Knowledge, attitudes and practices related to influenza and influenza vaccine among healthcare workers in Chongqing, China—a cross-sectional study

Figures & data

Table 1. The demographic information of all HCWs, physicians, nurses, and others in Chongqing during the 2018/2019 influenza season

Variable	N(%)	Physicians	Nurses	Others ^c
N(%)	1412(100)	457(32.36)	741(52.48)	214(15.16)
Type of hospital ^a
Non-sentinel hospital	806(57.08)	266(58.21)	401(54.12)	139(64.95)
Sentinel hospital	606(42.92)	191(41.79)	340(45.88)	75(35.05)
Sex
Males	310(21.95)	212(46.39)	23(3.10)	75(35.05)
Females	1102(78.05)	245(53.61)	718(96.90)	139(65.95)
Age
≤30	737(52.20)	173(37.86)	475(64.10)	89(41.59)
31 ~ 40	466(33.00)	195(42.67)	195(26.32)	76(35.51)
41 ~ 50	161(11.40)	59(12.91)	60(8.10)	42(19.63)
≥51	48(3.40)	30(6.56)	11(1.48)	7(3.27)
Educational attainment
College degree and below	310(21.95)	19(4.16)	237(31.98)	54(25.23)
Bachelor degree	908(64.31)	272(59.52)	502(67.75)	134(62.62)
Postgraduate and above	194(13.74)	166(32.32)	2(0.27)	26(12.15)
Marital status
Unmarried	372(26.35)	90(19.70)	225(30.36)	57(26.64)
Married	998(70.68)	360(78.77)	494(66.67)	144(67.29)
Divorced, widowed and separated	42(2.97)	7(1.53)	22(2.97)	13(6.07)
Working department ^b
Low-risk department	789(55.88)	231(50.55)	344(46.42)	214(100.00)
High-risk department	623(44.12)	226(49.45)	397(53.58)	0(0.00)
Years in profession
≤5	536(37.96)	176(38.51)	284(38.33)	76(35.51)
6 ~ 10	441(31.23)	117(25.60)	268(36.17)	56(26.17)
11 ~ 15	202(14.31)	73(15.98)	101(13.63)	28(13.09)
≥16	233(16.50)	91(19.91)	88(11.87)	54(25.23)
Job title
Junior	891(63.10)	200(43.76)	561(75.71)	130(60.75)
Middle	394(27.90)	177(38.73)	155(20.92)	62(28.97)
Senior	127(9.00)	80(17.51)	25(3.37)	22(10.28)

^aThe hospitals in this study were classified into two types: hospitals that participate in the National Influenza Surveillance System were categorized as “sentinel hospital,” while the others were categorized as “non-sentinel hospital.”

^bThe working department of HCWs includes “High-risk department” and “Low-risk department.” The former includes respiratory disease, infectious disease, pediatrics, gynecology and obstetrics and emergency, and the latter includes general surgery, obstetrics and gynecology, laboratory and radiology according to our definition in the method part.

^cOthers: those HCWs without patient contact include laboratory and radiology technicians and administrative support staff.

Table 2. Healthcare workers’ knowledge about influenza and influenza vaccine, Chongqing, 2018–2019 influenza season (n = 1412)

Statements	Agree		Disagree or do not know
	n	%	n	%
Influenza
1. Influenza is transmitted primarily by coughing and sneezing.	1393	98.65	19	1.35
2. Mask wearing can limit the spread of Influenza.	714	50.57	698	49.43
3. The incubation period of influenza is 1–4 days.	1026	72.66	386	27.34
4. Influenza can be transmitted via close contact with an infected individual.	1100	77.90	312	22.10
5. Influenza patients have been able to spread influenza before their symptoms appear.	1269	89.87	143	10.13
Influenza vaccine
6. The influenza shot contains live viruses cannot cause people to get influenza.	1211	85.76	201	14.24
7. The immunity afforded by the influenza vaccine is better than the natural immunity.	819	58.00	593	42.00
8. The best time for influenza vaccination is before the influenza season.	1024	72.52	388	27.48
9. Influenza vaccination should be given once a year.	1089	77.12	323	22.88
10. Influenza vaccination cannot alleviate or treat the influenza.	1334	94.48	78	5.52
The side effects of the influenza vaccine include:
11. Fever	1307	92.56	105	7.44
12. Headache	878	62.18	534	37.82
13. Soreness and/or swelling at the site of injection	1237	87.61	175	12.39
The most recommended groups for influenza vaccination include:
14. People over 60 years old	1209	85.62	203	14.38
15. Frail people particularly who suffer from chronic diseases	1265	89.59	147	10.41
16. Healthcare workers	1316	93.20	96	6.80
17. Pupils and kindergarten children	1347	95.40	65	4.60
18. Pregnant women	564	39.94	848	60.06

Figure 1. Sources of influenza-related information for all HCWs, physicians, nurses, and others in Chongqing, 2018–2019 influenza season.

Table 3. HCWs’ attitude toward influenza vaccine, Chongqing, 2018–2019 influenza season (n = 1412)

Statements	SA	A	N	DA	SDA	Agree^a	Disagree^b
	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)
1.I believe the influenza vaccine is safe.	267(18.91)	892(63.17)	239(16.93)	10(0.71)	4(0.28)	1159(82.08)	253(17.92)
2.I think it’s necessary to get the influenza vaccine.	381(26.98)	833(59.00)	182(12.89)	14(0.99)	2(0.14)	1214(85.98)	198(14.02)
3.I don’t worry about the side effects of the influenza vaccine.	39(2.76)	461(32.65)	588(41.64)	284(20.11)	40(2.83)	500(35.41)	912(64.59)
4.I believe the influenza vaccine is effective in preventing seasonal influenza.	224(15.86)	882(62.46)	298(21.10)	5(0.35)	3(0.21)	1106(78.33)	306(21.67)
5. I think even if I never get influenza, I still need to vaccinate the influenza vaccine.	284(20.11)	822(58.22)	251(17.78)	47(3.33)	8(0.57)	1106(78.33)	306(21.67)
6.It’s important to get the influenza vaccine every year.	198(14.02)	544(38.53)	577(40.86)	89(6.30)	4(0.28)	742(52.55)	670(47.45)
7.I agree with the guidance of the Chinese Center for Disease Control and Prevention on recommending that healthcare workers be vaccinated against influenza every year.	239(16.93)	842(59.63)	226(16.01)	29(2.05)	76(5.38)	1081(76.56)	331(23.44)

SA: strongly agree; A: agree; N: neutral; DA: disagree; SDA: strongly disagree.

^aResponses included “strongly agree” and “agree” were considered to agree with the statement.

^bThe “neutral,” “disagree” and “strongly disagree” responses were considered to disagree with the statement.

Table 4. Influenza vaccination coverage of 1412 HCWs in Chongqing during the 2018/2019 influenza season

Variable	Total (%)	Vaccinated	Unvaccinated	Crude OR (95% CI)	p-value	Adjusted OR (95%CI)	p-value
Type of hospital ^a					0.009		.020
Non-sentinel hospital	806(57.08)	117(14.52)	689(85.48)	Ref		Ref
Sentinel hospital	606(42.92)	120(19.80)	486(80.20)	1.454(1.099–1.924)		1.427(1.057–1.925)
Sex					0.121		-
Males	310(21.95)	43(13.87)	267(86.13)	Ref		-
Females	1102(78.05)	194(17.60)	908(82.40)	1.327(0.928–1.897)		-
Age					0.099		-
≤30	737(52.20)	108(14.65)	629(85.35)	Ref		-
31 ~ 40	466(33.00)	88(18.88)	378(81.12)	1.356(0.995–1.847)		-
41 ~ 50	161(11.40)	29(18.01)	132(81.99)	1.280(0.815–2.008)		-
51~	48(3.40)	12(25.00)	36(75.00)	1.941(0.979–3.849)		-
Educational attainment					0.656		-
College degree and below	310(21.95)	47(15.16)	263(84.84)	Ref		-
Bachelor degree	908(64.31)	158(17.40)	750(82.60)	1.179(0.827–1.681)		-
Postgraduate and above	194(13.74)	32(16.49)	162(83.51)	1.105(0.677–1.804)		-
Marital status					0.587		-
Unmarried	372(26.35)	170(17.03)	828(82.97)	Ref		-
Married	998(70.68)	58(15.59)	314(84.41)	1.112(0.803–1.539)		-
Divorced, widowed and separated	42(2.97)	9(21.43)	33(78.57)	1.476(0.671–3.248)		-
Working department ^b					<0.001		<.001
Low-risk department	789(55.88)	95(12.04)	694(87.96)	Ref		Ref
High-risk department	623(44.12)	142(22.79)	481(77.21)	2.157(1.622–2.867)		1.919(1.423–2.589)
Profession					0.022		-
Physicians	457(32.37)	79(17.29)	378(82.71)	Ref		-
Nurses	741(52.48)	136(18.35)	605(81.65)	1.076(0.792–1.460)		-
Others ^c	214(15.16)	22(10.28)	192(89.72)	0.548(0.331–0.907)		-
Years in profession					0.010		-
≤5	536(37.96)	68(12.69)	468(87.31)	Ref		-
6 ~ 10	441(31.23)	80(18.14)	361(81.86)	1.525(1.073–2.167)		-
11 ~ 15	202(14.31)	43(21.29)	159(78.71)	1.861(1.220–2.839)		-
≥16	233(16.50)	46(19.74)	187(80.26)	1.693(1.123–2.553)		-
Job title					0.235		-
Junior	891(63.10)	138(15.49)	753(84.51)	Ref		-
Middle	394(27.90)	75(19.04)	319(80.96)	1.283(0.941–1.749)		-
Senior	127(8.99)	24(18.90)	103(81.10)	1.271(0.787–2.054)		-
Did you take the initiative to learn influenza information?					<0.001		<.001
No	441(31.23)	30(6.80)	411(93.20)	Ref		Ref
Yes	971(68.77)	207(21.32)	764(78.68)	3.712(2.485–5.544)		3.000(1.983–4.538)
Knowledge					0.004		-
Poor	700(49.58)	97(13.86)	603(86.14)	Ref		-
Good ^d	712(50.42)	140(19.66)	572(80.34)	1.522(1.146–2.019)		-
Attitude					<0.001		<.001
Negative	527(37.32)	45(8.54)	482(91.46)	Ref		Ref
Positive ^e	885(62.68)	192(21.69)	693(78.31)	2.968(2.102–4.189)		2.429(1.697–3.477)

^aThe hospitals in this study were classified into two types: hospitals that participate in the National Influenza Surveillance System were categorized as “sentinel hospital,” while the others were categorized as “non-sentinel hospital.”

^bThe working department of HCWs includes “High-risk department” and “Low-risk department.” The former includes respiratory disease, infectious disease, pediatrics, gynecology and obstetrics and emergency, and the latter includes general surgery, obstetrics and gynecology, laboratory and radiology according to our definition in the method part.

^cOthers: those HCWs without patient contact include laboratory and radiology technicians and administrative support staff.

^dGood knowledge: Participants who scored 15 and above in the knowledge section of our questionnaire were categorized as with good knowledge.

^ePositive attitude: Participants who scored 26 and above in the attitude section of our questionnaire were categorized as with a positive attitude.

Table 5. Reasons for influenza vaccination and non-vaccination among all HCWs, physicians, nurses, and others in Chongqing, 2018–2019 influenza season

	Total		Physicians		Nurses		Others*
	n	%	n	%	n	%	n	%
Got influenza vaccination last year	237	100	79	33.34	136	57.38	22	9.28
Reasons for vaccination**
Protecting me from the influenza	221	93.25	73	92.41	129	94.85	19	86.36
Recommended by the government and health authorities	104	43.88	37	46.84	61	44.85	6	27.27
Recommended by relatives or friends	85	35.87	25	31.65	53	38.97	7	31.82
Others	8	3.38	4	5.06	2	1.47	2	9.09
Didn’t get influenza vaccination last year	1175	100	378	32.17	605	51.49	192	16.34
Reasons for non-vaccination**
Have no time to vaccinate	772	65.70	258	68.25	409	67.60	105	54.69
Believe that it is unnecessary to vaccinate	348	29.62	119	31.48	162	26.78	67	34.90
Worry about the quality of the influenza vaccine	323	27.49	115	30.42	161	26.61	47	24.48
Worry about the adverse reactions after vaccination	302	25.70	81	21.43	170	28.10	51	26.65
Believe that the price of influenza vaccine is too high	200	17.02	59	15.61	109	18.02	32	16.67
Allergy contraindications	173	14.72	52	13.76	89	14.71	32	16.67
Believe that influenza vaccination is inconvenient and poor accessible	168	14.30	56	14.81	94	15.54	18	9.38
Believe that the influenza vaccine does not work	138	11.74	46	12.17	75	12.40	17	8.85

* Others: those HCWs without patient contact include laboratory and radiology technicians and administrative support staff.

** These reasons are not mutually exclusive.