) to get vaccinated in the following flu season. While only 59 (4.5%) HCWs responded large chance (including large possible, very large possible and almost certain) to get vaccinated. And the vaccination rate during the following flu season was significantly higher among those who responded large chance (OR = 17.4, 95%CI: 7.5-39.4) to get vaccinated.

Practices

Our survey showed that 66.9% of HCWs responded they would learn the knowledge of flu actively, and 58.1% responded they would take the initiative to get information related flu vaccine. The main way of HCWs to get information related flu was network (76.3%), secondly were TV or radio (74.3%); in addition, newspaper or book (55.0%) and informed by colleagues (50.2%) were also important ways. 2018/4/21

70.3% of HCWs responded they would continue to work even they got flu; their main reason was too busy. While 28.5% of HCWs responded they would choose to have a rest when got flu because of worrying about transmitting flu to their patients

There were 63 HCWs got vaccinated during 2013-2014 flu season in Qingdao. The vaccination rate was only 4.8%. The rate in the primary health units was significantly higher than that in the second-level hospital (4.1%) and the third-level hospital (1.9%) (χ² =56.96, P < 0.01).

Reasons for accepting and refusing vaccination

The main reasons for refusing flu vaccine included “Concern about side-effects of flu vaccine” (43.4%, 412/950), “Healthy enough, there is no need to be vaccinated” (27.1%, 257/950), “Too busy to be vaccinated” (23.7%, 225/950), “No protection after vaccination” (20.3%, 193/950), “Flu is not a serious disease” (13.6%, 129/950) and “Too expensive” (11.7%, 111/950). The main reasons for accepting flu vaccine included “To prevent flu” (86.6%, 55/63), “To protect my families” (49.3%, 31/63), “To protect patients and colleagues” (38.8%, 24/63), “The flu vaccine is very safe” (32.8%) and so on.

Multivariate analysis of influence factors for flu vaccination

Multivariate analysis results Multivariate analysis showed that compared with HCWs from the third-level hospital, flu vaccination rate among HCWs from primary health units was higher (OR = 5.2, 95%CI: 1.8-14.8). HCWs who consistently receive flu vaccination during prior 3 years is easier to be vaccinated (OR = 11.2, 95%CI: 2.8-45.4) than those who never be vaccinated before. The flu vaccination rate was significantly higher among HCWs with stronger pre-season vaccination intention. HCWs concerned about getting flu during flu season were more likely to be vaccinated (OR = 2.5, 95%CI: 1.2-5.1). What’s more, flu vaccination rates among HCWs who feel very vulnerable to the flu without flu vaccination (OR = 3.6, 95%CI: 1.2-5.6) and who will regret if they do not get a flu vaccination and end up getting flu (OR = 4.3, 95%CI: 1.2-8.5) were higher

Interpretation The influenza vaccination rate among HCWs in Qingdao is low. The vaccination intention was weak, and knowledge about influenza transmission and the effect of influenza vaccination was poor. Health-care education focusing on safety and importance of seasonal influenza vaccine might increase vaccination coverage in this group. 2018/4/21

Thanks！ 2018/4/21