Acceptance of influenza vaccine in healthcare workers in New Territories East cluster using a health belief model

Abstract

Background: Influenza vaccination is recommended for healthcare workers (HCW) to reduce mortality and morbidity attributable to influenza. HCW’s acceptance of influenza vaccination in Hong Kong is low when compared to western countries. Little is known about the acceptability and compliance with seasonal influenza vaccines among HCW in New Territories East Cluster (NTEC). Objectives: To examine the risk perception regarding seasonal influenza and influenza vaccination in HCW as well as the acceptance and compliance of influenza vaccination among HCW; to identify reasons for accepting or refusing influenza vaccination, and to determine information sources regarding the effectiveness of influenza vaccine. Methods: We conducted a cross-sectional survey in Family Clinics and four hospitals in NTEC, namely, Prince of Wales Hospital (PWH), Tai Po Hospital (TPH), Alice Ho Miu Ling Nethersole Hospital (AHNH), and North District Hospital (NDH). Definition of HCW included doctors, nurses, allied health professionals, administrative and supporting staff. Multiple logistic regression was performed to identify factors associated with immunization acceptance. Results: 1310 HCW returned their questionnaires by the end of February, 2016. The overall response rate was 43.7%. They were asked about their influenza immunization history as well as the reasons for accepting or declining influenza vaccination. Response rate in different groups of HCW were as follows: doctors 10.4%, allied health 7.3%, nursing staff 50.3%, administrative staff 4.4% and supporting staff 27.7%. Nearly forty percent of HCW (39.4%) had received influenza vaccine in the last three years but only 25.1% of medical staff had received influenza vaccine in the past 12 months. Less than a quarter of them (23.5%) intended to receive vaccination in coming 12 months. The most frequently cited reasons for accepting seasonal flu vaccination were “for patient’s safety”, “better to be protected” and “worry about catching flu”. Over half of HCW (56.3%) who refused influenza vaccination cited “dislike injections” as the main reason for refusing vaccination. The receipt of an influenza vaccine either in past three years (odds ratio (OR)= 1.99, 95% confidence interval (CI)= 1.19-3.32) or last year (p= 0.005, OR= 2.87, 95% CI= 1.38-5.96); perception of severity (p= 0.003, OR= 1.65, 95% CI= 1.19-2.30); perception of benefit (p< 0.001, OR= 1.99, 95% CI: 1.36-2.91); acceptation of injection (p= 0.002, OR=0.73, 95% CI: 0.60-0.89) and feeling regret of not taking flu shot (p= 0.006, OR= 1.54, 95% CI: 1.13-2.09) were factors associated with the intention to receive flu shot. For those HCW received information gathering from Infection Control Team from Hospital Authority (p< 0.001, OR= 14.60, 95% CI: 9.13-23.36), Centers of Health Protection (p< 0.001, OR= 7.84, 95% CI: 3.69-16.70) and colleagues (p< 0.001, OR= 3.79, 95% CI: 2.03-7.10), they are more likely to accept influenza vaccination. Conclusion: The seasonal influenza vaccination coverage among the HCW in our cluster was low. We have identified a number of factors associated with the intention to receive influenza vaccination in the NTEC. Health education and health promotion campaigns that address these factors may improve staff immunization acceptance rate.