Low influenza vaccination rate despite good knowledge on seasonal influenza and its vaccine among Malaysian urban dwellers: A cross-sectional study

Abstract

Objective: To assess knowledge levels regarding seasonal influenza and its vaccine among high-risk Malaysian urban dwellers and identify factors associated with both knowledge acquisition and vaccination behavior.

Methods: This is a cross-sectional study conducted between April-July 2024 in two urban communities in Malaysia. High-risk participants (n=390) including adults ≥65 years or aged 18+ with chronic illnesses, were recruited through convenience sampling from public areas. Knowledge was assessed using a validated 12-item questionnaire (Cronbach's α=0.977), categorized as good (7-12 points) or poor (0-6 points). Primary outcomes included knowledge scores, vaccination uptake rates, and associated demographic and clinical factors. Multivariate logistic regression identified independent predictors of good knowledge and vaccination behavior.

Results: A total of 390 respondents were included in this study The mean age of the respondents were (58.4±12.7) years, and the majority of them were aged 65 or above (113/390, 29.0%), males (212/390, 54.4%), and of Chinese ethnicity (363/390, 93.1%). Though 68.7% (268/390; 95% CI 63.9%-73.2%) demonstrated good influenza knowledge, only 12.1% (47/390; 95% CI 9.0%-15.8%) received annual vaccination. Independent predictors of good knowledge included female sex (aOR 1.65, 95% CI 1.04-2.62, P=0.034), tertiary education (aOR 8.76, 95% CI 2.79-27.51, P<0.001), diabetes (aOR 2.68, 95% CI 1.07-6.69, P=0.035), and vaccination history (aOR 1.89, 95% CI 1.09-3.28, P=0.024). Only 24.4% (95/390) respondents received physician vaccination recommendations. Social media constituted the primary information source (34.6% vs. 24.4% from physicians).

Conclusions: A substantial knowledge-behavior gap exists in influenza vaccination among high-risk Malaysian adults. Despite good knowledge levels, vaccination rates remain critically low, highlighting that knowledge alone is insufficient to drive vaccination behavior. Low physician recommendation rates represent a critical missed opportunity for prevention. Healthcare system interventions focusing on provider education, systematic vaccination recommendations, and evidence-based social media campaigns are essential to improve vaccination coverage in high-risk populations.

Keywords

Influenza / Influenza vaccination / Knowledge / Associated factors

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