title: Associations between the prevalence of influenza vaccination and patient's knowledge about antibiotics: a cross-sectional study in the framework of the APRES-project in Austria.
abstract: BACKGROUND
  This study aimed to identify associations between GP patient's knowledge about the spectrum of effectiveness of antibiotics and the probability of vaccination against influenza. The underlying hypothesis was that individuals with an understanding that antibiotics are ineffective against viruses, common colds, and flu were more likely to be vaccinated than persons lacking this knowledge.
  
  
  METHODS
  This cross-sectional study was conducted within the context of the European APRES project in Austria. Between November 2010 and July 2011, patients were recruited from GP practices to complete questionnaires about their knowledge about antibiotics and their influenza vaccination status. Statistical analyses included subgroup analyses and logistic regression models.
  
  
  RESULTS
  Data of 3224 patients was analyzed, demonstrating that patients with better knowledge concerning antibiotics had a significantly higher likelihood of being vaccinated (OR 1.35, CI 95 % 1.18-1.54). While the overall vaccination rate was low (18.6 % in 2009/2010 and 14.0 % in 2010/2011), elderly compared to younger adults (OR 0.06 CI 95 % 0.03-0.13) and healthcare workers (OR 2.24, CI 95 % 1.42-3.54) demonstrated higher likelihood of vaccination. Additionally, female GPs had significantly more vaccinated patients than male GPs (OR 2.90, CI 95 % 1.32-6.40).
  
  
  CONCLUSIONS
  There has been little prior study on the association between a patient's knowledge of the effectiveness spectrum of antibiotics and influenza vaccination status. Given the public health imperative to increase annual prevalence of influenza vaccination, understanding this educational gap can improve specificity in counseling as well as vaccination rates. Ultimately, we found that those with a better knowledge on about antibiotics had a significantly higher likelihood of being vaccinated.
  
  
  CONCLUSIONS
  The results of this study demonstrate that vaccination prevalence is associated with patient's knowledge about antibiotics. It can be concluded that one strategy to improve the overall low vaccination rates for seasonal influenza in Austria would be, particularly for male GPs, to have a specific discussion with patients about these circumstances by focusing on younger patients. Further, public health efforts could supplement in-office strategies to improve this area of health literacy.
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria. kathryn.hoffmann@meduniwien.ac.at.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hoffmann
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. emevanbijnen@gmail.com.
authors.forename: Evelien Me
authors.initials: EM
authors.lastname: van Bijnen
authors.affiliation: Department of Community and Family Medicine, Duke Medical Center, Durham, NC, USA. aaron.george@duke.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: George
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria. ruth.kutalek@meduniwien.ac.at.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kutalek
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria. elena.jirovsky@meduniwien.ac.at.
authors.forename: Elena
authors.initials: E
authors.lastname: Jirovsky
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria. silvia.wojczewski@meduniwien.ac.at.
authors.forename: Silvia
authors.initials: S
authors.lastname: Wojczewski
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria. manfred.maier@meduniwien.ac.at.
authors.forename: Manfred
authors.initials: M
authors.lastname: Maier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001317:Austria; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006282:Health Personnel; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007252:Influenza Vaccines