Investigators Explore Factors Related to Influenza Vaccine Hesitation Among Healthcare Personnel


An estimated 23% of healthcare personnel contract influenza annually.

New research looks at why some healthcare personnel are hesitant about receiving an annual seasonal influenza vaccine, despite an increased risk for contracting the virus.

A team, led by Caroline M. Hall, BA Nursing, RN, MPH, Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, explored the determinants of and behavior change models for seasonal influenza vaccination compliance among healthcare personnel.

The Risk

Healthcare personnel are exposed to the seasonal influenza more so than the general population, with an estimated 23% of healthcare personnel contracting influenza annually.

By exploring seasonal influenza vaccine hesitancy, investigators might be better able to explain the COVID-19 vaccine hesitancy among healthcare personnel.

“The WHO [World Health Organization] recognizes the vulnerability of healthcare personnel to seasonal influenza and the need to vaccinate to reduce HCP morbidity, absenteeism, disruption to health services and to protect patients, and other high-risk groups,” the authors wrote.

Reviewing the Data

In the integrative literature review, the investigators conducted a systematic search and screened 6048 articles, 78 of which met the inclusion criteria. The range of methodologies incorporated quasi-experimental, cohort, cross-sectional, qualitative, mixed methods, and peer-reviewed articles between 2009-2020.

They also conducted a narrative synthesis utilizing a conceptual metric to identify thematic categories because of the heterogeneity of the included articles.

The investigators sought primary expected outcomes of the rates of seasonal influenza vaccine uptake and identified healthcare personnel knowledge attitudes and beliefs to inform future interventions.

The studies identified sample populations of nurses (including registered nurses, and enrolled nurses), registered midwives, physicians, and general practitioners (including hospital-based medical residents and general practitioner trainees), and mixed healthcare workers that included physicians, nurses, allied health (including dentists), pharmacists and administration staff and technicians.


The investigators identified 6 thematic categories that influence compliance—perceived vulnerability, trust, past behavior, professional duty, access and convenience, and knowledge and experience.

“Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake,” the authors wrote. “In particular, an emerging focus on ‘trust’ or the more emotive considerations of decision-making around health-protective behaviors requires further exploration in the context of a pandemic.”

Overall, influenza vaccination uptake ranged from 9.3% in Slovakia to 85% in Singapore.

The investigators also found males, physicians, and older individuals were more likely to accept seasonal influenza vaccinations.

Within the seasonal influenza vaccination context, the Health Belief Model (HBM) was the most commonly utilized health behavior change. However, few studies examined seasonal influenza vaccine acceptance and uptake within the Australian healthcare personnel context, especially those involved with community and aged care.

“Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behavior change model,” the authors wrote.

The study, “Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review,” was published online in the Journal of Clinical Nursing.

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