title: Knowledge, attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand.
abstract: BACKGROUND
  In 2009, Thailand recommended pregnant women be prioritized for influenza vaccination. Vaccine uptake among Thai pregnant women is lower than other high-risk groups.
  
  
  METHODS
  During December 2012-April 2013, we conducted a cross-sectional survey of a convenience sample of Thai pregnant women aged ≥ 15 years attending antenatal clinics at public hospitals in 8 of 77 provinces. A self-administered questionnaire covered knowledge, attitudes, and beliefs related to influenza vaccination using the Health Belief Model. We examined factors associated with willingness to be vaccinated using log-binomial regression models.
  
  
  RESULTS
  The survey was completed by 1031 (96%) of 1072 pregnant women approached. A total of 627 (61%) women had heard about influenza vaccine and were included in the analysis, of whom 262 (42%) were willing to be vaccinated, 155 (25%) had received a healthcare provider recommendation for influenza vaccination and 25 (4%) had received the influenza vaccine during the current pregnancy. In unadjusted models, high levels of perceptions of susceptibility (prevalence ratio [PR] 1.5, 95% CI 1.2-2.0), high levels of belief in the benefits of vaccination (PR 2.3, 95% CI 1.7-3.1), moderate (PR 1.7, 95% CI 1.2-2.3) and high (PR 3.4, 95% CI 2.6-4.5) levels of encouragement by others to be vaccinated (i.e., cues to action) were positively associated with willingness to be vaccinated. Moderate (PR 0.5, 95% CI 0.4-0.7) and high levels of (PR 0.5, 95% CI 0.4-0.8) perceived barriers were negatively associated with willingness to be vaccinated. In the final adjusted model, only moderate (PR 1.5, 95% CI 1.1-2.0) and high levels of cues to action (PR 2.7, 95% CI 2.0-3.6) were statistically associated with willingness to be vaccinated.
  
  
  CONCLUSIONS
  Cues to action were associated with willingness to be vaccinated and can be used to inform communication strategies during the vaccine campaign to increase influenza vaccination among Thai pregnant women.
authors: Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors: Darunee
authors: D
authors: Ditsungnoen
authors: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors: Adena
authors: A
authors: Greenbaum
authors: Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors: Prabda
authors: P
authors: Praphasiri
authors: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors: Fatimah S
authors: FS
authors: Dawood
authors: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors: Mark G
authors: MG
authors: Thompson
authors: Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors: Pornsak
authors: P
authors: Yoocharoen
authors: Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors: Kim A
authors: KA
authors: Lindblade
authors: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors: Sonja J
authors: SJ
authors: Olsen
authors: National Vaccine Institute, Ministry of Public Health, Nonthaburi, Thailand. Electronic address: charungm@hotmail.com.
authors: Charung
authors: C
authors: Muangchana
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013785:Thailand; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Pregnant women; Seasonal influenza vaccine; Thailand