title: The expected emotional benefits of influenza vaccination strongly affect pre-season intentions and subsequent vaccination among healthcare personnel.
abstract: BACKGROUND
  The relative importance of different attitudes in predicting vaccination among healthcare personnel (HCP) is unclear. We hypothesized that HCP who feel at risk without vaccination or say they would regret not getting vaccinated would be more likely to get vaccinated than HCP who do not expect these emotional benefits.
  
  
  METHODS
  A prospective cohort of 1544 HCP with direct patient care was enrolled from September 18 to December 18, 2010 at Scott & White Healthcare in Texas and Kaiser Permanente Northwest in Oregon and Washington. An Internet-based questionnaire assessed pre-season intention to be vaccinated and included 12 questions on attitudes about vaccination: single-item measures of perceived susceptibility and vaccine effectiveness, 5 items that were summed to form a concerns about vaccine scale, and 5 items summed to form an emotional benefits of vaccination scale. Influenza vaccination status for the 2010-2011 season and for 5 prior seasons was confirmed by medical record extraction.
  
  
  RESULTS
  There were significant differences between vaccinated and unvaccinated HCP on all attitude items; 72% of vaccinated HCP agreed that they "worry less about getting the flu" if vaccinated, compared to only 26% of the unvaccinated (odds ratio=7.4, 95% confidence interval=5.8-9.5). In a multivariate model, the emotional benefits scale was the strongest predictor of 2010-2011 seasonal influenza vaccination, after adjusting for other attitude measures, prior vaccination history, and pre-season intention to be vaccinated. The predictive value of the emotional benefits scale was strongest for HCP with low pre-season intention to be vaccinated, where HCP vaccine receipt was 15% versus 83% for those with low versus high scores on the emotional benefits scale.
  
  
  CONCLUSIONS
  The expected emotional benefits of vaccination strongly affect seasonal influenza vaccination among HCP, even after taking into account other attitudes, pre-season intentions, and prior vaccination history. These attitudes are promising targets for future vaccination campaigns.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. isq8@cdc.gov
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thompson
authors.forename: Manjusha J
authors.initials: MJ
authors.lastname: Gaglani
authors.forename: Allison
authors.initials: A
authors.lastname: Naleway
authors.forename: Sarah
authors.initials: S
authors.lastname: Ball
authors.forename: Emily M
authors.initials: EM
authors.lastname: Henkle
authors.forename: Leslie Z
authors.initials: LZ
authors.lastname: Sokolow
authors.forename: Beth
authors.initials: B
authors.lastname: Brennan
authors.forename: Hong
authors.initials: H
authors.lastname: Zhou
authors.forename: Lydia
authors.initials: L
authors.lastname: Foster
authors.forename: Carla
authors.initials: C
authors.lastname: Black
authors.forename: Erin D
authors.initials: ED
authors.lastname: Kennedy
authors.forename: Sam
authors.initials: S
authors.lastname: Bozeman
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Grohskopf
authors.forename: David K
authors.initials: DK
authors.lastname: Shay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control* / Q000523:psychology*; D020407:Internet; D008297:Male; D008875:Middle Aged; D009922:Oregon; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013781:Texas; D014611:Vaccination / Q000523:psychology*; D014861:Washington; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines