Next Article in Journal
Choice and Design of Adjuvants for Parenteral and Mucosal Vaccines
Next Article in Special Issue
Emerging Influenza Strains in the Last Two Decades: A Threat of a New Pandemic?
Previous Article in Journal / Special Issue
M2e-Based Universal Influenza A Vaccines
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy

1
Department of Clinical and Experimental Medicine, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy
2
Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy
3
School of Specialization in Hygiene and Preventive Medicine, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy
*
Author to whom correspondence should be addressed.
Vaccines 2015, 3(1), 137-147; https://doi.org/10.3390/vaccines3010137
Submission received: 26 November 2014 / Revised: 16 January 2015 / Accepted: 12 February 2015 / Published: 26 February 2015
(This article belongs to the Special Issue Influenza Vaccines)

Abstract

:
Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced.

1. Introduction

Influenza is a major public health challenge. The most effective way to prevent infection with the influenza virus and its potentially severe complications is immunization. Vaccination is safe and well-tolerated and can prevent up to 70%–90% of influenza cases in healthy adults [1,2].
Health care workers (HCWs) and medical students not only are at risk of exposure to influenza viruses because of their contact with patients but are also considered a potential source of transmission. The World Health Organization and the United States Centers for Disease Control and Prevention recommend influenza vaccination for health care personnel, health profession students, and trainees [1,3] to protect themselves and their patients.
Immunization of HCWs has been associated with improvements in patient safety and decreased severe morbidity and mortality in hospitals and other health care facilities [4,5,6,7,8,9]. Moreover, vaccination of HCWs can reduce workplace absences, deliver economic benefits for healthcare systems, and provide cost savings for healthcare organizations [10,11].
Assessing the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza and the influenza vaccine can be useful for planning tailored influenza vaccination campaigns and improving vaccination rates [12,13].

2. Materials and Methods

2.1. Setting

As described in other publications [14,15], the survey was conducted between October 2010 and April 2011 in the Florence metropolitan area, and the data were collected between October and November 2010. In Italy, the seasonal influenza vaccination is offered free of charge every year to all HCWs and students, and the same has happened for the pandemic influenza vaccination.
We recruited the study sample from the employees of the Local Health Units (LHUs) of Empoli and Pistoia, at Careggi University Teaching Hospital, and among students in the final two years of degree programs in Medicine, Nursing, Health Care Assistance, and Techniques of Prevention in the Environment and in the Workplace in Florence.
In the LHUs of Empoli and Pistoia, and in the Careggi University Teaching Hospital, the total number of employees, including medical, paramedical, and non-medical workers, was 11,369, overall, while the students of the final two years of degree programs included in the survey totaled approximately 920.
The study was conducted according to the Helsinki Declaration of 1975.

2.2. Questionnaire and Sampling Mode

The tool used for the survey was an anonymous self-administered questionnaire with closed questions. The questionnaire was formulated and shared in a peer group, then validated in a survey of 95 HCWs.
The questionnaire was composed of three sections. In the first section, the study participants recorded their agreement or disagreement (“totally agree,” “partially agree,” “partially disagree,” or “totally disagree”) with factual statements regarding influenza and the influenza vaccine.
In the second section, the participants indicated their previous influenza vaccination status (against pandemic influenza in 2009 and against seasonal influenza between 2007 and 2009) and their reasons for having been vaccinated or not vaccinated. The participants were also asked about their role in administering the influenza vaccine, their preferred type of influenza vaccine, and which categories of patients they would recommend receive vaccinations.
The third section included questions on the participants’ socio-demographic characteristics, their degree qualifications, home department, whether they lived with people at risk to transmit influenza (children under 9 years) or to get flu (people over 65 years and/or with chronic illness), and their history of chronic cardiovascular disease, chronic respiratory disease, chronic renal failure, diabetes, autoimmune diseases, and respiratory infections in the previous years. Finally, the questionnaire included an assessment of self-perceived health status (from 1 for “bad” to 10 for “excellent”) that was subsequently grouped into two categories (“not good” from 1 to 5 and “good” from 6 to 10).
The sampling criteria are explained in previous publications [14,15]. The study was conducted on a convenience sample. We recruited the subjects among medical and paramedical employees; for the Careggi University Teaching Hospital we limited the survey to the Emergency Department as well as the Departments of Obstetrics and Gynecology, Cardiology, and General Surgery. A small number of non-HCWs working in the LHUs under examination was also included (administrative staff and cleaning company employees), to compare attitudes and beliefs.
Recruitment was performed according to different approaches: the study team asked HCWs to complete the questionnaire and to return it to a locked box located within the department, or directly administered the questionnaire during mandatory training events. The students were recruited during their classes.
The total number of questionnaires distributed was 3597, of which 2627 (73%) were returned.

2.3. Statistical Analysis

In this paper, we analyze the first and the third sections of the questionnaire, focusing on perceptions of the risk of contracting and transmitting influenza, attitudes regarding being vaccinated, and knowledge of vaccine effectiveness and safety. The other sections have been discussed in other papers, as well as predictors of vaccination against pandemic influenza [14,15].
The collected data were entered into an ad hoc database. The statistical analysis was performed using IBM SPSS Statistics 20 (SPSS Inc., Chicago, IL, USA, 2011).
Data regarding previous vaccination against seasonal influenza were re-coded into three categories: “always vaccinated” (in 2007, 2008, and 2009); “sometimes vaccinated” (once or twice from 2007 to 2009); and “never vaccinated” (not vaccinated in 2007, 2008, or 2009).
A descriptive analysis was performed, including an evaluation of associations using the Chi2 test. An alpha level of 0.05 was considered significant.

3. Results

3.1. Descriptive Analysis

Of a total of 2627 questionnaires, 2576 were fully completed. Three hundred seventeen subjects answered “always vaccinated,” which indicated they had been vaccinated in all three seasonal vaccination campaigns under consideration (2007–2008 to 2009–2010), and 338 reported receiving vaccinations once or twice. In contrast, 1921 subjects had never been vaccinated during the campaigns under consideration. The data are displayed in Table 1. During the three years under examination, the vaccination rates showed no significant changes (18.3% in 2007, 17.8% in 2008, and 18.1% in 2009).
The analysis of the results by gender indicates that vaccination continuity (meaning subjects were vaccinated in 2007–2008, 2008–2009, and 2009–2010) was more common in males than in females (18.3% vs. 9.8%).
As educational levels increase, there is a greater tendency to be “always vaccinated” rather than “sometimes vaccinated.” One exception to this is the category of high school graduates, where this trend is not confirmed.
Among all occupational categories, physicians have the lowest proportion of “never vaccinated” (48.4%), followed by non-healthcare workers (administrative staff and cleaning company employees).
Nurses, healthcare assistants, and other HCWS have a high percentage of “never vaccinated” (71.9%–81.4%). This is also the case for students (79.7%). The highest proportion of “always vaccinated” (35.3%) is found among physicians, followed by non-healthcare workers.
The subjects living with elderly people or with people affected by chronic illnesses had a greater tendency to receive vaccinations in all three seasons than to receive them once or twice in the three seasonal vaccination campaigns studied. This is also observed in the subjects affected by chronic illnesses such as cardiovascular, respiratory, and autoimmune diseases, kidney-related diseases, and diabetes.
Living with children younger than nine years of age or having had a respiratory infection in recent years does not influence vaccination continuity.
Those who believe that their own health is “not good” are observed in greater numbers in the “always vaccinated” subgroup than the “vaccinated once or twice” subgroup.
Furthermore, the “always vaccinated” subjects have a higher mean age than the other subgroups.

3.2. Knowledge about Influenza, Vaccines, and Vaccination

Figure 1 illustrates the participants’ agreement or disagreement with factual statements regarding influenza, influenza vaccination, and vaccines, and attitudes towards them. For each statement, the data were analyzed to compare the previously identified three categories according to vaccination status.
Table 1. Seasonal influenza vaccination coverage from 2007–2008 to 2009–2010.
Table 1. Seasonal influenza vaccination coverage from 2007–2008 to 2009–2010.
VariablesTotal (N = 2576)Coverage % Never VaccinatedCoverage % Vaccinated Once or TwiceCoverage % Always Vaccinated
N% ^(N = 1921; 74.6%) °(N = 338; 13.1%) °(N = 317; 12.3%) °
Gender
Male66025.666.515.218.3
Female180970.277.812.49.8
Educational qualification
Elementary school70.371.414.314.3
Middle school1676.577.29.613.2
High school14445679.212.28.7
University degree62424.270.414.714.9
Postgraduate2088.152.418.329.3
Occupational category
Physicians2581048.416.335.3
Nurses101039.278.812.19.1
Health care assistants1023.981.46.911.8
Other healthcare workers39115.271.914.613.6
Non-healthcare workers973.869.18.222.7
Students60123.379.714.65.7
Children <9 years in household
Yes57822.473.415.211.4
People >65 years in household
Yes51319.969.813.816.4
People with chronic illness in household
Yes32412.66615.718.2
Chronic Cardiovascular disease
Yes341.338.220.641.2
Chronic Respiratory Disease
Yes1495.859.710.729.5
Chronic Kidney-related Disease
Yes140.564.314.321.4
Diabetes
Yes341.341.214.744.1
Autoimmune Disease
Yes1094.267.915.616.5
Respiratory infection in the previous year
Yes28811.268.419.112.5
Perceived health status
Not good (1–5)1355.260.71722.2
Good (6–10)244194.875.312.911.8
Age+
N (%)2365 (91.8)1768 (68.6) 308 (11.9)289 (11.2)
Mean (DS)38.3 (11.6)37.5 (11.3)37.4 (11.5)44.4 (11.1)
Range18–6619–6520–6618–65
^ The difference between 100% and the sum of the percentages of each variable corresponds to missing values; ° For all categorical variables, distribution compared to seasonal influenza vaccination (never vaccinated, vaccinated once or twice, always vaccinated): p < 0.05 (Chi2 test); + Comparison between averages for seasonal influenza for those never vaccinated, vaccinated once or twice, or always vaccinated: p < 0.05 (ANOVA).
Figure 1. Agreement or disagreement with factual statements regarding influenza, influenza vaccination, and vaccines in the “never vaccinated” (N), “sometimes vaccinated” (S), and “always vaccinated” (A) subgroups. * p < 0.05.
Figure 1. Agreement or disagreement with factual statements regarding influenza, influenza vaccination, and vaccines in the “never vaccinated” (N), “sometimes vaccinated” (S), and “always vaccinated” (A) subgroups. * p < 0.05.
Vaccines 03 00137 g001
The three categories were significantly associated with each statement, with the exception of “fear of needles” and “my Local Health Unit promotes vaccination.”
Compared to those who responded that they were “never vaccinated” or “sometimes vaccinated,” those who responded “always vaccinated” were more likely to believe that influenza is a serious illness.
Moreover, 54.7% of those “always vaccinated,” 52.3% of those “sometimes vaccinated,” and 40.9% of those “never vaccinated” totally agree with the statement “it is likely that I can transmit influenza.”
Among the “never vaccinated” subjects, 10.4% totally disagree that it is better to contract influenza than to get vaccinated; the percentage of disagreement increases in the “sometimes vaccinated” and “always vaccinated” subgroups.
Regarding the effectiveness of the influenza vaccine, the percentage of agreement (considering both total and partial agreement) is high for each category (greater than 71.7%).
The subjects who refused vaccination have a greater tendency to believe that the vaccine could cause influenza and that it could have serious side effects than those in the other two subgroups.
Agreement regarding adjuvant effectiveness increases from those who were never vaccinated to those who were always vaccinated; in contrast, there is no significant difference between the three categories in beliefs regarding possible side effects caused by adjuvants.
Most of the respondents know where the vaccine is offered and are aware that the Local Health Unit promotes vaccination.

3.3. Attitudes towards Vaccination

The percentage of subjects opposed to vaccination (those in partial and total agreement with the statement) is 57.7% in the “never vaccinated” group, 37.3% in the “sometimes vaccinated” group, and 14.2% in the “always vaccinated” group.
More than 60% of the subjects in the “always vaccinated” group totally agreed that HCWs should be vaccinated, but only 17.5% of the “never vaccinated” group shared that opinion.
Self-protection and protecting family members and other people close to the HCWs from being infected and representing potential sources of influenza can be considered one of the motivating factors for subjects to receive the vaccine.
The percentage of subjects who were “always vaccinated” is higher than those who were “sometimes vaccinated” or “never vaccinated” (32.6%, 9.9%, and 4.9%, respectively) among the respondents who believed that the flu vaccine is important to their family members or other people close to them.

4. Discussion

The results of the survey show that the enrolled subjects tend to be in the “never vaccinated” category despite considering influenza to be a serious illness and believing that the influenza vaccine is effective.
Because a person’s history of influenza vaccination is considered a positive predictor of future vaccination [14,15,16], we chose to focus on that particular aspect: the continuity of vaccination over time, in accordance with other studies [17,18]. Like these authors, we found that influenza vaccination continuity was more common in males than females, and among people with a higher mean age; moreover, a major chronic condition increases compliance with vaccination.
We paid attention to attitudes and motivators driving vaccine acceptance. These include protection of oneself and family members or other close people, and the belief that influenza is a serious illness and that the vaccine against it is effective. Past research supports our findings [16,19,20,21].
Awareness that influenza is a serious illness with an effective vaccine and understanding that one may transmit influenza are all lower in the “never vaccinated” group than in the “always vaccinated” and “sometimes vaccinated” groups. For this reason, it is important to increase the level of knowledge regarding the risk of acquiring and transmitting influenza in the workplace and to improve the adoption of preventive measures, namely, immunization in this group. For the “always vaccinated” and “sometimes vaccinated” groups, the purpose of public health interventions could be to maintain and support their level of influenza awareness and knowledge through informational campaigns in workplaces.
As has been previously demonstrated [22,23], physicians exhibit a stronger tendency to receive vaccines. This finding supports the need for professional-sensitive programs to increase vaccination coverage, taking into account different levels of knowledge and attitudes towards influenza and influenza vaccination among various occupational categories [22].
The survey also investigated possible barriers to vaccination. Contrary to findings in other publications [24,25], in this research, organizational issues are not perceived to be barriers: in fact, subjects know where they can be vaccinated and they are aware that their Local Health Unit promotes vaccination. Regarding attitudes against vaccination, it is noteworthy that the HCWs who were not vaccinated in the three seasons considered do not perceive immunization against influenza to be a duty of a health professional. Moreover, a relatively small proportion of HCWs are still opposed to vaccination in general, so it would be interesting to understand their reasons for maintaining this position.

5. Conclusions

In Italy, other studies have been conducted to investigate the attitudes and knowledge of HCWs and medical students regarding influenza and seasonal [26], pandemic [27,28], or both types [29,30,31] of influenza vaccines. The contributions of those studies and this survey offer the opportunity to focus on the need for information and education, in addition to correct perceptions of risk in HCWs and health professions students.
The strengths and limitations of this study are mainly related to its design, as previously described [14,15].
Adapting strategies for the distribution of questionnaires to the specific needs of the HCWs allowed us to obtain information on as many professionals and students as possible. However, this strategy also had the potential to limit the generalizability of the collected data, introducing a confounder. The ability to administer the questionnaire during training courses led to high response rates. In contrast, the use of locked boxes to collect the questionnaires in some departments resulted in lower levels of compliance.
Another limit of the study is represented by the fact that we do not have any information regarding those who did not return the questionnaire; this aspect may further limit the generalizability of the results.
In conclusion, the results highlight the importance of improving vaccination among HCWs through multi-component interventions. Targets should include both HCWs who do not usually get vaccinated or who sometimes get vaccinated and HCWs who have been vaccinated in previous years.
This study also underlines the importance of improving knowledge of influenza transmission and vaccination among HCWs. Moreover, the findings of this study indicate a need to strengthen knowledge of the risks of influenza through university coursework.

Highlights

  • Assessing attitudes of HCWs regarding influenza vaccination can be useful.
  • The enrolled subjects tended to respond that they were “never vaccinated” (74.6%).
  • Knowledge of influenza and vaccines should be reinforced among those who have never been vaccinated.
  • Levels of awareness should be maintained among the “sometimes” and “always vaccinated” subjects.

Author Contributions

Guglielmo Bonaccorsi: conception and design of the study; interpretation of data; drafting and revision of the manuscript. Barbara Rita Porchia: conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; drafting and revision of the manuscript. Giuditta Niccolai: conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; drafting and revision of the manuscript. Elettra Pellegrino: conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; drafting and revision of the manuscript. Francesca Santomauro: conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; drafting and revision of the manuscript. Chiara Lorini: conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; drafting and revision of the manuscript. Paolo Bonanni: interpretation of data; drafting and revision of the manuscript. All authors have approved the final article.

Conflicts of Interest

The authors declare no conflict of interest

References

  1. World Health Organization. Media Center. Influenza (seasonal). Fact Sheet no 211. March 2014. Available online: http://www.who.int/mediacentre/factsheets/fs211/en/ (accessed on 20 October 2014).
  2. Barbadoro, P.; Marigliano, A.; di Tondo, E.; Chiatti, C.; di Stanislao, F.; D’Errico, M.M.; Prospero, E. Determinants of influenza vaccination uptake among Italian healthcare workers. Hum. Vaccin. Immunother. 2013, 9, 911–916. [Google Scholar] [CrossRef] [PubMed]
  3. CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory. Committee on Immunization Practices (ACIP). MMWR Recomm. Rep. 2011, 60, 1–45. [Google Scholar]
  4. Salgado, C.D.; Giannetta, E.T.; Hayden, F.G.; Farr, B.M. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect. Control Hosp. Epidemiol. 2004, 25, 923–928. [Google Scholar] [CrossRef] [PubMed]
  5. Carman, W.F.; Elder, A.G.; Wallace, L.A.; McAulay, K.; Walker, A.; Murray, G.D.; Stott, D.J. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: A randomised controlled trial. Lancet 2000, 355, 93–97. [Google Scholar] [CrossRef] [PubMed]
  6. Hayward, A.C.; Harling, R.; Wetten, S.; Johnson, A.M.; Munro, S.; Smedley, J.; Murad, S.; Watson, J.M. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: Cluster randomised controlled trial. BMJ 2006. [Google Scholar] [CrossRef]
  7. Burls, A.; Jordan, R.; Barton, P.; Olowokure, B.; Wake, B.; Albon, E.; Hawker, J. Vaccinating healthcare workers against influenza to protect the vulnerable—Is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine 2006, 24, 4212–4221. [Google Scholar] [CrossRef]
  8. Thomas, R.E.; Jefferson, T.; Lasserson, T.J. Influenza vaccination for healthcare workers who work with the elderly: Systematic review. Vaccine 2010, 29, 344–356. [Google Scholar] [CrossRef] [PubMed]
  9. Van den Dool, C.; Bonten, M.J.; Hak, E.; Heijne, J.C.; Wallinga, J. The effects of influenza vaccination of health care workers in nursing homes: Insights from a mathematical model. PLOS Med 2008. [Google Scholar] [CrossRef]
  10. Music, T. Protecting patients, protecting healthcare workers: A review of the role of influenza vaccination. Int. Nurs. Rev. 2012, 59, 161–167. [Google Scholar] [CrossRef] [PubMed]
  11. Cella, M.; Corona, G.; Tuccillo, E.; Franco, G. Assessment of efficacy and economic impact of an influenza vaccination campaign in the personnel of a health care setting. Med. Lav. 2005, 96, 483–489. [Google Scholar] [PubMed]
  12. Angus, K.; Cairns, G.; Purves, R.; Bryce, S.; MacDonald, L.; Gordon, R. Systematic Literature Review to Examine the Evidence for The Effectiveness of Interventions that Use Theories and Models of Behaviour Change: Towards the Prevention and Control of Communicable Diseases; ECDC: Stockholm, Sweden, 2013. [Google Scholar]
  13. Vasilevska, M.; Ku, J.; Fisman, D.N. Factors associated with healthcare worker acceptance of vaccination: A systematic review and meta-analysis. Infect. Control Hosp. Epidemiol. 2014, 35, 699–708. [Google Scholar] [CrossRef] [PubMed]
  14. Bonaccorsi, G.; Lorini, C.; Santomauro, F.; Guarducci, S.; Pellegrino, E.; Puggelli, F.; Balli, M.; Bonanni, P. Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy. Hum. Vaccin. Immunother. 2013, 9, 2603–2612. [Google Scholar] [CrossRef] [PubMed]
  15. Bonaccorsi, G.; Lorini, C.; Porchia, B.R.; Niccolai, G.; Martino, G.; Giannarelli, L.; Santomauro, F. Influenza vaccination: Coverage and risk perception among students of the health professions at Florence University, Italy. Ann. Ig. 2013, 25, 181–189. [Google Scholar]
  16. Crowley, K.A.; Myers, R.; Magda, L.A.; Morse, S.S.; Brandt-Rauf, P.; Gershon, R.R.M. Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center. Am. J. Infect. Control 2013, 41, 824–830. [Google Scholar] [CrossRef]
  17. Castilla, J.; Martínez-Baz, I.; Godoy, P.; Toledo, D.; Astray, J.; García, S.; Mayoral, J.M.; Martín, V.; González-Candelas, F.; Guevara, M.; et al. Trends in influenza vaccine coverage among primary healthcare workers in Spain, 2008–2011. Prev. Med. 2013, 57, 206–211. [Google Scholar] [CrossRef] [PubMed]
  18. Martínez-Baz, I.; Díaz-González, J.; Guevara, M.; Toledo, D.; Zabala, A.; Domínguez, A.; Castilla, J. Attitudes, perceptions and factors associated with influenza vaccination among primary healthcare professionals in Navarre, 2011–2012. An. Sist. Sanit. Navar. 2013, 36, 263–273. [Google Scholar] [CrossRef] [PubMed]
  19. Naleway, A.L.; Henkle, E.M.; Ball, S.; Bozeman, S.; Gaglani, M.J.; Kennedy, E.D.; Thompson, M.G. Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel. Am. J. Infect. Control 2014, 42, 371–375. [Google Scholar] [CrossRef] [PubMed]
  20. Corace, K.; Prematunge, C.; McCarthy, A.; Nair, R.C.; Roth, V.; Hayes, T.; Suh, K.N.; Balfour, L.; Garber, G. Predicting influenza vaccination uptake among health care workers: What are the key motivators? Am. J. Infect. Control 2013, 41, 679–684. [Google Scholar] [CrossRef]
  21. Takayanagi, I.J.; Cardoso, M.R.; Costa, S.F.; Araya, M.E.; Machado, C.M. Attitudes of health care workers to influenza vaccination: Why are they not vaccinated? Am. J. Infect. Control 2007, 35, 56–61. [Google Scholar] [CrossRef] [PubMed]
  22. Hollmeyer, H.G.; Hayden, F.; Poland, G.; Buchholz, U. Influenza vaccination of health care workers in hospitals—A review of studies on attitudes and predictors. Vaccine 2009, 27, 3935–3944. [Google Scholar] [CrossRef] [PubMed]
  23. Tanguy, M.; Boyeau, C.; Pean, S.; Marijon, E.; Delhumeau, A.; Fanello, S. Acceptance of seasonal and pandemic a (H1N1) 2009 influenza vaccination by healthcare workers in a French teaching hospital. Vaccine 2011, 29, 4190–4194. [Google Scholar] [CrossRef] [PubMed]
  24. Smedley, J.; Poole, J.; Waclawski, E.; Stevens, A.; Harrison, J.; Watson, J.; Hayward, A.; Coggon, D. Influenza immunisation: Attitudes and beliefs of UK healthcare workers. Occup. Environ. Med. 2007, 64, 223–227. [Google Scholar] [CrossRef] [PubMed]
  25. Lehmann, B.A.; Ruiter, R.A.; Wicker, S.; van Dam, D.; Kok, G. “I don’t see an added value for myself”: A qualitative study exploring the social cognitive variables associated with influenza vaccination of Belgian, Dutch and German healthcare personnel. BMC Public Health 2014. [Google Scholar] [CrossRef]
  26. Spadea, A.; Unim, B.; Ursillo, P.; Saulle, R.; Giraldi, G.; Miccoli, S.; Barbato, A.; Corda, B.; D’Amici, A.M.; Boccia, A.; la Torre, G. Effectiveness of a training course on influenza vaccination in changing medical students’ and healthcare workers’ attitudes towards vaccination. Ig. Sanita Pubbl. 2013, 69, 387–402. [Google Scholar] [PubMed]
  27. Albano, L.; Matuozzo, A.; Marinelli, P.; di Giuseppe, G. Knowledge, attitudes and behaviour of hospital health-care workers regarding influenza A/H1N1: A cross sectional survey. BMC Infect. Dis. 2014. [Google Scholar] [CrossRef]
  28. Cadeddu, C.; di Thiene, D.; Ricciardi, W.; Boccia, A.; la Torre, G. Knowledge about pandemic flu among Italian health care workers (HCWs): An Italian survey. J. Prev. Med. Hyg. 2011, 52, 127–130. [Google Scholar] [PubMed]
  29. Boccia, A.; di Thiene, D.; de Giusti, M.; la Torre, G. Seasonal and pandemic influenza: The role of communication and preventive strategies. J. Prev. Med. Hyg. 2011, 52, 124–126. [Google Scholar] [PubMed]
  30. Falato, R.; Ricciardi, S.; Franco, G. Influenza risk perception and vaccination attitude in medical and nursing students during the vaccination campaigns of 2007/2008 (seasonal influenza) and 2009/2010 (H1N1 influenza). Med. Lav. 2011, 102, 208–215. [Google Scholar] [PubMed]
  31. Bonfiglioli, R.; Vignoli, M.; Guglielmi, D.; Depolo, M.; Violante, F.S. Getting vaccinated or not getting vaccinated? Different reasons for getting vaccinated against seasonal or pandemic influenza. BMC Public Health 2013. [Google Scholar] [CrossRef]

Share and Cite

MDPI and ACS Style

Bonaccorsi, G.; Santomauro, F.; Porchia, B.R.; Niccolai, G.; Pellegrino, E.; Bonanni, P.; Lorini, C. Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy. Vaccines 2015, 3, 137-147. https://doi.org/10.3390/vaccines3010137

AMA Style

Bonaccorsi G, Santomauro F, Porchia BR, Niccolai G, Pellegrino E, Bonanni P, Lorini C. Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy. Vaccines. 2015; 3(1):137-147. https://doi.org/10.3390/vaccines3010137

Chicago/Turabian Style

Bonaccorsi, Guglielmo, Francesca Santomauro, Barbara Rita Porchia, Giuditta Niccolai, Elettra Pellegrino, Paolo Bonanni, and Chiara Lorini. 2015. "Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy" Vaccines 3, no. 1: 137-147. https://doi.org/10.3390/vaccines3010137

Article Metrics

Back to TopTop