Influenza Vaccination Uptake, Knowledge, Attitudes, and Barriers Among Healthcare Workers in Primary Health Care Centres in Karbala, Iraq: A Cross-Sectional Study

Rana Kareem Salih Alfursan; Bahaa Abdulsahib Hamad; Yusra Haleem Hasan Alaraji

doi:10.59675/U423

Authors

Rana Kareem Salih Alfursan Public Health Department, The Holy Karbala Health Directorate, Karbala, Iraq Author
Bahaa Abdulsahib Hamad Public Health Department, The Holy Karbala Health Directorate, Karbala, Iraq Author
Yusra Haleem Hasan Alaraji Public Health Department, The Holy Karbala Health Directorate, Karbala, Iraq Author

DOI:

https://doi.org/10.59675/U423

Keywords:

influenza vaccination, healthcare workers, knowledge, attitudes, vaccine hesitancy.

Abstract

Background: Healthcare workers (HCWs) can become infected with seasonal influenza and may transmit infection within healthcare facilities. Although annual influenza vaccination is recommended for HCWs, uptake may be limited by access, convenience, confidence, and misinformation. Objective: To determine influenza vaccination uptake, knowledge, attitudes, practices, concerns, and reported barriers among HCWs in primary health care (PHC) centres in Karbala Governorate, Iraq, and to assess factors independently associated with good influenza-vaccination knowledge. Methods: A descriptive cross-sectional study was conducted among 364 HCWs from 15 PHCs across four health sectors of Karbala Governorate during 2026. A self-administered structured Arabic questionnaire was used to collect information on sociodemographic characteristics, vaccine-related training, knowledge, attitudes, vaccination practices, concerns, intention to vaccinate, and reported barriers. Eight knowledge items were scored and categorised as poor, fair, or good. Data were analysed using descriptive statistics, chi-square tests, and binary logistic regression. Good knowledge was used as the dependent variable in the regression model. Results: Of 364 HCWs, 253 (69.5%) had good knowledge, 80 (22.0%) had fair knowledge, and 31 (8.5%) had poor knowledge. Attitudes were positive/good in 43.1%, neutral/fair in 54.1%, and negative/poor in 2.7%. A total of 101 participants (27.7%) reported receiving influenza vaccine during the 2025–2026 season, whereas 222 (60.9%) reported vaccination during the three previous influenza seasons. The most commonly reported barriers were vaccine unavailability (38.2%), fear of side effects (25.9%), lack of time (22.8%), and perceived lack of necessity (19.8%). Good knowledge was independently associated with vaccine-related training (AOR=2.290, 95% CI: 1.333–3.934; P=0.003) and being a physician/doctor compared with administrative staff (AOR=3.118, 95% CI: 1.168–8.325; P=0.023). Female sex was associated with lower odds of good knowledge (AOR=0.562, 95% CI: 0.328–0.962; P=0.036). Conclusion: The study demonstrates a descriptive gap between generally favourable knowledge and attitudes and reported influenza vaccination uptake. The findings support combining vaccine-related education with reliable vaccine availability, convenient workplace vaccination, and communication strategies addressing safety concerns and rumours. Because this study is cross-sectional, the findings should be interpreted as associations rather than causal effects.

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