Nurses’ Knowledge And Attitudes Towards Influenza Vaccination And Their Vaccination Behaviors: A Cross-sectional Survey

This study is sponsored by Shanghai Pujiang Program (No.11PJC106).AimsThe aim of this study is to explore the nurses’ influenza vaccination behaviors and relatedfactors in Shanghai using combination of questionnaire survey and qualitative interviewand to provide the evidence for the project development to enhance influenza vaccinationrates among nurses.MethodologiesAn exploratory, descriptive research design using both qualitative and quantitativemethodologies was used. The research process comprised the following stages.Stage I: literature review and theoretical research. Basic concepts involving in the studywere identified. The study is to clarify influenza events, the history of influenzavaccination and the policy of influenza vaccination recommendation. A systematicliterature review was used to analyze the influencing factors related to nurses’ influenzavaccination behaviors. The theories the study borrowed ideas were introduced and researchquestions and hypotheses were developed in the last.Stage II: Chinesization of the KNIVQ. The authorized KNIVQ was chinesized basing onBrislin’s translation and re-translation principle and adjusted after culture appraise andpreprimary experiment. C-KNIVQ was tested among a large convenient sample of nursesincluding the reliability and exploratory factor analysis.Stage III: Survey of nurses’ influenza vaccination behaviors and influencing factors. Alarge sample of nurses in9hospitals in Shanghai was recruited to participate in the surveywith using the C-KNIVQ as a study tool. The vaccination coverage among nurses andfactors influencing their vaccination behaviors were explored.Stage IV: Qualitative interview about influencing factors related to nurses’ influenza vaccination behavior. Semi-structured interview with nurses, nurse administrators andplanned immunization professionals was used to help explore the influencing factors.ResultsFindings of literature review indicated the some known factors related to nursesvaccination behaviors. The facilitating factors included higher knowledge level, higher riskperception level, believing in safety and effectiveness of influenza vaccination, selfprotection, organization identification and patient’s protection. The hindering factorsincluded concern about safety and effectiveness of influenza vaccine, no need bevaccinated, side effects after vaccination, using other precaution procedures, andinconvenience to be vaccinated. Vaccinated nurses were founded more likely torecommend vaccination to patients.The chinesized C-KNIVQ included6sections with79items, ie, knowledge sectionincluding seasonal influenza section with22items and H1N1section with8items; riskperception section with12items; health locus of control section with18items; behaviorssection with9items; reasons section; and general characteristics section. The reliabilitytest showed the Cronbach’s αcoefficients of section1-4ranged from0.623and0.759.The exploratory factor analysis showed similar structure between original KNIVQ andC-KNIVQ and the majority of factors were same.Overall vaccination rate among respondents was8.8%reporting having vaccinated againstseasonal influenza and6.4%against H1N1. Nurses with higher knowledge level, higherrisk perception level and other powers health locus of control pattern were more likely tobe vaccinated. The different kinds of clinical departments and hospital were also foundfactors related to nurses’vaccination behaviors. The main reasons to be vaccinatedincluded self-protection, peer influence and job demand and ones for unvaccinatedincluded being healthy and no need be vaccinated, concern about side effects of theinfluenza vaccine, and concern about safety and effectiveness of vaccination.The findings from18nurses’interviews revealed9themes on3dimensions, includingphysical, mental and behaviors factors on individual dimension; working environment,peer influence and administrator’s model role, and family prompting factor on environment dimension; and policy awareness, policy publicity, and cost-oriented factor on policydimension.ConclusionsThis study reviewed the influenza vaccination status among domestic and oversea nursesand influencing factors related to nurses’ vaccination behaviors. The KNIVQ was selectedbasing on systematic literature analysis and chinesized to the C-KNIVQ which was showna reliable survey tool. A survey using the C-KNIVQ was conducted among a large sampleof nurses in Shanghai and a qualitative interview was used to provide further informationabout factors influencing nurses’ vaccination behaviors. The findings will provide theevidence for further developing the project to enhance influenza vaccination coverageamong nurses.