Research Article: Who Participates in Seasonal Influenza Vaccination? Past Behavior Moderates the Prediction of Adherence

Date Published: August 23, 2011

Publisher: SAGE-Hindawi Access to Research

Author(s): Anna Ernsting, Sonia Lippke, Ralf Schwarzer, Michael Schneider.


Background. Vaccination effectively prevents seasonal influenza. To promote vaccination adherence, it is necessary to understand the motivational process that underlies vaccination behavior. This was examined along with the moderating influence of past behavior on intention formation. Methods. German employees (N = 594) completed questionnaires at baseline and at 7-month followup. Regression analyses were conducted for mediation and moderated mediation. Results. Intention at Time 1 mediated the effect of risk perception, and positive and negative outcome expectancies on Time 2 vaccination. Past behavior moderated this effect: there was a mediation effect for risk perception and outcome expectancies only for those individuals who did not participate annually. Conclusions. Risk perception and outcome expectancies influenced intentions to receive vaccination, which in turn predicted participation. Hence, these social-cognitive variables could be targeted in vaccination campaigns to increase intentions. However, vaccination experience affected the formation of intentions and should be accounted for when developing interventions.

Partial Text

Seasonal influenza is one of the most frequent contagious diseases worldwide. Every year the seasonal flu can lead to suffering, illness, or death. Moreover, it causes major societal (e.g., consultations, hospitalization, and deaths) and economic (e.g., absenteeism) problems [1–3]. Annual influenza vaccination is considered the most effective way to prevent the onset of influenza and its complications, and it is officially recommended by the World Health Organization [4] and national institutions [5, 6] amongst others for older adults and individuals working in crowded settings.

The first aim of the study was to identify the social-cognitive processes that determine vaccination behavior. Findings supported the first hypothesis: the higher the risk perception of seasonal influenza is, the more positive outcomes—respectively, the fewer negative outcomes—in conjunction with obtaining a vaccination were reported. As a result of these associations, the vaccination motivation becomes higher, and later participation becomes more likely. The complete mediation effect for risk perception and negative outcome expectancies confirmed their limited influence on vaccination behavior via the formation of intentions. Risk perception and negative outcome expectancies can be seen as rather distal antecedents of intention and might set the stage for a more sophisticated reflection of potential action [12]. Hence, the influence of risk perception and outcome expectancies on health behavior is only indirect. In contrast, the partial mediation effect for positive outcome expectancies revealed that perceived positive consequences of getting a vaccination were of motivational importance but also had a direct effect on behavior performance [18]. Overall intention represented a good predictor for later participation. This leads to the conclusion that interventions targeting risk perception and outcome expectancies may effectively enhance vaccination motivation and subsequent participation. This could be done by providing information about the risk and potential severity of the infection (risk perception). Outcome expectancies could be targeted by discussing their options—no vaccination, preventive, and curative methods—with the respective consequences, for example, data on safety, effectiveness, and putative side effects of the vaccine [38].




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