Determinants of influenza vaccination among young Taiwanese children

A context-sensitive collectivism during the COVID-19 pandemic: Effect on the adoption of containment measures in China and the US

This study investigates individuals' adoption of containment measures (e.g., wearing masks) from the perspectives of cultural values and trust in two countries-China and the US. Distinguished from previous definitions that characterise cultural values as rigid and fixed concepts, this study reconceptualizes collectivism to be a context-sensitive construct. With survey data from a collectivism-prevalent culture (China, n = 1578) and an individualism-prevalent culture (the US, n = 1510), it unfolds the underlying mechanism by which collectivism influences people's adoption of containment measures in both countries. Results indicate that institutional trust serves as a significant mediator in this relationship. In both countries, individuals who hold a collectivistic value on the pandemic are more likely to endorse the adoption of containment measures. This endorsement is driven by their trust in public institutions, which stems from their collectivistic values. Additionally, slight distinctions emerge, revealing that collectivistic values directly predict the behaviours among Chinese individuals, whereas such a direct effect is not observed in the US. Practical implications will be offered.

Credibility Perceptions of Information and Vaccine Intention: The Role of Collective Vs. Individual Framing Messages

After four years into the pandemic, we know that COVID-19 vaccines are effective, and it is crucial to increase public compliance with getting the COVID-19 vaccines. The current study examines the interplay of credibility perceptions, perceived benefits, and two different types of vaccine promotion messages: individual versus collective. Data was collected using an online randomized experiment. Findings demonstrated that individual versus collective frames did not influence everyone similarly. The results show a significantly moderated mediation model, such that the association between message frame and vaccine intention was mediated by the credibility of the message, and the relationship between message frame and perceived credibility was moderated by perceived benefits of the vaccine.

Predictors of Intention to Vaccinate or Continue to Vaccinate Children Against SARS-CoV-2 During the Fifth Wave of the COVID-19 Pandemic in the USA

The Centre for Disease Control recommends vaccination of children against SARS-CoV-2 to reduce the severity of COVID-19 disease and reduce the likelihood of associated complications. Vaccination of children requires the consent of parents or guardians, and levels of consent may ebb and flow over the course of the pandemic. This exploratory study examines predictors of parental intentions to vaccinate their children and the speed with which they would have them vaccinated during the fifth wave of the pandemic when vaccines were just being approved for use in children using a convenience sample of 641 parents reporting on 962 children. Multi-level regression analyses demonstrated regional differences in likelihood, with those in the Northeast reporting higher likelihood than those in the West. Parents with a conservative belief system were less likely to want to have their children vaccinated. Parents were more likely to have their child vaccinated if the child had COVID-19-related health risks, their child had a more complete vaccination history, and COVID-19 was perceived to be a greater threat to oneself and one's family. Faster intended vaccination speed was associated with regional urbanicity, liberal belief systems, more complete vaccination histories, and parental COVID-19 vaccination history. Higher levels of parental anxiety and lower levels of perceived vaccine danger were associated with increased speed. The severity of the COVID-19 pandemic within one's county was marginally related to speed, but not likelihood. These results underscore the importance of regular assessment of parental intentions across the pandemic, for practitioners to probe parental anxiety levels when discussing vaccination, to explicitly address risk/benefit analyses when communicating with parents, and to target previously routine unvaccinated parents and those in more rural areas to increase vaccine uptake. Comparisons are made with Galanis et al.'s (2022) recent meta-analysis on the topic.

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6-59 Months: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis summarises the literature on parental acceptance, parental hesitancy, uptake, and the associated factors of seasonal influenza vaccination (SIV) among children aged 6-59 months. Studies were sourced from the following platforms: PubMed, Web of Science, MEDLINE, and EMBASE databases. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of parental acceptance, parental hesitancy, and SIV uptake in the last flu season and lifetime among children. A total of 36 studies were included for analysis. The overall prevalence was 64% for parental acceptance (95% CI: 51-75%), 34% for parental hesitancy (95% CI: 22-48%), 41% for SIV uptake in the last flu season (95% CI: 33-50%), and 46% for SIV uptake in a lifetime (95% CI: 20-74%). Associated factors of parental acceptance/hesitancy and uptake included the age of the children or parents, parental education level, household income level, ethnicity, and other modifiable factors, including perceived benefits, perceived barriers, perceived severity, perceived susceptibility, and cues to action related to SIV. Meta-regression analyses revealed regional differences in parental acceptance (Americas: 79% vs. Asia: 60%). The results provided implications informing us of the development of intervention programs targeting parents to improve SIV coverage among young children.

Knowledge, Attitude, and Practice of Vaccination Among Parents in Jeddah City, Saudi Arabia

Background Vaccine misconception plays an important role in delaying vaccination for children, which can lead to serious health problems. Assessing the knowledge, attitude, and practice (KAP) and potential associated factors among Saudi parents of preschool and school-age children and adolescents for all types of vaccines would help increase vaccine coverage. Methodology This cross-sectional, questionnaire-based survey was performed among parents in Jeddah, Saudi Arabia. The study enrolled all Saudi parents visiting primary healthcare centers (PHC) in Jeddah with their children aged 3-18 years old. A self-administered questionnaire in Arabic was used to assess KAP. Descriptive statistics were performed, and the chi-square test was used to assess the association between KAP and sociodemographic factors with significance set at p-values <0.05. Results Out of 301 participants, 68.1% were mothers, and 55.8% of children were female. The largest percentage (81.7%) of the parents were aged between 31 and 50 years old. Although 94.4% of the parents agreed or strongly agreed that childhood vaccines protect their children from serious diseases, 26.6% of parents agreed or strongly agreed that vaccines can potentially cause autism, and 18.6% believed they could lead to learning difficulties. Most parents (67.4%) were in favor of vaccination, while others were hesitant about vaccinating their children and believed in alternative methods of disease prevention. About one-third knew other parents who did not vaccinate their children for religious, ideological, or cultural reasons. Sociodemographic factors such as gender (p = 0.042), educational level (p = 0.017), nationality (p = 0.001), and first child (p = 0.013) had some influence on parents' beliefs and knowledge about vaccination, while the number of children (child order) (p = 0.022) and parents' education level were associated with hesitancy (p = 0.028). Conclusions These findings show that most parents had good KAP toward vaccination, influenced by sociodemographic factors. However, there is a need to address vaccination hesitancy by acting on identified contributing factors.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study

Background

Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR).

Methods

A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH.

Results

Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p &lt; 0.001), high-income countries residents (50.6%, p &lt; 0.001), and mothers with higher educational levels (52.1%, p &lt; 0.001). Parents of school-aged children (5–9 years) (55.6%, p &lt; 0.001), children free from any comorbidities (52.5%, p &lt; 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p &lt; 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p &lt; 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p &lt; 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p &lt; 0.001). The SEM suggested that mother’s age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH.

Conclusion

A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

Go for zero tolerance: Cultural values, trust, and acceptance of zero-COVID policy in two Chinese societies

This study seeks to explain the wide acceptance of the stringent zero-COVID policy in two Chinese societies—Mainland China (n = 2,184) and Taiwan (n = 1,128)—from perspectives of cultural values and trust. By employing the efficacy mechanism, this study identifies significant indirect effects of trust in government and key opinion leaders (KOL) on people’s policy acceptance in both societies. Namely, people who interpret the pandemic as a collectivist issue and who trust in government will be more accepting of the zero-COVID policy, whereas those who framed the pandemic as an individual issue tend to refuse the policy. Trust in government and KOLs foster these direct relationships, but trust in government functions as a more important mediator in both societies. The different contexts of the two Chinese societies make the difference when shaping these relationships. These findings provide practical considerations for governmental agencies and public institutions that promote the acceptance of the zero-COVID policy during the pandemic.

Factors associated with caregivers' hesitancy to vaccinate children against influenza: A cross-sectional survey in China

BACKGROUND

Seasonal influenza can cause serious harm to children under five years of age, while caregivers are still hesitant to vaccinate children against influenza. This study aimed to investigate caregivers' hesitancy regarding influenza vaccination and assess the associated factors.

METHODS

From August to October 2019, a cross-sectional survey was conducted in ten provinces in China. The questionnaire collected information about sociodemographic characteristics and caregivers' knowledge, perceptions and attitudes toward influenza vaccination. Caregivers were identified as not hesitating, hesitating or refusing to vaccinate children. Multinomial logistic regression was adopted to determine factors related to vaccine hesitancy based on the 3C model with three dimensions namely complacency, convenience and confidence.

RESULTS

A total of 6668 valid questionnaires were collected, among which 38.57% did not hesitate to vaccinate children against influenza, 56.03% were hesitant, and 5.40% refused. Multinomial logistic regression showed that caregivers perceiving high importance (AOR = 0.68 for hesitancy; 0.15 for refusal), safety (AOR = 0.42; 0.46) or efficacy (AOR = 0.73; 0.65) of influenza vaccination, knowing children as a priority group (AOR = 0.80; 0.48), and trusting vaccination advice from medical staff (AOR = 0.65; 0.51) had lower odds of hesitancy or refusal. Those considering price as a hindering factor had higher odds of hesitancy (AOR = 1.66) or refusal (AOR = 1.47), and those viewing time or distance as a hindering factor (AOR = 1.45) or having heard of vaccine-related negative information (AOR = 1.78) had higher odds of hesitancy. Sociodemographic characteristics were associated with vaccine hesitancy or refusal, and the associations varied for hesitators and refusers.

CONCLUSION

A large proportion of caregivers in China reported their hesitancy for influenza vaccination, and the associated factors of such hesitancy were complicated. Health professionals are recommended to spread relevant scientific knowledge and give vaccine-related suggestions to caregivers in doctor visits to promote caregivers' trust in influenza vaccination and therefore expand childhood vaccine coverage.

COVID-19 Vaccine Acceptance and Associated Factors among Unvaccinated Workers at a Tertiary Hospital in Southern Thailand

Background

Hospital workers are at high risk of COVID-19 infection which is now vaccine-preventable. However, vaccine refusals also occur among hospital workers, but the associated factors have not been described.

Objectives

To describe: (1) the level of COVID-19 vaccine acceptance, and; (2) the extent that history of pre-pandemic vaccine hesitancy and health beliefs regarding COVID-19 were associated with COVID-19 vaccine acceptance among workers at a tertiary hospital in southern Thailand.

Methods

We conducted a cross-sectional study using a paper-based self-administered questionnaire at a tertiary hospital in south Thailand in April 2021 and used multivariable logistic regression to identify psychological-behavioral factors associated with vaccine acceptance.

Results

Of 359 workers invited to participate, 226 participants returned the questionnaires, 67% of whom reported willingness to accept the vaccine. Vaccine acceptance was associated with perceived severity of disease (Adjusted OR = 2.07, 95% CI = 1.04, 4.10), perceived harm from non-vaccination (Adjusted OR = 2.51, 95% CI = 1.27, 4.96), and lower expectation of vaccine efficacy (Adjusted OR = 3.80, 95% CI = 1.87, 7.71).

Conclusion

Most workers in this study were willing to accept the COVID-19 vaccine, and such acceptance was associated with components of the health belief model. However, the cross-sectional study design did not allow causal inference, and study data were all self-reported with no probing of the responses. These limitations should be considered as caveats in the interpretation of the study findings.

Knowledge, attitude and practice of influenza vaccination among Lebanese parents: A cross-sectional survey from a developing country

Background

A growing number of parents refuse vaccination due to concerns about side effects. Influenza vaccine is no exception and remains one of the most controversial vaccines. Data regarding influenza vaccine uptake and parental knowledge, attitude and practice towards vaccination in the Lebanese population is lacking. The aim of this study was to assess the rate of vaccination refusal and potential associated factors among Lebanese parents of school-aged children, in general and with a focus on influenza vaccine.

Methods

A parent questionnaire was distributed in randomly selected 2 public and 2 private schools from the greater Beirut area during the school year 2017–2018. Questionnaires covered knowledge, attitude (including themes of efficacy, hesitancy and trust), and practice of vaccination in general and influenza vaccine in particular.

Results

The response rate was 76.5% (306/400). Overall, 29.4% parents reported vaccinating their children against influenza (62.2% in private and 37.7% in public schools). Younger age, paternal employment and higher household income were associated with higher vaccination rates (p = 0.01, 0.02 and <0.0001 respectively). Lack of vaccine recommendation by the physician was the most common reason for not taking it (47%). Parents who accepted influenza vaccination had higher scores in efficacy, hesitancy and trust and were more compliant with other vaccinations.

Conclusion

One third of parents of school aged children in the greater Beirut area vaccinate their children against influenza. This rate is likely lower in rural remote areas. Physician’s recommendation is the single most important predictor of such vaccination. Future studies tackling physicians’ attitude and practice are needed to help improve influenza vaccination rates in the Lebanese population.

COVID-19 Vaccination Attitudes and Intention: Message Framing and the Moderating Role of Perceived Vaccine Benefits

The United States is one of the hardest-hit countries by the COVID-19 pandemic and yet there is widespread hesitancy to take the vaccine. In order to address vaccine hesitancy and foster public understanding of the COVID-19 vaccine, it is necessary to strategize public health messages based on evidence. To this end, we use experimental data to examine the effects of four message frames on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. The primary purposes of this paper are to examine the 1) impact of loss vs. gain frames and individual vs. collective frames and 2) role of perceived benefits on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. Our findings show that participants with higher perceived benefits and exposed to the loss frame showed higher positive attitudes toward the COVID-19 vaccine and greater intention to vaccinate. Similar patterns were revealed in case of the individual frame message. Implications are discussed.

Demographic, psychological, and experiential correlates of SARS-CoV-2 vaccination intentions in a sample of Canadian families

The COVID-19 pandemic has been ongoing for close to a year, with second waves occurring presently and many viewing vaccine uptake as the most likely way to curb successive waves and promote herd immunity. Reaching herd immunity status likely necessitates that children, as well as their parents, receive a vaccine targeting SARS-CoV-2. In this exploratory study, we investigated the demographic, experiential, and psychological factors associated with the anticipated likelihood and speed of having children receive a SARS-CoV-2 vaccine in a sample of 455 Canadian families (858 children; parents' mean age = 38.2 ± 6.82 years). Using linear mixed-effects and proportional odds logistic regression models, we demonstrated that older parental age, living in the Prairies (relative to Central Canada), more complete child vaccination history, and a greater tendency to prioritise the risks of the disease relative to the risks of side effects (i.e. lower omission bias) were associated with higher likelihoods of intention to vaccinate participants' children, with trend-level associations with lower perceived danger of the vaccine and higher psychological avoidance of the pandemic. Faster speed of intended vaccination was predicted by a similar constellation of variables with an additional predictor of a child in the family having a COVID-19 related health risk being associated with slower intended speed. Results are discussed concerning public health knowledge mobilisation and the unique Canadian health landscape.

Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study

Background

Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years.

Methods

Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers’ and children’s demographic characteristics, and caregivers’ knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children’s influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children’s parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children’s influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model.

Results

During August 2018-February 2019, 700 children’s caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3–6.0), parents’ strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5–5.9), using health insurance provided by the government or parent’s employer for children’s doctor visits (aOR, 2.6; 95% CI, 1.1–6.6), and the children’s history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4–7.8).

Conclusion

The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children’s history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season.

Portuguese parental beliefs and attitudes towards vaccination

Introduction

Portugal has one of the highest vaccine coverage rates among European countries, associated with excellent vaccine convenience and confidence levels. Considering both the high rate of pediatric vaccination in Portugal and the excellent indicators of vaccine convenience established, an analysis of confidence and complacency indicators could help understand this positive example. This study aimed to characterize parental beliefs according to the intention to vaccinate a next child and identify cognitive and demographic predictors of that intention in a Portuguese sample.

Methods

We measured perceptions of vaccines’ safety and efficacy, perceptions of the severity of vaccine-preventable diseases, beliefs related to conspiracy theories, attitudes towards immunization requirements, perceptions of social norms as predictors of the intention to vaccinate a subsequent child. We also inquired if parents had previously refused a recommended vaccine. The authors disseminated the questionnaire online to reach a diverse population of parents of 0–12 years old children. The final sample included 1,118 parents, 96.9% reported their intention to vaccinate the next child, and 3.6% had previously refused a vaccine. Two additional open-ended questions regarding motives to vaccinate or refuse a future baby's vaccination were answered by 886 parents.

Results

All the evaluated parental cognitive dimensions were significantly different between the group of parents who would vaccinate a next child and those who expressed the intention not to vaccinate. Beliefs about the safety and efficacy of vaccines and having fewer children were significant predictors of that intention.

Conclusion

The vast majority of parents reported attitudes and beliefs favorable to pediatric vaccination with high consistency in all cognitive dimensions assessed. Concerns regarding pediatric vaccines’ safety need to be sensitively and actively addressed by health providers to maintain excellent vaccination coverage rates.

Associated Factors of Behavioral Intention Regarding Childhood Influenza Vaccination Among Parents of Ever-Vaccinated and Never-Vaccinated 24- to 59-Month-Old Children in Hong Kong

The World Health Organization recommends young children receive influenza vaccination (IV) annually. Stratified by children's previous IV status, this study investigated the associated factors of parental intention to let their children aged 24 to 59 months receive IV in the next 12 months in Hong Kong, China. We conducted a cross-sectional population-based telephone survey among 540 Chinese parents of children aged 24 to 59 months. The prevalence of parental intention regarding their child's IV was 68.9% and 19.8%, respectively, in the ever-vaccinated and never-vaccinated groups. Adjusted for background factors, perceived susceptibility (adjusted odds ratio [ORa] = 3.20, 95% confidence interval [CI] = 1.07-9.54), perceived benefit (ORa = 4.77, 95% CI = 2.52-9.05), perceived barrier (ORa = 0.38, 95% CI = 0.17-0.84), cue to action (ORa = 3.57, 95% CI = 1.88-6.78), subjective norm (ORa = 11.23, 95% CI = 6.17-20.46), and having family members vaccinated (ORa = 1.79, 95% CI = 1.09-2.96) were associated with parental intention for ever-vaccinated children's IV, while only perceived benefit (ORa = 8.85, 95% CI = 3.36-23.34) and subjective norm (ORa = 21.66, 95% CI = 9.25-50.71) were significant for never-vaccinated children. Our findings showed that the identified factors and applicability of the health belief model varied according to child's vaccination status. Health promotion should consider segmentation principles. Besides modifying related cognitions like perceived benefit and barrier (only for the ever-vaccinated group), such programs should improve cue to action involving health professionals and family members and create supportive subjective norms.

Resources for assessing parents' vaccine hesitancy: a systematic review of the literature

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.

A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination

Background

Acceptance of vaccines is an important predictor of vaccine uptake. This has public health implications as those who are not vaccinated are at a higher risk of infection from vaccine preventable diseases. We aimed to examine how parental attitudes and beliefs towards childhood vaccination were measured in questionnaires through a systematic review of the literature.

Methods

We systematically reviewed the literature to identify primary research studies using tools to measure vaccine attitudes and beliefs, published between January 2012 and May 2018. Studies were included if they involved a quantitative survey of the attitudes and beliefs of parents about vaccinations recommended for children. We undertook a synthesis of the results with a focus on evaluating the tools used to measure hesitancy.

Results

A total of 116 studies met the inclusion criteria, 99 used a cross sectional study design, 5 used a case control study design, 4 used a pre-post study design and 8 used mixed methods study designs. Sample sizes of included studies ranged from 49 to 12,259. The most commonly used tool was the Parent Attitudes about Childhood Vaccines (PACV) Survey (n = 7). The most common theoretical framework used was the Health Belief Model (n = 25). Questions eliciting vaccination attitudes and beliefs varied widely.

Conclusions

There was heterogeneity in the types of questionnaires used in studies investigating attitudes and beliefs about vaccination in parents. Methods to measure parental attitudes and beliefs about vaccination could be improved with validated and standardised yet flexible instruments. The use of a standard set of questions should be encouraged in this area of study.

Factors associated with pneumococcal vaccination uptake by cancer survivors

PURPOSE

This study aimed to evaluate factors associated with pneumococcal vaccination uptake (PVU) of cancer survivors.

METHODS

A total of 2032 Korean adult cancer survivors diagnosed between June of 1975 and February of 2018 have participated. Information on PVU status and selected variables were collected through self-administered questionnaires and medical record review. Factors associated PVU were investigated using multiple logistic regression analysis.

RESULTS

PVU rate markedly differed by age strata and cancer sites: 73.9% for elderly (≥ 65 years) survivors and 34.6% for younger (< 65 years) survivors and 73.4% for lung cancer survivors and 42.1% for non-lung cancer survivors. Regular physical exercise was associated with higher PVU in both age groups: Odds ratio (OR) and 95% confidence interval (CI) were 1.52 (1.20, 1.94) for younger and 1.78 (1.09, 2.90) for elderly survivors. Complementary medication use was positively associated with PVU with borderline significance in both age groups. However, the association of PVU with other factors differed between the two age groups. In younger survivors, a positive association with PVU was evident for longer time lapse after cancer diagnosis, chronic disease, and living with spouse/or partner, while cancer stage, educational achievement, and alcohol use were inversely associated PVU. On the other hand, multi-modality (≥ 3) cancer treatment was inversely associated with PVU only in elderly survivors.

CONCLUSIONS

PVU of Korean cancer survivors was suboptimal in younger survivors and non-lung cancer survivors. Factors associated with PVU differed between younger and elderly survivors, and more diverse factors were identified for younger survivors.

IMPLICATIONS FOR CANCER SURVIVORS

In order to promote adherence to PVU in cancer survivors, careful consideration of high-risk factors for non-immunization within cancer survivorship context would be necessary together with free-of-charge vaccination policy.

A longitudinal study using parental cognitions based on the theory of planned behavior to predict childhood influenza vaccination

BACKGROUND

The World Health Organization recommends young children aged 6-59 months receive influenza vaccination (IV) annually. This study investigated the IV incidence in a 12-month follow-up period among 24-59 month-old children and identified its predictors based on the theory of planned behavior (TPB).

METHODS

A population-based random telephone survey was conducted at baseline (March-June 2011) among Chinese parents of 24-59 month-old children in Hong Kong, China, and a follow-up survey was conducted 12 months afterwards (N=440).

RESULTS

The IV prevalence was 63.2% at follow-up (3% increased from baseline). The IV incidence during the follow-up period for all sampled, ever-vaccinated, and never-vaccinated children was 35.6, 58.5, and 7.7 per 100 person-years, respectively. Stratified analyses of logistic regression were performed for the ever-vaccinated and never-vaccinated children. After adjusting for significant socio-demographic variable(s), parental positive attitude, norm, and behavioral intention were significant predictors of IV at follow-up among ever-vaccinated children, while intention was the only significant predictor among never-vaccinated children.

CONCLUSIONS

Most of the IVs received during the follow-up period were re-vaccinations rather than first-time vaccinations. Efforts should target never-vaccinated children's parents, who reported low incidence and intention. TPB also worked less well among never-vaccinated children, and thus research for other predictors of never-vaccinated children's first-time vaccination are warranted. Promotion programs should consider segmentation by children's prior vaccination status.

Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017-2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy - the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) - and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.

Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China

Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents' acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents' intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between "cues to action" and "perceived susceptibility" and/or "perceived severity." A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents' intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents' perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.

Influenza vaccine coverage and predictive factors associated with influenza vaccine uptake among pediatric patients

BACKGROUND

Despite recommendations from health care authorities, reports of severe influenza occur yearly among unvaccinated infants and children.

OBJECTIVES

This study investigated influenza vaccine coverage and predictive factors for vaccination status among pediatric patients during the 2016-2017 winter influenza season.

METHODS

A cross-sectional survey was conducted among parents of our study population identified through a major pediatric outpatient clinic in Hong Kong. Parents with a child aged 6 months to 17 years were invited to complete a questionnaire that assessed the current influenza vaccine status of the child and the parents' understanding and beliefs regarding influenza and its vaccine. A backward logistic regression was conducted to determine predictive factors and adjusted odds ratios associated with influenza vaccine uptake.

RESULTS

Our study included 348 parents and 405 pediatric patients. Of these, 142 pediatric patients (35.1%) received full vaccination. Predictive factors associated with the child's positive influenza vaccine status include a "very good" parental understanding of influenza and its vaccine (adjusted odds ratio, 6.7; 95% confidence interval,  2.1-21.5), a child with chronic medical condition and a "high" cue to action (adjusted odds ratio, 5.7; 95% confidence interval, 2.8-11.6), and a "high" perceived susceptibility toward influenza (adjusted odds ratio, 4.8; 95% confidence interval, 2.1-10.8).

CONCLUSIONS

This study reflects the low influenza vaccine coverage among pediatric patients. Interventions focusing on parental knowledge and understanding of influenza and its vaccine may improve future vaccine uptake among the pediatric population.

How can the health belief model and self-determination theory predict both influenza vaccination and vaccination intention ? A longitudinal study among university students

Background and objective Seasonal influenza is frequent among students and often responsible for impaired academic performance and lower levels of general health. However, the vaccination rate in this population is very low. As the seasonal influenza vaccine is not compulsory in France, it is important to improve the vaccination uptake by identifying predictors of both intention and behaviour. This study investigated the effect of decisional balance, motivation and self-efficacy on vaccination acceptance using the Extended Health Belief Model (HBM) and Self-Determination Theory (SDT). Design and Main Outcome Measures University students were invited to fill in an online survey to answer questions about their influenza vaccination intention, and HBM and SDT constructs. A one-year longitudinal follow-up study investigated vaccination behaviour. Results Autonomous motivation and self-efficacy significantly influenced the intention to have the influenza vaccine, and vaccine behaviour at one-year follow-up. Intention predicted a significant proportion of variation (51%) in behaviour, and mediated the effect of these predictors on vaccination behaviour. Conclusion These results suggest that motivation concepts of the Self-Determination Theory can be adequately combined with the Health Belief Model to understand vaccination behaviour.

Economic benefits of sharing and redistributing influenza vaccines when shortages occurred

Background

Recurrent influenza outbreak has been a concern for government health institutions in Taiwan. Over 10% of the population is infected by influenza viruses every year, and the infection has caused losses to both health and the economy. Approximately three million free vaccine doses are ordered and administered to high-risk populations at the beginning of flu season to control the disease. The government recommends sharing and redistributing vaccine inventories when shortages occur. While this policy intends to increase inventory flexibility, and has been proven as widely valuable, its impact on vaccine availability has not been previously reported.

Material and methods

This study developed an inventory model adapted to vaccination protocols to evaluate government recommended polices under different levels of vaccine production. Demands were uncertain and stratified by ages and locations according to the demographic data in Taiwan.

Results

When vaccine supply is sufficient, sharing pediatric vaccine reduced vaccine unavailability by 43% and overstock by 54%, and sharing adult vaccine reduced vaccine unavailability by 9% and overstock by 15%. Redistributing vaccines obtained greater gains for both pediatrics and adults (by 75%). When the vaccine supply is in short, only sharing pediatric vaccine yielded a 48% reduction of unused inventory, while other polices do not improve performances.

Conclusions

When implementing vaccination activities for seasonal influenza intervention, it is important to consider mismatches of demand and vaccine inventory. Our model confirmed that sharing and redistributing vaccines can substantially increase availability and reduce unused vaccines.

An integrative review on parents' perceptions of their children's vaccinations

An integrative literature review was conducted for studies published between January 2005 and January 2016 to obtain evidence on parents' experiences and perceptions of vaccinations. Considering the mandatory nature of vaccinations in many countries and the influences of parental experiences on the outcome of vaccinations, it is essential to understand the experiences and needs of parents regarding their children's vaccinations. CINAHL, PsycINFO, PubMed, Scopus and ScienceDirect were searched for data. In this review, 20 studies (10 quantitative and 10 qualitative) that related to parental perceptions regarding their child's vaccination were included. The parents had varied views on vaccination and they had many vaccination-related concerns and difficulties. Different factors influenced their vaccination decisions and they had varied support needs. This review found that exploring parental perceptions regarding their child's vaccination in terms of the attitudes and experiences of parents, how these affect vaccination decisions as well as the needs of parents regarding their children's vaccinations is important in multicultural societies.

Factors Determining the Uptake of Influenza Vaccination Among Children With Chronic Conditions

BACKGROUND

Studies report that the influenza vaccination uptake rate among children with chronic conditions is alarmingly low. In Hong Kong, there has been no study examining parental decision making about influenza vaccination for children with chronic conditions, thereby limiting the knowledge base to inform the development of specific strategies to improve influenza vaccination rates. The aim of this study was to identify factors determining the uptake of influenza vaccination among children with chronic conditions.

METHODS

We conducted a cross-sectional survey of 623 parents with children having a chronic condition recruited from pediatric wards and specialty outpatient departments of 2 acute hospitals. A questionnaire developed by Daley et al based on the Health Belief Model was used to examine parents' beliefs and attitudes toward influenza and vaccination.

RESULTS

The parents' and their children's mean age were 40.1 ± 8.1 and 8.0 ± 4.5 years, respectively. Among the children, the most prevalent chronic conditions were asthma, chronic respiratory disease and cardiomyopathy. One-third (33%) of the children had influenza vaccination in the past 12 months. More than one-third (39%) of parents intended to vaccinate their children against influenza in the coming influenza season. A multivariable logistic regression analysis revealed that all subscale scores except perceived severity and knowledge about influenza were independently significantly associated with uptake.

CONCLUSIONS

The findings indicate that parents of children with chronic conditions lack awareness of the risks of influenza and have insufficient understanding about the benefits of vaccination. These findings could inform the development of interventions to promote vaccination uptake among children with chronic conditions.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Influenza vaccination uptake and associated factors among elderly population in Hong Kong: the application of the Health Belief Model

The impact of influenza on elderly can be severe and fatal. Influenza vaccination (IV) has been shown to be effective in reducing influenza-related complications, but the IV uptake among elderly in Hong Kong remains low. This study investigated the prevalence and factors associated with IV among Chinese elderly in Hong Kong using the Health Belief Model (HBM). A total of 1101 Chinese elderly aged over 65 was randomly selected and completed a phone interview. Background information, experience of and intention to receive IV and IV-related knowledge and perceptions based on the HBM were measured. Results showed that 48.5 and 49.5% of the participants have ever been vaccinated and intended to receive IV, respectively. Female gender, having chronic disease, and participating in community activities were significantly associated with previous IV. Knowledge of the fact that IV is required every year, lower perceived side effect, IV price lower than HK$150, and recommendations from health care providers was associated with both previous IV and intention to be vaccinated in the next year. Interventions promoting IV among elderly should disseminate knowledge regarding the necessity of IV and correct misconceptions about the side effects of IV.