EVALUATING BARRIERS AND DRIVERS OF INFLUENZA VACCINATION IN HIGH-RISK GROUPS TO OPTIMIZE IMMUNIZATION STRATEGIES

Abstract

Objectives. Identifying barriers and drivers of influenza vaccination among people at increased risk is necessary for optimizing immunization strategies. This study assessed knowledge, attitudes, and practices regarding seasonal influenza vaccination and identified the main factors associated with vaccine acceptance or refusal in the Republic of Moldova.

Methods. A descriptive cross-sectional study was conducted in 2025 within Cohort IV of the Field Epidemiology Training Program–Intermediate (FETP-I). The pragmatic sample included 220 participants purposively selected in seven healthcare institutions in Chișinău municipality, based on the profiles of participating departments and patient lists prepared by primary healthcare physicians. Risk-group eligibility was established before the interview. Self-reported risk characteristics could overlap: 148 people reported chronic diseases, 62 were healthcare workers, 66 were aged 65 years or older, and 23 were pregnant women. Data were collected through face-to-face interviews using a standardized questionnaire.

Results. Among 208 respondents with definitive vaccination status (a “yes” or “no” response), 140 (67.3%) reported having received seasonal influenza vaccination at least once in adulthood and 68 (32.7%) were unvaccinated. Vaccination status was unknown for 12 respondents: 11 did not remember and one declined to answer. Vaccination was highest among healthcare workers (88.5%) and lowest among pregnant women (27.3%). The main barriers were the perception that vaccination was unnecessary (60.3%), fear of adverse events (26.5%), and fear of complications (26.5%). Among 139 vaccinated respondents who reported reasons, 67.6% cited physician recommendation and 56.8% personal decision.

Conclusions. Healthcare workers play an essential role in vaccination decisions. Evidence-based communication and interventions tailored to each priority group are needed, with emphasis on explaining the need for vaccination, addressing fears about adverse events and complications, and strengthening confidence in influenza vaccination.