Knowledge, attitudes, and practices towards influenza among Chinese adults during the epidemic of COVID-19: a cross-sectional online survey

Figures & data

Table 1. Demographic characteristics of participants and their knowledge scores

Characteristics	Proportion of overall Chinese adults^# (%)	N (%)	Mean score (SD)	Median score (IQR)	Statistics	P-value
Total	-	4822 (100.00)	5.51 (1.55)	6 (5,7)
Gender					−2.800	0.005
Male	51.13	1872 (38.82)	5.41 (1.63)	6 (5,7)
Female	48.87	2950 (61.18)	5.57 (1.49)	6 (5,7)
Age (years)					89.000	<0.001
18–40	41.03	3186 (66.07)	5.55 (1.49)	6 (5,7)
41–60	36.65	1458 (30.24)	5.50 (1.61)	6 (5,7)
>60	22.32	178 (3.69)	4.81 (1.90)	5 (4,6)
Place of residence					−7.457	<0.001
URBAN	59.58	3985 (82.64)	5.58 (1.50)	6 (5,7)
Rural	40.42	837 (17.36)	5.14 (1.69)	5 (4,6)
Marital status					30.582	<0.001
Unmarried	18.16	1330 (27.58)	5.44 (1.40)	6 (5,7)
Married	74.12	3336 (69.18)	5.55 (1.59)	6 (5,7)
Divorced	2.11	127 (2.63)	5.14 (1.76)	6 (4,7)
Widowed	5.61	29 (0.60)	4.97 (1.80)	5 (4,6)
Education level					196.423	<0.001
High school or below	85.99	536 (11.12)	4.61 (1.94)	5 (3,6)
College or undergraduate	13.41	3103 (64.35)	5.52 (1.50)	6 (5,7)
Master or above	0.60	1183 (24.53)	5.87 (1.30)	6 (5,7)
Profession					378.137	<0.001
Medical	1.53	1834 (38.03)	6.03 (1.16)	6 (5,7)
Non-medical	94.77	2322 (48.15)	5.28 (1.59)	6 (4,7)
No profession	3.70	666 (13.81)	4.83 (1.84)	5 (4,6)
Monthly income (CNY)					95.085	<0.001
≤5000	31.80	2084 (43.22)	5.27 (1.63)	6 (4,7)
5000–10000	37.80	1817 (37.68)	5.66 (1.46)	6 (5,7)
≥10000	30.40	921 (19.10)	5.74 (1.45)	6 (5,7)
Health condition					24.719	<0.001
Good	-	3432 (71.17)	5.58 (1.50)	6 (5,7)
General	-	1332 (27.62)	5.36 (1.60)	6 (4,7)
Poor	-	58 (1.20)	4.67 (2.22)	5 (3,7)
Infected by influenza last year*					31.416	<0.001
Yes	-	656 (13.60)	5.52 (1.55)	6 (5,7)
No	-	3927 (81.44)	5.54 (1.51)	6 (5,7)
Unknown	-	239 (4.96)	4.85 (1.91)	5 (4,6)
Received influenza vaccination last year*					183.324	<0.001
Yes	-	768 (15.93)	6.06 (1.30)	7 (6,7)
No	-	3866 (80.17)	5.44 (1.55)	6 (5,7)
Unknown	-	188 (3.90)	4.68 (1.82)	5 (4,6)

CNY: Chinese Yuan; SD: standard deviation; IQR: inter quartile range; ^#The data were derived from the 2019 Report of National Bureau of Statistics; *participants or their family members.

Table 2. Multiple linear regression analysis on factors associated with knowledge score

Variable	Coefficient (β)	Standard error	t	P-value
Gender
Female	0
Male	−0.061	0.044	−1.38	0.169
Age (years)
>60	0
18–40	0.185	0.118	1.56	0.118
41–60	0.398	0.117	3.41	<0.001
Place of residence
Rural	0
Urban	0.302	0.138	2.19	0.003
Marital status
Unmarried	0
Married	0.032	0.056	0.57	0.570
Divorced	−0.212	0.139	−1.52	0.127
Widowed	−0.153	0.276	−0.56	0.579
Education level
High school or below	0
College or undergraduate	0.535	0.079	6.78	<0.001
Master or above	0.813	0.091	8.92	<0.001
Profession
Non-medical	0
Medical	0.684	0.046	14.705	<0.001
No profession	−0.108	0.071	−1.532	0.1270
Monthly income (CNY)
≤5000	0
5000–10000	0.103	0.051	2.01	0.045
≥10000	0.063	0.065	0.97	0.333
Health condition
Poor	0
Good	0.423	0.193	2.19	0.029
General	0.383	0.194	1.97	0.048
Infected by influenza last year*
No	0
Yes	−0.149	0.061	−2.432	0.0149
Unknown	−0.572	0.097	−5.138	<0.001
Received influenza vaccination last year*
No	0
Yes	0.564	0.058	9.734	<0.001
Unknown	−0.520	0.109	−4.745	<0.001

CNY: Chinese Yuan; *participants or their family members.

Table 3. Attitudes of statement on influenza and influenza vaccination

	N (%)					Attitude score
	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	Mean (SD)	Median (IQR)
1) Influenza is a common disease, and its social hazard is far less than the COVID-19.	581 (12.05)	1812(37.58)	1121 (23.25)	1155 (23.95)	153 (3.17)	2.68 (1.06)	3 (2,4)
2) Influenza infection will not cause severe health and economic burden.	202 (4.19)	1091 (22.63)	1270 (26.34)	1899 (39.38)	360 (7.47)	3.23 (1.01)	3 (2,4)
3) Antibiotics can be used to treat an influenza infection, such as amoxicillin and cephalosporins.	130 (2.70)	1277 (26.48)	1513 (31.38)	1272 (26.38)	630 (13.07)	3.20 (1.06)	3 (2,4)
4) I know the location of influenza vaccination.	94 (1.95)	361 (7.49)	1733 (35.94)	2001 (41.50)	633 (13.13)	2.43 (0.88)	2 (2,3)
5) I think it is not necessary to receive influenza vaccination.	124 (2.57)	787 (16.32)	949 (19.68)	2301 (47.72)	661 (13.71)	3.54 (1.00)	4 (3,4)
6) I would not receive influenza vaccination even if it was offered free.	112 (2.32)	468 (9.71)	1035 (21.46)	1918 (39.78)	1289 (26.73)	3.79 (1.02)	4 (3,5)
Total	4822 (100.00%)					20.01 (3.50)	20 (18,22)

SD: standard deviation; IQR: inter quartile range; COVID-19: coronavirus disease 2019.

Table 4. Multiple linear regression analysis on factors associated with attitude score

Variable	Coefficient (β)	Standard error	t	P-value
Gender
Female	0
Male	−0.181	0.101	−1.78	0.074
Age (years)
>60	0
18–40	1.697	0.271	6.26	<0.001
41–60	0.803	0.267	3.00	0.003
Place of residence
Rural	0
Urban	0.302	0.137	2.19	0.028
Marital Status
Unmarried	0
Married	−0.046	0.129	−0.36	0.718
Divorced	−0.307	0.320	−0.96	0.336
Widowed	−0.327	0.633	−0.52	0.606
Education level
High school or below	0
College or undergraduate	0.322	0.181	1.78	0.075
Master or above	0.830	0.209	3.97	<0.001
Profession
Non-medical	0
Medical	1.218	0.109	11.41	<0.001
No profession	0.026	0.164	0.16	0.873
Monthly income (CNY)
≤5000	0
5000–10000	−0.037	0.118	−0.32	0.752
≥10000	0.161	0.149	1.08	0.280
Health condition
Poor	0
Good	0.532	0.443	1.20	0.229
General	0.508	0.445	1.14	0.253
Infected by influenza last year*
No	0
Yes	−0.574	0.141	−4.08	<0.001
Unknown	−0.572	0.223	−2.57	0.010
Received influenza vaccination last year*
No	0
Yes	1.678	0.133	12.60	<0.001
Unknown	−0.113	0.251	−0.45	0.652

CNY: Chinese Yuan; *participants or their family members.

Table 5. Practices toward influenza and influenza vaccination

Questions	N (%)
1) Do you learn more knowledge of influenza during the epidemic of COVID-19?
Yes	3669 (76.09)
No	1153 (23.91)
2) If there was no COVID-19 outbreak, do you often wear face mask to go outdoor in the flu season?
Yes	1883 (39.05)
No	2939 (60.95)
3) Will you take the initiative to focus on influenza-related information?
Yes	2840 (58.90)
No	1982 (41.10)
4) Which of the following sources will you choose to derive influenza-related information? (multiple choices)
Community publicity	2312 (47.95)
Social media, such as WeChat and Weibo	4524 (93.82)
TV	2924 (60.64)
Newspaper	956 (19.83)
Magazines	691 (14.33)
Radio	730 (15.14)
Other sources	1326 (27.50)
5) Which of the following measures did you previously take to prevent influenza infection? (multiple choices)
No measures	571 (11.84)
Influenza vaccination	1402 (29.08)
Maintain indoor ventilation	3731 (77.37)
Wear a mask outside	2460 (51.02)
Wash hands frequently	3635 (75.38)
Take more physical exercises	3349 (69.45)
Less go to crowded places	3273 (67.88)
Other measures	502 (10.41)
6) Which of the following option is your first choice if you have influenza-like illness (such as fever, cough, and muscle pain)?
No treatment	259 (5.37)
Take leftover medicines at home	2093 (43.41)
Take medicine from a retail pharmacy	729 (15.12)
Seek medical care from hospital	1741 (36.11)
7) Will you consider receiving influenza vaccination in the future?
Yes	3015 (62.53)
No	510 (10.58)
Uncertain	1297 (26.9)
8) If clinicians recommend influenza vaccination to you, are you willing to receive it?
Yes	4138 (85.82)
No	684 (14.18)

COVID-19: coronavirus disease 2019.

Table 6. Logistic regression analysis on factors associated with participants’ behaviors of influenza prevention

Variable	If there was no COVID-19 outbreak, do you often wear face mask to go outdoor in the flu season?	Will you consider receiving influenza vaccination in the future?
Score
Knowledge	1.112 (1.064–1.163) *	1.238 (1.187–1.291) *
Attitude	1.035 (1.016–1.055) *	1.127 (1.105–1.149) *
Gender
Female	1	1
Male	0.675 (0.593–0.768) **	0.959 (0.847–1.087)
Age (years)
>60	1	1
18–40	1.120 (0.794–1.581)	1.179 (0.848–1.640)
41–60	1.141 (0.813–1.600)	0.870 (0.630–1.201)
Place of residence
Rural	1	1
Urban	0.88 (0.739–1.048)	1.028 (0.861–1.227)
Marital status
Unmarried	1	1
Married	1.074 (0.911–1.266)	1.036 (0.882–1.218)
Divorced	1.450 (0.977–2.153)	0.860 (0.587–1.259)
Widowed	1.046 (0.477–2.292)	0.908 (0.431–1.912)
Education level
High school or below	1	1
College or undergraduate	0.902 (0.721–1.130)	0.957 (0.765–1.198)
Master or above	0.599 (0.460–0.780) **	0.786 (0.607–1.018)
Profession
Non-medical	1	1
Medical	1.410 (1.232–1.613) **	1.268 (1.110–1.447) *
No profession	0.950 (0.773–1.166)	1.203 (0.978–1.415)
Monthly income (CNY)
≤5000	1	1
5000–10000	0.767 (0.660–0.891) **	0.987 (0.850–1.147)
≥10000	0.501 (0.408–0.613) **	0.855 (0.707–1.034)
Health condition
Poor	1	1
Good	1.722 (0.962–3.086)	1.643 (0.977–2.762)
General	1.507 (0.839–2.707)	1.332 (0.791–2.245)
Infected by influenza last year^#
No	1	1
Yes	0.961 (0.803–1.149)	0.977 (0.820–1.165)
Unknown	0.711 (0.531–0.953) *	0.727 (0.559–0.946) *
Received influenza vaccination last year^#
No	1	1
Yes	1.305 (1.106–1.541) **	3.275 (2.679–4.003) **
Unknown	1.234 (0.902–1.688)	1.061 (0.782–1.438)

COVID-19: coronavirus disease 2019; CNY: Chinese Yuan; ^#participants or their family members; *P< 0.05; **P< 0.01.