Access the full text.
Sign up today, get DeepDyve free for 14 days.
Loading next page...
/lp/hindawi-publishing-corporation/knowledge-and-attitudes-regarding-seasonal-influenza-and-influenza-LdBLeq4y1f
References
References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.
- Publisher
- Hindawi Publishing Corporation
- Copyright
- Copyright © 2021 Issa Alawneh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- ISSN
- 2356-6868
- eISSN
- 2314-7784
- DOI
- 10.1155/2021/3611846
- Publisher site
- See Article on Publisher Site
Abstract
Hindawi Advances in Public Health Volume 2021, Article ID 3611846, 5 pages https://doi.org/10.1155/2021/3611846 Research Article Knowledge and Attitudes Regarding Seasonal Influenza and Influenza Vaccination among Patients and Their Companions in North Palestine Hospitals 1 1 1 1 2 Issa Alawneh , Hamza Al-Sayeh, Mahdi Zaid, Maysa Alawneh, and Hossam Al-Tatari Department of Pediatrics, An-Najah National University Hospital, Nablus, State of Palestine !e Heart Medical Center, Al Ain, UAE Correspondence should be addressed to Issa Alawneh; issaalawneh2007@hotmail.com Received 12 April 2021; Accepted 11 September 2021; Published 15 September 2021 Academic Editor: Carol J. Burns Copyright © 2021 Issa Alawneh et al. &is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Seasonal influenza is a common highly infectious disease that can affect the upper and lower airway in children and adults mainly in wintertime which is caused by many different influenza viruses and, in some cases, may cause serious com- plications such as pneumonia. We conducted this study to assess the knowledge and attitudes among patients and their companions in North Palestine hospitals regarding seasonal influenza and influenza vaccination and factors influencing the uptake of this vaccine so that we can identify gaps in their knowledge and give feedback to health authorities for future quality improvement projects by increasing awareness of its effectiveness and safety. Methods. A cross-sectional 17-item survey included randomly selected samples of 327 North Palestinian patients and their companions at North Palestine hospitals. Result. A total of 327 completed questionnaires were received with a response rate of 92%. Of these, 129 participants (39.4%) believed that influenza is the same as common cold. &e majority of participants (85.3%) had heard of the influenza vaccine before. Although nearly half of them (53.6%) believed that the influenza vaccine is safe, only 112 (34.7%) of the participants considered vaccination an effective means in preventing serious influenza-related complications and only 89 (27.2%) participants were previously vaccinated. &e main reasons for not being vaccinated included that vaccination is not necessary because flu is not a serious disease (67%), concerns about vaccine efficacy and its side effects (25.6%), fear of needles and injection (25.2%), and 17.8% of the participants believed that this vaccine is expensive. Conclusion. &e uptake and knowledge of the influenza vaccine among Palestinians are low. Vaccinated participants in our survey showed a higher level of knowledge compared to nonvaccinated participants. Half of the participants believed in the safety of the vaccine and one-third of them believed in its efficacy in preventing flu illness and its complications. Extensive and sustained efforts are needed by public health programs to promote the flu vaccine among the public by increasing awareness of its effectiveness and safety. causing 290,000–650,000 deaths worldwide annually [2, 3]. 1. Introduction Moreover, influenza is also associated with a significant Seasonal influenza is a common highly infectious disease economic burden on healthcare costs [4]. that can affect the upper and lower airway in children and Influenza vaccination is a safe and effective primary adults, mainly in wintertime, which is caused by many available tool for the prevention of influenza and reduction different influenza viruses and, in some cases, may cause of economic and social burden. Indeed, seasonal influenza serious complications such as pneumonia. Yearly, between vaccination is the most effective strategy for preventing 250000 and 500000 deaths of the world’s population are influenza virus infection and its complications [5]. However, estimated due to influenza virus [1]. It is known that in- despite the national recommendations that encourage this fluenza virus has high mutation rates, and it has been shown vaccination taken, the rates of vaccination uptake remain that its annual epidemics is 5–15% of the global population, low [6, 7]. 2 Advances in Public Health Table1: Demographic characters of the study sample (n � 327). Numerous national studies have proved the effectiveness of annual influenza vaccination in the reduction of mortality Demographics Percentages (%) and morbidity, especially in high-risk groups such as the Gender elderly, chronically ill patients, pregnant, and children [8, 9]. Male 56 For example, in the USA, during the season of influenza Female 44 between 2017 and 2018, vaccination prevented approxi- Age (yr) mately 7 million influenza illnesses, 109,000 hospitalizations, 20–30 51.1 and 8,000 deaths [10]. 31–40 26.6 &e varying influenza vaccine coverage across countries 41–50 12.2 corresponds to the level of knowledge and attitude toward >50 10.1 seasonal influenza vaccines, both in the general population Level of education and in the at-risk groups: individuals with little knowledge Primary 4.3 and a negative attitude towards vaccination are usually not Secondary 22.3 University and higher 73.4 vaccinated [11–14]. Previous studies showed that the influenza vaccine was usually significantly protective and that most clinicians and (1) Demographic information: sex, age, and education family physicians were supportive of vaccination and had level good knowledge of vaccination indications [15–19]. In Palestine, infectious diseases cause less than 10% of all (2) General knowledge about influenza illness (five deaths; respiratory diseases (ICD10 code: J00–J99.9) cause questions) 70% of those deaths with a mortality rate of 17.0 per 100,000 (3) Knowledge and attitude toward the influenza vaccine population during 2016, being the sixth most common cause (ten questions) of death [20]. Overall, influenza viruses were the most common cause We modified a questionnaire used in Pretoria, South of respiratory tract infections (RTIs) among hospitalized Africa, assessing knowledge, attitudes, and practices re- Palestinian patients in the West Bank. Children and the garding seasonal influenza and influenza vaccination among elderly were the most affected with RTIs. &e elderly pop- diabetics in September 2015 [22]. It was reviewed and ap- ulation (≥60 years old) had the highest rates [21]. proved by the An-Najah National University Institution In Palestine, the influenza vaccine is not included in the Review Board (IRB). &en, the permissions to conduct the Palestinian National Immunization program and not cov- research at the Palestinian MOH-related facilities were ered by insurance except for healthcare workers. obtained from Palestinian MOH as well as from the private No previously published studies are focused on receiving sectors visited prior to the study start date. influenza vaccine and assessing Palestinian population Written informed consent was taken from all partici- knowledge about vaccine-related risks and vaccine safety. pants before they completed the questionnaire. We used a In this study, we conducted a cross-sectional study on a convenient sampling method in this study. sample of the Palestinian population in North Palestine All collected data were treated with confidentiality and hospitals to assess public knowledge, attitudes, and prac- would be used for research purposes only. tices (KAP) related to influenza illness and influenza vaccination. 2.3. Statistical Analysis. Answers of the population responded were translated into an Excel sheet and then 2. Methods whether the respondents strongly agreed or just agree with a good practice; the answers were considered true, as if he 2.1. Study Design and Setting. A descriptive cross-sectional strongly disagrees or just disagree with a wrong practice. survey was conducted during a period of 3 months from We considered any question with returned correct an- June to August 2018 of patients and their companions at swers of less than 90% as a “Gap” in participant knowledge. North Palestine hospitals, both in the private and govern- mental sectors, involving five major cities in North Palestine including Nablus, Jenin, Tulkarm, Tubas, and Qalqilia. 3. Results Inclusions criteria: male or female, at least 18 years of A total number of 327 patients and their companions age, married, and at least have one dependent child participated in the study with a response rate of 92.0% (301/ Exclusion criteria: less than 18 years of age, single, and 327). Most of the participants (167/327, 51.1%) were between 20–30 years; out of them, 56% were females (Table 1). married but does not have children When asked about influenza, the majority believed that flu was caused by the virus (289/327, 88.4%), while 129 2.2. !e Questionnaire and Data Collection. To achieve the participants (39.4%) still believed that it is the same as aim of our study, we used a structured 17-item questionnaire common cold. assessing the knowledge and attitude towards influenza Regarding the major symptoms of influenza, the most illness and its vaccination consisting of three main parts. frequent choices were muscle ache (263/327, 80.4%), fever Advances in Public Health 3 Table 2: Surveyed questions and responses to each question. Responses Agree (%) Disagree (%) Not sure (%) Seasonal influenza Flu is caused by a virus 88.4 2.1 10.4 Flu is the same as common cold 39.4 46.2 14.4 Flu can spread from one person to the other 94.5 4 2.1 Flu occurs at a certain period of the year 50.8 44 5.2 Symptoms Percentage Fever 78.3 Vomiting 19.3 Headache 65.7 Diarrhea 16.8 Muscle ache 80.4 Runny nose 77.1 Cough 60.6 Seasonal flu vaccine Percentage Knowledge Have you ever heard of a vaccine to prevent flu before? (i) Yes 85.3 (ii) No 14.7 Is the flu vaccine safe? (i) Yes 53.6 (ii) No 16 (iii) Not sure 30.4 Can you still get the flu after flu vaccine? (i) Yes 34.7 (ii) No 36.2 (iii) Not sure 29.4 How is the vaccine given? (i) Injection 80.6 (ii) Nasal spray 4.3 (iii) Mouth drops 3.1 (iv)Not sure 14.2 Does the vaccine have side effects? (i) Yes 46.5 (ii) No 16.3 (iii) Not sure 37.2 Side effects: (i) Headache 54.8 (ii) Fever 73.4 (iii) Swelling at the injection site 62.1 (iv) Vomiting and fatigue 36.2 For how long can the vaccine protect? (i) One flu season 65 (ii) Two flu seasons 4.3 (iii) &ree more seasons 5.5 (iv) Not sure 34.3 When is the appropriate time to take the flu vaccine? (i) Before the flu season starts 74.2 (ii) During the flu season 7.7 (iii) Immediately after the flu season 0.6 (iv) Not sure 17.8 Attitudes Have you received a flu vaccine before? (i) Yes 27.2 (ii) No 72.8 What is the reason(s) for not taking a flu vaccine? (i) It is not necessary as flu is just a minor illness 67 (ii) It is expensive 17.8 (iii) It has serious side effects 25.6 (iv) Fears of needles and injection 25.2 4 Advances in Public Health Table 3: Seasonal flu knowledge scores of participants (n � 327). efforts and awareness in the community regarding influenza illness and vaccination to reduce the economic and social Seasonal flu knowledge score Participants (%) burden. Good seasonal flu knowledge 69.9 &e utilitarian value of vaccination in enhancing public Poor seasonal flu knowledge 30.1 health to assure the population of the efficacy and safety of the vaccine by using media such as newspapers, posters, brochures, and mobile messages with adequate education Table 4: Vaccine knowledge scores of participants (n � 327). received from medical staff proved to be the most effective Flu vaccine knowledge score Participants (%) tools for improving influenza vaccination practices in North Good vaccine knowledge 53.4 Palestine and can greatly simplify this process [23]. More- Poor vaccine knowledge 46.6 over, many studies advised that mandatory freely available vaccination could be helpful in limiting disease burden [24, 25]. (256/327, 78.3%), runny nose (252/327, 77.1%), headache (215/327, 65.7%), and cough (198/327, 60.6%) (Table 2). 5. Conclusions Out of the 85.3% (279/327) of participants who had heard of the influenza vaccine previously to prevent flu, only Overall, the uptake and knowledge of the influenza vaccine 171/327, 53.6%, indicated that the vaccine is safe and 83.8% among Palestinians are low. Vaccinated participants in our (140/167), although 36.2% (117/327) of the participants survey showed a higher level of knowledge compared to indicated that one can still develop flu despite being nonvaccinated participants. Half of the participants believed vaccinated. in the safety of the vaccine, and one-third of them believed in Nearly half of the participants (151/327, 46.5%) reported its efficacy in preventing flu illness as well as its known known side effects of the vaccine, including fever (73.4%), complications. Extensive and sustained efforts are needed by headache (54.8%), swelling at the injection site (62.1%), and public health programs to promote the flu vaccine among vomiting with fatigue (36.2%). Nearly half of the participants the public by increasing awareness of its effectiveness and (183/327, 56%) indicated that it can only protect for one flu safety. season and that 74.2% of them know that the appropriate time to take the vaccine is before the flu season starts (242/ 5.1. Limitations. &is study has some limitations. Specifi- 327). About 69.9% and 53.4% had good knowledge about cally, the study occurred in North Palestine hospitals and seasonal flu and vaccine, respectively (Tables 3 and 4). may not be generalizable to other regions of Palestine. When asked about their previous influenza vaccination Additionally, the study sample size was small which was practice, only 27.2% (89/327) had previously been vacci- drawn from a selected population in hospitals, so a signif- nated at one point in the time of their lives. A majority of the icant selection bias cannot, therefore, be ruled out. participants had never received influenza vaccination before (238/327, 72.8%), and the main reasons given by them in- cluded that vaccination is not necessary because flu is just a Data Availability minor illness (67%), %), concerns about vaccine efficacy and &e datasets generated and analysed during the current its side effects (25.6%), fear of needles and injection (25.2%), study are not publicly available due to participant private and 17.8% of the participants believed that this vaccine is polices and research regulation agreement related to Najah expensive. National University but are available from the corre- sponding author on reasonable request. 4. Discussion Ethical Approval &is study is the first of its kind in Palestine to investigate and assess the knowledge and attitudes of populations re- &e authors confirm that all methods were carried out in garding influenza illness and its vaccines. accordance with relevant guidelines and regulations related In this study, although approximately half of participants to Najah National University and the Palestinian Ministry of had good knowledge scores about seasonal flu and its Health. &e study was approved by the An-Najah National vaccine, only one-third of them had taken the influenza University Institution Review Board (IRB). vaccine previously and nearly half of them believed that the vaccine may have many side effects. Consent In keeping with that, the average cost of influenza vaccine in Palestine is near 13 US dollars, and the cost is not Written informed consent was obtained from all subjects or/ covered by health insurance. &ese significant fears of side and, if subjects are under 18, from a parent and/or legal effects, false belief about vaccine safety, limited availability guardian. and coverage of vaccination services, and even poor knowledge of the vaccine’s benefits ultimately led to lower Conflicts of Interest vaccination rates among the general population in North Palestine. &ese findings highlight the need to increase None of the authors declares conflicts of interest. Advances in Public Health 5 Environmental Research and Public Health, vol. 12, no. 12, Authors’ Contributions pp. 15486–15497, 2015. [14] Y. Ma, T. Li, W. Chen, J. Chen, M. Li, and Z. Yang, Issa Alawneh prepared the proposal and wrote and edited “Knowledge, attitudes and practices (KAP) toward seasonal the manuscript. Hamza Al-Sayeh helped in data collection. influenza vaccine among young workers in south China,” Mahdi Zaid divided the work among the investigators, Human Vaccines & Immunotherapeutics, vol. 14, no. 5, collected data, and conducted analysis in addition to pre- pp. 1283–1293, 2018. paring the tables. Maysa Alawneh as the first supervisor [15] Y.-C. Chang, Y.-J. Chou, J.-Y. Liu, T.-F. Yeh, and N. Huang, reviewed the data analysis and the manuscript and guided “Additive benefits of pneumococcal and influenza vaccines steps to conduct the research step by step. Hossam Al-Tatari among elderly persons aged 75 years or older in Taiwan—a as the second supervisor helped in the idea of the research, representative population-based comparative study,” Journal emphasized the importance of the study, and helped in of Infection, vol. 65, no. 3, pp. 231–238, 2012. validating the questioner, as well as guided the research flow [16] E. Dube, V. Gilca, C. Sauvageau et al., “Canadian family and monitored the steps from the proposal to data entry. physicians’ and paediatricians’ knowledge, attitudes and practices regarding A(H1N1) pandemic vaccine,” BMC Re- search Notes, vol. 3, p. 102, 2010. References [17] J. M. McAnerney, S. Walaza, A. L. Cohen et al., “Effectiveness and knowledge, attitudes and practices of seasonal influenza [1] World Health Organization, A Manual for Estimating Disease vaccine in primary healthcare settings in south Africa, Burden Associated with Seasonal Influenza, World Health 2010–2013,” Influenza and Other Respiratory Viruses, vol. 9, Organization, Geneva, Switzerland, 2015. no. 3, pp. 143–150, 2015. [2] World Health Organization, Influenza (Seasonal), World [18] M. T. Osterholm, N. S. Kelley, A. Sommer, and E. A. Belongia, Health Organization, Geneva, Switzerland, 2018. “Efficacy and effectiveness of influenza vaccines: a systematic [3] A. D. Iuliano, K. M. Roguski, H. H. Chang et al., “Estimates of review and meta-analysis,” !e Lancet Infectious Diseases, global seasonal influenza-associated respiratory mortality: a vol. 12, no. 1, pp. 36–44, 2012. modelling study,” Lancet (London, England), vol. 391, [19] J. K. Breteler, J. S. Tam, M. Jit, J. C. F. Ket, and M. R. De Boer, no. 10127, pp. 1285–1300, 2018. “Efficacy and effectiveness of seasonal and pandemic A [4] P. R. Blank and T. D. Szucs, “Increasing influenza vaccination (H1N1) 2009 influenza vaccines in low and middle income coverage in recommended population groups in Europe,” countries: a systematic review and meta-analysis,” Vaccine, Expert Review of Vaccines, vol. 8, no. 4, pp. 425–433, 2009. vol. 31, no. 45, pp. 5168–5177, 2013. [5] L. A. Grohskopf, E. Alyanak, K. R. Broder, E. B. Walter, [20] Ministry-of-Health, Health Annual Report: Palestine, Minis- A. M. Fry, and D. B. Jernigan, “Prevention and control of try-of-Health, Ramallah, Palestine, 2016. seasonal influenza with vaccines: recommendations of the [21] R. Abu Seir, W. Njoum, R. Najajrah et al., “Acute respiratory advisory committee on immunization practices—United tract infections among hospitalized palestinian patients States, 2019-20 influenza season,” MMWR. Recommendations (2011–2016): a retrospective study,” !e Canadian Journal of and Reports, vol. 68, no. 3, pp. 1–21, 2019. Infectious Diseases & Medical Microbiology, vol. 2021, Article [6] H. G. Hollmeyer, F. Hayden, G. Poland, and U. Buchholz, ID 5643134, 8 pages, 2021. “Influenza vaccination of health care workers in hospitals-a [22] O. D. Olatunbosun, T. M. Esterhuizen, and C. S. Wiysonge, review of studies on attitudes and predictors,” Vaccine, vol. 27, “A cross sectional survey to evaluate knowledge, attitudes and no. 30, pp. 3935–3944, 2009. practices regarding seasonal influenza and influenza vacci- [7] O. Yaqub, S. Castle-Clarke, N. Sevdalis, and J. Chataway, nation among diabetics in Pretoria, south Africa,” Vaccine, “Attitudes to vaccination: a critical review,” Social Science & vol. 35, no. 47, pp. 6375–6386, 2017. Medicine, vol. 112, pp. 1–11, 2014. [23] M. M. Masadeh, K. H. Alzoubi, S. I. Al-Azzam, H. S. Al-Agedi, [8] A. Pless, S. R. McLennan, D. Nicca, D. M. Shaw, and B. E. Abu Rashid, and T. L. Mukattash, “Public awareness B. S. Elger, “Reasons why nurses decline influenza vaccina- regarding children vaccination in Jordan,” Human Vaccines & tion: a qualitative study,” BMC Nursing, vol. 16, no. 1, p. 20, Immunotherapeutics, vol. 10, no. 6, pp. 1762–1766, 2014, þ. [24] A. L. Ottenberg, J. T. Wu, G. A. Poland, R. M. Jacobson, [9] D. J. Opel, J. Heritage, J. A. Taylor et al., “&e architecture of B. A. Koenig, and J. C. Tilburt, “Vaccinating health care provider-parent vaccine discussions at health supervision workers against influenza: the ethical and legal rationale for a visits,” Pediatrics, vol. 132, no. 6, pp. 1037–1046, 2013. mandate,” American Journal of Public Health, vol. 101, no. 2, [10] Centers for Disease Control and Prevention (CDC), 2016- pp. 212–216, 2011, þ. 2017 Estimated Influenza Illnesses, Medical Visits, and Hos- [25] J. J. M. van Delden, R. Ashcroft, A. Dawson, G. Marckmann, pitalizations Averted by Vaccination in the United States, R. Upshur, and M. F. Verweij, “&e ethics of mandatory CDC, Atlanta, Georgia, 2018. vaccination against influenza for health care workers,” Vac- [11] M. P. S. Yeung, F. L. Y. Lam, and R. Coker, “Factors associated cine, vol. 26, no. 44, pp. 5562–5566, 2008, þ. with the uptake of seasonal influenza vaccination in adults: a systematic review,” Journal of Public Health, vol. 38, Article ID fdv194, 2016. [12] A. Kamimura, H. N. Trinh, S. Weaver et al., “Knowledge and perceptions of influenza vaccinations among college students in Vietnam and the United States,” Journal of Preventive Medicine and Public Health, vol. 50, no. 4, pp. 268–273, 2017. [13] G. El Khoury and P. Salameh, “Influenza vaccination: a cross- sectional survey of knowledge, attitude and practices among the lebanese adult population,” International Journal of
Journal
Advances in Public Health – Hindawi Publishing Corporation
Published: Sep 15, 2021