title: Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study.
abstract: Notwithstanding decades of efforts to increase the uptake of seasonal influenza (flu) vaccination among European healthcare workers (HCWs), the immunisation rates are still unsatisfactory. In order to understand the reasons for the low adherence to flu vaccination, a study was carried out among HCWs of two healthcare organisations in Liguria, a region in northwest Italy.
  
  
  
  A cross-sectional study based on anonymous self-administered web questionnaires was carried out between October 2013 and February 2014. Through univariate and multivariate regression analysis, the study investigated the association between demographic and professional characteristics, knowledge, beliefs and attitudes of the study participants and (i) the seasonal flu vaccination uptake in the 2013/2014 season and (ii) the self-reported number of flu vaccination uptakes in the six consecutive seasons from 2008/2009 to 2013/2014.
  
  
  
  A total of 830 HCWs completed the survey. Factors statistically associated with flu vaccination uptake in the 2013/2014 season were: being a medical doctor and agreeing with the statements 'flu vaccine is safe', 'HCWs have a higher risk of getting flu' and 'HCWs should receive flu vaccination every year'. A barrier to vaccination was the belief that pharmaceutical companies influence decisions about vaccination strategies.
  
  
  
  All the above-mentioned factors, except the last one, were (significantly) associated with the number of flu vaccination uptakes self-reported by the respondents between season 2008/2009 and season 2013/2014. Other significantly associated factors appeared to be level of education, being affected by at least one chronic disease, and agreeing with mandatory flu vaccination in healthcare settings.
  
  
  
  This survey allows us to better understand the determinants of adherence to vaccination as a fundamental preventive strategy against flu among Italian HCWs. These findings should be used to improve and customise any future promotion campaigns to overcome identified barriers to immunisation.
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Occupational Medicine Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Durando
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: C
authors.identifier: 0000-0002-6473-9870
authors.initials: C
authors.lastname: Alicino
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Occupational Medicine Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Dini
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Hygiene Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Barberis
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Bagnasco
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Iudici
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zanini
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Martini
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Occupational Medicine Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Toletone
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Hygiene Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Paganino
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Occupational Medicine Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Massa
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy Hygiene Unit, IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Genoa, Italy.
authors.forename: A
authors.identifier: 0000-0002-2433-9610
authors.initials: A
authors.lastname: Orsi
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Sasso
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D008297:Male; D037141:Mandatory Programs; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012621:Seasons; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Influenza vaccine; Italy; adherence; healthcare workers