Uptake rates, knowledge, attitudes, and practices toward seasonal influenza vaccination among healthcare workers in Lebanon

Figures & data

Table 1. Characteristics of the study participants

Characteristics	Category	Frequency (%)
Health facility site	Beirut	269 (62.7)
n = 429*	Bekaa	101 (23.5)
	Tripoli	59 (13.8)
Age (years)	18–24	93 (21.7)
n = 429	25–34	178 (41.5)
	35–49	93 (21.7)
	≥50	65 (15.2)
Gender	Male	256 (59.7)
n = 429	Female	173 (40.3)
Profession	Nurse	183 (42.7)
n = 429	Physician	123 (28.7)
	Resident	47 (11.0)
	Intern	34 (7.9)
	Pharmacist	5 (1.2)
	Other	37 (8.6)
Specialty	General/internal medicine	95 (22.3)
n = 429
	Emergency department	12 (2.8)
	Obstetrics/ gynecology	19 (4.5)
	Adults Intensive Care Unit	42 (9.9)
	Neonatal Intensive Care Unit	10 (2.3)
	Pediatrics	49 (11.5)
	Radiology	14 (3.3)
	Surgery	35 (8.2)
	Other	150 (35.2)
Average number of patients (per day)	≤10	138 (32.8)
n = 421	11–30	242 (57.5)
	>30	41 (9.7)
Experience (years)	<5	168 (39.6)
n = 424	5–14	148 (34.9)
	15–24	57 (13.4)
	≥25	51 (12.0)

*, number of responses

Table 2. Attitudes toward influenza vaccination

Attitude toward vaccination		Frequency (%)
History of influenza vaccination	Yes	264 (61.5)
n = 429*	No	142 (33.1)
	I don’t remember	23 (5.4)
Number of influenza vaccines taken in past 5 years	Once	74 (25.3)
n = 292	2–4 times	88 (30.1)
	5 times	60 (20.5)
	I don’t remember	70 (24.0)
Vaccinated this season	Yes	118 (40.4)
n = 292	No	162 (55.5)
	I don’t remember	12 (4.1)
Vaccine available for free in healthcare facility	Yes	140 (33.3)
n = 421	No	198 (47.0)
	I don’t know	83 (19.7)
Taking the vaccine for free	Yes	287 (67.2)
n = 427	No	116 (27.2)
	I don’t know	24 (5.6)
Taking the vaccine purchased	Yes	193 (46.7)
n = 413	No	158 (38.3)
	I don’t know	62 (15.0)
Recommend the vaccine for patients	Yes	328 (76.8)
n = 427	No	51 (11.9)
	I don’t know	48 (11.2)
Frequency of influenza vaccination	Every 6 months	27 (6.3)
n = 428	Every year	375 (87.6)
	Every 5 years	2 (0.5)
	Once in a lifetime	5 (1.2)
	Never	19 (4.4)

*, number of responses

Figure 1. Enablers and barriers of influenza vaccination. (a) Reasons for vaccine acceptance. (b) Reasons for vaccine refusal.

Figure 2. Sources of recommendation or advice for taking the vaccine.

Figure 3. Guideline recommendations for influenza vaccination.

Figure 4. Measures to prevent influenza after diagnosing a patient with influenza.

Table 3. Association between demographics and willingness to receive/recommend the influenza vaccine

	Willingness to receive the vaccine				Willingness to recommend the vaccine
Characteristics	N *	N(%)	Adjusted OR [95%CI)	P	N	N(%)	Adjusted OR [95%CI)	P
Age (years)
18–24	92	68 (23.7)	Ref		82	70 (21.3)	Ref
25–34	178	118 (41.1)	0.69 [0.40,1.21]	0.201	155	129 (39.3)	0.88 [0.49,1.57]	0.672
35–49	92	57 (19.9)	0.57 [0.31,1.08]	0.084	87	77 (23.5)	1.58 [0.77,3.23]	0.209
≥50	65	44 (15.3)	0.74 [0.37,1.49]	0.397	55	52 (15.9)	1.42 [0.65,3.12]	0.378
Sex
Female	173	110 (38.3)	Ref		158	130 (39.6)	Ref
Male	254	177 (61.7)	1.32 [0.87,1.98]	0.188	221	198 (60.4)	1.17 [0.74,1.84]	0.500
Occupation
Physician	123	84 (29.3)	Ref		114	104 (31.7)	Ref
Resident	46	28 (9.8)	0.72 [0.36,1.46]	0.365	38	31 (9.5)	0.38 [0.17,0.83]	0.015
Intern	34	16 (5.6)	0.41 [0.19,0.89]	0.025	27	21 (6.4)	0.29 [0.13,0.69]	0.005
Nurse	182	124 (43.2)	0.99 [0.61,1.62]	0.976	159	133 (40.5)	0.51 [0.28,0.91]	0.024
Other	42	35 (12.2)	2.32 [0.95,5.69]	0.065	41	39 (11.9)	1.78 [0.57,5.57]	0.321
Specialty
General/ internal medicine	94	57 (20.1)	Ref		79	71 (21.8)	Ref
Pediatrics	49	38 (13.4)	2.24 [1.02,4.93]	0.045	46	43 (13.2)	2.46 [0.93,6.49]	0.070
Obstetrics/ gynecology	19	16 (5.6)	3.46 [0.94,12.71]	0.061	19	19 (5.8)	-	-
Other	262	173 (60.9)	1.26 [0.78,2.05]	0.349	232	193 (59.2)	0.98 [0.57,1.68]	0.936
Average number of patients seen per day
≤10	137	94 (33.5)	Ref		123	106 (33.1)	Ref
11–30	241	163 (58.0)	0.96 [0.61,1.50]	0.845	208	178 (55.6)	0.87 [0.53,1.41]	0.567
>30	41	24 (8.5)	0.65 [0.31,1.32]	0.233	40	36 (11.2)	2.17 [0.79,6.00]	0.134
Experience (years)
<5	167	114 (40.4)	Ref		144	123 (38.1)	Ref
5–14	147	97 (34.4)	0.90 [0.56,1.45]	0.688	133	111 (34.4)	1.13 [0.68,1.87]	0.642
15–24	57	36 (12.8)	0.80 [0.42,1.49]	0.480	53	48 (14.9)	2.19 [0.96,4.99]	0.061
≥25	51	35 (12.4)	1.02 [0.52,1.99]	0.961	44	41 (12.7)	1.50 [0.69,3.24]	0.303

* N totals for each factor may not sum to the total N since missing responses (i.e. respondent indicated “I don’t know” or “I don’t remember” or skipped the question) are not included in Table 3 calculations.

Table 4. Association between attitudes toward influenza and willingness to recommend the influenza vaccine

Question		N*	Willing to recommend or give influenza vaccination n (%)	Crude OR (CI)	P value
Have you ever been vaccinated against influenza?	Yes	263	216 (82.1)	2.37 [1.48,3.79]	<0.001
	No	141	93 (66)	Ref
Are you willing to receive free influenza vaccine?	Yes	286	253 (88.5)	6.93 [4.27,11.34]	<0.001
	No	139	73 (52.5)	Ref
Is influenza vaccine available for free to you and other health workers at your health facility?	Yes	140	117 (83.6)	1.93 [1.12,3.34]	0.018
	No	196	142 (72.4)	Ref
Did you receive influenza vaccine last year?	Yes	118	102 (86.4)	1.71 [0.89,3.26]	0.106
	No	161	127 (78.9)	Ref
How many times did you receive influenza vaccine in the past 5 years?	1	74	55 (74.3)	Ref
	2–4	147	131 (89.1)	2.83 [1.35,5.90]	0.006
How confident are you that influenza vaccine can prevent influenza? ^$	≤3 (Low confidence)	131	74(22.6)	Ref
	≥4 (High confidence)	296	254 (77.4)	4.66 [2.90,7.49]	<0.001
Have you ever made a laboratory-confirmed diagnosis of influenza in a patient?	Yes	211	173 (82.0)	1.81 [1.12,2.92]	0.016
	No	176	126 (71.6)	Ref
Have you ever made a clinical, non-laboratory confirmed diagnosis of influenza in a patient?	Yes	187	187 (100.0)	2.01 [1.23,3.28]	0.005
	No	165	118 (71.5)	Ref

*N totals for each question may not sum to the total N since missing responses (i.e. respondent indicated “I don’t know” or “I don’t remember” or skipped the question) are not included in Table 3 calculations.

^$Likert scale; 1 being “not at all” and 5 being “very much.” Neutral answers were considered low confidence.

Table 5. Association between knowledge about influenza and influenza vaccine and willingness to receive or give influenza vaccination

Total sample n = 402		Knowledge index * Range [0–11]	Mann Whitney U test	P-value
Median [IQR]		8.0 [6.0–9.0]
Willing to receive influenza vaccination	No	6.0 [5.0–8.0]	7485.5	<0.001
	Yes	8.0 [7.0–9.0]
Willing to recommend or give influenza vaccination	No	6.0 [4.0–7.75]	4673.0	<0.001
	Yes	8.0 [7.0–9.0]