Abstract
Introduction. Influenza is a highly contagious viral respiratory infection that spreads quickly in crowded and closed environments. Non-physician healthcare workers (HCW) play an essential role in vaccination discussions and initiatives in healthcare facilities. Our study aims to explore influenza vaccination acceptance and advocacy behavior among non-physician HCW during the 2024-25 respiratory virus season within a large healthcare system in Georgia, USA.
Methods. A cross-sectional survey was conducted using validated instruments, the Motors of influenza vaccination acceptance (MoVac-flu) and the Motors of engagement with vaccination advocacy (MovAd-flu). Data was collected via an online survey platform between February 4 and March 15, 2025.
Results. A total of 156 responses were received, with 141 included after data cleaning. Most participants were registered nurses (27.7%), aged 25-34 years (29.8%) and identified as female (84.4%). The average MoVac score was 5.31 (SD=1.43) and the average MovAd score was 4.7 (SD=1.27), both out of a maximum of 7. Linear regression analysis revealed a significant positive correlation between participants’ comfort in discussing influenza vaccination with patients and their MoVac and MovAd scores. Clinical guidelines and recommendations emerged as strong motivators for initiating vaccination discussions.
Conclusion. Findings indicate that non-physician HCW demonstrate favorable attitudes toward influenza vaccination acceptance and advocacy, as reflected in consistently high MoVac and MovAd scores. These results suggest that non-physician healthcare workers may serve as effective messengers in promoting influenza vaccination within healthcare systems. Future initiatives could leverage their role to strengthen vaccination uptake and patient engagement.
References
World Health Organization. Influenza (Seasonal). Available at: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal). Accessed on: 11/04/2025.
Thompson WW, Weintraub E, Dhankhar P, Cheng PY, Brammer L, Meltzer MI, Bresee JS, Shay DK. Estimates of US influenza-associated deaths made using four different methods. Influenza Other Respir Viruses 2009;3:37-49. https://doi.org/10.1111/j.1750-2659.2009.00073.x.
Healthy Children. Which Flu Vaccine Should Children Get? Available at: https://www.healthychildren.org/English/health-issues/conditions/flu/Pages/which-flu-vaccine-should-my-child-get-this-year.aspx. Accessed on: 11/04/2025.
Centers for Disease Control and Prevention. Who Should and Who Should NOT Get a Flu Vaccine. Available at: https://www.cdc.gov/flu/prevent/whoshouldvax.htm. Accessed on: 11/04/2025.
Centers for Medicare & Medicaid Services. Flu Shot. Available at: https://www.cms.gov/flu-provider. Accessed on: 11/04/2025.
Centers for Disease Control and Prevention CDC. Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel – United States, 2023-24 Influenza Season. Available at: https://www.cdc.gov/fluvaxview/coverage-by-season/health-care-personnel-coverage-2023-24.html#cdc_report_pub_study_section_6-authors. Accessed on: 11/04/2025.
Centers for Disease Control and Prevention CDC. Influenza Vaccination Coverage Among Health Care Personnel – United States, 2022–23 Influenza Season. Available at: https://www.cdc.gov/fluvaxview/coverage-by-season/health-care-personnel-2022-2023.html#cdc_report_pub_study_section_6-authors. Accessed on: 11/04/2025.
Centers for Disease Control and Prevention . Influenza Vaccination Coverage Among Health Care Personnel – United States, 2019–2020 Influenza (Seasonal). Available at: https://www.cdc.gov/fluvaxview/coverage-by-season/health-care-personnel-2019-2020.html#cdc_report_pub_study_section_6-authors. Accessed on: 11/04/2025.
Bell J, Meng L, Barbre K, Haanschoten E, Reses HE, Soe M, Edwards J, Massey J, Tugu Yagama Reddy GR, Woods A, Stuckey MJ, Kuhar DT, Bolden K, Dubendris H, Wong E, Rowe T, Lindley MC, Kalayil EJ, Benin A. Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel - National Healthcare Safety Network, United States, 2022-23 Influenza Season. MMWR Morb Mortal Wkly Rep 2023;72:1237-43. https://doi.org/10.15585/mmwr.mm7245a5.
Vallée-Tourangeau G, Promberger M, Moon K, Wheelock A, Sirota M, Norton C, Sevdalis N. Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: Development and validation of two short scales. Vaccine 2018;36:6540-5. https://doi.org/10.1016/j.vaccine.2017.08.025.
Burrowes SAB, Casey SM, Dobbins S, Hall T, Ma M, Bano R, Drainoni ML, Schechter-Perkins EM, Garofalo C, Perkins RB, Pierre-Joseph N. Healthcare workers' perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study. Z Gesundh Wiss 2022 Dec 25:1-14. https://doi.org/10.1007/s10389-022-01793-1.
Fan J, Xu S, Liu Y, Ma X, Cao J, Fan C, Bao S. Influenza vaccination rates among healthcare workers: a systematic review and meta-analysis investigating influencing factors. Front Public Health 2023;11:1295464. https://doi.org/10.3389/fpubh.2023.1295464.
Hamdan O, Amarin JZ, Potter M, Haddadin Z, Yanis A, Shawareb Y, Khuri-Bulos N, Haddadin R, Halasa NB, Spieker AJ. Seasonal influenza vaccination: Attitudes and practices of healthcare providers in Jordan. PLOS ONE 2024;19:e0314224. https://doi.org/10.1371/journal.pone.0314224.
Kassianos G, Kuchar E, Nitsch-Osuch A, Kyncl J, Galev A, Humolli I, Falup-Pecurariu O, Thomson A, Klein C, Vallée-Tourangeau G. Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: A comparative study in six European countries. Vaccine 2018;36:6546-52. https://doi.org/10.1016/j.vaccine.2018.02.031. Epub 2018 Mar 28.
Dardalas I, Pourzitaki C, Manomenidis G, Malliou F, Galanis P, Papazisis G, Kouvelas D, Bellali T. Predictors of influenza vaccination among elderly: a cross-sectional survey in Greece. Aging Clin Exp Res 2020;32:1821-8. https://doi.org/10.1007/s40520-019-01367-4.
Bellali T, Liamopoulou P, Karavasileiadou S, Almadani N, Galanis P, Kritsotakis G, Manomenidis G. Intention, Motivation, and Empowerment: Factors Associated with Seasonal Influenza Vaccination among Healthcare Workers (HCWs). Vaccines 2023;11:1508. https://doi.org/10.3390/vaccines11091508.
Tanriover MD, Vallee-Tourangeau G, Kokorin VA, Larina VN, Maamar M, Harmouche H, Uyaroğlu OA, Kutlay DY, Ben Khelil J, Anjorin AA, Rana MS, Jabrayilov J, Al Slail F, Al Kathiry D, Al Harthi H, Ghazy RM, Gahwagi M, Mafi A, Koul P, Al Awaidy S. The vaccination acceptance, confidence, and conviction on influenza in the Middle East, Eurasia, and Africa among healthcare providers (VACCIMENA-HCP) project 2023: Determinants of vaccination behavior. IJID reg 2025;14:100572. https://doi.org/10.1016/j.ijregi.2025.100572.
Cortes García-Rodríguez L, Luengo-González R, Nieves Moro-Tejedor M, Asenjo-Esteve A, Montserrat García-Sastre M, Cuesta-Lozano D. Adaptación y validación de la escala MoVac-flu sobre motivación hacia la vacuna de la gripe. Gaceta Sanitaria 2023;37:102345. https://doi.org/10.1016/j.gaceta.2023.102345.
Chen IH, Ahorsu DK, Ko NY, Yen CF, Lin CY, Griffiths MD, Pakpour AH. Adapting the Motors of Influenza Vaccination Acceptance Scale into the Motors of COVID-19 Vaccination Acceptance Scale: Psychometric evaluation among mainland Chinese university students. Vaccine 2021;39:4510-5. https://doi.org/10.1016/j.vaccine.2021.06.044.
Pramukti I, Strong C, Chen IH, Yen CF, Rifai A, Ibrahim K, Pandin MGR, Subramaniam H, Griffiths MD, Lin CY, Ko NY. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S): Measurement Invariant Evidence for Its Nine-Item Version in Taiwan, Indonesia, and Malaysia. Psychol Res Behav Manag 2022;15:1617-25. https://doi.org/10.2147/PRBM.S363757. Erratum in: Psychol Res Behav Manag 2022;15:1915-6. https://doi.org/10.2147/PRBM.S383784.
Adu P, Popoola T, Collings S, Aspin S, Medvedev O, Simpson C. Psychometric properties of the motors of COVID-19 vaccination acceptance scale in New Zealand: Insights from confirmatory factor analysis. Current Psychology 2024;26628-38. https://doi.org/10.1007/s12144-024-05877-x.
Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers’ Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021;9:713. https://doi.org/10.3390/vaccines9070713.
Emory University. Comprehensive Figures. Available at: https://whsc.emory.edu/about/facts-figures/figures.html. Accessed on: 17/04/2025.
Zippia. Emory Healthcare demographics and statistics. Available at: https://www.zippia.com/emory-healthcare-careers-22447/demographics/. Accessed on: 18/04/2025.
Emory Healthcare. For Medical Professionals. Available at: https://www.emoryhealthcare.org/medical-professionals/credentialing/prevent-the-spread#:~:text=to%20influenza%20vaccination.-,The%20vaccine%20is%20mandatory%20for%20all%20providers%2C%20except%20those%20with,for%20an%20exemption%20each%20year. Accessed on: 18/04/2025.
Haridi HK, Salman KA, Basaif EA, Al-Skaibi DK. Influenza vaccine uptake, determinants, motivators, and barriers of the vaccine receipt among healthcare workers in a tertiary care hospital in Saudi Arabia. J Hosp Infect 2017;96:268-75. https://doi.org/10.1016/j.jhin.2017.02.005. Epub 2017 Feb 9.
National Foundation for Infectious Diseases NFID. NFID Surveys Find Gaps in Communication about Flu Between Healthcare Professionals and Patients with Chronic Health Conditions. Available at: https://www.nfid.org/nfid-surveys-find-gaps-in-communication-about-flu-between-healthcare-professionals-and-patients-with-chronic-health-conditions/. Accessed on: 18/04/2025.
Association of Professionals in Infection Control and Epidemiology. APIC Position Paper: Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel, Unless Medically Contraindicated. Available at: https://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/APIC_Influenza_Immunization_of_HCP_12711.pdf. Accessed on: 18/04/2025.
Bish A, Yardley L, Nicoll A, Michie S. Factors associated with uptake of vaccination against pandemic influenza: a systematic review. Vaccine 2011;29:6472-84. https://doi.org/10.1016/j.vaccine.2011.06.107.
Kaddour O, Ben Mabrouk A, Arfa S, Lassoued N, Berriche O, Chelli J. Knowledge and attitudes of healthcare workers about influenza vaccination. Infect Dis Health 2024;29:203-211. https://doi.org/10.1016/j.idh.2024.04.005.
Guillari A, Polito F, Pucciarelli G, Serra N, Gargiulo G, Esposito MR, Botti S, Rea T, Simeone S. Influenza vaccination and healthcare workers: barriers and predisposing factors. Acta Biomed 2021;92:e2021004. https://doi.org/10.23750/abm.v92iS2.11106.
Goje O, Kapoor A. Meeting the challenge of vaccine hesitancy. Cleve Clin J Med 2024;91:S50-6. https://doi.org/10.3949/ccjm.91.s1.08.
Green SB. How Many Subjects Does It Take To Do A Regression Analysis. Multivariate Behav Res 1991;26:499-510. https://doi.org/10.1207/s15327906mbr2603_7.
Zaraketa H, Abubakar A. Harnessing the power of advocacy to improve seasonal influenza vaccination coverage in the Eastern Mediterranean Region. East Mediterr Health J 2020;26:138-40. https://doi.org/10.26719/2020.26.2.138.
