Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools
Abstract
:1. Background
2. Methods
2.1. Study Design and Sample
2.2. Data Collection
- (1)
- Demographic characteristics (12 questions), including age, sex, ethnicity, residence, education, occupation, marital status, average monthly household income per capita (which refers to the total monthly income of a household divided by the number of household members), height and weight, duration of diabetes, diabetes complications, and other chronic diseases. Body mass index (BMI) was calculated by dividing body weight in kilograms by the square of body height in meters. In this study, we defined adults with a BMI of 18.5 kg/m2 as underweight, those with a BMI between 24.0 and 28.0 kg/m2 as overweight, and those with a BMI of 28.0 kg/m2 as obese [23].
- (2)
- Influenza history and vaccination status in the past year (5 questions), including the history of influenza and vaccination records. For those who received influenza vaccinations during the past year, additional information was sought regarding the vaccination site, adverse effects, and vaccination payment.
- (3)
- Practice and knowledge of influenza and influenza vaccination (13 questions), encompassing the following aspects: (a) learning about influenza prevention and control, (b) acquiring knowledge about influenza vaccination, (c) recognizing influenza vaccination as the most effective way to prevent influenza, and (d) identifying priority groups for influenza vaccination (10 questions). For the knowledge of influenza vaccination (the final two questions), one point was awarded for each correct response, with incorrect responses receiving no points. The total score for the questions ranged from 0 to 11. Attaining a score of seven or above (60%) was considered to indicate good IV knowledge, whereas scores below 7 were considered to indicate poor knowledge. Higher scores indicated better knowledge.
- (4)
- To explore the determinants of IV uptake in patients with T2DM, we further investigated the willingness to receive influenza vaccination and its influencing factors (15/18 questions), which included the willingness to be vaccinated in the 2023/2024 influenza season, drivers and barriers to receiving seasonal influenza vaccination (in relation to their thinking and feeling, social processes, and practical issues), and willingness to receive influenza vaccination when a free vaccination policy was implemented. The reasons for willingness (11 questions) or hesitancy (14 questions) to receive seasonal influenza vaccination were evaluated on a 3-point scale, with answers ranging from 0 = “disagree” to 2 = “agree”, to identify factors that affected influenza vaccination. The higher the score, the greater the impact of the factor. The average score for each question was calculated by dividing the total score by the number of participants; the standardized score for each dimension was the total dimension score divided by the number of questions.
2.3. Ethics Approval and Consent to Participate
2.4. Statistical Analyses
3. Results
3.1. Demographic Characteristics and Influenza History of the Participants with T2DM
3.2. Knowledge and Practice of Influenza Vaccination among the Participants with T2DM
3.3. Factors Associated with the Willingness to Receive Influenza Vaccination
3.4. Main Drivers and Barriers for Willingness to Receive Influenza Vaccination Based on the BeSD Framework
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
- Jing, Y.; Hong, T.; Bi, Y.; Hu, D.; Chen, G.; Li, J.; Zhang, Y.; Zhang, R.; Ji, L.; Zhu, D. Prevalence, treatment patterns and control rates of metabolic syndrome in a Chinese diabetic population: China Cardiometabolic Registries 3B study. J. Diabetes Investig. 2018, 9, 789–798. [Google Scholar] [CrossRef] [PubMed]
- Ruiz, P.L.D.; Bakken, I.J.; Håberg, S.E.; Tapia, G.; Hauge, S.H.; Birkeland, K.I.; Gulseth, H.L.; Stene, L.C. Higher frequency of hospitalization but lower relative mortality for pandemic influenza in people with type 2 diabetes. J. Intern. Med. 2020, 287, 78–86. [Google Scholar] [CrossRef] [PubMed]
- Goeijenbier, M.; van Sloten, T.; Slobbe, L.; Mathieu, C.; van Genderen, P.; Beyer, W.E.; Osterhaus, A.D. Benefits of flu vaccination for persons with diabetes mellitus: A review. Vaccine 2017, 35, 5095–5101. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Influenza (Seasonal). 2023. Available online: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) (accessed on 8 March 2024).
- National Immunization Advisory Committee (NIAC) Technical Working Group (TWG); Influenza Vaccination TWG. Technical guidelines for seasonal influenza vaccination in China (2022–2023). Zhonghua Liu Xing Bing Xue Za Zhi 2022, 43, 1515–1544. [Google Scholar]
- Bechini, A.; Ninci, A.; Del Riccio, M.; Biondi, I.; Bianchi, J.; Bonanni, P.; Mannucci, E.; Monami, M. Impact of Influenza Vaccination on All-Cause Mortality and Hospitalization for Pneumonia in Adults and the Elderly with Diabetes: A Meta-Analysis of Observational Studies. Vaccines 2020, 8, 263. [Google Scholar] [CrossRef] [PubMed]
- Fan, J.; Cong, S.; Wang, N.; Bao, H.; Wang, B.; Feng, Y.; Lv, X.; Zhang, Y.; Zha, Z.; Yu, L.; et al. Influenza vaccination rate and its association with chronic diseases in China: Results of a national cross-sectional study. Vaccine 2020, 38, 2503–2511. [Google Scholar] [CrossRef] [PubMed]
- Zhao, H.T.; Peng, Z.B.; Ni, Z.L.; Yang, X.K.; Guo, Q.Y.; Zheng, J.D.; Qin, Y.; Zhang, Y.P. Investigation on influenza vaccination policy and vaccination situation during the influenza seasons of 2020–2021 and 2021–2022 in China. Zhonghua Yu Fang Yi Xue Za Zhi 2022, 56, 1560–1564. [Google Scholar] [PubMed]
- MacDonald, N.E. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef] [PubMed]
- Ma, Y.; Li, T.; Chen, W.; Chen, J.; Li, M.; Yang, Z. Knowledge, Attitudes and Practices (KAP) toward seasonal influenza vaccine among young workers in South China. Hum. Vaccines Immunother. 2018, 14, 1283–1293. [Google Scholar] [CrossRef]
- Dallagiacoma, G.; Allora, A.; Salvati, S.; Cocciolo, G.; Capraro, M.; Lamberti, A.; Senatore, S.; Gentile, L.; Gianfredi, V.; Laurenzi, A.; et al. Type 1 Diabetes Patients’ Practice, Knowledge and Attitudes towards Influenza Immunization. Vaccines 2021, 9, 707. [Google Scholar] [CrossRef]
- Chen, S.; Jiang, Y.; Tang, X.; Gan, L.; Xiong, Y.; Chen, T.; Peng, B. Research on Knowledge, Attitudes, and Practices of Influenza Vaccination Among Healthcare Workers in Chongqing, China-Based on Structural Equation Model. Front. Public Health 2022, 10, 853041. [Google Scholar] [CrossRef] [PubMed]
- Erazo, C.E.; Erazo, C.V.; Grijalva, M.J.; Moncayo, A.L. Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador. BMC Public Health 2021, 21, 72. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Understanding the Behavioural and Social Drivers of Vaccine Uptake WHO Position Paper–May 2022. 2022. Available online: https://www.who.int/publications/i/item/who-wer9720-209-224 (accessed on 5 October 2022).
- Alagarsamy, S.; Mehrolia, S.; Pushparaj, U.; Jeevananda, S. Explaining the intention to uptake COVID-19 vaccination using the behavioral and social drivers of vaccination (BeSD) model. Vaccine X 2022, 10, 100140. [Google Scholar] [CrossRef] [PubMed]
- Jiang, B.; Cao, Y.; Qian, J.; Jiang, M.; Huang, Q.; Sun, Y.; Dai, P.; Yi, H.; Zhang, R.; Xu, L.; et al. Healthcare Workers’ Attitudes toward Influenza Vaccination: A Behaviour and Social Drivers Survey. Vaccines 2023, 11, 143. [Google Scholar] [CrossRef] [PubMed]
- Qi, L.; Li, Q.; Ding, X.-B.; Gao, Y.; Ling, H.; Liu, T.; Xiong, Y.; Su, K.; Tang, W.-G.; Feng, L.-Z.; et al. Mortality burden from seasonal influenza in Chongqing, China, 2012–2018. Hum. Vaccines Immunother. 2020, 16, 1668–1674. [Google Scholar] [CrossRef] [PubMed]
- Ding, X.; Mao, D.; Yan, J.; Xu, J. Analysis of prevalence, mortality and disability-adjusted life year rate of diabetes in Chongqing City. J. Shanghai Jiao Tong Univ. (Med. Dcience) 2021, 41, 78–81. (In Chinese) [Google Scholar]
- Welch, V.L.; Metcalf, T.; Macey, R.; Markus, K.; Sears, A.J.; Enstone, A.; Langer, J.; Srivastava, A.; Cane, A.; Wiemken, T.L. Understanding the Barriers and Attitudes toward Influenza Vaccine Uptake in the Adult General Population: A Rapid Review. Vaccines 2023, 11, 180. [Google Scholar] [CrossRef] [PubMed]
- Department of Primary Health Care, National Health Commission, PRC. Standards for National Basic Public Health Services. 3rd ed.; 2017. Available online: http://www.nhc.gov.cn/jws/s3578/201703/aefef3d0b2a14279b76ad57d7e7a2c4e.shtml (accessed on 30 October 2023).
- Zhou, L.; Su, Q.; Xu, Z.; Feng, A.; Jin, H.; Wang, S.; Feng, Z. Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in China by season (2009/10 to 2011/12). PLoS ONE 2013, 8, e73724. [Google Scholar] [CrossRef] [PubMed]
- Yang, L.; Nan, H.; Liang, J.; Chan, Y.H.; Chan, L.; Sum, R.W.M.; Kwan, Y.M.; Zhou, F.; Meng, H.; Suen, L.K.P. Influenza vaccination in older people with diabetes and their household contacts. Vaccine 2017, 35, 889–896. [Google Scholar] [CrossRef]
- Zeng, Q.; He, Y.; Dong, S.; Zhao, X.; Chen, Z.; Song, Z.; Chang, G.; Yang, F.; Wang, Y. Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults. Br. J. Nutr. 2014, 112, 1735–1744. [Google Scholar] [CrossRef]
- Tacken, M.A.; Jansen, B.; Mulder, J.; Campbell, S.M.; Braspenning, J.C. Dutch influenza vaccination rate drops for fifth consecutive year. Vaccine 2015, 33, 4886–4891. [Google Scholar] [CrossRef] [PubMed]
- Jiménez-Garcia, R.; Lopez-De-Andres, A.; Hernandez-Barrera, V.; Gómez-Campelo, P.; Andrés-Rebollo, F.J.S.; de Burgos-Lunar, C.; Cárdenas-Valladolid, J.; Abánades-Herranz, J.C.; Salinero-Fort, M.A. Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7 years follow up study. Vaccine 2017, 35, 101–108. [Google Scholar] [CrossRef] [PubMed]
- Lee, D.-H.; Yang, B.; Gu, S.; Kim, E.-G.; Kim, Y.; Kang, H.K.; Choe, Y.H.; Jeon, H.J.; Park, S.; Lee, H. Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database. Front. Endocrinol. 2023, 14, 1077846. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Prevention and Control of Influenza Pandemics and Annual Epidemics. 2003. Available online: https://apps.who.int/gb/archive/pdf_files/WHA56/ea56r19.pdf (accessed on 8 March 2024).
- World Health Organization. Influenza Vaccination Coverage and Effectiveness. 2018. Available online: https://www.who.int/europe/news-room/fact-sheets/item/influenza-vaccination-coverage-and-effectiveness (accessed on 10 October 2023).
- Yuan, X.; Wang, R.; Fu, Y.; Xie, K.; Ni, W.; Xu, J. The analysis of knowledge-attitude-practice (KAP) and Influencing Factors of Influenza Vaccination in Type 2 Diabetes Mellitus (T2DM) Patients. Chin. J. Prev. Control. Chronic Dis. 2018, 26, 905–909. (In Chinese) [Google Scholar]
- Feng, W.; Cui, J.; Li, H. Determinants of Willingness of Patients with Type 2 Diabetes Mellitus to Receive the Seasonal Influenza Vaccine in Southeast China. Int. J. Environ. Res. Public Health 2019, 16, 2203. [Google Scholar] [CrossRef] [PubMed]
- Hu, J.; Huang, S.; Wu, M.; Luo, F. lnfluenza vaccination intention and its influencing factors among the patients with type 2 diabetes mellitus in Changsha. China Prev. Med. J. 2020, 32, 1126–1129. (In Chinese) [Google Scholar]
- Guillari, A.; Polito, F.; Pucciarelli, G.; Serra, N.; Gargiulo, G.; Esposito, M.R.; Botti, S.; Rea, T.; Simeone, S. Influenza vaccination and healthcare workers: Barriers and predisposing factors. Acta Biomed. 2021, 92, e2021004. [Google Scholar]
- Li, T.; Qi, X.; Li, Q.; Tang, W.; Su, K.; Jia, M.; Yang, W.; Xia, Y.; Xiong, Y.; Qi, L.; et al. A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers. Vaccines 2021, 9, 1104. [Google Scholar] [CrossRef] [PubMed]
- Olatunbosun, O.D.; Esterhuizen, T.M.; Wiysonge, C.S. A cross sectional survey to evaluate knowledge, attitudes and practices regarding seasonal influenza and influenza vaccination among diabetics in Pretoria, South Africa. Vaccine 2017, 35, 6375–6386. [Google Scholar] [CrossRef] [PubMed]
- Alnaheelah, I.M.; Awadalla, N.J.; Al-Musa, K.M.; Alsabaani, A.A.; Mahfouz, A.A. Influenza Vaccination in Type 2 Diabetes Patients: Coverage Status and Its Determinants in Southwestern Saudi Arabia. Int. J. Environ. Res. Public Health 2018, 15, 1381. [Google Scholar] [CrossRef]
- Yang, X.; Ding, X.; Tang, W.; Tang, C.; He, Y.; Chen, L. Willingness of influenza vaccination among elderly residents over 65 years old in Chongqing Municipality and its influence factors analysis. Chongqing Med. J. 2021, 50, 1389–1393. (In Chinese) [Google Scholar]
- Verger, P.; Bocquier, A.; Vergelys, C.; Ward, J.; Peretti-Watel, P. Flu vaccination among patients with diabetes: Motives, perceptions, trust, and risk culture—A qualitative survey. BMC Public Health 2018, 18, 569. [Google Scholar] [CrossRef] [PubMed]
- Tsai, Y.Y.; Lee, J.J.; Hsieh, W.H. Determinants of the public intent to receive the seasonal influenza vaccine and protective behaviors: A population-based study in Taiwan. Vaccine 2014, 32, 6667–6675. [Google Scholar] [CrossRef]
- Jones-Gray, E.; Robinson, E.J.; Kucharski, A.J.; Fox, A.; Sullivan, S.G. Does repeated influenza vaccination attenuate effectiveness? A systematic review and meta-analysis. Lancet Resp. Med. 2023, 11, 27–44. [Google Scholar] [CrossRef]
- Brewer, N.T.; Chapman, G.B.; Rothman, A.J.; Leask, J.; Kempe, A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol. Sci. Public Interestig. 2017, 18, 149–207. [Google Scholar] [CrossRef]
- Sallam, M.; Ghazy, R.M.; Al-Salahat, K.; Al-Mahzoum, K.; AlHadidi, N.M.; Eid, H.; Kareem, N.; Al-Ajlouni, E.; Batarseh, R.; Ababneh, N.A.; et al. The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic. Vaccines 2022, 10, 1355. [Google Scholar] [CrossRef]
- Dos, S.G.; Tahrat, H.; Bekkat-Berkani, R. Immunogenicity, safety, and effectiveness of seasonal influenza vaccination in patients with diabetes mellitus: A systematic review. Hum. Vaccines Immunother. 2018, 14, 1853–1866. [Google Scholar]
- Ye, L.; Chen, J.; Fang, T.; Cui, J.; Li, H.; Ma, R.; Sun, Y.; Li, P.; Dong, H.; Xu, G. Determinants of healthcare workers’ willingness to recommend the seasonal influenza vaccine to diabetic patients: A cross-sectional survey in Ningbo, China. Hum. Vaccines Immunother. 2018, 14, 2979–2986. [Google Scholar] [CrossRef]
- Yi, B.; Zhou, S.; Song, Y.; Chen, E.; Lao, X.; Cai, J.; Greene, C.M.; Feng, L.; Zheng, J.; Yu, H.; et al. Innovations in adult influenza vaccination in China, 2014-2015: Leveraging a chronic disease management system in a community-based intervention. Hum. Vaccines Immunother. 2018, 14, 947–951. [Google Scholar] [CrossRef]
- Rong, H.; Lai, X.; Ma, X.; Hou, Z.; Li, S.; Jing, R.; Zhang, H.; Peng, Z.; Feng, L.; Fang, H. Seasonal Influenza Vaccination and Recommendation: The Difference between General Practitioners and Public Health Workers in China. Vaccines 2020, 8, 265. [Google Scholar] [CrossRef]
- Watkinson, R.E.; Williams, R.; Gillibrand, S.; Munford, L.; Sutton, M. Evaluating socioeconomic inequalities in influenza vaccine uptake during the COVID-19 pandemic: A cohort study in Greater Manchester, England. PLoS Med. 2023, 20, e1004289. [Google Scholar] [CrossRef] [PubMed]
- Sun, K.S.; Lam, T.P.; Kwok, K.W.; Lam, K.F.; Wu, D.; Ho, P.L. Seasonal influenza vaccine uptake among Chinese in Hong Kong: Barriers, enablers and vaccination rates. Hum. Vaccines Immunother. 2020, 16, 1675–1684. [Google Scholar] [CrossRef] [PubMed]
- Wu, D.; Jin, C.; Bessame, K.; Tang, F.F.-Y.; Ong, J.J.; Wang, Z.; Xie, Y.; Jit, M.; Larson, H.J.; Chantler, T.; et al. Effectiveness of a pay-it-forward intervention compared with user-paid vaccination to improve influenza vaccine uptake and community engagement among children and older adults in China: A quasi-experimental pragmatic trial. Lancet Infect. Dis. 2022, 22, 1484–1492. [Google Scholar] [CrossRef] [PubMed]
- National Bureau of Statistics of China. Households’ Income and Consumption Expenditure in 2023. 2024. Available online: https://www.stats.gov.cn/english/PressRelease/202402/t20240201_1947120.html (accessed on 16 July 2024).
- Bonanni, P.; Steffen, R.; Schelling, J.; Balaisyte-Jazone, L.; Posiuniene, I.; Zatoński, M.; Van Damme, P. Vaccine co-administration in adults: An effective way to improve vaccination coverage. Hum. Vaccines Immunother. 2023, 19, 2195786. [Google Scholar] [CrossRef]
- Ma, J.; Mena, M.; Mandania, R.A.; Ghosh, A.; Dodoo, C.; Dwivedi, A.K.; Mukherjee, D. Associations between Combined Influenza and Pneumococcal Pneumonia Vaccination and Cardiovascular Outcomes. Cardiology 2021, 146, 772–780. [Google Scholar] [CrossRef]
Characteristics | Total | Willingness to Be Vaccinated | p 1 | |
---|---|---|---|---|
Acceptance | Hesitancy | |||
Total | 1672 (100.0) | 989 (59.2) | 683 (40.8) | |
Age (mean ± SD) | 65.96 (10.04) | 65.23 (10.26) | 67.02 (9.61) | <0.001 |
<60 years | 461 (27.6) | 307 (66.6) | 154 (33.4) | <0.001 |
≥60 years | 1211 (72.4) | 682 (56.3) | 529 (43.7) | |
Duration of T2DM (mean ± SD) | 6.99 (5.53) | 6.60 (5.1) | 7.55 (6.0) | <0.001 |
<7 years | 954 (57.1) | 598 (62.7) | 356 (37.3) | <0.001 |
≥7 years | 718 (42.9) | 391 (54.5) | 327 (45.5) | |
Sex | 0.78 | |||
Male | 621 (37.1) | 370 (59.6) | 251 (40.4) | |
Female | 1051 (62.9) | 619 (58.9) | 432 (41.1) | |
Ethnicity | <0.001 | |||
Han | 1591 (95.2) | 919 (57.8) | 672 (42.2) | |
Minority ethnicity | 81 (4.8) | 70 (86.4) | 11 (13.6) | |
Residence | <0.001 | |||
Rural | 741 (44.3) | 481 (64.9) | 260 (35.1) | |
Urban | 931 (55.7) | 508 (54.6) | 423 (45.4) | |
Marital status | <0.001 | |||
Single | 11 (0.7) | 6 (54.5) | 5 (45.5) | |
Married | 1431 (85.6) | 878 (61.4) | 553 (38.6) | |
Widowed | 201 (12.0) | 89 (44.3) | 112 (55.7) | |
Divorced | 29 (1.7) | 16 (55.2) | 13 (44.8) | |
Education level | 0.36 | |||
Primary school and below | 969 (58.0) | 579 (59.8) | 390 (40.2) | |
Junior high school | 516 (30.9) | 297 (57.6) | 219 (42.4) | |
Senior high school or equivalent | 132 (7.9) | 75 (56.8) | 57 (43.2) | |
College/bachelor’s degree or above | 55 (3.3) | 38 (69.1) | 17 (30.9) | |
Occupation | <0.001 | |||
Office worker | 108 (6.5) | 62 (57.4) | 46 (42.6) | |
Businessman | 77 (4.6) | 36 (46.8) | 41 (53.2) | |
Worker/farmer | 873 (52.2) | 488 (55.9) | 385 (44.1) | |
Retiree | 142 (8.5) | 51 (35.9) | 91 (64.1) | |
Unemployed individual | 472 (28.2) | 352 (74.6) | 120 (25.4) | |
Body mass index | 0.61 | |||
Underweight | 21 (1.3) | 10 (47.6) | 11 (52.4) | |
Normal | 666 (39.8) | 387 (58.1) | 279 (41.9) | |
Overweight | 688 (41.2) | 413 (60.0) | 275 (40.0) | |
Obese | 297 (17.8) | 179 (60.3) | 118 (39.7) | |
Average monthly household income per capita | <0.001 | |||
2000 RMB | 892 (53.4) | 522 (58.5) | 370 (41.5) | |
2000–5000 RMB | 638 (38.2) | 353 (55.3) | 285 (44.7) | |
5000 RMB | 142 (8.5) | 114 (80.3) | 28 (19.7) | |
Diabetes complications | 0.004 | |||
Yes | 192 (11.5) | 132 (68.8) | 60 (31.3) | |
No | 1480 (88.5) | 857 (57.9) | 623 (42.1) | |
Other chronic diseases | 0.050 | |||
Yes | 887 (53.1) | 505 (56.9) | 382 (43.1) | |
No | 785 (46.9) | 484 (61.7) | 301 (38.3) | |
Influenza vaccine knowledge | 6.65 (3.08) | 7.37 (2.53) | 5.62 (3.48) | <0.001 |
Fail | 744 (44.5) | 362 (48.7) | 382 (51.3) | <0.001 |
Pass | 928 (55.5) | 627 (67.6) | 301 (32.4) |
Variables | Total | Willingness to Be Vaccinated | p 1 | |
---|---|---|---|---|
Acceptance | Hesitancy | |||
Total | 1672 (100.0) | 989 (59.2) | 683 (40.8) | |
History of influenza | <0.001 | |||
Severe | 59 (3.5) | 39 (66.1) | 20 (33.9) | |
Mild | 629 (37.6) | 406 (64.5) | 223 (35.5) | |
None | 984 (58.8) | 544 (55.3) | 440 (44.7) | |
History of influenza vaccination | <0.001 | |||
Yes | 196 (11.7) | 173 (88.3) | 23 (11.7) | |
No | 1476 (88.3) | 816 (55.3) | 660 (44.7) | |
Vaccination site (n = 196) | 0.77 | |||
Hospital | 70 (35.7) | 61 (87.1) | 9 (12.9) | |
Local CDCs | 5 (2.6) | 4 (80.0) | 1 (20.0) | |
Community health centers | 121 (61.7) | 108 (89.3) | 13 (10.7) | |
Adverse effects (n = 196) | 0.091 | |||
Yes | 2 (1.0) | 1 (50.0) | 1 (50.0) | |
No | 194 (99.0) | 172 (88.7) | 22 (11.3) | |
Payment of influenza vaccination (n = 196) | 0.31 | |||
Self-paid | 145 (74.0) | 127 (87.6) | 18 (12.4) | |
Employer paid | 8 (4.1) | 6 (75.0) | 2 (25.0) | |
Medical insurance | 43 (21.9) | 40 (93.0) | 3 (7.0) |
Knowledge and Practice of Influenza and Influenza Vaccination | Yes | No | |
---|---|---|---|
Practice | Learning about influenza prevention and control | 345 (20.6) | 1327 (79.3) |
Acquiring knowledge about influenza vaccination | 314 (18.7) | 1358 (81.2) | |
Knowledge | Recognizing influenza vaccination as the most effective method for preventing influenza | 883 (52.8) | 789 (47.2) |
The priority groups for influenza vaccination | |||
(1) Healthcare workers | 1312 (78.5) | 360 (21.5) | |
(2) Adults ≥ 60 years of age | 1295 (77.5) | 377 (22.6) | |
(3) Individuals with diabetes | 1254 (75.0) | 418 (25.0) | |
(4) Individuals with chronic respiratory diseases | 1245 (74.5) | 427 (25.5) | |
(5) Individuals with high blood pressure | 1220 (73.0) | 452 (27.0) | |
(6) People living in nursing homes or welfare homes and staff who take care of vulnerable, at-risk individuals | 1171 (70.0) | 501 (30.0) | |
(7) People who work in nursery institutions, primary and secondary schools, and supervision places | 1158 (69.3) | 514 (30.7) | |
(8) Participants and support personnel for large-scale events | 1042 (62.3) | 630 (37.7) | |
(9) Children 6–59 months of age | 1011 (60.5) | 661 (39.5) | |
(10) Pregnant women | 788 (47.1) | 884 (52.9) |
Characteristics | OR (95% CI) * | p | |
---|---|---|---|
Demographic characteristics | |||
Age | |||
<60 years (Ref) | 1 | ||
≥60 years | 0.90 (0.69–1.18) | 0.442 | |
Ethnicity | |||
Han (Ref) | 1 | ||
Minority ethnicity | 3.18 (1.58–6.39) | 0.001 | |
Residence | |||
Rural (Ref) | 1 | ||
Urban | 0.68 (0.53–0.89) | 0.004 | |
Marital status | |||
Single (Ref) | 1 | ||
Married | 1.42 (0.40–5.05) | 0.585 | |
Widowed | 0.72 (0.20–2.64) | 0.622 | |
Divorced | 1.44 (0.32–6.53) | 0.637 | |
Occupation | |||
Office worker (Ref) | 1 | ||
Businessman | 0.99 (0.51–1.93) | 0.976 | |
Worker/farmer | 1.17 (0.70–1.95) | 0.558 | |
Retiree | 0.59 (0.32–1.07) | 0.084 | |
Unemployed individual | 2.69 (1.60–4.52) | 0.000 | |
Average monthly household income per capita | |||
<2000 RMB (Ref) | 1 | ||
2000–5000 RMB | 0.94 (0.73–1.22) | 0.642 | |
>5000 RMB | 2.72 (1.65–4.50) | 0.000 | |
History of chronic diseases | |||
Duration of diabetes | |||
<7 years (Ref) | 1 | ||
≥7 years | 0.74 (0.59–0.93) | 0.011 | |
Diabetes complications | |||
No (Ref) | 1 | ||
Yes | 1.76 (1.23–2.51) | 0.002 | |
Other chronic diseases | |||
No (Ref) | 1 | ||
Yes | 0.92 (0.73–1.15) | 0.460 | |
Influenza history and vaccination status | |||
History of influenza | |||
Severe (Ref) | 1 | ||
Mild | 0.76 (0.41–1.39) | 0.371 | |
No | 0.56 (0.31–1.02) | 0.056 | |
History of influenza vaccination | |||
No (Ref) | 1 | ||
Yes | 7.75 (4.83–12.44) | 0.000 | |
Influenza vaccine knowledge | |||
Fail (Ref) | 1 | ||
Pass | 1.87 (1.48–2.37) | 0.000 |
Domains | Disagree | Neutral | Agree | Standardized Score (Mean ± SD) * |
---|---|---|---|---|
Drivers | ||||
Thinking and feeling | 489 (9.9) | 1771 (35.8) | 2685 (54.3) | 1.44 (0.54) |
Social processes | 541 (18.2) | 1065 (35.9) | 1361 (45.9) | 1.28 (0.64) |
Practical issues | 381 (12.8) | 1312 (44.2) | 1274 (42.9) | 1.30 (0.54) |
Barriers | ||||
Thinking and feeling | 1724 (42.1) | 1453 (35.5) | 921 (22.5) | 0.80 (0.56) |
Social processes | 638 (31.1) | 844 (41.2) | 567 (27.7) | 0.97 (0.67) |
Practical issues | 1516 (44.4) | 1108 (32.4) | 791 (23.2) | 0.79 (0.49) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Li, Z.; Feng, L.; Long, J.; Xiong, Y.; Li, T.; Jiang, B.; Yang, S.; Fu, L.; Shi, Z.; Zhao, Y.; et al. Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools. Vaccines 2024, 12, 898. https://doi.org/10.3390/vaccines12080898
Li Z, Feng L, Long J, Xiong Y, Li T, Jiang B, Yang S, Fu L, Shi Z, Zhao Y, et al. Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools. Vaccines. 2024; 12(8):898. https://doi.org/10.3390/vaccines12080898
Chicago/Turabian StyleLi, Zhourong, Luzhao Feng, Jiang Long, Yu Xiong, Tingting Li, Binshan Jiang, Shuang Yang, Lin Fu, Zumin Shi, Yong Zhao, and et al. 2024. "Increasing Influenza Vaccination Rates among Patients with Type 2 Diabetes Mellitus in Chongqing, China: A Cross-Sectional Analysis Using Behavioral and Social Drivers Tools" Vaccines 12, no. 8: 898. https://doi.org/10.3390/vaccines12080898