Introduction
Methods
Study design and participants
Instrumentation
Sample size calculation
Data collection
Data analysis
Results
Baseline characteristics of the study participants
n | % | |
---|---|---|
Gender | ||
Male | 152 | 27.1% |
Female | 408 | 72.9% |
Age (years) | ||
20-29 | 219 | 39.1% |
30-49 | 302 | 53.9% |
> 50 | 39 | 7.0% |
Marital status | ||
Married | 370 | 66.1% |
Unmarried | 190 | 33.9% |
Urbanicity | ||
Urban | 314 | 56.1% |
Rural | 246 | 43.9% |
Type of hospital | ||
Private | 422 | 75.4% |
Public | 138 | 24.6% |
Occupation | ||
Physician | 81 | 14.5% |
Lab specialist | 74 | 13.2% |
Pharmacist | 51 | 9.1% |
Nurse | 354 | 63.2% |
Years of experience | ||
Less than 10 years | 315 | 56.3% |
10 years or more | 245 | 43.8% |
Heath status | ||
Fair or below | 86 | 15.4% |
Good or above | 474 | 84.6% |
Presence of comorbidities | ||
Yes | 135 | 24.1% |
No | 425 | 75.9% |
Type of hospital | ||
Private | 422 | 75.4% |
Public | 138 | 24.6% |
Health Coverage | ||
Public insurance | 490 | 87.5% |
Private insurance | 29 | 5.2% |
None | 41 | 7.3% |
Influenza vaccine uptake in previous season | ||
Yes | 180 | 32.1% |
No | 380 | 67.9% |
Refused vaccination of a certain type of vaccine in the past | ||
Yes | 82 | 14.6% |
No | 478 | 85.4% |
Flu vaccination uptake
HCWs knowledge toward flu vaccination
Poor (<50%) | Moderate (50-79%) | Good (≥80%) | |
---|---|---|---|
n (%) | n (%) | n (%) | |
Domains of Knowledge score | |||
Domain1: Influenza: nature, symptoms and transmission | 52(9.2%) | 114(20.4%) | 394(70.4%) |
Domain 2: Influenza vaccine importance and safety | 39(7%) | 90(16%) | 431(77%) |
Domain 3: Influenza vaccine target groups | 168(30%) | 107(19.1%) | 285(50.9%) |
Domain 4: Vaccine administration and storage | 74(13.2%) | 170(30.4%) | 316(56.4%) |
Domain 5: Timing of vaccination | 22(3.9%) | 138(24.6%) | 400(71.5%) |
Domain 6: Influenza and COVID-19 | 18(3.2%) | 150(26.8%) | 392(70%) |
Knowledge score (28 items) | 2(0.4%) | 290(51.8%) | 268(47.9%) |
# | Correct | Wrong | |
---|---|---|---|
n(%) | n(%) | ||
Influenza: nature, symptoms and transmission (n = 6 items) | |||
Influenza, caused by a virus can be a serious disease that can lead to hospitalization and sometimes even death | 1 | 498(88.9%) | 62(11.1%) |
Anyone can’t get very sick from flu including people who are healthy | 2 | 451(80.5%) | 109(19.5%) |
The signs and symptoms of influenza include fever, headache, sore throat, pain and aches | 3 | 554(98.9%) | 6(1.1%) |
You can get flu from patients and coworkers who are sick with flu | 4 | 558(99.6%) | 2(0.4%) |
If you become sick with flu, you can spread it to others even if you don’t feel sick | 5 | 422(75.4%) | 138(24.6%) |
Symptoms typically appear 8 to 10 days after a person is exposed to influenza | 6 | 283(50.5%) | 277(49.5%) |
Influenza vaccine safety and importance (n = 5 items) | |||
The seasonal vaccine protects against the most common influenza viruses including H1N1 | 1 | 488(87.1%) | 72(12.9%) |
Flu vaccine cannot cause flu | 2 | 361(64.5%) | 199(35.5%) |
Flu vaccines are safe, serious problems from a flu vaccine are very rare | 3 | 497(88.8%) | 63(11.2%) |
MOPH recommends that HCWs receive influenza vaccine | 4 | 518(92.5%) | 42(7.5%) |
By getting vaccinated, you help protect yourself, your family, and your patients. | 5 | 517(92.3%) | 43(7.7%) |
Influenza vaccine target groups (n = 4 items2) | |||
Vaccination to prevent flu is particularly important for people who are at high risk of developing serious flu complications | 1 | 540(96.4%) | 20(3.6%) |
Pregnant women and people with certain chronic health conditions can get a flu shot | 2 | 382(68.2%) | 178(31.8%) |
Children younger than 6 months of age are too young to get a flu should not get flu shot | 3 | 409(73%) | 151(27%) |
When vaccine supply is limited, vaccination efforts should be prioritized to: | 4 | ||
Children aged 6 months through 4 years (59 months); | 4a | 224(40%) | 336(60%) |
People with chronic diseases pulmonary, cardiovascular, renal, hepatic, neurologic | 4b | 463(82.7%) | 97(17.3%) |
People who are immunosuppressed | 4c | 408(72.9%) | 152(27.1%) |
Pregnant woman | 4d | 199(35.5%) | 361(64.5%) |
Health care personnel; | 4e | 430(76.8%) | 130(23.2%) |
Administration and storage of vaccine (n = 3 items) | |||
A trivalent flu shot made using an adjuvant is approved for administration for people ≥65 y of age and older. | 1 | 372(66.4%) | 188(33.6%) |
Antibodies develop in the body about 2 weeks after influenza vaccination. | 2 | 465(83.0%) | 95(17%) |
Influenza vaccine should be stored at 2 to 8 ° C | 3 | 517(92.3%) | 43(7.7%) |
Timing of vaccination (n = 3 items) | |||
Vaccination should occur before onset of influenza activity in the community. | 1 | 545(97.3%) | 15(2.7%) |
Vaccination should continue to be offered as long as influenza viruses are circulating | 2 | 427(76.3%) | 133(23.8%) |
Annual vaccination is needed to get the “optimal” or best protection against flu | 3 | 523(93.4%) | 37(6.6%) |
COVID-19 and influenza (n = 3 items) | |||
Flu vaccine didn’t protect against COVID-19 | 1 | 481(85.9%) | 79(14.1%) |
Both viruses influenza and COVID-19 are transmitted by respiratory droplets | 2 | 554(98.9%) | 6(1.1%) |
COVID-19, and influenza are vastly different pathogens, but there are important areas of overlap | 3 | 459(82%) | 101(18%) |
HCWs attitudes toward flu vaccination
Strongly disagree | Disagree | Neutral | Agree | Strongly agree | |
---|---|---|---|---|---|
n(%) | n(%) | n(%) | n(%) | n(%) | |
General attitudes towards influenza and vaccination (N = 560) | |||||
I think it is not compulsory for HCW to get vaccinated for Influenza | 241(43%) | 174(31.1%) | 55(9.8%) | 70(12.5%) | 20(3.6%) |
I think that influenza is not a serious condition and therefore is not worth vaccination against. | 192(34.3%) | 261(46.6%) | 53(9.5%) | 50(8.9%) | 4(0.7%) |
I think that the benefits of avoiding the disease are not enough | 86(15.4%) | 214(38.2%) | 114(20.4%) | 121(21.6%) | 25(4.5%) |
I think vaccines weaken or overload the immune system | 141(25.2%) | 298(53.2%) | 70(12.5%) | 43(7.7%) | 8(1.4%) |
It is better for me to develop natural immunity by getting sick rather than to get a vaccine | 74(13.2%) | 240(42.9%) | 118(21.1%) | 111(19.8%) | 17(3%) |
I think healthy people do not need to be vaccinated | 74(13.2%) | 269(48%) | 90(16.1%) | 115(20.5%) | 12(2.1%) |
I consider that allergies are on the rise due to vaccinations | 69(12.3%) | 282(50.4%) | 137(24.5%) | 69(12.3%) | 3(0.5%) |
I think that frequency of adverse reactions to influenza vaccines is underestimated | 17(3%) | 122(21.8%) | 197(35.2%) | 206(36.8%) | 18(3.2%) |
Vaccines are among the safest and most tested medicinal products | 10(1.8%) | 46(8.2%) | 145(25.9%) | 324(57.9%) | 35(6.3%) |
HCWs Attitudes towards health facility, government and society (N = 560) | |||||
I think that health care facilities should ensure availability of influenza vaccine at their institutions | 54(9.6%) | 136(24.3%) | 122(21.8%) | 217(38.8%) | 31(5.5%) |
I think that the government should finance the vaccine for all | 7(1.3%) | 27(4.8%) | 47(8.4%) | 202(36.1%) | 277(49.5%) |
I think Lebanese society has more important problems than influenza | 42(7.5%) | 99(17.7%) | 92(16.4%) | 195(34.8%) | 132(23.6%) |
I think vaccine policy in Lebanon is influenced by financial profits of pharmaceutical companies | 9(1.6%) | 56(10%) | 141(25.2%) | 217(38.8%) | 137(24.5%) |
I think that vaccine information provided by health authorities and scientific societies is reliable | 15(2.7%) | 66(11.8%) | 185(33%) | 268(47.9%) | 26(4.6%) |
HCWs practices toward flu vaccination
Never | Occasionally | Always | |
---|---|---|---|
n(%) | n(%) | n(%) | |
Vaccine promotion and Advertising | |||
I encourage my patients to get flu vaccine | 36(6.4%) | 213(38%) | 311(55.5%) |
I encourage my colleagues and the office staff to get flu vaccine | 46(8.2%) | 194(34.6%) | 320(57.1%) |
I encourage my family members who need to be vaccinated to get vaccinated | 43(7.7%) | 182(32.5%) | 335(59.8%) |
I encourage HCWs to get flu vaccine to minimize sick days, loss of productivity and to ensure patient safety | 46(8.2%) | 167(29.8%) | 347(62%) |
I encourage HCWs to get flu vaccine to avoid dual infection by COVID-19 | 41(7.3%) | 177(31.6%) | 342(61.1%) |
I encourage HCWs to get vaccinated to set an example to other workers | 62(11.1%) | 156(27.9%) | 342(61.1%) |
Addressing vaccine hesitance | |||
I communicate the importance of getting influenza vaccine during office/clinics visits | 90(16.1%) | 243(43.4%) | 227(40.5%) |
I communicate the importance of getting influenza vaccine by telephone or by email | 268(47.9%) | 193(34.5%) | 99(17.7%) |
I use brochures and posters in my clinic/office revealing the importance of vaccine | 163(29.1%) | 264(47.1%) | 133(23.8%) |
I send influenza vaccine reminder by text to my patient | 298(53.2%) | 165(29.5%) | 97(17.3%) |
I celebrate event related to vaccination (vaccination day…..) | 285(50.9%) | 184(32.9%) | 91(16.3%) |
Trainings and Workshops | |||
I participate in trainings related to influenza vaccine in the past | 46(8.2%) | 147(26.3%) | 367(65.5%) |
I encourage my staff (HCWs) to participate in trainings related to influenza vaccine | 74(13.2%) | 227(40.5%) | 259(46.3%) |
Perceived barriers and benefits toward flu vaccination
Factors associated with influenza uptake
Influenza vaccine uptake | ||||||
---|---|---|---|---|---|---|
No | Yes | p-value | ORa | 95% CI | ||
n = 111(%) | n = 449(%) | Lower | Upper | |||
Gender | 0.612 | |||||
Male | 28(18.4%) | 124(81.6%) | ||||
Female | 83(20.3%) | 325(79.7%) | ||||
Age (years) | 0.604 | |||||
< 30 | 41(18.7%) | 178(81.3%) | ||||
30-49 | 64 (21.2%) | 238(78.8%) | ||||
50 and above | 6(15.4%) | 33(84.6%) | ||||
Urbanicity | 0.489 | |||||
Urban | 59(18.8%) | 255(81.2%) | ||||
Rural | 52(21.1%) | 194(78.9%) | ||||
Occupation | 0.273 | |||||
Physician | 12(14.8%) | 69(85.2%) | ||||
Pharmacist | 12(16.2%) | 62(83.8%) | ||||
Lab technician | 14(27.5%) | 37(72.5%) | ||||
Nurses | 73(20.6%) | 281(79.4%) | ||||
Marital status | 0.041 | |||||
Married | 71(19.2%) | 299(80.8%) | 1.00 | |||
Unmarried | 40(21.1%) | 150(78.9%) | 0.527 | 0.284 | 0.978 | |
Perceived Health status | 0.370 | |||||
Good and Above | 97(20.5%) | 377(79.5%) | ||||
Fair and below | 14(16.3%) | 72(83.7%) | ||||
Presence of comorbidities | 0.851 | |||||
Yes | 26(19.3%) | 109(80.7%) | ||||
No | 85(20%) | 340(80%) | ||||
Type of the hospital | 0.118 | |||||
Private | 90(21.3%) | 332(78.7%) | ||||
Public | 21(15.2%) | 117(84.8%) | ||||
Health Coverage | 0.605 | |||||
Public | 94(19..2%) | 396(80.8%) | ||||
Private | 7(24.1%) | 22(75.9%) | ||||
None | 10(24.4%) | 31(75.9%) | ||||
Years of experience | 0.926 | |||||
< 10 years | 62(19.7%) | 253(80.3%) | ||||
> 10 years | 49(20%) | 196(80%) | ||||
Influenza vaccine uptake in previous season | <0.001 | |||||
No | 100(9.9%) | 280(37.6%) | 1.00 | |||
Yes | 11(6.1%) | 169(93.9%) | 6.812 | 3.045 | 15.239 | |
Knowledge toward influenza vaccination | <0.001 | |||||
Poor Knowledge | 26(66.7%) | 13(33.3%) | 1.00 | |||
Moderate Knowledge | 28(31.1%) | 62(68.9%) | 2.205 | 0.703 | 6.913 | |
Good Knowledge | 57(13.2%) | 374(86.8%) | 3.305 | 1.155 | 9.457 | |
Attitude toward influenza vaccination | 0.065 | |||||
Negative | 30(60%) | 20(40%) | ||||
Neutral | 22(56.4%) | 17(43.6%) | ||||
Positive | 59(12.5%) | 412(87.5%) | ||||
Perceived benefits | <0.001 | |||||
Low | 37(56.1%) | 29(43.9%) | 1.00 | |||
Moderate | 27(29%) | 66(71%) | 3.433 | 1.466 | 8.040 | |
High | 47(11.7%) | 354(88.3%) | 6.264 | 2.919 | 13.442 | |
Perceived barriers | <0.001 | |||||
High | 29(53.7%) | 25(46.3%) | 1.00 | |||
Moderate | 36(31.3%) | 79(68.7%) | 1.808 | 0.783 | 4.177 | |
Low | 46(11.8%) | 345(88.2%) | 4.130 | 1.827 | 9.334 |