Next Article in Journal
Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States
Previous Article in Journal
A Single-Dose Intramuscular Immunization of Pigs with Lipid Nanoparticle DNA Vaccines Based on the Hemagglutinin Antigen Confers Complete Protection against Challenge Infection with the Homologous Influenza Virus Strain
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Hesitance and Misconceptions about the Annual Influenza Vaccine among the Saudi Population Post-COVID-19

Department of Family & Community Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
*
Author to whom correspondence should be addressed.
Vaccines 2023, 11(10), 1595; https://doi.org/10.3390/vaccines11101595
Submission received: 31 July 2023 / Revised: 3 October 2023 / Accepted: 13 October 2023 / Published: 15 October 2023
(This article belongs to the Section Influenza Virus Vaccines)

Abstract

:
(1) Background: Vaccination is a cornerstone of public health strategy for mitigating the morbidity and mortality associated with seasonal influenza. However, vaccine hesitancy and misconceptions pose significant barriers to this effort, particularly in the context of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the transfer of COVID-19 vaccine hesitancy to the influenza vaccine and to identify misconceptions about the influenza vaccine among the Saudi population in the post-COVID-19 era. (2) Methods: A web-based, cross-sectional study was conducted between February and June 2023 using a questionnaire adapted from the Adult Vaccine Hesitancy Scale (aVHS). The questionnaire was disseminated to 589 Saudi residents, aged 18 and above, with access to digital devices. Data were analyzed via logistic regression analysis to determine the associations between vaccine hesitancy, knowledge of influenza, and baseline characteristics. (3) Results: This study found that 37.7% of respondents exhibited vaccine hesitancy, while 56.7% demonstrated good knowledge about influenza. There was a significant relationship between nationality and vaccine hesitancy (p-value > 0.05), with non-Saudi respondents exhibiting higher hesitancy. Logistic regression analysis revealed significant associations between vaccine hesitancy, age, and nationality. Meanwhile, participants with higher educational qualifications showed greater knowledge about influenza. (4) Conclusions: The findings highlight an important crossover of COVID-19 vaccine hesitancy to influenza vaccines. This study underscores the need for targeted public health interventions to address misconceptions about the influenza vaccine, particularly among certain demographic groups, in order to improve influenza vaccine uptake in the post-COVID era.

1. Introduction

Seasonal influenza, colloquially known as the flu, is a recurring acute respiratory ailment attributed to a spectrum of influenza viruses. It is categorized into four distinct types: A, B, C, and D. Predominantly, types A and B are implicated in annual outbreaks, and they have been substantially associated with seasonal flu morbidity and mortality [1]. Data from the Center for Disease Control and Prevention (CDC) substantiated the rapid transmissibility of the virus, indicating its role in approximately nine million infections and 5000 consequential deaths during the 2021–2022 cycle worldwide [2]. Such a pervasive spread underscores the need for effective prevention measures. To this end, the seasonal influenza vaccine emerged as the most potent preventive measure, providing optimal protection against associated morbidities [1].
However, globally, and notably in regions like Saudi Arabia, there has been discernible reluctance toward vaccine uptake. This hesitancy is augmented by prevailing misconceptions, thus posing a potential health risk to susceptible populations such as pregnant women, the immunocompromised, and the elderly [1]. A myriad of studies from Saudi Arabia and its neighboring Gulf States have identified these barriers and their underlying causes [3,4,5,6,7,8].
The advent of the coronavirus disease 2019 (COVID-19) pandemic in 2020, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), introduced additional complexities in public health messaging concerning vaccinations. With over 760 million confirmed cases globally by 26 April 2023, of which 800,000 were reported in Saudi Arabia, the pandemic, which was declared official by the World Health Organization (WHO) in March 2020, engendered pressing concerns [9,10]. The expeditious development and deployment of COVID-19 vaccines accentuated apprehensions about vaccine safety and efficacy. A 2021 study corroborated these apprehensions by revealing that only 48% of Saudi adults expressed willingness to receive the COVID-19 vaccine [11]. Such hesitancy has significant implications as, given the pivotal role vaccines play in reducing hospitalization and mortality rates, reduced vaccination rates would subsequently increase the economic burdens on healthcare systems. In the recent literature, such as Minshawi et al., there were suggestions that the hesitancy exhibited toward the COVID-19 vaccine might have a spillover effect on attitudes toward the influenza vaccine [12]. Given this context, our study endeavors to elucidate the potential transference of COVID-19 vaccine hesitancy onto the influenza vaccine and to discern the associated misconceptions among the Saudi population in the post-COVID-19 era.

2. Materials and Methods

2.1. Study Design and Sampling Strategy

An anonymous web-based, cross-sectional study was conducted from February 2023 to June 2023. The questionnaire used was adapted from a previously validated questionnaire, the “Adult Vaccine hesitancy scale (aVHS)” [13], and combined with a survey that was utilized in a study approved by an institutional review board of King Fahad Medical City in Riyadh, Saudi Arabia [14], to collect data from a sample of 500 participants in Saudi Arabia. The questionnaire included both open-ended and closed-ended questions. The survey was disseminated through various online platforms and social media channels that are prevalent in Saudi Arabia to ensure a diverse range of respondents. The study did not conduct a separate pilot because the questionnaire was based on previously validated scales, and it was refined with the expertise of the co-authors. The survey was open to all Saudi Arabia residents aged 18 years and above. All adults equipped with cellphones or personal computers had the capability to participate in the survey. Implicit consent was assumed upon participation, with respondents aware that their engagement was entirely voluntary.

2.2. Sample Size and Sampling Technique

In this study, a two-sided test with a 95% confidence interval and a power of 80% was used. Based on previous studies on vaccine hesitancy, it was assumed that the prevalence of vaccine hesitancy in the Saudi population post-COVID would be around 50%. Using these assumptions, the following formula for sample size calculation for a cross-sectional study was used:
n = (Z2 × P × (1 − P))/(d2)
where n is the sample size, Z is the standard normal deviation corresponding to the level of confidence, P is the expected proportion of vaccine hesitancy, and d is the margin of error.
Based on this formula, it was calculated that a sample size of 384 would be needed to achieve a power of 80% with a margin of error of 5%. However, to account for potential non-responses or incomplete surveys, the sample size was increased to 500.
In summary, the sample size of 500 participants was determined based on power analysis, using a two-sided test with a 95% confidence interval and a power of 80% and assuming a prevalence of vaccine hesitancy of 50%. This sample size calculation provided sufficient statistical power to detect meaningful differences and relationships between variables, thus ensuring the validity and reliability of the study findings.

2.3. Study Outcomes and Variables

An online survey was developed using Google Forms to ensure respondent anonymity. This survey was composed of several questions designed to support the primary objectives of the research. Included within the questionnaire were structured queries, specifically those related to participant demographics. An introductory section of the research instrument delineated the aims of the study, reassured respondents of the confidentiality of their submissions, and granted them the autonomy to abstain from responding to specific items or to retract their participation entirely. Moreover, the aims, methodologies, potential risks, and benefits of the investigation were lucidly articulated to the participants. Before participating, respondents confirmed their informed consent. All collected data were securely housed, with exclusive access granted only to the research team, thereby ensuring protection against unauthorized use, access, or dissemination. The principal investigator guaranteed the confidentiality of the data. A few of the close-ended questions examined demographic data, including age, gender, education, and occupation, as well as opinions regarding vaccination, vaccine hesitancy, vaccine effectiveness and safety, and healthcare system trust. Participants were given the opportunity to express their opinions and views about the influenza vaccine, as well as any misconceptions they might have, through the presence of open-ended questions.

2.4. Statistical Analysis

Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS), version 28. Continuous data were represented in terms of the mean and standard deviation, while categorical data were depicted as frequencies and percentages. To assess the data distribution, both the Kolmogorov–Smirnov and Shapiro–Wilk tests were executed. The validity of the scales employed was ascertained by evaluating their Cronbach’s Alpha, which demonstrated high internal consistencies: the Adult Vaccine Hesitancy Scale registered at 0.869, while the Knowledge of Influenza Scale arrived at 0.812. Reliance on the specified cut-off points was based on the original study and detailed as follows:
(A) The Knowledge of Influenza Scale encompassed 12 items. Responses of “Yes” were assigned 1 point, whereas “No” or “Don’t know” received 0, with an exception for questions 9 and 10, where “No” was valued at 1 point and “Yes” or “Don’t know” at 0. Consequently, the peak score achievable was 12. Respondents obtaining scores that exceeded the mean (6.8) were deemed to possess proficient knowledge, while those scoring below this threshold were categorized as having insufficient knowledge [13].
(B) The Adult Vaccine Hesitancy Scale (aVHS) consisted of 10 items with responses ranging on a 5-point Likert scale, from “strongly disagree” (5 points) to “strongly agree” (1 point). However, items 5, 9, and 10 deviated from this scoring pattern. The highest possible score was 50. Participants scoring within the range of 10–24 were classified as “Not exhibiting vaccine hesitancy,” whereas those within the 25–50 range were identified as vaccine-hesitant individuals [14].
For the analysis of variances between vaccine hesitancy, influenza knowledge, and baseline traits, both the Kruskal–Wallis and Mann–Whitney U tests were utilized. To evaluate the correlation between the assessed scales, Kendall’s tau-b test was employed. Furthermore, to pinpoint the factors (independent variables) correlated with a comprehensive understanding of influenza and hesitancy toward the annual influenza vaccine (dependent variables), logistic regression analyses were undertaken in two distinct models (unadjusted and adjusted for all covariates). Statistical significance was determined for p-values that were less than or equal to 0.05.

2.5. Ethical Considerations

The study was approved by the Alfaisal University Institutional Review Board (IRB log no. IRB-20222). It was explicitly clarified at the commencement of the survey that participation was voluntary and that, by proceeding, respondents were providing their implicit consent. The objectives of the study were also explained to the participants beforehand.

2.6. Representation across Demographics

The sample demographics gathered from the survey were contrasted with the demographics of the central region of Saudi Arabia and the nation at large to gauge its representativeness. While there were slight variances, these discrepancies are addressed and acknowledged in the discussion section of the paper, whereby the potential sampling bias inherent to web-based surveys is emphasized.

2.7. Supplementary Materials

Additional data tables supporting the results are available in the Supplementary Materials, and they are referred to as Supplementary Materials in the text.

3. Results

3.1. Baseline Characteristics

The study encompassed 589 responses from Saudi participants. Of these, 57% were female, 62.6% were married, and 37.9% were Saudi nationals. Over half (54.3%) were employed, and the majority (74.5%) did not have chronic diseases. Additional characteristics are presented in Table 1.

3.2. Responses to the aVHS

When asked about vaccine beliefs, 48.6% strongly believed in the essential role of vaccines for personal health, while 49.4% emphasized their importance for community health. However, 34.3% were unsure about the safety of newer vaccines compared to older ones. For a comprehensive breakdown, refer to Table 2.

3.3. Knowledge on Influenza and its Vaccine

Firstly, 89.8% agreed that flu infection is highly contagious, 69.1% granted that flu infection can cause hospital admission if severe, and 60.3% believed that the seasonal influenza vaccine could be given to people with chronic diseases. Moreover, 45.3% did not know if pregnant women should take the vaccine.
Additionally, 62.6% concurred that annual vaccination is the best way to protect from influenza, and 70.6% stated that seasonal vaccination is the best way to avoid complications. Participants who agreed that influenza vaccines are safe and effective were 66.2%, and 45.7% did not agree that seasonal vaccines weaken the immune system.
Furthermore, 55% did not know if the vaccines are recommended for children of more than 6 months of age. However, 52.8% declared that older people (65 years or above) should receive the influenza vaccine (Supplementary Table S1).

3.4. Inclination toward Influenza Vaccination

From our investigation, 34.3% of the subjects reported prior vaccination against influenza. Interestingly, an additional 26.1% expressed intentions to receive the vaccination within the study year. Nonetheless, a significant proportion, 39.6%, displayed reluctance toward the vaccine (Table 3).

3.5. Factors Influencing Influenza Vaccine Uptake

Table 4 shows the barriers to influenza vaccination. Predominantly, the notion of influenza as a benign ailment not necessitating vaccination emerged as the principal deterrent at 22.1%. Subsequent barriers encompassed forgetfulness (16%) and apprehensions about vaccine-associated adverse reactions (14.9%).
Table 5 catalogues the motivations prompting individuals to opt for influenza vaccination. The most prevalent inducements were physician recommendations (15.3%), occupational mandates (11.4%), and endorsements from acquaintances or kin (10%).

3.6. Quantifying the aVHS and Knowledge

As depicted in Supplementary Table S2, the mean score for the Adult Vaccine Hesitancy Scale (aVHS) was determined to be 22.87 out of a possible 50, with a standard deviation of 6.80. Simultaneously, the aggregate knowledge score concerning influenza settled at 6.81 out of a total 12, with a standard deviation of 3.21. Following the evaluation via the aVHS, the data revealed that 37.7% of the participants could be categorized as vaccine-hesitant. When it comes to general influenza awareness, a promising 56.7% showcased commendable knowledge, while 43.3% exhibited inadequate understanding (refer to Supplementary Table S3).

3.7. Correlation of the aVHS with the Participants’ Demographics

A comprehensive analysis was conducted to discern the relationship between the aVHS and the baseline characteristics of the participants. Interestingly, only nationality emerged as a significant predictor of vaccine hesitancy (p-value < 0.05). Specifically, 21.1% of the vaccine-hesitant group were non-Saudi nationals, as opposed to 16.6% being Saudis (Table 6).

3.8. Influenza Knowledge and Its Interplay with Demographic Factors

Analysis revealed that gender, age, marital status, employment status, and the presence of chronic diseases were not significant predictors of knowledge about influenza (all with p-values > 0.05). A noteworthy finding was the evident disparity in knowledge based on nationality: 38% of non-Saudi participants exhibited commendable knowledge, contrasted with 24.1% showcasing inadequate understanding (p-value = 0.004). In comparison, 18.7% of Saudi participants had a good grasp, while 19.2% displayed limited knowledge. Furthermore, the educational background was significantly associated with influenza knowledge (p-value = 0.00056), with the highest knowledge observed among postgraduate participants, followed by undergraduate and master’s degree holders (Table 7).

3.9. Variation in Mean Scores Based on Participant Characteristics

According to Table 8, a significant association was noted between the aVHS and two baseline variables (p-value < 0.05). Specifically, the participants within the 45–60 age bracket displayed superior knowledge, recording a mean score of 24.17 ± 7.01. Conversely, the 18–30 age cohort registered the lowest average score of 21.88 ± 6.96. Non-Saudi participants had a mean aVHS score of 22.08 ± 6.66, which was lower than their Saudi counterparts, who averaged 24.17 ± 6.85.
Upon the evaluation of influenza and vaccine knowledge of it, significant differences were observed across three characteristic variables (p-value< 0.05). Participants holding Ph. D. qualifications exhibited higher knowledge levels, averaging 8.34 ± 3.27, compared to other educational categories. Additionally, respondents without a Kingdom of Saudi Arabia nationality posted higher knowledge scores, averaging 7.28 ± 3.09. Among the employment categories, those currently employed exhibited the highest knowledge levels (Table 9).

3.10. Logistic Regression Analyses

Upon examination of the adjusted odds ratios in Table 10, most baseline characteristics did not exhibit a statistically significant association with the aVHS (p-value > 0.05). However, age proved an exception. Respondents aged 30–45 years exhibited significantly higher odds of vaccine hesitancy relative to the 18–30 age cohort (AOR 2.048, p = 0.036). Similarly, the age bracket of 45–60 years displayed 2.4 times elevated hesitancy odds in comparison with the 18–30 years group (AOR 2.399, p = 0.023). Furthermore, possessing a comprehensive understanding of influenza reduced the likelihood of hesitancy when juxtaposed against those with limited knowledge (AOR = 0.163, p < 0.001)
Table 11 illustrates that vaccine-hesitant respondents have significantly diminished odds of possessing an in-depth understanding of influenza relative to their non-hesitant counterparts (AOR 0.163, p < 0.001).
Table 12 reveals the non-significant relationships between most characteristics and the inclination to receive the vaccine (p > 0.05). However, the participants with chronic diseases demonstrated greater odds of vaccine acceptance (AOR = 3.635, p < 0.05) compared to their healthier peers. Conversely, vaccine-hesitant individuals and those with limited influenza knowledge were less likely to be vaccinated (AOR = 0.174, p < 0.001 and AOR = 5.096, p < 0.001, respectively).
Investigations into the relationships between vaccine hesitancy, knowledge of influenza, and the willingness to receive the influenza vaccine revealed significant correlations, as detailed in Table 13.

4. Discussion

The purpose of this study was to understand and analyze the level of hesitancy toward the influenza vaccine, as well as the myths and misconceptions that have arisen since the emergence of COVID-19. The World Health Organization (WHO) has identified vaccine hesitancy as one of the top ten health threats [15], thus making it crucial to understand and investigate the matter. Overall, we have anticipated a greater hesitancy surrounding the influenza vaccine among Saudi residents than in pre-COVID findings [16]. This is largely due to widespread rumors on various platforms and the pandemic’s impact on residents and their daily routines. Exposure to vaccination criticism and misinformation, often via social media and the Internet, plays a significant role in the crisis of vaccine hesitancy. While many people may not entirely trust the sources of these narratives, exposure to them could elicit emotions and bring about certain doubts and uncertainty [14,17]. However, while exposure to misinformation through social media platforms contributes to vaccine hesitancy, it is worth noting that social media can also serve as a vehicle for accurate information dissemination when used appropriately [18]. Several studies have highlighted the importance of strategic online health campaigns in shaping public perception positively [19,20].
It is important to recognize the different factors that play a role in the knowledge surrounding flu shots. Gender, age, and the presence of chronic disease were all found to be statistically insignificant factors (p-values > 0.05), while education level was found to be statistically significant (p-value = 0.00056). This can be shown by the fact that only 0.5% of respondents who had only completed primary school demonstrated good knowledge surrounding the influenza vaccine. Additionally, 6.3%, 6.6%, 7.5%, 10.2%, and 25.6% demonstrated good vaccine knowledge, with each number representing doctorate, master, high school, undergraduate, and postgraduate levels of education, respectively. Similarly, a study from the American Journal of Infection Control (AJIC) found that the lack of a high school education was one of the strongest predictors of vaccine hesitancy [21]. Another study also found that influenza vaccination rates were higher in adults with a bachelor’s degree or higher (45.1%) than in adults with less than a high school education (34.1%) [22]. Furthermore, participants with a strong knowledge of influenza tend to be 5.096 times more likely to receive the vaccine than those with poor knowledge (p-value = 0.000), which can be seen frequently when approaching vaccine hesitancy [23,24]. Overall, these findings are consistent with the available literature, and they suggest that an individual’s educational level is one of the strongest factors that can affect vaccine knowledge, which can thus impact a patient’s willingness to take the influenza vaccine. Despite the clear link between education level and vaccine hesitancy, it is essential to consider that the mere acquisition of formal education does not equate to a comprehensive understanding of vaccines. The quality and sources of the information available to the individuals is also relevant [25].
Concurrently, our results show that respondents who had a good knowledge of influenza were less likely to be resistant to the vaccine when compared to those with poor knowledge. Furthermore, the results also show that vaccine-hesitant respondents have an AOR of 0.163 for lower knowledge when compared to those who are not vaccine-hesitant (p-value = 0.000). This was also demonstrated in a study carried out in Austria for vaccine hesitancy, where the most common reason against vaccination was a “lack of specific knowledge” [26].
Varied educational backgrounds were obtained in this study, and it was found that participants with Ph. D. degrees were more knowledgeable than other education level subgroups. A higher degree of study was consistently seen to be associated with a higher agreeability to taking the influenza vaccine [27,28,29,30]. On the other hand, this could also be related to the finding that employed participants scored higher in terms of knowledge than others. A study in the Al-Jouf region in Saudi Arabia yielded comparable results, where employed respondents were more likely to receive the annual influenza vaccination than the unemployed respondents [31].
Further statistical analysis of the results found that respondents aged 30–45 had a hesitancy 2.048 times that of the 18–30 age group. In addition, it was also indicated that people aged 45–60 were 2.4 times more hesitant than those aged 18–30. This trend is also supported by a study conducted in Poland to assess the factors associated with attitudes toward the seasonal influenza vaccine after the COVID-19 pandemic, where the study’s results indicated that the odds of having a positive attitude toward seasonal influenza vaccination significantly increased after 60 years of age. This observation is consistent with the global trends in seasonal influenza vaccination uptake. Moreover, that study’s results reflected that, in the European Union/European Economic Area region, older age groups had a higher vaccination coverage rate compared to the youngest groups [32]. This can be explained by the fact that older individuals are considered a priority group for the seasonal influenza vaccination. Our study confirms that similar trends exist in Saudi Arabia, which is the direct result of the Ministry of Health’s promotion of influenza vaccination for high-priority groups, including the ages of 50 and older, as well as the awareness campaigns that increase this age group’s knowledge of the importance of vaccination [33]. In fact, a study conducted in Riyadh in 2022 showed that respondents who had a difference of being one year older were 1.6 times more likely to get the flu vaccine [23]. However, participants in the 45–60 age range had the greatest knowledge scores, while those in the 18–30 age range had the lowest. This can be compared to a study conducted in the United States that showed that, compared to older age groups, fewer young adults showed positive attitudes toward the influenza vaccine [34]. Yet, some studies have indicated varying reasons for hesitancy across age groups. For instance, younger adults may have concerns regarding vaccine side effects or the immediacy of the perceived threat, while older adults may have developed trust in vaccines over time, based on their prior exposure to vaccination campaigns [35].
As most people are unaware of the importance of the influenza vaccination, it is crucial to understand people’s attitudes toward the influenza vaccine after the COVID-19 pandemic. It was found that those who were vaccine-hesitant were less likely to take the vaccine when compared with non-hesitant respondents (p-value = 0.000). This was commonly seen at the beginning of the emergence of the COVID-19 pandemic, where the efficacy of vaccines was coated with misconceptions about how the vaccines work and the target population of the vaccines [36]. Further analysis revealed that individuals who have had chronic diseases were more willing to take the influenza vaccine than those who did not have any chronic diseases (p-value < 0.05). This could be due to the vaccine being particularly recommended to high-risk individuals rather than healthy adults by the Ministry of Health in Saudi Arabia [33], and these recommendations were issued since infection in these individuals could cause serious health conditions that could end up being fatal.
The majority of the study participants believed vaccines were important for their health. Conversely, only 34.4% of those surveyed said they were vaccinated for influenza. Healthcare workers frequently recognize a discrepancy between intention and action when it comes to individual health. This was evident when the survey responses revealed a moderate negative correlation between vaccine hesitancy and knowledge of influenza, as well as between vaccine hesitancy and a willingness to receive the vaccine (p-value < 0.05). Similar findings were shown in an Italian survey conducted in 2020, where most believed in the vaccine’s importance, yet remained unvaccinated due to the misconceptions and hesitance around it [37]. Out of the 588 responses of our surveyed participants, 386 of them reported that they have not taken the influenza vaccine yet or are not planning on taking it. The most chosen reasons out of the 13 listed ones were “Forgot” (n = 94 [16.0%]) and “I think flu is a simple disease and there is no need to prevent or vaccinate against it” (n = 130 [22.1%]). A study by Alabbad et al., conducted in 2016 in a hospital in Riyadh, showed similar results, where participants believed it “doesn’t have any positive effect or benefits” [16]. Another study conducted post-COVID in Jordan showed that the major reason for avoiding influenza vaccination was because “influenza was not considered as a threat” [12].
Trust in the source of information is an essential aspect that influences vaccine uptake, especially considering how the pandemic brought about extensive misinformation among everyone. This is also seen when surveyed participants were asked the question “Generally, I do what my doctor or healthcare provider recommends about vaccines for me,” where most of the respondents agreed with the statement (n = 506 [86.1%]). This notion is supported by a study that concluded that healthcare professionals are the most trusted source of vaccine-related information [38]. A moderately positive correlation was found between influenza knowledge and a willingness to receive the vaccine (p-value < 0.05). Furthermore, for the individuals who chose to be vaccinated with the influenza vaccine (n = 202 [34.4%]), most of them decided to go for the vaccine because of a doctor’s recommendation (n = 90 [15.3%]). This reinforces the fact that many rely on healthcare professionals to help them make important, life-altering decisions with respect to their health, and this includes vaccine uptake [39,40,41,42]. This was also seen when surveyed participants were asked the question “Generally, I do what my doctor or healthcare provider recommends about vaccines for me,” where most of the respondents agreed with the statement (n = 506 [86.1%]).
Regardless of the positive findings found above, this study nevertheless has certain limitations, such as the cross-sectional design and the online distribution of the questionnaire, which may have limited the representativeness of the study population. The collection of data online could have also introduced selection bias. Moreover, the online format of the survey may limit the study population to only those who have access to the Internet. Additionally, since the study was conducted in the central region of Saudi Arabia, other regions in Saudi Arabia were unfortunately not adequately represented. Furthermore, a particularly small number of respondents were over the age of 60; thus, that age group was not accurately represented.

5. Conclusions

This research identified a marked hesitancy among Saudi residents toward the influenza vaccine, one that was notably influenced by the aftereffects of the COVID-19 pandemic and the spread of misinformation on social media. These findings can furnish healthcare practitioners and policymakers with crucial insights that can be utilized to design strategies that boost vaccination uptake in the region. Public awareness campaigns need intensification, and they need to focus on the influenza vaccine’s safety and efficacy by drawing parallels with the COVID-19 vaccination success. Partnering with influential figures on social media can offer an effective avenue through which to reshape perceptions, given their significant reach to diverse demographics. The trust residents place in healthcare providers also suggests an opportunity. Platforms for these professionals to directly address concerns and queries related to vaccines can enhance public confidence. Concurrently, health authorities must utilize social media adeptly by rolling out informative campaigns, showcasing genuine testimonials, and presenting digestible scientific information to combat myths. To summarize, this study accentuates the necessity of countering vaccine hesitancy and misinformation, especially during pandemics. Adopting these evidence-informed strategies can enhance vaccine acceptance in Saudi Arabia, thereby promoting better health outcomes regionally and globally.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/vaccines11101595/s1. Table S1: The questions of the knowledge of influenza and its vaccine; Table S2: The mean of Adult Vaccine Hesitancy Scale and the knowledge of influenza and its vaccine; Table S3: The categories of Adult Vaccine Hesitancy Scale and the knowledge of influenza and its vaccine.

Author Contributions

B.A.: supervision, data analysis, and writing—review and editing; T.G.: conceptualization, data curation, investigation, methodology, writing—original draft, and writing—review and editing; R.H.: data curation, investigation, and writing—review and editing; L.I.: methodology, validation, and writing—review and editing; Y.E.: data curation, investigation, and writing—review and editing; D.H.: investigation, methodology, and writing—review and editing; Z.A.: data curation, validation, and writing—review and editing; and A.R.Z.Z.: conceptualization, supervision, investigation, writing—original draft, writing—review and editing, and project administration. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Alfaisal University (protocol code IRB-20222 on 14 January 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding authors.

Acknowledgments

We would like to thank the College of Medicine, Alfaisal University, for their support.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Influenza (Seasonal). Available online: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) (accessed on 31 July 2023).
  2. CDC Preliminary In-Season 2021–2022 Flu Burden Estimates. Available online: https://t.cdc.gov/L9PG4 (accessed on 10 September 2023).
  3. Algabbani, A.; AlOmeir, O.; Algabbani, F. Vaccine Hesitancy in the Gulf Cooperation Council Countries. East. Mediterr. Health J. 2023, 29, 402–411. [Google Scholar] [CrossRef]
  4. Alzeer, A.A.; Alfantoukh, L.A.; Theneyan, A.; Bin Eid, F.; Almangour, T.A.; Alshememry, A.K.; Alhossan, A.M. The Influence of Demographics on Influenza Vaccine Awareness and Hesitancy among Adults Visiting Educational Hospital in Saudi Arabia. Saudi Pharm. J. 2021, 29, 188–193. [Google Scholar] [CrossRef]
  5. Mallhi, T.H.; Bokharee, N.; Bukhsh, M.; Khan, Y.H.; Alzarea, A.I.; Khan, F.U.; Khan, S.-U.-D.; Alotaibi, N.H.; Alanazi, A.S.; Butt, M.H.; et al. Evaluation of Knowledge and Barriers of Influenza Vaccine Uptake among University Students in Saudi Arabia; a Cross-Sectional Analysis. PeerJ 2022, 10, e13959. [Google Scholar] [CrossRef] [PubMed]
  6. Minshawi, F.; Samannodi, M.; Alwafi, H.; Assaggaf, H.M.; Almatrafi, M.A.; Salawati, E.; Alsafi, R.; Alharbi, R.A.; Alduais, R.F.; Alrehaili, M.; et al. The Influence of COVID-19 Pandemic on Influenza Immunization in Saudi Arabia: Cross-Sectional Study. J. Multidiscip. Healthc. 2022, 15, 1841–1849. [Google Scholar] [CrossRef] [PubMed]
  7. Sales, I.A.; Syed, W.; Almutairi, M.F.; Al Ruthia, Y. Public Knowledge, Attitudes, and Practices toward Seasonal Influenza Vaccine in Saudi Arabia: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2021, 18, 479. [Google Scholar] [CrossRef] [PubMed]
  8. Hamadah, R.E.; Hussain, A.N.; Alsoghayer, N.A.; Alkhenizan, Z.A.; Alajlan, H.A.; Alkhenizan, A.H. Attitude of Parents towards Seasonal Influenza Vaccination for Children in Saudi Arabia. J. Fam. Med. Prim. Care 2021, 10, 904–909. [Google Scholar] [CrossRef]
  9. WHO. Coronavirus (COVID-19) Dashboard. Available online: https://covid19.who.int (accessed on 31 July 2023).
  10. Coronavirus Disease (COVID-19) Pandemic. Available online: https://www.who.int/europe/emergencies/situations/covid-19 (accessed on 31 July 2023).
  11. Alfageeh, E.I.; Alshareef, N.; Angawi, K.; Alhazmi, F.; Chirwa, G.C. Acceptability of a COVID-19 Vaccine among the Saudi Population. Vaccines 2021, 9, 226. [Google Scholar] [CrossRef]
  12. Zalloum, W.A.; Elayeh, E.R.; Ali, B.A.H.; Zalloum, N. Perception, Knowledge and Attitude towards Influenza Vaccine during COVID-19 Pandemic in Jordanian Population. Eur. J. Integr. Med. 2022, 49, 102100. [Google Scholar] [CrossRef]
  13. Nour, R.; Powell, L.; Alnakhi, W.K.; Mamdouh, H.; Zidoun, Y.; Hussain, H.Y.; Al Suwaidi, H.; Zary, N. Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for Translation and Validation in the World Health Organization Eastern Mediterranean Region. JMIR Res. Protoc. 2022, 11, e36928. [Google Scholar] [CrossRef]
  14. Aljamili, A. Knowledge and Practice toward Seasonal Influenza Vaccine and Its Barriers at the Community Level in Riyadh, Saudi Arabia. J. Fam. Med Prim. Care 2020, 9, 1331. [Google Scholar] [CrossRef]
  15. Ten Health Issues WHO Will Tackle This Year. Available online: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 (accessed on 14 September 2023).
  16. Alabbad, A.A.; Alsaad, A.K.; Al Shaalan, M.A.; Alola, S.; Albanyan, E.A. Prevalence of Influenza Vaccine Hesitancy at a Tertiary Care Hospital in Riyadh, Saudi Arabia. J. Infect. Public Health 2018, 11, 491–499. [Google Scholar] [CrossRef] [PubMed]
  17. Chou, W.-Y.S.; Budenz, A. Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence. Health Commun. 2020, 35, 1718–1722. [Google Scholar] [CrossRef] [PubMed]
  18. Smith, N.; Graham, T. Mapping the Anti-Vaccination Movement on Facebook. Inf. Commun. Soc. 2019, 22, 1310–1327. [Google Scholar] [CrossRef]
  19. Dunn, A.G.; Leask, J.; Zhou, X.; Mandl, K.D.; Coiera, E. Associations Between Exposure to and Expression of Negative Opinions About Human Papillomavirus Vaccines on Social Media: An Observational Study. J. Med. Internet Res. 2015, 17, e144. [Google Scholar] [CrossRef] [PubMed]
  20. Kata, A. Anti-Vaccine Activists, Web 2.0, and the Postmodern Paradigm--an Overview of Tactics and Tropes Used Online by the Anti-Vaccination Movement. Vaccine 2012, 30, 3778–3789. [Google Scholar] [CrossRef]
  21. Lack of High School Education Predicts Vaccine Hesitancy|CIDRAP. Available online: https://www.cidrap.umn.edu/lack-high-school-education-predicts-vaccine-hesitancy (accessed on 10 September 2023).
  22. Abbas, K.M.; Kang, G.J.; Chen, D.; Werre, S.R.; Marathe, A. Demographics, Perceptions, and Socioeconomic Factors Affecting Influenza Vaccination among Adults in the United States. PeerJ 2018, 6, e5171. [Google Scholar] [CrossRef]
  23. Alhatim, N.; Al-Bashaireh, A.M.; Alqudah, O. Knowledge, Attitude, and Practice of Seasonal Influenza and Influenza Vaccine Immunization among People Visiting Primary Healthcare Centers in Riyadh, Saudi Arabia. PLoS ONE 2022, 17, e0266440. [Google Scholar] [CrossRef]
  24. Zhang, J.; While, A.E.; Norman, I.J. Knowledge and Attitudes Regarding Influenza Vaccination among Nurses: A Research Review. Vaccine 2010, 28, 7207–7214. [Google Scholar] [CrossRef] [PubMed]
  25. Brunson, E.K. The Impact of Social Networks on Parents’ Vaccination Decisions. Pediatrics 2013, 131, e1397–e1404. [Google Scholar] [CrossRef]
  26. Sandhofer, M.J.; Robak, O.; Frank, H.; Kulnig, J. Vaccine Hesitancy in Austria: A Cross-Sectional Survey. Wien. Klin. Wochenschr. 2017, 129, 59–64. [Google Scholar] [CrossRef]
  27. Zhao, M.; Liu, H.; Qu, S.; He, L.; Campy, K.S. Factors Associated with Parental Acceptance of Influenza Vaccination for Their Children: The Evidence from Four Cities of China. Hum. Vaccines Immunother. 2021, 17, 457–464. [Google Scholar] [CrossRef] [PubMed]
  28. Aguolu, O.G.; Willebrand, K.; Elharake, J.A.; Qureshi, H.M.; Kiti, M.C.; Liu, C.Y.; Restrepo Mesa, A.; Nelson, K.; Jenness, S.; Melegaro, A.; et al. Factors Influencing the Decision to Receive Seasonal Influenza Vaccination among US Corporate Non-Healthcare Workers. Hum. Vaccines Immunother. 2022, 18, 2122379. [Google Scholar] [CrossRef] [PubMed]
  29. Mercadante, A.R.; Law, A.V. Will They, or Won’t They? Examining Patients’ Vaccine Intention for Flu and COVID-19 Using the Health Belief Model. Res. Soc. Adm. Pharm. 2021, 17, 1596–1605. [Google Scholar] [CrossRef]
  30. Giacomelli, A.; Galli, M.; Maggi, S.; Noale, M.; Trevisan, C.; Pagani, G.; Antonelli-Incalzi, R.; Molinaro, S.; Bastiani, L.; Cori, L.; et al. Influenza Vaccination Uptake in the General Italian Population during the 2020–2021 Flu Season: Data from the EPICOVID-19 Online Web-Based Survey. Vaccines 2022, 10, 293. [Google Scholar] [CrossRef] [PubMed]
  31. Alzahrani, A.M.; Felix, H.C.; Al-Etesh, N.S. Low Uptake of Seasonal Influenza Vaccination in Al-Jouf Region of Saudi Arabia. Saudi Pharm. J. 2023, 31, 687–691. [Google Scholar] [CrossRef]
  32. Samel-Kowalik, P.; Jankowski, M.; Lisiecka-Biełanowicz, M.; Ostrowska, A.; Gujski, M.; Kobuszewski, B.; Pinkas, J.; Raciborski, F. Factors Associated with Attitudes towards Seasonal Influenza Vaccination in Poland: A Nationwide Cross-Sectional Survey in 2020. Vaccines 2021, 9, 1336. [Google Scholar] [CrossRef]
  33. Ministry Of Health Saudi Arabia. Available online: https://www.moh.gov.sa/en/Pages/Default.aspx (accessed on 10 September 2023).
  34. Lutz, C.S.; Fink, R.V.; Cloud, A.J.; Stevenson, J.; Kim, D.; Fiebelkorn, A.P. Factors Associated with Perceptions of Influenza Vaccine Safety and Effectiveness among Adults, United States, 2017–2018. Vaccine 2020, 38, 1393–1401. [Google Scholar] [CrossRef]
  35. Nguyen, T.; Henningsen, K.H.; Brehaut, J.C.; Hoe, E.; Wilson, K. Acceptance of a Pandemic Influenza Vaccine: A Systematic Review of Surveys of the General Public. Infect. Drug Resist. 2011, 4, 197–207. [Google Scholar] [CrossRef]
  36. Troiano, G.; Nardi, A. Vaccine Hesitancy in the Era of COVID-19. Public Health 2021, 194, 245–251. [Google Scholar] [CrossRef]
  37. Domnich, A.; Cambiaggi, M.; Vasco, A.; Maraniello, L.; Ansaldi, F.; Baldo, V.; Bonanni, P.; Calabrò, G.E.; Costantino, C.; de Waure, C.; et al. Attitudes and Beliefs on Influenza Vaccination during the COVID-19 Pandemic: Results from a Representative Italian Survey. Vaccines 2020, 8, 711. [Google Scholar] [CrossRef]
  38. Goldstein, S.; MacDonald, N.E.; Guirguis, S.; SAGE Working Group on Vaccine Hesitancy. Health Communication and Vaccine Hesitancy. Vaccine 2015, 33, 4212–4214. [Google Scholar] [CrossRef]
  39. Peretti-Watel, P.; Ward, J.K.; Vergelys, C.; Bocquier, A.; Raude, J.; Verger, P. “I Think I Made The Right Decision … I Hope I’m Not Wrong”. Vaccine Hesitancy, Commitment and Trust among Parents of Young Children. Sociol. Health Illn. 2019, 41, 1192–1206. [Google Scholar] [CrossRef] [PubMed]
  40. Ward, J.K.; Peretti-Watel, P.; Bocquier, A.; Seror, V.; Verger, P. Vaccine Hesitancy and Coercion: All Eyes on France. Nat. Immunol. 2019, 20, 1257–1259. [Google Scholar] [CrossRef] [PubMed]
  41. Kharroubi, G.; Cherif, I.; Bouabid, L.; Gharbi, A.; Boukthir, A.; Ben Alaya, N.; Ben Salah, A.; Bettaieb, J. Influenza Vaccination Knowledge, Attitudes, and Practices among Tunisian Elderly with Chronic Diseases. BMC Geriatr. 2021, 21, 700. [Google Scholar] [CrossRef] [PubMed]
  42. Prada-García, C.; Fernández-Espinilla, V.; Hernán-García, C.; Sanz-Muñoz, I.; Martínez-Olmos, J.; Eiros, J.M.; Castrodeza-Sanz, J. Attitudes, Perceptions and Practices of Influenza Vaccination in the Adult Population: Results of a Cross-Sectional Survey in Spain. Int. J. Environ. Res. Public Health 2022, 19, 11139. [Google Scholar] [CrossRef] [PubMed]
Table 1. The baseline characteristics of the participants.
Table 1. The baseline characteristics of the participants.
FrequencyPercentage (%)
GenderMale25343.0%
Female33657.0%
Age18–3021736.8%
30–4521135.8%
45–6013923.6%
60<223.7%
Education LevelPrimary School91.5%
High School8113.8%
Undergraduate9416.0%
Postgraduate30151.1%
Master579.7%
Doctorate478.0%
NationalityNon-Saudi36662.1%
Saudi22337.9%
Marital StatusSingle22037.4%
Married36962.6%
EmploymentUnemployed23139.2%
Looking for a Job233.9%
Employed32054.3%
Retired152.5%
Presence of Chronic DiseaseNo43974.5%
Yes15025.5%
Table 2. The aVHS questions.
Table 2. The aVHS questions.
FrequencyPercentage (%)
1. Vaccines are important for my healthStrongly Disagree162.7%
Somewhat Disagree132.2%
Undecided7112.1%
Somewhat Agree20334.5%
Strongly Agree28648.6%
2. Vaccines are effectiveStrongly Disagree81.4%
Somewhat Disagree254.2%
Undecided8314.1%
Somewhat Agree24741.9%
Strongly Agree22638.4%
3. Being vaccinated is important for the health of others in my communityStrongly Disagree101.7%
Somewhat Disagree193.2%
Undecided6010.2%
Somewhat Agree20935.5%
Strongly Agree29149.4%
4. All routine vaccinations recommended by the government are beneficialStrongly Disagree122.0%
Somewhat Disagree355.9%
Undecided9315.8%
Somewhat Agree21135.8%
Strongly Agree23840.4%
5. New vaccines carry more risks than older vaccinesStrongly Disagree396.6%
Somewhat Disagree10117.1%
Undecided20234.3%
Somewhat Agree15225.8%
Strongly Agree9516.1%
6. The information I receive about vaccines from the government is reliable and trustworthyStrongly Disagree132.2%
Somewhat Disagree274.6%
Undecided9816.6%
Somewhat Agree22938.9%
Strongly Agree22237.7%
7. Getting vaccines is a good way to protect me from diseaseStrongly Disagree81.4%
Somewhat Disagree172.9%
Undecided7412.6%
Somewhat Agree22337.9%
Strongly Agree26745.3%
8. Generally, I do what my doctor or healthcare provider recommends about vaccines for meStrongly Disagree111.9%
Somewhat Disagree172.9%
Undecided549.2%
Somewhat Agree25843.8%
Strongly Agree24942.3%
9. I am concerned about the serious adverse effects of vaccinesStrongly Disagree244.1%
Somewhat Disagree7212.2%
Undecided11920.2%
Somewhat Agree20935.5%
Strongly Agree16528.0%
10. I do not need vaccines for diseases that are not common anymoreStrongly Disagree7312.4%
Somewhat Disagree14725.0%
Undecided12020.4%
Somewhat Agree15726.7%
Strongly Agree9215.6%
Table 3. The willingness to receive the influenza vaccine.
Table 3. The willingness to receive the influenza vaccine.
FrequencyPercentage (%)
Willingness to Receive the Influenza VaccineI am not planning to take the vaccine23339.6%
I am planning to take the vaccine this year15426.1%
I have been vaccinated with the influenza vaccine20234.3%
Table 4. Barriers for influenza vaccination.
Table 4. Barriers for influenza vaccination.
Reasons Why the Respondents Did Not Receive the Influenza VaccineFrequencyPercentage (%)
I don’t know where to go and get vaccinated345.8%
Forgot9416.0%
I avoid medications6210.5%
I do not believe that the vaccine is effective498.3%
I think the flu is a simple disease and there is no need to prevent or vaccinate against it13022.1%
The risk of acquiring the disease is low417.0%
Fear of injection284.8%
The Ministry of Health has not made vaccination obligatory5910.0%
The flu shot will make me sick335.6%
I am concerned about the side effects8814.9%
I do not think that I belong to a group that vaccination is recommended for437.3%
I had a bad experience with the previous flu vaccine244.1%
I do not believe that the vaccine is safe305.1%
Table 5. Reasons for influenza vaccination.
Table 5. Reasons for influenza vaccination.
I Have Been Vaccinated Because…FrequencyPercentage (%)
It was recommended by family/friend5910.0%
It was a job demand6711.4%
It was recommended by a doctor9015.3%
It was a Hajj requirement183.1%
It was because of a media campaign183.1%
Table 6. The Adult Vaccine Hesitancy Scale based on the baseline characteristics of the participants.
Table 6. The Adult Vaccine Hesitancy Scale based on the baseline characteristics of the participants.
Adult Vaccine Hesitancy Scale Categories
Non-Vaccine-HesitantVaccine-Hesitantp-Value
FrequencyPercentage (%)FrequencyPercentage (%)
GenderMale16728.4%8614.6%0.107964
Female20034.0%13623.1%
Age18–3014925.3%6811.5%0.084950
30–4512621.4%8514.4%
45–607813.2%6110.4%
60<142.4%81.4%
Education LevelPrimary School40.7%50.8%0.349932
High School579.7%244.1%
Undergraduate6210.5%325.4%
Postgraduate17830.2%12320.9%
Master355.9%223.7%
Doctorate315.3%162.7%
NationalityNon-Saudi24241.1%12421.1%0.014477
Saudi12521.2%9816.6%
Marital StatusSingle14224.1%7813.2%0.387142
Married22538.2%14424.4%
EmploymentUnemployed15025.5%8113.8%0.070265
Looking for a Job122.0%111.9%
Employed20034.0%12020.4%
Retired50.8%101.7%
Presence of Chronic DiseaseNo27546.7%16427.8%0.775175
Yes9215.6%589.8%
Table 7. The knowledge of influenza and its vaccine based on the baseline characteristics of the participants.
Table 7. The knowledge of influenza and its vaccine based on the baseline characteristics of the participants.
Knowledge of Influenza Categories
PoorGoodp-Value
FrequencyPercentage %FrequencyPercentage %
GenderMale10217.3%15125.6%0.205680
Female15326.0%18331.1%
Age18–309115.4%12621.4%0.559287
30–458915.1%12220.7%
45–606711.4%7212.2%
60<81.4%142.4%
Education LevelPrimary School61.0%30.5%0.000561
High School376.3%447.5%
Undergraduate345.8%6010.2%
Postgraduate15025.5%15125.6%
Master183.1%396.6%
Doctorate101.7%376.3%
NationalityNon-Saudi14224.1%22438.0%0.004784
Saudi11319.2%11018.7%
Marital StatusSingle9416.0%12621.4%0.830366
Married16127.3%20835.3%
EmploymentUnemployed10918.5%12220.7%0.079765
Looking for a Job101.7%132.2%
Employed12621.4%19432.9%
Retired101.7%50.8%
Presence of Chronic DiseaseNo19232.6%24741.9%0.711077
Yes6310.7%8714.8%
Table 8. The difference between the mean of the Adult Vaccine Hesitancy Scale based on the baseline characteristics of the participants.
Table 8. The difference between the mean of the Adult Vaccine Hesitancy Scale based on the baseline characteristics of the participants.
Adult Vaccine Hesitancy Scale
MeanStandard Deviationp-Value
GenderMale22.796.960.503211
Female22.936.69
Age18–3021.886.960.008589
30–4523.006.12
45–6024.177.01
60<23.148.90
Education LevelPrimary School26.448.780.474148
High School22.076.36
Undergraduate22.467.72
Postgraduate23.106.56
Master23.097.03
Doctorate22.666.48
NationalityNon-Saudi22.086.660.000143
Saudi24.176.85
Marital StatusSingle22.487.030.138581
Married23.116.66
EmploymentUnemployed22.496.800.073707
Looking for a Job23.785.77
Employed22.876.75
Retired27.278.28
Presence of Chronic DiseaseNo22.596.530.259970
Yes23.697.50
Table 9. The difference between the mean of the Knowledge of Influenza Scale and its vaccine based on the baseline characteristics of the participants.
Table 9. The difference between the mean of the Knowledge of Influenza Scale and its vaccine based on the baseline characteristics of the participants.
Knowledge of Influenza
MeanStandard Deviationp-Value
GenderMale7.013.310.127296
Female6.673.13
Age18–306.882.880.631531
30–456.823.37
45–606.603.32
60<7.413.94
Education LevelPrimary School5.442.240.000279
High School6.752.86
Undergraduate7.042.89
Postgraduate6.413.30
Master7.653.29
Doctorate8.343.27
NationalityNon-Saudi7.283.090.000015
Saudi6.053.26
Marital StatusSingle6.803.000.787038
Married6.833.33
EmploymentUnemployed6.482.960.003566
Looking for a Job6.703.11
Employed7.173.32
Retired4.673.33
Presence of Chronic
Disease
No6.733.180.258909
Yes7.053.28
Table 10. Binary logistic regression between the baseline characteristics of the study population and the Adult Vaccine Hesitancy Scale.
Table 10. Binary logistic regression between the baseline characteristics of the study population and the Adult Vaccine Hesitancy Scale.
Adult Vaccine Hesitancy Scale
Confidence Interval 95% Confidence Interval 95%
p-ValueCORLowerUpperp-ValueAORLowerUpper
GenderMaleRef.Ref.
Female0.1081.3200.9411.8540.0911.4310.9452.169
Age18–300.087Ref.0.135Ref.
30–450.0541.4780.9932.2000.0362.0481.0503.994
45–600.0171.7141.1032.6630.0232.3991.1265.114
60<0.6301.2520.5023.1260.2522.0810.5947.295
Education LevelPrimary School0.359Ref.0.397Ref.
High School0.1270.3370.0831.3640.2430.4060.0901.845
Undergraduate0.2100.4130.1041.6450.8440.8590.1903.896
Postgraduate0.3840.5530.1462.1000.6070.6820.1582.939
Master0.3420.5030.1222.0780.8580.8660.1794.192
Doctorate0.2310.4130.0971.7540.8070.8160.1604.167
NationalityNon-SaudiRef.Ref.
Saudi0.0151.5301.0872.1530.1371.3660.9062.058
Marital StatusSingleRef.Ref.
Married0.3871.1650.8241.6480.2440.6880.3661.291
EmploymentUnemployed0.092Ref.0.340Ref.
Looking for a Job0.2291.698.7174.0180.1662.0290.7465.517
Employed0.5581.111.7811.5810.6021.1420.6931.883
Retired0.0203.7041.22411.2050.1932.4340.6379.301
Presence of Chronic DiseaseNoRef.Ref.
Yes0.7751.0570.7221.5480.8030.9430.5951.495
Knowledge of Influenza CategoriesPoorRef.Ref.
Good0.0000.1680.1160.2420.0000.1630.1110.241
The derived logistic regression model was found to be statistically significant, as indicated by an X2 (16) = 122.53 with a p-value < 0.001. The Hosmer–Lemeshow test yielded a result of 12.14 with a p-value = 0.144718. The model’s efficacy in explaining the variance in the Adult Vaccine Hesitancy Scale was estimated at 25.6%, as gauged by the Nagelkerke R Square.
Table 11. Binary logistic regression of the baseline characteristics vs. influenza knowledge.
Table 11. Binary logistic regression of the baseline characteristics vs. influenza knowledge.
Knowledge of Influenza and Its Vaccine
Confidence Interval 95% Confidence Interval 95%
p-ValueCORLowerUpperp-ValueAORLowerUpper
GenderMaleRef.Ref.
Female0.2060.8080.5811.1240.9720.9930.6631.486
Age18–300.561Ref.0.638Ref.
30–450.9590.9900.6741.4530.9110.9640.5041.843
45–600.2460.7760.5061.1910.3270.6880.3261.453
60<0.6141.2640.5093.1380.7970.8500.2462.939
Education LevelPrimary School0.001Ref.0.004Ref.
High School0.2432.3780.55610.1720.5551.6090.3327.805
Undergraduate0.0883.5290.82915.0220.2662.4620.50312.043
Postgraduate0.3292.0130.4948.1990.7431.2950.2766.075
Master0.0544.3330.97319.3080.2002.9510.56315.464
Doctorate0.0117.4001.56734.9350.0645.1250.91028.872
NationalityNon-SaudiRef.Ref.
Saudi0.0051.6201.1582.2680.0830.7000.4681.048
Marital StatusSingleRef.Ref.
Married0.8301.0380.7411.4540.9471.0210.5541.880
EmploymentUnemployed0.089Ref.0.246Ref.
Looking for a Job0.7341.1610.4902.7560.2311.8260.6824.890
Employed0.0681.3760.9771.9370.0571.6060.9862.615
Retired0.1530.4470.1481.3480.5611.4820.3935.586
Presence of Chronic DiseaseNoRef.Ref.
Yes0.7110.9320.6401.3560.8730.9630.6081.526
Adult Vaccine Hesitancy ScaleNon-Vaccine-HesitantRef.Ref.
Vaccine-Hesitant0.0000.1680.1160.2420.0000.1630.1110.240
The logistic regression model was statistically significant, with an X2 (16) = 131.27 and a p-value < 0.001. Hosmer–Lemeshow test: 8.663781 (p-value = 0.37). The model explained 26.8% (Nagelkerke R Square) of the Knowledge of Influenza Scale.
Table 12. Binary logistic regression between the baseline characteristics of the study population and the willingness to receive the vaccine.
Table 12. Binary logistic regression between the baseline characteristics of the study population and the willingness to receive the vaccine.
Willingness to Receive the Vaccine
Confidence Interval 95% Confidence Interval 95%
p-ValueCORLowerUpperp-ValueAORLowerUpper
GenderMaleRef.Ref.
Female0.3870.8630.6171.2060.1401.4060.8952.211
Age18–300.643Ref.0.569Ref.
30–450.2961.2300.8351.8120.6320.8330.3931.764
45–600.5971.1240.7291.7340.2130.5810.2481.365
60<0.3401.5770.6184.0240.4350.5730.1412.324
Education LevelPrimary School0.115Ref.0.871Ref.
High School0.5751.4860.3725.9420.7511.2960.2626.416
Undergraduate0.2902.1070.5308.3730.4171.9440.3919.664
Postgraduate0.4181.7360.4576.5940.4571.8000.3828.477
Master0.2082.5000.60110.3990.5611.6530.3048.980
Doctorate0.0624.0910.93317.9360.4132.1150.35212.727
NationalityNon-SaudiRef.Ref.
Saudi0.0041.6551.1782.3230.2080.7490.4771.175
Marital StatusSingleRef.Ref.
Married0.0370.6970.4960.9790.0851.8630.9193.780
EmploymentUnemployed0.011Ref.0.270Ref.
Looking for a job0.2950.6300.2651.4950.3590.5960.1971.803
Employed0.0071.6071.1352.2760.1521.4940.8632.587
Retired0.5330.7170.2522.0410.4361.7570.4257.267
Presence of Chronic DiseaseNoRef.Ref.
Yes0.0000.4250.2810.6420.0003.6352.0746.369
Adult Vaccine Hesitancy ScaleNon-Vaccine-HesitantRef.Ref.
Vaccine-Hesitant0.0000.1350.0930.1970.0000.1740.1120.271
Knowledge of Influenza CategoriesPoorRef.Ref.
Good0.0007.4335.12610.7770.0005.0963.3107.846
The derived logistic regression model was statistically robust, with an χ2 (17) = 226.04 and a p < 0.001. The Hosmer–Lemeshow test produced a value of 9.64 with a p-value of 0.29. This model elucidated on 43.1% of the variation in terms of willingness to receive the vaccine, as indicated by the Nagelkerke R Square.
Table 13. Kendall’s tau-b correlation between vaccine hesitancy, knowledge of influenza and its vaccine, and the willingness to receive the influenza vaccine.
Table 13. Kendall’s tau-b correlation between vaccine hesitancy, knowledge of influenza and its vaccine, and the willingness to receive the influenza vaccine.
Adult Vaccine Hesitancy Scale CategoriesKnowledge of Influenza CategoriesWillingness to Receive the Vaccine or Have Already Received it
Kendall’s tau-bAdult Vaccine Hesitancy Scale CategoriesCorrelation Coefficient1.000−0.409 **−0.453 **
p-value 0.0000.000
Knowledge of Influenza CategoriesCorrelation Coefficient−0.409 **1.0000.456 **
p-value0.000 0.000
Willingness to Receive the Vaccine or Have Already Received itCorrelation Coefficient−0.453 **0.456 **1.000
p-value0.0000.000
** Indicates that the correlation is statistically significant at the 0.01 level (two-tailed).
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Alghalyini, B.; Garatli, T.; Hamoor, R.; Ibrahim, L.; Elmehallawy, Y.; Hamze, D.; Abbara, Z.; Zaidi, A.R.Z. Hesitance and Misconceptions about the Annual Influenza Vaccine among the Saudi Population Post-COVID-19. Vaccines 2023, 11, 1595. https://doi.org/10.3390/vaccines11101595

AMA Style

Alghalyini B, Garatli T, Hamoor R, Ibrahim L, Elmehallawy Y, Hamze D, Abbara Z, Zaidi ARZ. Hesitance and Misconceptions about the Annual Influenza Vaccine among the Saudi Population Post-COVID-19. Vaccines. 2023; 11(10):1595. https://doi.org/10.3390/vaccines11101595

Chicago/Turabian Style

Alghalyini, Baraa, Tala Garatli, Reela Hamoor, Linda Ibrahim, Yara Elmehallawy, Dima Hamze, Zain Abbara, and Abdul Rehman Zia Zaidi. 2023. "Hesitance and Misconceptions about the Annual Influenza Vaccine among the Saudi Population Post-COVID-19" Vaccines 11, no. 10: 1595. https://doi.org/10.3390/vaccines11101595

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop