Does Vaccine Confidence Mediate the Relationship Between Vaccine Literacy and Influenza Vaccination? Exploring Determinants of Vaccination Among Staff Members of Nursing Homes in Tuscany, Italy, During the COVID-19 Pandemic

Overview

Journal Vaccines (Basel)

Date 2023 Aug 26

PMID 37631943

Authors

Francesca Collini

Guglielmo Bonaccorsi

Marco Del Riccio

Mario Bruschi

Silvia Forni

Giacomo Galletti

Fabrizio Gemmi

Francesca Ierardi

Chiara Lorini

Affiliations

Soon will be listed here.

Abstract

Background: Low coverage of influenza vaccination in nursing home (NH) staff may be attributed to factors such as vaccine confidence (VC) and vaccine literacy (VL). Our study aimed to evaluate the role of VL and VC in predicting the intention to get the influenza vaccine in a sample of employees of NHs in Tuscany, Italy.

Methods: Data from staff members in Tuscany were collected using an online questionnaire that examined influenza vaccination history, intentions, demographic information, health status, and VL. Statistical analyses explored the relationships between VC, VL, and vaccination intentions.

Results: The study included 1794 respondents, (86.3%) and assistants/aides (58.1%), with a median age of 46 years. The intention to get vaccinated was significantly higher among those with health risk conditions, and there was a positive association between VC and VL, specifically its interactive/critical component. The mediation analysis showed that VC completely mediated the relationship between VL and the intention to get vaccinated, with significant effects observed in different subgroups.

Conclusions: VC is a key factor that mediates the effect of VL on vaccine intention. These results suggest that interventions aimed at improving VL alone may not be sufficient to increase vaccine uptake unless VC is also addressed.

Citing Articles

A Psychosocial Critique of the Consequences of the COVID-19 Pandemic on UK Care Home Staff Attitudes to the Flu Vaccination: A Qualitative Longitudinal Study.

Anyiam-Osigwe A, Katangwe-Chigamba T, Scott S, Seeley C, Patel A, Sims E Vaccines (Basel). 2025; 12(12.

PMID: 39772097 PMC: 11728680. DOI: 10.3390/vaccines12121437.

Bibliometric and visual analyses of vaccine literacy research from 1982 to 2023.

Wang J, Wang Y, Li Y, Ma M, Xie Y, Zhang Y Hum Vaccin Immunother. 2024; 20(1):2363019.

PMID: 39693185 PMC: 11188838. DOI: 10.1080/21645515.2024.2363019.

Combating the Co-Circulation of SARS-CoV-2 and Seasonal Influenza: Identifying Multi-Dimensional Factors Associated with the Uptake of Seasonal Influenza Vaccine among a Chinese National Sample.

Zhang X, Zheng P, Chen X, Li A, Na L Vaccines (Basel). 2024; 12(9).

PMID: 39340036 PMC: 11435884. DOI: 10.3390/vaccines12091005.

Vaccine literacy, vaccination intention, and their correlation among adults in Mainland China: a cross-sectional study.

Gao S, Li Y, Wang X, Li S, Chen M, Yue B J Health Popul Nutr. 2024; 43(1):122.

PMID: 39127762 PMC: 11316985. DOI: 10.1186/s41043-024-00602-7.

Perspectives in the Development of Tools to Assess Vaccine Literacy.

Biasio L, Zanobini P, Lorini C, Bonaccorsi G Vaccines (Basel). 2024; 12(4).

PMID: 38675804 PMC: 11054371. DOI: 10.3390/vaccines12040422.

References

Siena L, Isonne C, Sciurti A, De Blasiis M, Migliara G, Marzuillo C . The Association of Health Literacy with Intention to Vaccinate and Vaccination Status: A Systematic Review. Vaccines (Basel). 2022; 10(11). PMC: 9692286. DOI: 10.3390/vaccines10111832. View

Karlsson L, Lewandowsky S, Antfolk J, Salo P, Lindfelt M, Oksanen T . The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PLoS One. 2019; 14(10):e0224330. PMC: 6822763. DOI: 10.1371/journal.pone.0224330. View

Krammer F, Schultz-Cherry S . We need to keep an eye on avian influenza. Nat Rev Immunol. 2023; 23(5):267-268. PMC: 10028763. DOI: 10.1038/s41577-023-00868-8. View

Lorini C, Riccio M, Zanobini P, Biasio R, Bonanni P, Giorgetti D . Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy. BMC Public Health. 2023; 23(1):1501. PMC: 10408168. DOI: 10.1186/s12889-023-16437-6. View

Biasio L, Giambi C, Fadda G, Lorini C, Bonaccorsi G, DAncona F . Validation of an Italian tool to assess vaccine literacy in adulthood vaccination: a pilot study. Ann Ig. 2020; 32(3):205-222. DOI: 10.7416/ai.2020.2344. View

Paoli S, Lorini C, Puggelli F, Sala A, Grazzini M, Paolini D . Assessing Vaccine Hesitancy among Healthcare Workers: A Cross-Sectional Study at an Italian Paediatric Hospital and the Development of a Healthcare Worker's Vaccination Compliance Index. Vaccines (Basel). 2019; 7(4). PMC: 6963296. DOI: 10.3390/vaccines7040201. View

Toh M, Kannan P, Chen Y, Chng F, Tang W . Healthcare workers and H1N1 vaccination: does having a chronic disease make a difference?. Vaccine. 2011; 30(6):1064-70. PMC: 7127734. DOI: 10.1016/j.vaccine.2011.12.037. View

Mehta M, Pastor C, Shah B . Achieving optimal influenza vaccination rates: a survey-based study of healthcare workers in an urban hospital. J Hosp Infect. 2008; 70(1):76-9. DOI: 10.1016/j.jhin.2008.04.028. View

Singh P, Dhalaria P, Kashyap S, Soni G, Nandi P, Ghosh S . Strategies to overcome vaccine hesitancy: a systematic review. Syst Rev. 2022; 11(1):78. PMC: 9044888. DOI: 10.1186/s13643-022-01941-4. View

10.

Moretti F, Visentin D, Bovolenta E, Rimondini M, Majori S, Mazzi M . Attitudes of Nursing Home Staff Towards Influenza Vaccination: Opinions and Factors Influencing Hesitancy. Int J Environ Res Public Health. 2020; 17(6). PMC: 7143910. DOI: 10.3390/ijerph17061851. View

11.

Biasio L . Vaccine literacy is undervalued. Hum Vaccin Immunother. 2019; 15(11):2552-2553. PMC: 6930053. DOI: 10.1080/21645515.2019.1609850. View

12.

Hollmeyer H, Hayden F, Poland G, Buchholz U . Influenza vaccination of health care workers in hospitals--a review of studies on attitudes and predictors. Vaccine. 2009; 27(30):3935-44. DOI: 10.1016/j.vaccine.2009.03.056. View

13.

Lorini C, Collini F, Gasparini F, Paolini D, Grazzini M, Ierardi F . Health Literacy, Vaccine Confidence and Influenza Vaccination Uptake among Nursing Home Staff: A Cross-Sectional Study Conducted in Tuscany. Vaccines (Basel). 2020; 8(2). PMC: 7348841. DOI: 10.3390/vaccines8020154. View

14.

Gostin L, Salmon D . The Dual Epidemics of COVID-19 and Influenza: Vaccine Acceptance, Coverage, and Mandates. JAMA. 2020; 324(4):335-336. DOI: 10.1001/jama.2020.10802. View

15.

Lansbury L, Brown C, Nguyen-Van-Tam J . Influenza in long-term care facilities. Influenza Other Respir Viruses. 2017; 11(5):356-366. PMC: 5596516. DOI: 10.1111/irv.12464. View

16.

Smetana J, Chlibek R, Shaw J, Splino M, Prymula R . Influenza vaccination in the elderly. Hum Vaccin Immunother. 2017; 14(3):540-549. PMC: 5861798. DOI: 10.1080/21645515.2017.1343226. View

17.

Khorramdelazad H, Kazemi M, Najafi A, Keykhaee M, Zolfaghari Emameh R, Falak R . Immunopathological similarities between COVID-19 and influenza: Investigating the consequences of Co-infection. Microb Pathog. 2020; 152:104554. PMC: 7607235. DOI: 10.1016/j.micpath.2020.104554. View

18.

Li C, Su Z, Chen Z, Cao J, Xu F . Trust of healthcare workers in vaccines may enhance the public's willingness to vaccinate. Hum Vaccin Immunother. 2022; 18(7):2158669. PMC: 9891667. DOI: 10.1080/21645515.2022.2158669. View

19.

Ratzan S . Vaccine literacy: a new shot for advancing health. J Health Commun. 2011; 16(3):227-9. DOI: 10.1080/10810730.2011.561726. View

20.

Cadeddu C, Regazzi L, Bonaccorsi G, Rosano A, Unim B, Griebler R . The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019. Int J Environ Res Public Health. 2022; 19(8). PMC: 9029177. DOI: 10.3390/ijerph19084429. View