Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia

INTRODUCTION: As scientific, media and individual opinions on the need for seasonal influenza vaccination differ, we explored patients’ decisional conflict and perceived physician and social support when making a vaccination choice. MATERIAL AND METHODS: We conducted a survey of patients with previous vaccination experience in a single family medicine office in Split, Croatia. The questionnaire included the Decisional Conflict Scale (DCS), perceived social support, and attitudes and knowledge concerning vaccination. RESULTS: Out of 203 (86%) adult patients with previous vaccination experience, 182 (40.4%) opted to vaccinate in the current season, 98 (48.3%) refused, and 22 (11.3%) were undecided. The median decisional conflict score was highest among those undecided (43.8 out of the maximum 100, interquartile range (IQR) 33.2–52.3), lowest among those opting to vaccinate (17.2, IQR 9.4–26.6), and intermediate among those who refused vaccination (25.0, IQR 17.2–39.1) (p < 0.001, Kruskal-Wallis test and post-hoc Mann-Whitney U tests). The most common self-reported reasons for vaccination were previous vaccination experience (n = 85, 42%) and media information (n = 62, 30%). Those who refused vaccination felt less satisfied with the support they received from their family physician than those who decided to vaccinate (median 6.5 (IQR 0–9) vs. 9 (IQR 5–10) on a scale from 0 to 10), respectively; p = 0.001, Mann-Whitney U test). CONCLUSIONS: Higher decisional conflict of patients who refuse influenza vaccination and those undecided, alongside their perceived low support of the family physician in making that choice, emphasize the importance family doctors play in advising and helping patients make informed decisions about seasonal influenza vaccination.