Knowledge, attitudes and practices about vaccination in Trentino, Italy in 2019

Figures & data

Table 1. Description of variables by vaccination reluctance in the 3 Shopping Centers in Italy, June-July 2019, long questionnaire, n = 567

	Total (n = 567)		Hesitant (n = 106, 18.7%)		Non hesitant (n = 461, 81.3%)
Variables	n	%	N	%	n	%	Crude OR	95% CI	P value
Age (years)									0.15
Mean	46.3		44.4		46.7		0.99	0.97–1.00
Standard deviation	15.5		13.8		15.8
Age rank									0.03
18 to 33	157	27.7	32	30.2	125	27.1	1
34 to 43	129	22.8	20	18.9	109	23.6	0.72	0.39–1.33
44 to 59	140	24.7	36	34.0	104	22.6	1.35	0.79–2.33
≥ 60	141	24.9	18	17.0	123	26.7	0.57	0.3–1.07
Sex									0.68
Woman	368	65.0	67	63.2	301	65.3	1
Man	199	35.0	39	36.8	160	34.7	1.1	0.71–1.7
Agreement with obligation									< 0.001
No	91	16.0	63	59.4	28	6.1	1
Yes	476	84.0	43	40.6	433	93.9	0.04	0.03–0.08
Would make the vaccination without obligation									< 0.001
No	35	6.2	31	29.2	4	0.9	1
Yes all	399	70.4	18	17.0	381	82.6	0.01	0.01–0.02
Only a few ones	133	23.5	57	53.8	76	16.5	0.1	0.03–0.29
Knowledge of the website VaccinarSì								0.57	0.57
No	488	86.1	93	87.7	395	85.7	1
Yes	79	13.9	13	12.3	66	14.3	0.84	0.44–1.58
VaccinarSì ever consulted n = 79 *							0.66		0.66
No	52	65.8	7	53.8	45	65,8	1
Yes	27	34.2	6	46.2	21	34.2	1.23	0.49–3.11

*Numbers for this characteristicsdo not add up to the total number of the study population due to the fact that only 79 people knew the website

Table 2. Description of socio-demographic variables according to the hesitancy to vaccination. Data collected through long questionnaires n = 396

	Total (n = 396)		Hesitant (n = 73, 18.4%)		Non hesitant (n = 323, 81.5%)
Variables	n	%	n	%	n	%	Crude OR	95% CI	P value
Province									0.29
Trento	384	97.0	71	97.3	313	97	0.57	0.11–2.98
Other	7	1.7	2	1.7	5	1.5	1
Country of origin									0.69
Africa	13	3.3	4	5.5	9	2.8	1.33	0.26–6.83
America	12	3.0	3	4.1	9	2.8	1	0.17–5.63
Asia	4	1.0	1	1.4	3	0.9	1	0.08–12.5
Italy	351	88.6	1	83.3	290	89.8	0.63	0.2–2
Other European country	16	4.0	4	5.5	12	3.7	1
Living environment									0.34
Urban	114	28.8	17	23.3	97	30.0	1
Rural	131	33.1	29	39.7	103	31.6	1.61	0.84–3.14
Peri-urban	151	38.1	27	37.0	124	38.4	1.24	0.64–2.41
Civil status									0.1
Single or widow	92	23.0	22	30.1	70	21.7	1
Engaged	304	77.0	51	69.9	253	78.3	0.61	0.34–1.1
Parents with
Children < 15 yrs old	166	42.0	28	38.4	138	42.7	0.83	0.5–1.4	0.49
Children < 3 yrs old	66	16.6	11	16.7	55	17.0	0.86	0.43–1.75	0.68
Pregnant									0.13
No	389	98.3	70	95.9	319	98.8	1
Yes	7	1.7	3	4.1	4	1.2	3.42	0.75–15.6
Educational attainment									0.23
PhD/Master degree	32	8.1	3	4.1	29	9.0	1
Bachelor	106	26.8	19	26.0	87	26.9	2.11	0.58–7.65
High school graduation	199	50.3	43	58.9	156	48.3	2.66	0.77–9.17
PSAT *	55	13.9	8	11.0	47	14.6	1.65	0.4–6.71
Occupation									< 0.001
Agriculture	8	2.0	1	1.4	7	2.2	1
Artisan	7	1.8	3	4.1	4	1.2	5.25	0.4–68.95
Housewife	24	6.1	2	2.7	22	6.8	0.64	0.05–8.12
Merchant	11	2.8	2	2.7	9	2.8	1.56	0.12–20.8
Manager	12	3.0	2	2.7	10	3.1	1.4	0.11–18.6
Unemployed	14	3.5	9	12.3	5	1.5	12.6	1.2–133.9
Employee	91	23.0	19	26.0	72	22.3	1.85	0.21–15.9
Teacher	29	7.3	3	4.1	26	8.0	0.81	0.07–9.0
Free-lance	26	6.6	6	8.2	20	6.2	2.1	0.2–20.64
Worker	42	10.6	8	11.0	34	10.5	1.65	0.18–15.3
Retired	51	12.9	1	1.4	50	15.5	0.14	0.01–2.5
Health professional	28	7.1	7	9.6	21	6.5	2.33	0.24–22.4
Student	16	4.0	1	1.4	15	4.6	0.47	0.03–8.6

* Preliminary National Merit Scholarship Qualifying Test

Table 3. Description of attitudes toward vaccines according to vaccination hesitancy. Data collected through the compilation of the entire questionnaire

	Total (n = 396)		Hesitant (n = 73, 18.4%)		Non hesitant (n = 323, 81.5%)
Variables	n	%	n	%	n	%	Crude OR	95% CI	P value
Confidence with efficiency									< 0.001
Yes	347	87.6	35	47.9	312	96.6	1
No	6	1.5	5	6.8	1	0.3	44.5	5.0–392.4
Does not know	43	10.9	33	45.2	10	3.1	29.42	13.3–64.7
Confidence with safety									< 0.001
Yes	290	73.2	17	24.7	272	84.2	0.01	0–0.05
No	83	5.8	19	26.0	4	1.2	1
Does not know	23	21.0	36	49.3	47	14.6	0.16	0.05–0.52
Confidence with utility									< 0.001
Yes	363	91.7	49	67.1	314	97.2	0.06	0.03–0.13
No	33	8.3	24	32.9	9	2.8	1
Conviction of adverse effects									< 0.001
Important	45	11.4	30	41.1	15	4.6	1
Light	226	57.1	26	35.6	200	61.9	0.06	0.03–0.14
Does not know	72	18.2	16	21.9	56	17.3	0.14	0.06–0.33
Without adverse effects	53	13.4	1	1.4	52	16.1	0.01	0–0.08
Fake news victim*									< 0.001
No	215	54.3	12	16.4	203	62.8	1
Yes	181	45.7	61	83.6	120	37.2	8.6	4.4–16.6

* have been influenced by false messages such as: link between autism and vaccination, presence of mercury in vaccines, risk of weakening of the immune system by vaccines

Table 4. Description of knowledge about vaccines based on vaccination hesitancy. Data collected though long questionnaires, n = 396

	Total (n = 396)		Hesitant (n = 73, 18.4%)		Non hesitant (n = 323, 81.6%)
Variables	n	%	n	%	n	%	Crude OR	95% CI	P value
Knows how a vaccine works									< 0.001
No	73	18.4	26	35.6	47	14.6	1
Yes	323	81.6	47	64.4	276	85.4	0.31	0.17–0.54
Would like to know more									0.427
Maybe	92	23.2	22	30.2	70	21.7	1
No, not interested	38	9.6	7	9.6	31	9.6	0.72	0.28–1.86
No, do not need	41	10.4	8	12.0	33	10.2	0.77	0.31–1.91
Yes	225	56.8	36	49.3	189	58.5	0.61	0.33–1.1
Knows what herd immunity is									0.02
Maybe	72	18.2	16	21.9	56	17.3	1
No	114	28.8	29	39.7	85	26.3	1.19	0.6–2.4
Yes	210	53.0	28	38.4	182	56.3	0.54	0.27–1.07
Adverse effects from food vs vaccine									< 0.001
Food	284	71.7	38	52.1	246	76.2	1
Vaccine	17	4.3	7	9.6	10	3.1	4.53	1.6–12.62
Same frequency	15	3.8	9	12.3	6	1.9	9.71	3.27–28.8
Does not know	80	20.2	19	26.0	61	18.9	2.02	1.09–3.74
Vaccine for rare diseases									< 0.001
No	31	7.8	16	21.9	15	4.6	1
Does not know	29	7.3	15	20.5	14	4.4	1	0.36–2.76
Yes	336	84.8	42	57.5	294	91.0	0.13	0.06–0.29
Why several vaccines at the same time									0.55
Maybe	75	18.9	11	15.1	64	19.8	1
No	198	50.0	40	54.8	158	48.9	1.47	0.71–3.05
Yes	123	31.1	22	30.1	101	31.5	1.27	0.57–2.79
Knowledge of alternatives to vaccines									0.04
Yes	340	85.9	57	78.1	283	87.6	0.5
Knowledge of tetanus									0.23
Yes	231	58.3	38	52.1	193	59.8	0.74
Knowledge of measles									0.27
Yes	292	73.7	50	68.5	242	74.9	0.73	0.42–1.27
Knowledge of pertussis									0.12
Yes	243	61.4	39	53.4	204	63.2	0.67	0.41–1.14
Knowledge of available vaccines°									0.47
Yes	185	50.0	17	46.5	103	50.8	0.84	0.53–1.35
Knowledge score*									0.43
Good	124	31.3	24	32.9	100	31.0	1
Bad	117	29.5	25	34.2	92	28.5	3.19	1.63–6.24
Intermediate	155	39.1	24	32.9	131	40.5	1.34	0.65–2.76
Concordance real level/estimated level									0.09
No	148	37.4	21	28.8	127	39.3	1
Yes	248	62.6	52	71.2	196	60.7	1.6	0.92–2.79

° The knowledge of available vaccines was considered as the acknowledgment of at least 6 existing vaccines and no more than one non-existing vaccine

* The knowledge score was created with the answers to the following questions: “Do you know how a vaccine works?” “Do you know what herd immunity is?” “Are the side effects of vaccines more or less common than those due to food?” “Do you think it is useful to vaccinate against diseases we don’t hear more about anymore?” “Do you know why several vaccines are made at the same time?” “What are the alternatives or supplements to vaccines to prevent infectious diseases in general?” “Do you know 2 symptoms or complications of tetanus? Measles? Whooping cough? For which of the following diseases are vaccines?”. If the score was greater than 8 out of 10, the knowledge was considered good, between 5 and 7 as intermediate, and less than 5 insufficient.

Table 5. Description of access to information on vaccines according to hesitation or no, in the 3 shopping centers in Italy, June-July 2019, n = 396

	Total (n = 396)		Hesitant (n = 73, 18.4%)		Non hesitant (n = 323, 81.6%)
Variables	n	%	n	%	n	%	Crude OR	95% CI	P value
Information by doctor									0.04
Yes	303	76.5	49	67.1	254	78.6	0.55	0.32–0.97
Information on media									0.04
Yes	185	46.7	42	57.5	143	44.3	1.71	1.02–2.8
Information on internet									0.34
Yes	197	49.7	40	54.8	157	48.6	1.28	0.77–2.13
Information on official sites									0.64
Yes	164	41.4	32	43.8	132	40.9	1.13	0.68–1.9
Information on social network									< 0.001
Yes	63	15.9	23	31.5	40	12.4	3.25	1.8–5.9
Clear information									< 0.001
Contradictory information	48	12.1	21	28.8	27	8.4	1
No	94	23.7	28	38.4	66	20.4	0.55	0.3–1.22
Does not know	60	15.2	12	16.4	48	14.9	0.32	0.14–0.7
Yes	194	49.0	12	16.4	182	56.3	0.08	0.04–0.2
Recent information									0.12
No	203	51.1	38	52.1	165	51.1	1
Does not know	23	5.8	8	11.0	15	4.6	2.32	0.92–5.9
Yes	170	43.1	27	37.0	143	44.3	0.8	0.48–1.4

Figure 1. Final multivariate model of characteristics associated with vaccine hesitancy among adults interviewed in 3 shopping centers in Italy, June-July 2019, n = 396

Table

SHORT QUESTIONNAIRE
1/ ID CODE |___||___||___||___|	2/ GENDER □ male □ female			3/ AGE |___||___|	4/ Do you know the website VaccinarSi? □ yes □ no
5/ What opinion do you have regarding vaccination? □ Positive □ Neutral □ Negative	6/ If the vaccinations would not be mandatory would you receive them? □ yes, probably all □ yes, just some of them □ no				7/ Do you agree with the mandatory vaccinations? □ yes (go to 8) □ no (go to 9)
8/ If you agree is it because… (MCQ) □ it also protects the children who cannot get vaccinated □ it stops the diffusion of potentially serious diseases □ those scientific arguments are difficult to understand for parents so it’s better if scientists decide who needs to be vaccinated	9/ If you don’t agree is it because it is not fare because…(MCQ) □ the diseases are rare so the vaccines are not needed □ others should not decide for my child □ it is not right to exclude a child from school				10/ Do you agree to go further with the questionnaire? □ yes (go to 11) □ no (end of the questionnaire)
SOCIO-DEMOGRAFIC DATA
11/ How many children under 15 do you have? □ 0 □ 1 □ 2 □ 3 □ more than 3	12/ How many children under 3 do you have? (MCQ) □ 0 □ 1 □ 2 □ I am pregnant				13/ Where do you live? □ city center □ village □ countryside		14/ In which province do you live? □ Bolzano □ Trento □ other
15/ What is your level of education? □ primary □ secondary □ bachelor □ Master/PhD	16/ What is your profession? □ student □ retailer □ employee □ teacher □ artisan □ farmer □ manager			□ artist □ free lance □ disoccupied □ housewife □ retired □ doctor □ health professional	17/ Are you… □ in a relationship (married or cohabitee) □ single □ widowed		18/ What is your country of origin? □ Italy □ other European □ in Africa □ in Asia □ in America □ in Oceania □ other
SECTION 0 : ATTITUDES
19/ Do you believe vaccines are : (MCQ) a. □ Effective □ not effective □ don’t know b. □ Secure □ unsecure □ I don’t know c. □ useful for me □ useful for the community □ not useful because the diseases are rare □ not useful because the community is clean □ I don’t know	20/ Do/did you believe that vaccines: (MCQ) a. □ are without adverse effects □ have minor adverse effects □ have significant adverse effects B. □ can be responsible for autism □ contain quicksilver □ weaken the immune system □ none of the above answers □ I don’t know				21/ If you ever chose not to accept the vaccine for you/your child, what was the reason? (MCQ) □ I have always accepted vaccination □ adverse effect of a previous vaccine □ medical contraindication □ the vaccine was not mandatory □ religious reason □ fear of side effects □ missing information □ I don’t trust in scientific medicine
SECTION 1: KNOWLEDGE ABOUT VACCINES
22/ Do you know how does a vaccine work? □ very well □ well □ pretty well □ a little □ absolutely not	23/ Would you like to know more? □ yes □ maybe □ no, I don’t need it □ no, I am not interested				24/ Do you know what herd immunity means? □ yes □ maybe □ no
25/ Do you think allergy is more frequent with vaccines or food? □ vaccines □ food □ same frequency □ I don’t know	26/ Do you think it is useful to vaccinate for diseases no longer common? □ yes □ no □ I don’t know				27/ Do you know why more than one vaccine is administered at the same time? □ yes □ maybe □ no
28/ Do you think that too many vaccines are administered at the same time? □ yes (go to 29) □ no (go to 30) □ I don’t know (go to 30)	29/ Why do you think that too many vaccines are administered at the same time? Because… (MCQ) □ I think there could be more side effects □ I don’t know (=information missing) □ I think it is too strong for the body □ babies are small and have immature immune systems □ it is an invention from the pharmaceutical industry to sell more vaccines
SECTION 2: KNOWLEDGE ABOUT DIEASES PREVENTABLE BY VACCINES
30/ To prevent becoming infected by the diseases for which vaccines exist, what additional strategy would you adopt? (MCQ)
□ isolating the sick person □ wound desinfection □ physical activity □ washing hands □ organic diet		□ antibiotics □ essential oils/ natural erbs □ homeopathy □ live in contact with the nature □ live in remote areas/ far from cities			□ be infected by the disease □ I don’t know □ none of the answers
31/ Do you recognize 2 symptoms/ complications of tetanus among the following? □ cough □ rash □ meningitis □ convulsion □ palsy □ death □ I don’t know	32/ Do you recognize 2 symptoms/ complications of whooping cough among the following? □ cough □ rash □ meningitis □ convulsion □ palsy □ death □ I don’t know				33/ Do you recognize 2 symptoms/ complications of measles among the following? □ cough □ rash □ meningitis □ convulsion □ palsy □ death □ I don’t know
34/ Vaccines are available for which of the following diseases? □ diphteria □ tetanus □ poliomyelitis □ whooping cough □ pneumonia □ gastro-enteritis			□ chickenpox □ hepatitis B □ hepatitis C □ measles □ mumps □ rubella			□ tuberculosis □ meningitis □ papillomavirus □ influenza □ tick born encephalitis □ malaria
SECTION 3: MANDATORY VACCINES
35/ Do you know which vaccines are recommended and which are mandatory? □ yes □ maybe □ no
SECTION 4: INFORMATION
36/ Who do you usually get information about vaccines from? □ General practitioners □ pediatrician □ vaccination service □ school □ newspaper					□ radio □ television □ internet □ friends/family
37/ Do you think that the information received in the past were clear and sufficient? □ yes □ no □ contradictory information □ I don’t know
38/ Have you received information about vaccines recently (in the past semester)? □ yes □ no □ I don’t remember
SECTION 5: INTERNET
39/ Do you use internet to access information about vaccines? □ yes (go to 40) □ no (end of the questionnaire)
40/ If yes, how? □ official sites (ministry, state, vaccination services) □ newspaper websites □ blog □ Facebook					□ twitter □ instagram □ Youtube □ other
41/ Have you ever visited the website VaccinarSi? □ yes (go to 42) □ no (end of the questionnaire)					42/ Did you find it useful? □ yes (end of the questionnaire) □ no (go to 43)
43/ Why didn’t you find it useful? □ I didn’t like the design □ too much information □ the language is too complicated □ other