Exploring barriers to influenza vaccine uptake and recommendation among healthcare providers in the community in China: A qualitative study

Figures & data

Table 1. Thematic framework.

Theme	Sub-theme
Motivators and Barriers for Healthcare Workers to Receive Influenza Vaccine.	Influenza risk perception Vaccine confidence Accessibility of influenza vaccine
Influence factors on influenza vaccine recommendation by HCPs.	Knowledge. Job responsibilities and division of work. Costs of Doctor-patient communication. Self-vaccination behavior.
Need and proposal.	Strengthen public outreach and education and encourage community participation. Guide and regulate media communication. Improve the mode of vaccination service and enhance the convenience of vaccination.

Table 2. Demographic characteristics.

Group	Number of people	Constituent ratio (%)
gender
Male	45	25.0
Female	135	75.0
age
≤30	45	25.0
30–40	65	36.1
≥40	70	38.9
Work City
Jinan	45	25.0
Jining	45	25.0
Qingdao	45	25.0
Weifang	45	25.0
Type of medical institution
Community Hospital	120	66.7
Town Hospital	60	33.3
Job Category/Position Name
Primary doctor	52	28.4
Vaccination Nurse	89	49.4
Head of community hospital/vaccination clinic	14	7.8
Others	26	14.4
Years of working experience
≤10	69	38.3
10–20	52	28.9
≥20	59	32.8
Highest education level
Junior high school and below	2	1.1
Secondary school/high school and below	6	3.3
College	48	26.7
Undergraduate	123	68.3
Postgraduate and above	1	0.6

Table 3. Knowledge of key information on vaccines.

Question	Recommenders	Non-recommenders	Total accuracy rate	P-value
1. Do you know the Technical Guidelines for Influenza Vaccination in China (2022–2023)?				<.001
Very well understand	14.8%	6.9%
Understand	41.8%	31.0%
Roughly understand	27.0%	41.4%
Heard of it but not understood	18.9%	24.1%
Do not understand at all	0.8%	5.2%
2. The whole population is generally susceptible to influenza			87.2%	<.001
Yes	89.3%	82.8%
No	10.7%	17.2%
3. How does the flu spread?			67.8%	<.001
Droplet spread through sneezing and coughing	99.2%	96.6%
Direct or indirect contact with mucous membranes in the mouth and nose.	91.0%	77.6%
Aerosol transmission	77.0%	63.8%
Insect-borne	14.8%	17.2%
4. Influenza is not contagious during the incubation period			69.4%	<.001
Yes	29.5%	32.8%
No	70.5%	67.2%
5. There is no difference between influenza and the common cold.			79.4%	<.001
Yes	21.3%	19.0%
No	78.7%	81.0%
6. Which of the following are potential risks associated with contracting the flu?			55.6%	<.001
Fever and cough	97.5%	87.9%
Making a chronic underlying	98.4%	89.7%
Pneumonia	99.2%	89.7%
Encephalitis	93.4%	75.9%
Myocarditis	94.3%	77.6%
Cardiovascular events	77.0%	41.4%
Deaths	77.0%	46.6%
7. Who are the recommended priority groups for flu vaccination?			99.4%	<.001
Once a year	100.0%	96.6%
Once every 2–3 years	0.0%	3.4%
8. Who are the recommended priority groups for Flu vaccination?			23.9%	<.001
Healthcare workers	99.2%	84.5%
Home-bound seniors aged 60 years and older	98.4%	94.8%
Infants and children aged 6–23 months	77.0%	69.0%
Children aged 2–5 years	91.0%	77.6%
People with chronic health conditions	82.8%	67.2%
Family members and carers of babies under 6 months old	61.5%	41.4%
Pregnant women	32.8%	19.0%
9. Best time to get the flu vaccine in the North			96.7%	<.001
Any season	2.5%	5.2%
Usually, in autumn and winter	97.5%	94.8%
10. How long does the flu vaccine last?			98.3%	<.001
6–8 months	99.2%	96.6%
At least 5 years	0.8%	3.4%

Table 4. Univariate analysis of the influenza vaccine recommendation intentions of medical staff.

Item	Number of people	Willing to vaccinate	CMH P value
Whether to recommend			.001
Yes	122 (67.8%)	113 (62.8%)
No	58 (32.2%)	43 (23.9%)