Seasonal Influenza Vaccine Acceptance among Pregnant Women in Zhejiang Province, China: Evidence Based on Health Belief Model

Abstract

Background: Reasons for acceptance of seasonal influenza vaccine (SIV) vaccination among pregnant women in China are poorly understood. We assessed the intention to accept SIV among pregnant women in Zhejiang province, by using a self-administrated structured questionnaire developed on the basis of health belief model (HBM). Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks who attended antenatal clinics (ANCs) at public hospitals in 6 out of 90 districts were surveyed using a self-administered questionnaire that covered knowledge, attitudes, and beliefs related to SIV vaccination and influenza infection. We examined the associations between the acceptance of SIV vaccination and the demographic factors and HBM constructs using the logistic regression model, calculating the adjusted odds ratio (AOR). Results: Of the 1252 participants, 76.28% were willing to receive the SIV vaccination during their current pregnancy. High levels of perceived susceptibility of influenza (AOR = 1.75 (95%CI: 1.36–2.08)), high levels of perceived severity of influenza (AOR = 1.62 (95%CI: 1.25–1.95)), high level of perceived benefits of vaccination (AOR = 1.97 (95%CI: 1.76–2.21)), and high levels of cues to action were positively associated with the acceptance of SIV vaccination among pregnant women (AOR = 2.03 (95%CI: 1.70–2.69)), while high level of perceived barriers of vaccination was a negative determinant (AOR = 0.76 (95%CI: 0.62–0.94)). Conclusions: Poor knowledge and negative attitude towards SIV were associated with the poor acceptance of SIV. Health providers’ recommendations were important to pregnant women’s acceptance of SIV. Health education and direct communication strategies on SIV vaccination and influenza infection are necessary to improve the acceptance of SIV vaccination among pregnant women.

Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake

“…Our multivariable analysis taking into account both providers’ and women's characteristics revealed that pregnant women who received a recommendation from their attending physicians were more than twice as likely to receive the vaccine. This finding is consistent with other studies that demonstrated providers’ recommendation to be the most striking influencer with as much as 100‐fold increase in the likelihood of vaccination in pregnant women they cared for . We also found that physician self‐report of how frequently they recommended influenza vaccination to pregnant women in the past was not predictive of their recommendation during the visit as reported by the women.…”

“…This finding is consistent with other studies that demonstrated providers' recommendation to be the most striking influencer with as much as 100-fold increase in the likelihood of vaccination in pregnant women they cared for. [46][47][48][49][50][51] We also found that physician self-report of how frequently they recommended influenza vaccination to pregnant women in the past was not predictive of their recommendation during the visit as reported by the women. There was also no association between self-vaccination and recommendation for pregnant women to vaccine.…”

Will they, or Won't they? Examining patients' vaccine intention for flu and COVID-19 using the Health Belief Model

“… 49 , 50 One study conducted before the COVID-19 pandemic noted the significant associations between Perceived Threat or Risk, Barriers, and Cues to Action when determining flu or H1N1 vaccine intention, while another study focused on domains related to knowledge and attitudes towards the flu vaccine. 51 , 52 , 53 A recent study testing HBM with willingness to receive COVID-19 vaccine displayed that Perceived Benefits were significantly related to a “definite intention.” 50 Our study confirmed the role of Perceived Benefits and Perceived Barriers on the Vaccine Intention for both flu and COVID-19 vaccines. One published study used the HBM for vaccine intention among students for A/H1N1 influenza and reported that with similar predictors to this study, a calculated pseudo R 2 of 0.475 was significantly explained by Perceived Risk, Susceptibility, Seriousness, Barriers, and number of flu shots in the last 5 years.…”

Vaccination knowledge and acceptability among pregnant women in Italy

“…In the already mentioned Italian surveys, 21% pregnant women expressed their willingness to get vaccinated for pertussis 14 and for influenza. 16 Studies in other countries reported that the values of those who would get vaccine against influenza ranging from 34.5% in the United States 8 to 76.3% in China, 19 whereas against pertussis a value of 89% has been observed in Canada. 12 Vaccination acceptability in the present study was significantly influenced by the negative beliefs about the safety of the vaccinations, since this willingness was significantly lower among the pregnant women who felt that the recommended vaccines administered during pregnancy were very dangerous for them and for their unborn child.…”