Elsevier

Public Health

Volume 126, Issue 12, December 2012, Pages 1007-1012
Public Health

Minisymposium
Exploring predictors influencing intended and actual acceptability of the A/H1N1 pandemic vaccine: A cohort study of university students in Hong Kong

https://doi.org/10.1016/j.puhe.2012.09.011Get rights and content

Summary

Objectives

To investigate the factors associated with the uptake of influenza A/H1N1 vaccination by university students, and to examine the relationship between intention and actual vaccination.

Methods

A baseline survey was conducted among students at the Chinese University of Hong Kong in 2009 to collect data on demographics, pandemic risk perceptions and self-reported intention to be vaccinated in the future. A follow-up survey was conducted in 2011 using an online survey platform collecting information on actual vaccine uptake behaviour, and vaccine attitudes, knowledge and perceptions.

Results

Self-reported intention to be vaccinated in 2009 was significantly associated with actual vaccine acceptance. Vaccine perceptions (attitudes and knowledge) were found to be a better predictor of vaccine acceptance than disease risk perceptions. Being a medical or science student and receiving health advice about vaccination from a doctor or school-endorsed advertisement were also found to be predictors of vaccine acceptance.

Conclusions

University students in Hong Kong were wary of the A/H1N1 vaccination campaign, as revealed by their low uptake rate and doubts about the vaccine. Knowledge of the pandemic and vaccine was high in this population, but feelings of susceptibility were low. The results indicate a need to provide tailored messages emphasizing the importance of vaccination and the efficacy of the vaccine in the future.

Introduction

The influenza A/H1N1 pandemic that broke out in Mexico in March 2009 and rapidly spread to Hong Kong by May of the same year1 prompted the Hong Kong Special Administrative Region Government to embark on a vaccination campaign as an important line of defence against the pandemic.2 Approximately 3 million doses of vaccine were purchased to initiate the vaccination scheme, with priority given to risk groups such as healthcare workers and the elderly, before extending it to the general public.3 Such a plan, however, proved to be overly ambitious as the majority of Hong Kong citizens were reluctant to be inoculated. The result was approximately 2 million unused vaccines.3

Previous studies have documented similar failures in vaccination coverage rates around the world following introduction of the novel pandemic influenza H1N1 vaccine.4, 5, 6, 7, 8, 9 Established reasons for refusing vaccination have included concerns about vaccine safety and side-effects, uncertainty about vaccine efficacy, low self-risk perception, and low risk perception of the pandemic.8, 9, 10 Some studies distinguished factors related to intention from those related to actual vaccination.5, 6, 11 For example, various results suggest that the intention to be vaccinated depends largely on perceived susceptibility to influenza A/H1N1 and beliefs about the severity of the disease,6, 11, 12 whereas actual vaccination is more significantly determined by perceived benefits of the vaccine, perceived barriers to being vaccinated, and cues to action such as a doctor's recommendation.13 Uncertainties associated with a novel vaccine include expedited development, lack of adequate trials, and reported side-effects that hinder people from accepting the vaccine as a safe and effective means of protection.2

Other cited barriers to vaccination include cost sensitivities,6 accessibility,14 and scepticism towards media and government messages about the disease. Studies showed that people were more trustful of vaccination recommendations from their doctors than from the media or the Government, and that the apprehension of the public towards these channels of communication may be a result of a dissonance caused by competing information on the severity of the disease and the safety of the vaccine.11

A gap exists in the literature regarding the relationship, if any, between the intention to be vaccinated and actual vaccination. In addition, a plethora of research exists on vaccination intentions and uptake behaviour of the generally accepted ‘high-risk’ groups such as the elderly,3 healthy workers,15, 16 pregnant women and infants,2 but research is lacking with regards to other groups, such as students. In fact, the majority of previous research has failed to recognize the university student population as an important group. University students, although young, generally healthy and more resistant to disease than other groups, are potentially a high-risk group in community outbreaks of infectious disease.17 Close proximity and long exposure of social contacts in closed classrooms and dormitories, and the effectiveness by which viruses are transmitted in these circumstances make universities a probable place for outbreaks.7, 18 Students who do not live on campus may go on to spread the disease in their larger communities, infecting a much greater population.17 Students can also be effective agents of change within their communities. Educated and influential students can help to persuade others to follow recommended preventative measures if they trust them. This is important for future pandemic preparedness; government officials, as well as academic institutions, would be well advised to investigate vaccination uptake by university students as a means to minimize future risks of influenza outbreaks in the institutions and their surrounding communities.

A one-size-fits-all vaccination campaign may be ineffective if it does not consider the diversity in knowledge, attitudes and practices of all members of a community. This study aimed to gain a better understanding of the factors that influenced Hong Kong university students to accept or reject the A/H1N1 vaccine in light of a recent pandemic by examining the factors associated with vaccination intentions and actual behaviours in a group of 749 university students.

Section snippets

Participants

The study population consisted of first-year university students from all disciplines at the Chinese University of Hong Kong. All registered first-year full-time students were invited to participate in the baseline survey in August 2009, and each student was asked to complete a health survey. This study was approved by the Clinical Research Ethical Committee at the Chinese University of Hong Kong, and written consent was obtained from each participant.

Data collection

The baseline survey included a

Description of the cohort

Out of 3322 registered full-time first-year students, 782 completed the 2009 questionnaire (response rate 23.5%); however, only 749 of these participants were contacted in 2011 due to missing contact information. In total, 330 students completed the 2011 questionnaire (follow-up rate 44.1%, 330/749). Characteristics of the cohort are described in Table 1. No significant differences were found between respondents, non-respondents and baseline participants.

Vaccination outcome

Out of 330 students who completed the

Discussion

This study examined the factors associated with the uptake of influenza A/H1N1 vaccine by university students using a prospective cohort study design. Information on intention, pandemic risk perceptions, vaccine uptake behaviour, and vaccine attitudes, knowledge and perceptions was collected in 2009 and 2011. It was found that beliefs of low risk and susceptibility from influenza A/H1N1 and low knowledge combined with high risk perceptions of the A/H1N1 vaccine inhibited vaccine uptake.

Acknowledgements

The authors would like to thank the staff at the University Health Service of The Chinese University of Hong Kong for their help and support in collecting data.

Ethical approval

This study was approved by the Clinical Research Ethical Committee at The Chinese University of Hong Kong, and written consent was obtained from each student.

Funding

None declared.

Competing interests

None declared.

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