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
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Background
Method
Result
Suggestion
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Background
• Seasonal influenza vaccination among healthcare 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.
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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.
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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-fluseason questionnaire finished the post-fluseason 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 6.8% (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
(67.9%) 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.
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 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 secondlevel 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.
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Thanks！
2017/7/29