Health Care for Women International
ISSN: 0739-9332 (Print) 1096-4665 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcw20
Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women Hee Sun Kang, Jennie C. De Gagne & Jung-Hee Kim To cite this article: Hee Sun Kang, Jennie C. De Gagne & Jung-Hee Kim (2015) Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women, Health Care for Women International, 36:9, 1026-1038, DOI: 10.1080/07399332.2014.942903 To link to this article: http://dx.doi.org/10.1080/07399332.2014.942903
Accepted author version posted online: 25 Jul 2014. Published online: 26 Sep 2014. Submit your article to this journal
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Date: 05 November 2015, At: 20:20
Health Care for Women International, 36:1026–1038, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399332.2014.942903
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Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women HEE SUN KANG Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
JENNIE C. DE GAGNE Duke University School of Nursing, Durham, North Carolina, USA
JUNG-HEE KIM Department of Nursing, Dankook University, Cheonan, South Korea
Following our study of attitudes, barriers, and intentions concerning the influenza vaccination among pregnant women in South Korea, we discovered that women displaying a more positive attitude toward the influenza vaccination were more likely to receive it during their pregnancy. We also found that attitudes toward vaccination were more positive among vaccinated pregnant women than among those who were unvaccinated. Furthermore, women showed a greater intention to get vaccinated if a clinician, rather than friends, recommended it. The major perceived barriers to receiving an influenza vaccination were being pregnant, fearing harm to the baby, feeling healthy, and thinking it is unnecessary. Pregnant women tend to have low influenza vaccination rates in many countries, despite pregnant women’s high risk of influenza and the benefit of vaccination for both mothers and fetuses. Delineating factors such as attitudes, barriers, and intentions in regard to the influenza vaccination have the potential to increase influenza vaccination rates in pregnant women. Pregnant women were found to be at a high risk of complications due to the influenza A (H1N1) virus, which was identified in 2009 (Siston et al., 2010). During the 2009–2010 influenza season, therefore, the H1N1 vaccine was recommended for pregnant women (Chlibek et al., 2010; National
Received 15 August 2013; accepted 30 May 2014. Address correspondence to Jennie C. De Gagne, Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710, USA. E-mail: [email protected] 1026
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Center for Immunization and Respiratory Diseases, 2009). In the 2010–2011 influenza season, a trivalent influenza vaccine containing the A H1N1, A H3N2, and B strains was recommended for use (Louie, Wadford, Norman, & Jamieson, 2011), with the assumption that the 2009 H1N1 virus would still be an issue. Researchers have argued, however, that evidence supporting the routine recommendation of the trivalent inactivated influenza vaccine for all pregnant women is insufficient (Skowronski & De Serres, 2009). Nevertheless, the inactivated influenza vaccine has repeatedly been shown to be safe (Lim et al., 2010; Moro et al., 2011; Tamma et al., 2009) and effective in both pregnant women (Zaman et al., 2008) and infants aged 6 months and younger (Benowitz, Esposito, Gracey, Shapiro, & V´azquez, 2010; Eick et al., 2011; Song et al., 2011; Zaman et al., 2008). Despite the potential benefit of the influenza vaccination for pregnant women, low vaccination rates have been reported around the world. The percentage of pregnant women who received the 2009 H1N1-specific influenza vaccine was 8.9% in Turkey (Ozer, Arikan, Kirecci, & Ekerbicer, 2010); 22.7% in France (Bone, Guthmann, Nicolau, & L´evy-Bruhl, 2010); 47.2% in Canada (Gilmour & Hofmann, 2010); and 46.6% in 10 U.S. states (Centers for Disease Control and Prevention [CDC], 2010). In Korea, only 23.3% of pregnant Korean women received the influenza A vaccine during the 2009–2010 influenza season (Kwon, Cho, Lee, Bae, & Lee, 2011). Influenza may be a burden on infected pregnant women as well as on the family and society by increasing medical costs and decreasing economic productivity (Dodds et al., 2007; Martin et al., 2013; Peasah, AzzizBaumgartner, Breese, Meltzer, & Widdowson, 2013). Even though delineating vaccination-related factors may increase influenza vaccination rates in pregnant women, researchers have mainly focused on vaccination rates in health care workers (Hofmann, Ferracin, Marsh, & Dumas, 2006; Music, 2012; Prematunge et al., 2012). Furthermore, studies about factors related to influenza vaccination rates among pregnant women are scarce. Intention is the primary predictive factor regarding vaccination behavior (Dub´e et al., 2012; Rodas et al., 2012), while individuals’ vaccination intentions depend on their attitudes toward influenza vaccinations (Myers & Goodwin, 2011; Tong, Biringer, Ofner-Agostini, Upshur, & McGeer, 2008). It is important, therefore, to understand the intentions and attitudes toward influenza vaccination during pregnancy. In addition, pinpointing the specific barriers that prevent pregnant women from deciding to get the influenza vaccination is essential for promoting better compliance. In this study, we aimed to identify (a) the attitudes and intentions of pregnant women toward the influenza vaccination, (b) the relationships between intentions and attitudes, (c) the group differences in attitudes between vaccinated and unvaccinated women, and (d) perceived barriers of the influenza vaccination.
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METHODS
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Design and Sample This study was a cross-sectional descriptive correlation study with a convenience sample of pregnant women. Using anonymous self-administered questionnaires, data were collected from February to March 2011, from seven government districts across South Korea. The questionnaires were administered before or after a prenatal exam in the clinic or prenatal education classes, after the purpose of the study was explained and written consent obtained. This informed consent assured the participants of confidentiality and anonymity. Using a rigorous standard of a 50–50 chance that the sample would be evenly divided on a question, a 5% sampling error, and a 95% confidence interval, the required sample size for the study was estimated to be 377, while it was 643 with a 99% confidence level (Raosoft, Inc., 2004). In all, 750 pregnant women agreed to participate in this study, and 700 completed questionnaires were analyzed. This research project was approved for human subject participation by a university Institutional Review Board.
Measures Attitudes toward the influenza vaccination. Attitudes toward the influenza vaccination was measured by the 14-item influenza vaccination attitudes scale developed by the researchers, covering three areas: (a) safety concerns (five items); (b) protection and prevention effects (five items); and (c) perceived need (four items). Each item was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), and reverse items were reversely coded, with higher scores indicating a more positive view of influenza vaccination. Cronbach’s alpha was 0.85 overall, and for the subscales it was as follows: 0.86 for safety concerns, 0.80 for protection and prevention effects, and 0.70 for lack of perceived need. We developed a scale for attitudes toward the influenza vaccination based on the literature review and focus group interviews with 40 women who had been pregnant within 2 years. Content validity by using expert raters was established. Validity of the scale was confirmed using confirmatory factor analysis, showing a good fit to the data. Intention to receive the influenza vaccine. Intention to receive the influenza vaccine was measured by a single item rated on a 5-point Likert scale, with a higher score indicating greater intention to receive the influenza vaccine. The degree of impact of significant others (friends, husband, family, clinician, and government) on the woman’s intention to receive the influenza vaccine was measured with five items. These items were rated on a 5-point
Influenza Vaccination
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Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Likert scale, with a higher score indicating a greater impact of influence. Cronbach’s alpha for the study sample was 0.92. Perceived barriers to influenza vaccination. Perceived barriers to influenza vaccination were determined by 20 items developed from a literature review and focus group interviews with 40 women who had been pregnant within 2 years. Each item was recorded as “yes” or “no.” Content and face validity was established by consensus of experts and focus group participants. The reliability test KR-20 was 0.81.
Data Analysis All analyses were performed using SPSS for Windows, version 18.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to summarize the characteristics of the participants, as well as attitudes toward influenza vaccination, intention to receive the influenza vaccine, and barriers to vaccination. Differences in attitudes between the vaccinated and unvaccinated groups were compared by t-tests. Correlation of study variables was analyzed using Pearson’s correlation.
RESULTS Participants’ Characteristics The participants’ ages ranged from 18 to 46 years, with an average age of 31.26 years (SD = 3.89). Among the participants, 19.3% were in their first trimester of pregnancy, 23.1% in their second trimester, and 57.6% in their third trimester. Primigravid women accounted for 59.0% of the respondents, and multigravid women represented 41.0%. With respect to religion, half of the respondents noted a particular religion, with Christianity being the most common (24.6%), followed by Buddhism (14.9%), and Catholicism (10.3%). Most of the participants had completed college (68.6%) or a higher level of education (5.3%). The majority of the participants had not been vaccinated with influenza A (80.7%) or the seasonal influenza vaccine (72.7%) during the 2009–2010 epidemic season, and only 27.9% had received the influenza vaccine during the 2010–2011 influenza season. Only 23.6% of the participants had discussed the influenza vaccine with a clinician during pregnancy, and 19.0% had been recommended influenza vaccination by a clinician during pregnancy. Of the participants, 33.3% wanted to know more about the influenza vaccine. Among women in the unvaccinated group (n = 505), the participants’ average age was 31.30; 17.0% were in their first trimester of pregnancy, 24.8% in their second trimester, and 58.2% in their third trimester. Primigravid women accounted for 59.8%, and most of the participants had completed college (66.9%). The majority of the participants had not been vaccinated
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against the seasonal influenza (90.1%) and influenza A (89.3%) during the 2009–2010 epidemic season. Only 12.3% of the participants had discussed the influenza vaccine with a clinician during their pregnancy, and 7.5% had been recommended influenza vaccination by a clinician during pregnancy; 30.9% wanted to know more about the influenza vaccine.
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Attitudes and Intentions The average score of the participants’ attitudes toward the influenza vaccine was 3.09 (SD = 0.50; see Table 1). Scores were highest for the perceived need (M = 3.34, SD = 0.62), followed by protection and prevention effects (M = 3.14, SD = 0.55), and safety concerns (M = 2.83, SD = 0.75). Items with the most negative attitudes were fear of side effects and fear of harm to the fetus. The average score of participants’ intention to receive influenza vaccination was 3.08 (SD = 0.91) on a possible range of 1 to 5. The intent to receive the influenza vaccine was higher when a clinician had recommended it (M = 3.76, SD = 0.80) than when family members (e.g., parents; M = 3.13, SD = 0.80), husband (M = 3.12, SD = 0.92), government (M = 3.26, SD = 0.85), or a friend (M = 2.93, SD = 0.81) had recommended it.
Relationships Between Intention and Attitudes The intention to receive the influenza vaccine was significantly correlated with the attitudes toward influenza vaccination (r = .468, p < .001). TABLE 1 Attitudes Toward Influenza Vaccination (N = 700) Item
M ± SD
Safety concern Cannot trust∗ Might be harmful to body∗ Has not been widely tested∗ Afraid of the side effects∗ Might be harmful to the fetus∗ Protection and prevention effects Effective for influenza infection Important to protect myself and the baby Worth it to vaccinate Beneficial to mother and baby Help boost baby’s immune system Perceived need It’s bothersome∗ Might get influenza from vaccine∗ Not interested in∗ Do not need∗ Total
2.83 ± 0.75 3.11 ± 0.89 3.01 ± 0.91 2.77 ± 0.95 2.57 ± 0.97 2.71 ± 0.99 3.14 ± 0.55 3.23 ± 0.71 3.21 ± 0.74 3.14 ± 0.69 3.08 ± 0.80 3.05 ± 0.80 3.34 ± 0.62 3.55 ± 0.83 3.44 ± 0.81 3.36 ± 0.84 3.02 ± 0.92 3.09 ± 0.50
∗ Items
were reverse coded.
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Group Difference Those who received the influenza vaccine during their current pregnancy in the 2010–2011 influenza season had more positive attitudes (M = 3.39, SD = 0.48) than those who had not received the influenza vaccine (M = 2.97, SD = 0.45). The mean scores on attitudes significantly differed between the vaccinated and unvaccinated groups (t = −10.668, p
ISSN: 0739-9332 (Print) 1096-4665 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcw20
Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women Hee Sun Kang, Jennie C. De Gagne & Jung-Hee Kim To cite this article: Hee Sun Kang, Jennie C. De Gagne & Jung-Hee Kim (2015) Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women, Health Care for Women International, 36:9, 1026-1038, DOI: 10.1080/07399332.2014.942903 To link to this article: http://dx.doi.org/10.1080/07399332.2014.942903
Accepted author version posted online: 25 Jul 2014. Published online: 26 Sep 2014. Submit your article to this journal
Article views: 77
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=uhcw20 Download by: [University of Nebraska, Lincoln]
Date: 05 November 2015, At: 20:20
Health Care for Women International, 36:1026–1038, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399332.2014.942903
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Attitudes, Intentions, and Barriers Toward Influenza Vaccination Among Pregnant Korean Women HEE SUN KANG Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
JENNIE C. DE GAGNE Duke University School of Nursing, Durham, North Carolina, USA
JUNG-HEE KIM Department of Nursing, Dankook University, Cheonan, South Korea
Following our study of attitudes, barriers, and intentions concerning the influenza vaccination among pregnant women in South Korea, we discovered that women displaying a more positive attitude toward the influenza vaccination were more likely to receive it during their pregnancy. We also found that attitudes toward vaccination were more positive among vaccinated pregnant women than among those who were unvaccinated. Furthermore, women showed a greater intention to get vaccinated if a clinician, rather than friends, recommended it. The major perceived barriers to receiving an influenza vaccination were being pregnant, fearing harm to the baby, feeling healthy, and thinking it is unnecessary. Pregnant women tend to have low influenza vaccination rates in many countries, despite pregnant women’s high risk of influenza and the benefit of vaccination for both mothers and fetuses. Delineating factors such as attitudes, barriers, and intentions in regard to the influenza vaccination have the potential to increase influenza vaccination rates in pregnant women. Pregnant women were found to be at a high risk of complications due to the influenza A (H1N1) virus, which was identified in 2009 (Siston et al., 2010). During the 2009–2010 influenza season, therefore, the H1N1 vaccine was recommended for pregnant women (Chlibek et al., 2010; National
Received 15 August 2013; accepted 30 May 2014. Address correspondence to Jennie C. De Gagne, Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710, USA. E-mail: [email protected] 1026
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Influenza Vaccination
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Center for Immunization and Respiratory Diseases, 2009). In the 2010–2011 influenza season, a trivalent influenza vaccine containing the A H1N1, A H3N2, and B strains was recommended for use (Louie, Wadford, Norman, & Jamieson, 2011), with the assumption that the 2009 H1N1 virus would still be an issue. Researchers have argued, however, that evidence supporting the routine recommendation of the trivalent inactivated influenza vaccine for all pregnant women is insufficient (Skowronski & De Serres, 2009). Nevertheless, the inactivated influenza vaccine has repeatedly been shown to be safe (Lim et al., 2010; Moro et al., 2011; Tamma et al., 2009) and effective in both pregnant women (Zaman et al., 2008) and infants aged 6 months and younger (Benowitz, Esposito, Gracey, Shapiro, & V´azquez, 2010; Eick et al., 2011; Song et al., 2011; Zaman et al., 2008). Despite the potential benefit of the influenza vaccination for pregnant women, low vaccination rates have been reported around the world. The percentage of pregnant women who received the 2009 H1N1-specific influenza vaccine was 8.9% in Turkey (Ozer, Arikan, Kirecci, & Ekerbicer, 2010); 22.7% in France (Bone, Guthmann, Nicolau, & L´evy-Bruhl, 2010); 47.2% in Canada (Gilmour & Hofmann, 2010); and 46.6% in 10 U.S. states (Centers for Disease Control and Prevention [CDC], 2010). In Korea, only 23.3% of pregnant Korean women received the influenza A vaccine during the 2009–2010 influenza season (Kwon, Cho, Lee, Bae, & Lee, 2011). Influenza may be a burden on infected pregnant women as well as on the family and society by increasing medical costs and decreasing economic productivity (Dodds et al., 2007; Martin et al., 2013; Peasah, AzzizBaumgartner, Breese, Meltzer, & Widdowson, 2013). Even though delineating vaccination-related factors may increase influenza vaccination rates in pregnant women, researchers have mainly focused on vaccination rates in health care workers (Hofmann, Ferracin, Marsh, & Dumas, 2006; Music, 2012; Prematunge et al., 2012). Furthermore, studies about factors related to influenza vaccination rates among pregnant women are scarce. Intention is the primary predictive factor regarding vaccination behavior (Dub´e et al., 2012; Rodas et al., 2012), while individuals’ vaccination intentions depend on their attitudes toward influenza vaccinations (Myers & Goodwin, 2011; Tong, Biringer, Ofner-Agostini, Upshur, & McGeer, 2008). It is important, therefore, to understand the intentions and attitudes toward influenza vaccination during pregnancy. In addition, pinpointing the specific barriers that prevent pregnant women from deciding to get the influenza vaccination is essential for promoting better compliance. In this study, we aimed to identify (a) the attitudes and intentions of pregnant women toward the influenza vaccination, (b) the relationships between intentions and attitudes, (c) the group differences in attitudes between vaccinated and unvaccinated women, and (d) perceived barriers of the influenza vaccination.
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H. S. Kang et al.
METHODS
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Design and Sample This study was a cross-sectional descriptive correlation study with a convenience sample of pregnant women. Using anonymous self-administered questionnaires, data were collected from February to March 2011, from seven government districts across South Korea. The questionnaires were administered before or after a prenatal exam in the clinic or prenatal education classes, after the purpose of the study was explained and written consent obtained. This informed consent assured the participants of confidentiality and anonymity. Using a rigorous standard of a 50–50 chance that the sample would be evenly divided on a question, a 5% sampling error, and a 95% confidence interval, the required sample size for the study was estimated to be 377, while it was 643 with a 99% confidence level (Raosoft, Inc., 2004). In all, 750 pregnant women agreed to participate in this study, and 700 completed questionnaires were analyzed. This research project was approved for human subject participation by a university Institutional Review Board.
Measures Attitudes toward the influenza vaccination. Attitudes toward the influenza vaccination was measured by the 14-item influenza vaccination attitudes scale developed by the researchers, covering three areas: (a) safety concerns (five items); (b) protection and prevention effects (five items); and (c) perceived need (four items). Each item was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), and reverse items were reversely coded, with higher scores indicating a more positive view of influenza vaccination. Cronbach’s alpha was 0.85 overall, and for the subscales it was as follows: 0.86 for safety concerns, 0.80 for protection and prevention effects, and 0.70 for lack of perceived need. We developed a scale for attitudes toward the influenza vaccination based on the literature review and focus group interviews with 40 women who had been pregnant within 2 years. Content validity by using expert raters was established. Validity of the scale was confirmed using confirmatory factor analysis, showing a good fit to the data. Intention to receive the influenza vaccine. Intention to receive the influenza vaccine was measured by a single item rated on a 5-point Likert scale, with a higher score indicating greater intention to receive the influenza vaccine. The degree of impact of significant others (friends, husband, family, clinician, and government) on the woman’s intention to receive the influenza vaccine was measured with five items. These items were rated on a 5-point
Influenza Vaccination
1029
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Likert scale, with a higher score indicating a greater impact of influence. Cronbach’s alpha for the study sample was 0.92. Perceived barriers to influenza vaccination. Perceived barriers to influenza vaccination were determined by 20 items developed from a literature review and focus group interviews with 40 women who had been pregnant within 2 years. Each item was recorded as “yes” or “no.” Content and face validity was established by consensus of experts and focus group participants. The reliability test KR-20 was 0.81.
Data Analysis All analyses were performed using SPSS for Windows, version 18.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to summarize the characteristics of the participants, as well as attitudes toward influenza vaccination, intention to receive the influenza vaccine, and barriers to vaccination. Differences in attitudes between the vaccinated and unvaccinated groups were compared by t-tests. Correlation of study variables was analyzed using Pearson’s correlation.
RESULTS Participants’ Characteristics The participants’ ages ranged from 18 to 46 years, with an average age of 31.26 years (SD = 3.89). Among the participants, 19.3% were in their first trimester of pregnancy, 23.1% in their second trimester, and 57.6% in their third trimester. Primigravid women accounted for 59.0% of the respondents, and multigravid women represented 41.0%. With respect to religion, half of the respondents noted a particular religion, with Christianity being the most common (24.6%), followed by Buddhism (14.9%), and Catholicism (10.3%). Most of the participants had completed college (68.6%) or a higher level of education (5.3%). The majority of the participants had not been vaccinated with influenza A (80.7%) or the seasonal influenza vaccine (72.7%) during the 2009–2010 epidemic season, and only 27.9% had received the influenza vaccine during the 2010–2011 influenza season. Only 23.6% of the participants had discussed the influenza vaccine with a clinician during pregnancy, and 19.0% had been recommended influenza vaccination by a clinician during pregnancy. Of the participants, 33.3% wanted to know more about the influenza vaccine. Among women in the unvaccinated group (n = 505), the participants’ average age was 31.30; 17.0% were in their first trimester of pregnancy, 24.8% in their second trimester, and 58.2% in their third trimester. Primigravid women accounted for 59.8%, and most of the participants had completed college (66.9%). The majority of the participants had not been vaccinated
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H. S. Kang et al.
against the seasonal influenza (90.1%) and influenza A (89.3%) during the 2009–2010 epidemic season. Only 12.3% of the participants had discussed the influenza vaccine with a clinician during their pregnancy, and 7.5% had been recommended influenza vaccination by a clinician during pregnancy; 30.9% wanted to know more about the influenza vaccine.
Downloaded by [University of Nebraska, Lincoln] at 20:20 05 November 2015
Attitudes and Intentions The average score of the participants’ attitudes toward the influenza vaccine was 3.09 (SD = 0.50; see Table 1). Scores were highest for the perceived need (M = 3.34, SD = 0.62), followed by protection and prevention effects (M = 3.14, SD = 0.55), and safety concerns (M = 2.83, SD = 0.75). Items with the most negative attitudes were fear of side effects and fear of harm to the fetus. The average score of participants’ intention to receive influenza vaccination was 3.08 (SD = 0.91) on a possible range of 1 to 5. The intent to receive the influenza vaccine was higher when a clinician had recommended it (M = 3.76, SD = 0.80) than when family members (e.g., parents; M = 3.13, SD = 0.80), husband (M = 3.12, SD = 0.92), government (M = 3.26, SD = 0.85), or a friend (M = 2.93, SD = 0.81) had recommended it.
Relationships Between Intention and Attitudes The intention to receive the influenza vaccine was significantly correlated with the attitudes toward influenza vaccination (r = .468, p < .001). TABLE 1 Attitudes Toward Influenza Vaccination (N = 700) Item
M ± SD
Safety concern Cannot trust∗ Might be harmful to body∗ Has not been widely tested∗ Afraid of the side effects∗ Might be harmful to the fetus∗ Protection and prevention effects Effective for influenza infection Important to protect myself and the baby Worth it to vaccinate Beneficial to mother and baby Help boost baby’s immune system Perceived need It’s bothersome∗ Might get influenza from vaccine∗ Not interested in∗ Do not need∗ Total
2.83 ± 0.75 3.11 ± 0.89 3.01 ± 0.91 2.77 ± 0.95 2.57 ± 0.97 2.71 ± 0.99 3.14 ± 0.55 3.23 ± 0.71 3.21 ± 0.74 3.14 ± 0.69 3.08 ± 0.80 3.05 ± 0.80 3.34 ± 0.62 3.55 ± 0.83 3.44 ± 0.81 3.36 ± 0.84 3.02 ± 0.92 3.09 ± 0.50
∗ Items
were reverse coded.
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Group Difference Those who received the influenza vaccine during their current pregnancy in the 2010–2011 influenza season had more positive attitudes (M = 3.39, SD = 0.48) than those who had not received the influenza vaccine (M = 2.97, SD = 0.45). The mean scores on attitudes significantly differed between the vaccinated and unvaccinated groups (t = −10.668, p
