Testing an integrative theory of health behavioural change for predicting seasonal influenza vaccination uptake among healthcare workers

Abstract

Background: Although annual seasonal influenza vaccination is recommended for healthcare personnel (HCPs), their vaccination uptake has been suboptimal. This study aimed to examine the psychosocial determinants of influenza vaccination among HCPs in Hong Kong using a longitudinal study design based on behavioral change theories.

Methods: Participants were invited to complete a baseline survey before the 2017/18 influenza vaccination campaign to measure their baseline perceptions and vaccination intention, and followed up for 9 months to measure actual vaccination uptake. The survey used a theoretical framework combining the Health Belief Model and Theory of Planned Behaviour with extended psychosocial factors for predicting HCPs’ vaccination uptake. Structural equation modelling was used to test the theoretical model and estimate path coefficients (β) to infer associations of psychosocial factors with HCPs’ influenza vaccination uptake.

Results: Of the 845 participants who completed follow-up, 43.0% indicated intending to take vaccination and 30.8% reported actual receipt of the vaccination. The structural equation modeling analysis showed that positive attitude towards influenza vaccination (β = 0.69), greater perceived susceptibility to influenza virus infection (β = 0.34), greater anticipated regret for not vaccinating (β = 0.31), and more cues to action (β = 0.29) were significantly associated with higher vaccination intention which directly predicted greater vaccination uptake (β = 0.82). Norms were found to have an indirect association with vaccination intention through the mediation of attitude towards influenza vaccination (β = 0.63). Self-efficacy was significantly associated with actual receipt of influenza vaccination (β = 0.13) but not vaccination intention. The structural equation model explained 84.7% and 69.6% of the variance, respectively, in HCPs’ intention to receive and actual receipt of influenza vaccination.

Conclusions: Attitude towards influenza vaccination was the strongest predictor of HCPs’ intention and actual receipt of influenza vaccination. Social norm approach may be an intervention strategy to shape HCPs’ attitude towards influenza vaccination and their subsequent decision-making for influenza vaccination.