The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers

Autoři: Linda Cecilia Karlsson aff001;  Stephan Lewandowsky aff002;  Jan Antfolk aff001;  Paula Salo aff004;  Mikael Lindfelt aff006;  Tuula Oksanen aff005;  Mika Kivimäki aff005;  Anna Soveri aff001
Působiště autorů: Department of Psychology, Åbo Akademi University, Turku, Finland aff001;  School of Psychological Science, University of Bristol, Bristol, United Kingdom aff002;  School of Psychological Science, University of Western Australia, Perth, Australia aff003;  Department of Psychology, University of Turku, Turku, Finland aff004;  Finnish Institute of Occupational Health, Turku, Finland aff005;  Department of Theological Ethics, Åbo Akademi University, Turku, Finland aff006;  Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland aff007;  Institute of Clinical Medicine, University of Turku, Turku, Finland aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


Information and assurance from healthcare workers (HCWs) is reported by laypeople as a key factor in their decision to get vaccinated. However, previous research has shown that, as in the general population, hesitancy towards vaccines exists among HCWs as well. Previous studies further suggest that HCWs with a higher confidence in vaccinations and vaccine providers are more willing to take the vaccines themselves and to recommend vaccines to patients. In the present study with 2962 Finnish HCWs (doctors, head nurses, nurses, and practical nurses), we explored the associations between HCWs’ vaccination confidence (perceived benefit and safety of vaccines and trust in health professionals), their decisions to accept vaccines for themselves and their children, and their willingness to recommend vaccines to patients. The results showed that although the majority of HCWs had high confidence in vaccinations, a notable share reported low vaccination confidence. Moreover, in line with previous research, HCWs with higher confidence in the benefits and safety of vaccines were more likely to accept vaccines for their children and themselves, and to recommend vaccines to their patients. Trust in other health professionals was not directly related to vaccination or recommendation behavior. Confidence in the benefits and safety of vaccines was highest among doctors, and increased along with the educational level of the HCWs, suggesting a link between confidence and the degree of medical training. Ensuring high confidence in vaccines among HCWs may be important in maintaining high vaccine uptake in the general population.

Klíčová slova:

Behavior – Behavioral and social aspects of health – Child health – Influenza – Medical doctors – Nurses – Vaccination and immunization – Vaccines


1. World Health Organization. Immunization. 2019 [cited 8 Apr 2019]. In: World Health Organization [Internet]. Available from:

2. Gowda C, Dempsey AF. The rise (and fall?) of parental vaccine hesitancy. Hum Vaccines Immunother. 2013;9: 1755–1762. doi: 10.4161/hv.25085 23744504

3. World Health Organization. WHO vaccine-preventable diseases: monitoring system. 2019 [cited 27 Aug 2019]. In: World Health Organization [Internet]. Available from:

4. Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing vaccination: Putting psychological science into action. Psychol Sci Public Interes. 2017;18: 149–207. doi: 10.1177/1529100618760521 29611455

5. Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine. 2014;32: 2150–2159. doi: 10.1016/j.vaccine.2014.01.081 24598724

6. Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal? Vaccine. 2019;37: 984–990. doi: 10.1016/j.vaccine.2018.12.062 30655175

7. Masters NB, Tefera YA, Wagner AL, Boulton ML. Vaccine hesitancy among caregivers and association with childhood vaccination timeliness in Addis Ababa, Ethiopia. Hum Vaccines Immunother. 2018;14: 2340–2347. doi: 10.1080/21645515.2018.1480242 29792555

8. Napolitano F, D’Alessandro A, Angelillo IF. Investigating Italian parents’ vaccine hesitancy: A cross-sectional survey. Hum Vaccines Immunother. 2018;14: 1558–1565. doi: 10.1080/21645515.2018.1463943 29641945

9. Henrikson NB, Anderson ML, Opel DJ, Dunn J, Marcuse EK, Grossman DC. Longitudinal trends in vaccine hesitancy in a cohort of mothers surveyed in Washington State, 2013–2015. Public Health Rep. 2017;132: 451–454. doi: 10.1177/0033354917711175 28586623

10. Danchin MH, Costa-Pinto J, Attwell K, Willaby H, Wiley K, Hoq M, et al. Vaccine decision-making begins in pregnancy: Correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine. 2018;36: 6473–6479. doi: 10.1016/j.vaccine.2017.08.003 28811050

11. Frawley JE, McIntyre E, Wardle J, Jackson D. Is there an association between the use of complementary medicine and vaccine uptake: Results of a pilot study. BMC Res Notes. 2018;11. doi: 10.1186/s13104-018-3323-8 29609640

12. Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ. A systematic review of factors affecting vaccine uptake in young children. Vaccine. 2017;35: 6059–6069. doi: 10.1016/j.vaccine.2017.09.046 28974409

13. Yeung MPS, Lam FLY, Coker R. Factors associated with the uptake of seasonal influenza vaccination in adults: A systematic review. J Public Health. 2016;38: 746–753. doi: 10.1093/pubmed/fdv194 28158550

14. Brown KF, Kroll JS, Hudson MJ, Ramsay M, Green J, Long SJ, et al. Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review. Vaccine. 2010;28: 4235–4248. doi: 10.1016/j.vaccine.2010.04.052 20438879

15. Dubé E, Gagnon D, Ouakki M, Bettinger JA, Witteman HO, MacDonald S, et al. Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network. Vaccine. 2018;36: 545–552. doi: 10.1016/j.vaccine.2017.12.005 29233605

16. O’Leary ST, Brewer SE, Pyrzanowski J, Barnard J, Sevick C, Furniss A, et al. Timing of information-seeking about infant vaccines. J Pediatr. 2018;203: 125–130.e1. doi: 10.1016/j.jpeds.2018.07.046 30195554

17. Eller NM, Henrikson NB, Opel DJ. Vaccine information sources and parental trust in their child’s health care provider. Heal Educ Behav. 2019;46: 445–453. doi: 10.1177/1090198118819716 30616381

18. Bianco A, Pileggi C, Iozzo F, Nobile CGA, Pavia M. Vaccination against human papilloma virus infection in male adolescents: Knowledge, attitudes, and acceptability among parents in Italy. Hum Vaccines Immunother. 2014;10: 2536–2542. doi: 10.4161/21645515.2014.969614 25483471

19. Song Y, Zhang T, Chen L, Yi B, Hao X, Zhou S, et al. Increasing seasonal influenza vaccination among high risk groups in China: Do community healthcare workers have a role to play? Vaccine. 2017;35: 4060–4063. doi: 10.1016/j.vaccine.2017.06.054 28668569

20. Napolitano F, Napolitano P, Angelillo IF. Seasonal influenza vaccination in pregnant women: Knowledge, attitudes, and behaviors in Italy. BMC Infect Dis. 2017;17. doi: 10.1186/s12879-016-2138-2 28068918

21. Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34: 6700–6706. doi: 10.1016/j.vaccine.2016.10.042 27810314

22. Filia A, Bella A, D’Ancona F, Fabiani M, Giambi C, Rizzo C, et al. Childhood vaccinations: Knowledge, attitudes and practices of paediatricians and factors associated with their confidence in addressing parental concerns, Italy, 2016. Euro Surveill. 2019;24. doi: 10.2807/1560-7917.ES.2019.24.6.1800275 30755294

23. Picchio CA, Carrasco MG, Sagué-Vilavella M, Rius C. Knowledge, attitudes and beliefs about vaccination in primary healthcare workers involved in the administration of systematic childhood vaccines, Barcelona, 2016/17. Euro Surveill. 2019;24: 7–9. doi: 10.2807/1560-7917.ES.2019.24.6.1800117 30755298

24. Karafillakis E, Dinca I, Apfel F, Cecconi S, Wűrz A, Takacs J, et al. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine. 2016;34: 5013–5020. doi: 10.1016/j.vaccine.2016.08.029 27576074

25. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: An overview. Hum Vaccin Immunother. 2013;9: 1763–1773. doi: 10.4161/hv.24657 23584253

26. Napolitano F, Navaro M, Vezzosi L, Santagati G, Angelillo IF. Primary care pediatricians’ attitudes and practice towards HPV vaccination: A nationwide survey in Italy. PLoS One. 2018;13. doi: 10.1371/journal.pone.0194920 29596515

27. Collange F, Zaytseva A, Pulcini C, Bocquier A, Verger P. Unexplained variations in general practitioners’ perceptions and practices regarding vaccination in France. Eur J Public Health. 2019;29: 2–8. doi: 10.1093/eurpub/cky146 30085024

28. Dini G, Toletone A, Sticchi L, Orsi A, Bragazzi NL, Durando P. Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Hum Vaccines Immunother. 2018;14: 772–789. doi: 10.1080/21645515.2017.1348442 28787234

29. Shibli R, Shemer R, Lerner-Geva L, Rishpon S. Knowledge and recommendation regarding routine childhood vaccinations among pediatric healthcare providers in Israel. Vaccine. 2017;35: 633–638. doi: 10.1016/j.vaccine.2016.12.005 28043737

30. Larson HJ, Clarke RM, Jarrett C, Eckersberger E, Levine Z, Schulz WS, et al. Measuring trust in vaccination: A systematic review. Hum Vaccines Immunother. 2018;14: 1599–1609. doi: 10.1080/21645515.2018.1459252 29617183

31. Učakar V, Kraigher A. Acceptance of seasonal influenza vaccination among Slovenian physicians, 2016. Zdr Varst. 2019;58: 47–53. doi: 10.2478/sjph-2019-0006 30745950

32. Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, et al. Vaccine hesitancy among general practitioners and its determinants during controversies: A national cross-sectional survey in France. EBioMedicine. 2015;2: 891–897. doi: 10.1016/j.ebiom.2015.06.018 26425696

33. Ministry of Social Affairs and Health. Maternity and child health clinics. 2019 [cited 5 Sep 2019] In: Ministry of Social Affairs and Health [Internet]. Available from:

34. Finnish institute for health and welfare. National vaccination programme. 2019 [cited 5 Sep 2019] In: Finnish institute for health and welfare [Internet]. Available from:

35. Finnish institute for health and welfare. Sociaali- ja terveysalan henkilöstön rokotukset [Vaccinations for personnel within social services and healthcare]. 2019 [cited 5 Sep 2019]. In: Finnish institute for health and welfare [Internet]. Available from:

36. Infectious Diseases Act. 1227/2016 Finland; 2016.

37. Ministry of Social Affairs and Health. New Infectious Diseases Act will enter into force on 1 March 2017. 2016 Dec 21 [cited 5 Sep 2019]. In: Ministry of Social Affairs and Health [Internet]. Available from:

38. Virtanen M, Vahtera J, Batty GD, Tuisku K, Oksanen T, Elovainio M, et al. Health risk behaviors and morbidity among hospital staff − comparison across hospital ward medical specialties in a study of 21 Finnish hospitals. Scand J Work Env Heal. 2011; doi: 10.5271/sjweh.3264 22173213

39. World Health Organization. Vaccination and trust library. 2019 [cited 5 Sep 2019]. In: World Health Organization [Internet]. Available from:

40. Rosseel Y. lavaan: An R package for Structural Equation Modeling. J Stat Softw. 2012;48: 1–36.

41. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria; 2018.

42. Häggblom T, Oksi J, Rintala E. Terveydenhuollon henkilöstön asenteet influenssarokotusta kohtaan [Healthcare workers’ attitudes towards influenza vaccination]. Lääkärilehti. 2019;4: 187–192.

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden