Research on Knowledge, Attitudes, and Practices of Influenza Vaccination Among Healthcare Workers in Chongqing, China—Based on Structural Equation Model

BACKGROUND: Influenza is associated with a large number of disease burdens, and it is generally recommended that all healthcare workers (HCWs) get an influenza vaccination. However, the vaccination rates among HCWs are still low. This study aimed to assess HCWs' knowledge, attitude, and practice (KAP) about the influenza vaccine, and by establishing a structural equation model (SEM) to explore the influencing factors of medical personnel's influenza vaccination in Chongqing, China. METHODS: From September to November 2019, we conducted a cross-sectional survey in four sentinel hospitals and four non-sentinel hospitals in Chongqing, China. We calculated knowledge, attitude, and behavior scores for each study participant and assessed the level of knowledge, attitude, and behavior of the medical staff. An SEM was used to evaluate the relationship between latent variables, and the path graph between knowledge, attitude, and behavior was established. RESULTS: A total of 1,412 valid questionnaires were collected in this survey, including four sentinel hospitals (N = 606, 42.92%) and four non-sentinel hospitals (N = 806, 57.08%). Women (N = 1,102, 78.05%) were more than men (N = 310, 21.95%), with an average age of 32.36 ± 7.78 years old and under 30 years old (N = 737, 52.20%), respectively. Nurses (741, 52.48%) were the main subjects, followed by physicians (457, 32.37%). The final SEM model was obtained after the model was modified and adjusted. A bootstrap analysis of path coefficients was carried out on the final model. Knowledge has a direct influence on behavior. The normalized path coefficient is 0.071 (95% CI: 0.002–0.161), and the value of P of the hypothesis test result of the path coefficient is 0.042. The direct influence of knowledge on attitude standardization was 0.175 (95% CI: 0.095–0.281). The direct influence of attitude on practice standardization was 0.818 (95% CI: 0.770–0.862). The indirect effect of knowledge on the standardization of practice through attitude was 0.144 (95% CI: 0.076–0.235). CONCLUSIONS: According to the SEM, there is a direct positive correlation between KAP and the influenza vaccine. The indirect influence of knowledge on the standard of behavior through attitude is about two times as much as the direct influence on behavior, indicating that attitude plays a strong mediating role between knowledge and practice.