The Health Belief Model in predicting healthcare workers' intention for influenza vaccine uptake in Jordan
Introduction
Annual influenza vaccination is recommended for healthcare workers (HCWs) as they are at increased risk of exposure to influenza viruses compared with the general population potentially compromising their health and their patients' safety [1], [2].
Despite the longstanding recommendations, vaccination coverage among HCWs remains heterogeneous and usually suboptimal with rates well below the minimum targets of 90% according to “The CDC's Healthy People 2020” [3], [4].
Studies investigating influenza vaccination uptake by HCWs in relation to their knowledge, attitudes, and barriers to vaccination have found that adequate knowledge is not the only determinant in the decision to get vaccinated against influenza, and many aggressive campaigns and interventions to promote vaccination were marginally successful [5], [6]. Consequently, behavioral psychology and health behavior change theories are being explored in an attempt to understand HCWs’ influenza vaccination behavior and frame strategies aimed at improving vaccine uptake [7].
The theories often used in this field include the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), Risk Perception Attitude (RPA), and the Triandis Model [2], [7]. The HBM, followed by the TPB, is the most commonly employed model [7], [8]. It includes five key constructs influencing health behaviors: perceived susceptibility to the health threat, perceived severity of the health threat, perceived benefits associated with the behavior, perceived barriers associated with the behavior and cues to action [9].
Nonetheless, the HBM’s utility in predicting intention that, in turn, predicts actual behavior is inadequately studied, as the Theory of Planned Behavior (TPB) is typically the model used. The TPB indicates that the key determinant of behavior remains the behavioral intention that is essentially affected by the individuals’ attitude toward performing that behavior [7], [9], [10].
From an HBM’s standpoint, Cheney et al. have illustrated that individuals who did not intend to receive the influenza vaccine had no previous personal experience on which they based their perceptions [11]. Other authors have affirmed this finding concluding that prior vaccination was one of the key determinants of future influenza vaccination despite being not explicitly incorporated in the HBM [12], [13].
The majority of the research studies investigating these theories included a limited number of geographic areas in the west [7]. A recent review in the Eastern Mediterranean Region (EMR) has drawn attention to substantial research gaps and major disparities across EMR countries including data on influenza vaccine use, recommendations and coverage [14]. Of the 48 included studies, 21 addressed the influenza vaccine among HCW and the only included study from Jordan did not examine the influenza vaccine among HCWs [14], [15]. Thereafter, two more research papers have been published in Jordan: one included HCWs as a subcategory [16] and the other was primarily focused on HCWs [6]. Importantly, the Jordanian Ministry of Health, collaborating with the World Health Organization, offers a yearly influenza vaccine for judicious use where it defines priority levels for vaccine distribution and administrations, due to the usually expected shortage of supplies [17].
Up to our knowledge, none of the studies in the EMR countries explored health behavior change theories. Therefore, the purpose of this survey was to adopt a conceptual model based on the HBM’s constructs along with an explicit past vaccination behavior and examine its utility in predicting Jordanian HCWs’ intention for rather than actual influenza vaccine uptake. Of note, the HBM developers have supported combining and individualizing its main constructs instead of a comprehensive bland application [8], [18].
A secondary outcome was to recognize what specific HBM constructs are equivalent to the “attitude” component of the TPB in predicting intention rather than actual vaccine uptake [10].
Section snippets
Study design and sampling techniques
A cross-sectional questionnaire-based study was performed in a tertiary academic hospital in Amman, Jordan during the period March-May 2016. This hospital is considered a major referral center for more than a half million patients from all over the kingdom [6]. It also offers free influenza vaccine for HCWs [6]. A convenience sample of 477 healthcare workers (HCWs) was interviewed by three trained research assistants after obtaining a verbal informed consent. Participants would be eligible to
Characteristics of the sample
Table 1 shows the demographic characteristics of the study cohort in relation to their intention to receive the influenza vaccine. Most of the participants were physicians, married and non-smokers. A statistically significant difference was found between participants intending to vaccinate against influenza in the upcoming influenza season and those who had no intention to avail of the vaccine next year (P < 0.001), yet none of the demographic variables was significantly associated with the
Discussion
This study is the first one in Jordan to shed light on the factors that determine HCWs' intention to receive the influenza vaccine using a psychological theory of behavior change. We found that 32% of our sample of HCWs had received the influenza vaccine in the previous year, and 50% intended to receive it in the upcoming year. Significant differences in health beliefs and behaviors were identified between participants who intended and those who did not intend to receive the influenza vaccine.
Conclusion
The perceived benefit of the influenza vaccine, coupled with a prior history of vaccination, were the most significant predictors of intention for influenza vaccine uptake among HCWs. Emphasizing the tremendous benefits of the vaccine to the HCWs’ themselves, as well as to their patients, is believed to be a cornerstone to encourage HCWs to get vaccinated for the first time; the first step in making influenza vaccination a habit.
Conducting further longitudinal studies to evaluate the
Study strengths and limitations
This is the first research study examining theory-based behaviors in influenza vaccination among HCWs in an EMR country. Further, the HBM’s constructs were tested for validity and reliability and were essentially in accordance with findings from previous studies. Also, the presence of chronic diseases was included as a confounding variable to ascertain for a principal reason, rather than the occupation, for influenza vaccine uptake. It is believed that recruiting HCWs from different hospital
Ethical considerations
The study was funded by the Deanship of Scientific Research and approved by the IRB committee at the University of Jordan and Jordan University Hospital (reference No. 4/2015).
CRediT authorship contribution statements
Lana Alhalaseh: Conceptualization, Methodology, Formal analysis, Data curation, Writing - original draft, Writing - review & editing, Supervision, Project administration, Funding acquisition. Hanan Fayoumi: Conceptualization, Investigation, Writing - original draft. Bayan Khalil: Conceptualization, Investigation, Writing - original draft.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References (36)
- et al.
Using behavior change frameworks to improve healthcare worker influenza vaccination rates: A systematic review
Vaccine.
(2016) - et al.
Sociocognitive predictors of the intention of healthcare workers to receive the influenza vaccine in Belgian, Dutch and German hospital settings
J Hosp Infect
(2015) - et al.
Predictors of influenza vaccine acceptance among healthy adults
Prev Med
(1999) - et al.
Effectiveness of seasonal influenza vaccination in healthcare workers: a systematic review
J Hosp Infect
(2011) - et al.
Attitudes of healthcare workers to influenza vaccination
Infect Dis Health.
(2018) - et al.
Pandemic influenza A/H1N1 vaccination uptake among health care workers in Qatar: motivators and barriers
Vaccine.
(2011) - et al.
Nurses’ knowledge and risk perception towards seasonal influenza and vaccination and their vaccination behaviours: a cross-sectional survey
Int J Nurs Stud
(2011) - et al.
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
MMWR Recomm Rep.
(2018) - et al.
Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature
Hum Vaccin Immunother.
(2018) - National Vaccine Advisory Committee. Strategies to Achieve the Healthy People 2020 Annual Influenza Vaccine Coverage...
The Effectiveness of Vaccine Day and Educational Interventions on Influenza Vaccine Coverage Among Health Care Workers at Long-Term Care Facilities
Am J Public Health
Influenza vaccine: Immunization rates, knowledge and attitudes of healthcare workers in Jordan
Kuwait Medical Journal.
Health behavior and Health Education : Theory, Research, and Practice
Determinants of Influenza Vaccination among Healthcare Workers
Infect Control Hosp Epidemiol
Underutilization of Influenza Vaccine: A Test of the Health Belief Model
SAGE Open.
Cited by (41)
Why should I vaccinate? The role of mindfulness and health-protective behaviours during the COVID-19 pandemic
2023, Health Policy and TechnologyPandemic prevention via tourism: A conceptual framework
2022, Annals of Tourism ResearchPrevalence and factors of influenza vaccination during the COVID-19 pandemic among university students in China
2022, VaccineCitation Excerpt :Perceived severity and perceived susceptibility of COVID-19 are among the strongest drives for COVID-19 vaccination [33,44]. In IV research, perceived severity and susceptibility regarding influenza were also frequently investigated [45–47]. We included perceived chance of having future outbreak in China as COVID-19 was quite well controlled in China.
A multi-method analytical approach to predicting young adults’ intention to invest in mHealth during the COVID-19 pandemic
2022, Telematics and InformaticsCitation Excerpt :This study incorporates the HBM (Alhalaseh et al., 2020; Rosenstock et al., 1988) and the Expectation Confirmation Model (ECM) (Chiu et al., 2020; Oliver, 1980) to provide a holistic interpretation of young adults' intention to use mHealth services from a behavioural aspect. Prior studies have used the HBM as a theoretical basis for understanding individuals' intentions to use different mHealth applications (Alhalaseh et al., 2020; Puspita et al., 2017), while the ECM has been used to examine the factors that affect individuals' devotion to using mHealth apps (Chiu et al., 2020; Tam et al., 2020). Moreover, most prior studies have employed a single model with a limited number of factors, resulting in a relatively lower capability for explaining users' intentions from a particular viewpoint.
The antecedents of intention to use immunization information systems and usage behavior
2022, Informatics in Medicine UnlockedA predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model
2021, Geriatric NursingCitation Excerpt :The definition of poor health belief in this study was that the patients had poor health perception and attitudes toward hypertensive medication. Health belief is an essential predictor of health behaviors.46,47 It is a significant factor of low medication adherence in diabetes mellitus,48 acquired immunodeficiency syndrome,49 and asthma.50