Luz Paula M, Johnson Riley E, Brown Heidi E
Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, University of Arizona, Tucson, AZ, United States.
Vaccine. 2017 Oct 13;35(43):5890-5896. doi: 10.1016/j.vaccine.2017.08.078. Epub 2017 Sep 8.
Seasonal influenza, though mostly self-limited in the healthy adult, may lead to severe disease and/or complications in subpopulations. Annual influenza vaccination is available in many countries with coverage goals rarely being met. We conducted a cross-sectional study of influenza vaccine uptake and explored socio-demographic, economic, and psychological factors that explained vaccine uptake.
The survey was administered via Amazon Mechanical Turk (MTurk) to United States residents in January 2017, using the Qualtrics platform. Using principal axis factor analysis, we reduced the 25 items theory-based psychological determinants into the primary constructs they measure if/when internal consistency was sufficient (Cronbach's alpha >0.60). Logistic regression models were used to quantify the association of socio-demographic, economic, and psychological factors with reported vaccine behavior in the 2016-17 flu season.
1007 participants completed the survey, sex distribution was even, 67% had 25-44years of age, and 61% annual household income of $30-99 thousand United States dollars. About 25% had the flu shot offered at their workplace and 20% reported belonging to a group for whom the flu shot is recommended. Vaccine uptake was 31.5%. Eight predictors remained in the final adjusted model (R=0.489), having the vaccine offered at the workplace, belonging to a group for whom the vaccine is recommended, and higher perceived barriers were the strongest predictors of vaccine uptake, increasing (and decreasing in the case of barriers) the odds by >3-fold. Additionally, higher household income, higher perceived susceptibility and higher perceived benefits also independently predicted vaccine uptake.
We found evidence that perceived barriers significantly impaired vaccine uptake to the same extent that having the vaccine offered at the workplace or belonging to a group for whom the vaccine is recommended facilitated uptake. Ideally, a better understanding of drivers of vaccine hesitancy will result in improved interventions to increase vaccine uptake.
季节性流感虽然在健康成年人中大多为自限性疾病，但在某些亚人群中可能导致严重疾病和/或并发症。许多国家都提供年度流感疫苗接种，但覆盖率目标很少能实现。我们开展了一项关于流感疫苗接种情况的横断面研究，并探讨了解释疫苗接种情况的社会人口学、经济和心理因素。
2017年1月，通过亚马逊土耳其机器人（MTurk）使用Qualtrics平台对美国居民进行了调查。我们运用主轴因子分析方法，在内部一致性足够（Cronbach's α>0.60）的情况下，将基于理论的25项心理决定因素简化为它们所测量的主要结构。使用逻辑回归模型量化2016 - 17流感季节社会人口学、经济和心理因素与报告的疫苗接种行为之间的关联。
1007名参与者完成了调查，性别分布均匀，67%的人年龄在25 - 44岁之间，61%的家庭年收入为3万至9.9万美元。约25%的人在工作场所接种了流感疫苗，20%的人报告属于被推荐接种流感疫苗的群体。疫苗接种率为31.5%。最终调整模型中有8个预测因素（R = 0.489），在工作场所接种疫苗、属于被推荐接种疫苗的群体以及较高的感知障碍是疫苗接种最强的预测因素，使接种几率增加（对于障碍因素则降低）超过3倍。此外，较高的家庭收入、较高的感知易感性和较高的感知益处也独立预测了疫苗接种情况。
我们发现有证据表明，感知障碍对疫苗接种的显著阻碍程度与在工作场所接种疫苗或属于被推荐接种疫苗的群体对疫苗接种的促进程度相同。理想情况下，更好地了解疫苗犹豫的驱动因素将有助于改进干预措施，以提高疫苗接种率。
