Seasonal Influenza Vaccine During Pregnancy: Uptake, Knowledge, Attitudes and Perceptions in Al-Karak Governorate, Jordan using HBM

Seasonal Influenza Vaccine During Pregnancy: Uptake, Knowledge, Attitudes and Perceptions in Al-Karak Governorate, Jordan using HBM | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Seasonal Influenza Vaccine During Pregnancy: Uptake, Knowledge, Attitudes and Perceptions in Al-Karak Governorate, Jordan using HBM Mahmoud A Jaafreh, Munir Abu-Helalah, Mohammad Ahmad Abu-Lubad, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8158468/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Pregnant women are at an increased risk of developing severe flu and suffering its complications. Many countries recommend annual flu immunization during pregnancy, but in Jordan, it has not been routinely recommended or adopted through local guidelines. Moreover, there is limited data on the influenza vaccine uptake, knowledge, attitudes, and barriers for flu virus vaccinnation during pregnancy. Therefore, this study was proposed to assess flu vaccination rates and associated factors among pregnant women in Al-Karak governorate, south of Jordan, during the 2021-2022 flu season. This study applied the Health Belief Model to investigate factors affecting receiving the influenza vaccine during pregnancy. Methods : A cross-sectional study conducted using a reliable questionnaire on a representative sample of pregnant women who had been pregnant between September and November 2021 (N = 382). The Survey consisted of 5 parts to assess pregnant women socio-demographics, knowledge, uptake rate, attitude and perception as well as factors affecting influenza vaccine uptake. Results: The Influenza vaccine coverage among pregnant women was (8.1%) . An intermediate level of knowledge of influenza and its vaccine was reported among the study participants. There was a statistically significant difference between pregnant women in the vaccinated and non-vaccinated groups in terms of place of residence (p<.001) , educational level (p<.001) and past vaccination history (p OR 5.792) , university and high educational level (p<.005 OR 1.35), in addition to previous vaccination (p<.022 OR 2.6) . Other predictors revealed by the Health Belief Model (HBM) were the perceived severity of influenza, perceived benefits of vaccinations, perceived barriers to vaccinations, cues to action and attitudes toward influenza vaccine. Conclusions: This study provides baseline data necessary to develop strategies for increasing flu vaccination rates aiming to reduce flu burden during pregnancy in the south of Jordan. Flu flu vaccine knowledge Uptake Pregnancy Health Belief Model Jordan Introduction Seasonal Influenza (SI) is caused by a virus that spread through droplets or fomites affecting the respiratory system seasonally. In pregnant women, Influenza infection leads to severe symptoms and complications compared to nonpregnant women and other populations 1 . It significantly impacts pregnant women's respiratory, immune and cardiovascular systems, leading to a high risk for cardiopulmonary hospitalization during the influenza season. Cardiopulmonary hospitalization rates due to influenza were close to 3, 6, and 10 per 10,000 women-months among pregnant women in their first, second, and third trimesters, respectively, as compared with approximately 2 per 10,000 women-months among nonpregnant women during the influenza season 2 . The effect of influenza infection is not limited to the pregnant mother, but it also poses a threat to the fetus, although the transmission of the virus to the fetus through the placenta is rare 3 . Exposure to influenza during the first trimester of pregnancy increases the risk of any congenital abnormality two times more than the unexposed pregnant 4 . The influenza vaccine is routinely recommended in the northern hemisphere between September and November. It can protect pregnant women and their newborns from influenza-related morbidity and mortality leading to outpatient emergency visits and hospitalization. The protection extends to infants under six months of age by transmitting antibodies from mother to fetus through the placenta 5 . The influenza vaccine uptake among pregnant women varies from country to country. A systematic review 6 included 21 studies (from USA, Australia, UK, Canada, Netherlands, Hong-Kong, and Turkey) noted that the uptake rate of influenza vaccine during pregnancy ranged between 1.7% and 88.4%. Although the influenza vaccine is safe and effective to administer to pregnant women, published data on the uptake and acceptance of the influenza vaccine among pregnant women in the Middle East is limited. Few studies have shown that the rate of pregnant women receiving influenza vaccine during their current pregnancy ranges between 4.6% and 19.8% 7, 8 . This is in addition to poor awareness and knowledge about influenza and vaccines among pregnant women 8, 9 . Only few studies have identified barriers that may affect pregnant women knowledge of the influenza vaccine and their decision to receive it during pregnancy. These factors varied between demographic factors, medical history characteristics, level of knowledge and perceptions of pregnant women toward influenza and vaccines (10) , 11 . Currently, there are no published studies that focus on seasonal influenza vaccine uptake during pregnancy in Jordan. Therefore, this study proposes assessing pregnant women uptake, knowledge, attitudes and perceptions in Al-Karak governorate, south of Jordan. Understanding these factors will help address the gaps in vaccine acceptance and guide future public health interventions. Methods Study setting and subjects. The study was conducted at Al-Karak governorate in Jordan, which is divided into three regions (Northern, Central, and Southern), each has three or more comprehensive and primary health centres. Two health centers were selected randomly from each region, in addition to two public hospitals found in the governorate and selected private obstetrics clinics. The study was conducted in postnatal wards and Obstetrics and childhood out-patient clinics. Jordanian women who had been pregnant during the influenza season 2021-2022 in Al-Karak governorate during the study period were eligible to participate in the study, excluding those whoarenot permanent residents in Al-Karak governorate, those who refused to answer the questionnaire and those with a contra-indications to receiving the influenza vaccine. Target Sample size. Target sample size N was calculated using OpenEpi Version 3. The total study population is 7274 pregnant women based on the latest birth census over the city [12] . The prevalence rate = 50%; because no previous studies have measured the level of knowledge, attitudes and uptake rate of influenza vaccine among pregnant women in Jordan, the default prevalence used is 50%, with a confidence level of 95%, Z 0.95 = 1.96 (Normal Distribution Table). Therefore, the calculated sample size = 345. To consider for the non-response rate of the calculated sample size, 10% was added, therefore, a sample size of 380 pregnant women were required to reach the power of 95% with a 0.05 margin. Data Collection. Data collection period was conducted from June 2022 to September 2022, the obstetrics and childhood clinics were usually open for five days per week. Interviews were conducted by a team of female doctors and nurses trained to interview pregnant women. Training included the importance of the topic researched, the study objectives, ethical considerations and training on the questionnaires conduction and handling. The first phase included selective hospitals and outpatient obstetric clinics during the month of June 2022. The second phase was in conducted in the Maternity and childhood clinics in the primary and comprehensive health centers as of July 2022. Participants were informed that the decision on participation or responses will not affect the standard of care they should be receiving. After approval was obtained from the participant, the interviews took place in a time not exceeding 10 minutes. Questionnaire A structured Arabic questionnaire was constructed through the combination of items from reliable and valid questionnaires 7 , 12 , 13 . Backward-forward translation of the questionnaire was done by medical and social experts, additionally, pilot-tested 20 pregnant women were interviewed to test the acceptability, length, clarity, and assess the questions /statements formats of the questionnaire. Pilot interviews were not included in the study sample. The final version is composed of 46 questions/statements other than the demographic data. All questions/statements were close-ended questions addressing five areas of interest; socio-demographic and medical history Information such as ( age, level of education, residency, employment state, total monthly income, and health insurance, para and gravida status, miscarriage, medical history and history of influenza before and during the pregnancy), information related to influenza and influenza vaccine knowledge (10 multiple choice questions), perceptions and attitudes toward the influenza vaccine based on the Health Belief Model (HBM), uptake of influenza vaccine and, finally, factors affecting influenza vaccine uptake. In this context, the theory of the Health Belief Model (HBM) contributed to explaining women's perceptions about their tendency to adopt healthy behavior that is determined by other factors: perception of disease susceptibility and perceived severity of the consequences of influenza, exposure to information that may prompt a pregnant woman to take the action of receiving the vaccine and the amount of benefit that she thinks she will get. According to the HBM, a pregnant woman's readiness to take action (receive influenza vaccine) depends on the following beliefs or conditions: is she susceptible to this influenza? Is the threat of influenza serious to her health? Do the benefits of taking the vaccine outweigh the barriers? Is she confident she can carry out the vaccination successfully? Are there Cues to action present to motivate her to take the vaccine? The following components of HBM were used in the study: the pregnant woman’s perceived risk of getting influenza (perceived susceptibility), the belief of the resulting consequences for her and the health of the fetus (perceived severity), the potential positive benefits of influenza vaccine (perceived benefits), perceived barriers to influenza vaccine and the exposure to factors which prompt action (cues to action), as well as modifying variables (a person’s characteristics). Statistical analyses: To make the process of handling and analyzing the data more effective and easier, each variable and its respective items was coded with unique codes to ensure no duplication and ease of retrieval. This process helps to understand and manage these items for organizing purposes according to their unique codes 14 . Statistical processing was carried out using the statistical package for the social sciences program (SPSS V.22). Data was checked to identify possible entry errors, missing values, incorrect or illogical answers and non-response to statements questions. Chi-square analysis was used to analyze the association between all baseline characteristics, knowledge level and vaccination status. Binary logistic regression was performed to find the predictors of vaccine uptake and Stepwise regression was performed to study the effect of selected baseline characteristics on each item of barrier measure. Multiple linear regression was performed to study the effect of all HBM variables on women’s attitude toward vaccination. Results Demographic Characteristics and Receiving of SIV Vaccination. Four hundred fifteen (415) questionnaires were filled out, 33 were excluded because they were incomplete or did not match the inclusion criteria. Of the 382 interviewed pregnant women, 199 (52.1%) were from urban areas. Of the demographic characteristics, the place of residency and educational level were significantly different between pregnant women who received and did not receive influenza vaccine, 114 (29.8%) received influenza vaccine before, while the majority (70.2%) have remained unvaccinated. However, only 34 (8.9 %) received the vaccine during previous pregnancies while 31 (8.1 %) received the vaccine during the current pregnancy (table 1). Table 6 shows the likelihood of vaccination during the current pregnancy depending on HBM individual variables, knowledge score, attitude towards the vaccination, and other factors, The result revealed that women from urban areas and those with good knowledge of influenza and vaccination were more likely to increase the likelihood of vaccination (OR= 5.792, 1.352) prospectively. Further, being previously vaccinated was significantly and positively predictive of vaccination during the current pregnancy (OR= 2.600). Health Belief Model HBM And Attitude Towards Vaccination From each HBM domains except perceived susceptibility, at least one item was predictive of influenza vaccination during pregnancy. One of “Perceived Severity of Influenza” items predicted influenza vaccine uptake during current pregnancy: vaccinated women were more likely to perceive themselves at risk of severe complications from influenza (Table 2). Details of the attitudes according to the HBM are described in Table 3. Table 4 shows the participants' responses to selective factors that may predict vaccination rates. There were statistically significant predictors for influenza vaccine uptake during pregnancy through the stepwise regression analysis including urban residence (P<.013 OR 5.792), university and high educational level (p<.005 OR 1.35), in addition to previous vaccination (p<.022 OR 2.6). Other predictors revealed by the Health Belief Model were the perceived severity of influenza, perceived benefits of vaccinations, perceived barriers to vaccinations, cues to action and attitudes toward influenza vaccine (table 4). Discussion The influenza vaccine uptake was observed in the study at a rate of (8.1%). In fact, in Jordan, influenza vaccine is provided free of charge only for the elderly with underlying chronic diseases (for example, renal failure) and for healthcare workers in public health provision services. Furthermore, national health insurance does not cover the cost of the vaccine. However, Jordan is one of the 14 countries in the Eastern Mediterranean and Western Pacific region that has adopted a national immunization policy or guidelines against seasonal influenza (National Program for Surveillance and Control of Influenza since 1980 as well as Pandemic Influenza Preparedness and Response Plan since 2009) 15 . It seems that there are no practical steps to improve the uptake rates of the vaccine among the Jordanian community in general and pregnant women in particular. Similar findings of low uptake rates have been reported in other studies conducted in developing countries, which could be explained by the lack of an effective national policy regarding influenza vaccination among pregnant women. For instance, in a study conducted in Tunisia during the 2018–2019 influenza season, only (4.6%) of the surveyed pregnant women were vaccinated during their pregnancy (8) . Likewise, in another study conducted in Saudi Arabia, only 19.8% of the surveyed pregnant women received the vaccine during their pregnancy (7) . The lack of awareness of pregnant women regarding the importance of receiving vaccinated against influenza during pregnancy and the lack of physician recommendations of influenza vaccine are the main reasons for this low uptake. The overall knowledge of pregnant women about influenza and its vaccine was intermediate (see Table 5). An intermediate level of knowledge of influenza and the vaccine could be explained by inadequate health education in health centers and maternity clinics, as well as the weak role of audio-visual media in spreading awareness about the importance of vaccination during pregnancy. Moreover, the study shows that women of university degree and high-education have statistically significant more disease and vaccine knowledge than school-educated women. Similar results were reported in an Italian study, in addition to other variables such as age and number of children 7, 16 , the study showed different results where the educational level was not significantly related to vaccine knowledge, but other variables such as employment status, monthly income, and the number of pregnancies were significantly related. HBM Predictors of Seasonal Influenza Vaccination During Pregnancy Results of the multivariable analysis of the HBM items reveal that the significant predictors that are positively associated with influenza vaccine uptake during current pregnancy are their perception of influenza severity, perception of vaccination benefits and cues to act. In parallel, the perception of threats is negatively associated with women's vaccine uptake during pregnancy; pregnant women who feel that their influenza infection during pregnancy could lead to serious complications for their health and the health of the fetus are more likely to receive the influenza vaccine than those who didn’t feel that threat. Based on a similar study, all domains of HBM were found to have significant correlations with the vaccine uptake rates including the perception of disease severity, perception of susceptibility and perception of perceived benefits where they positively correlated with vaccine uptake, in contrast with perceived threats where they negatively correlated with vaccine uptake (12) . Studies have shown that women’s awareness of threats predicts the acceptance and uptake of vaccinations (17) , (18) . Regarding the aspect of perceived benefits, similar results were encountered in other studies; pregnant women who believed the vaccine would protect them, their fetuses and newborn babies from influenza complications had higher levels of acceptance than other pregnant women 17 , 18 . Pregnant women who believe that making the right decision about getting the vaccine depends on an HCPs recommendation are also more likely to accept the vaccine than other pregnant women. Similarly finding, in a Chinese study (13) . Trusting guidelines that recommend that all pregnant women receive the annual influenza vaccine makes them more likely to accept the vaccine than other pregnant women. This finding is constant with 12 , 17 . In addition to HBM barriers, the study identified several barriers that hindered pregnant women from receiving the vaccine; such as concern about mother and baby safety and belief that the vaccine is not effective. These results are consistent with a study conducted in Amman, the capital of Jordan, to understand factors affecting influenza vaccine uptake among Jordan's population, including 1107 adults 19 . Concerning barriers predictors, women in urban areas, having three or more para and having hospitalization experience due to influenza complications -whether during pregnancy or outside pregnancy-, are less likely to perceive barriers to vaccination and don’t believe that the flu vaccine can be dangerous for pregnant women or belief that the influenza vaccine can be dangerous to the fetus (table 6). Study Limitations . This study has a few limitations. Firstly, it was conducted between June and September, which is after the flu season, limiting the number of participants. Secondly, it coincided with the coronavirus pandemic, requiring the research team to clarify the differences between the coronavirus and influenza vaccines. Thirdly, there is no documented information in the health records to verify the data obtained during the interviews. Conclusion Influenza vaccine should be provided as part of the protocol for management of pregnant women with monitoring of the uptake rate. The investigation revealed a significant relationship between HCPs recommendation and vaccine uptake. The low rate of influenza vaccine uptake among pregnant women in Al-Karak governorate supports the need to establish health education programs to improve awareness and knowledge about seasonal influenza and the efficacy and safety of vaccines among this population. Vaccination program strategies should primarily target prenatal health care providers because their opinion can significantly influence a woman’s vaccination decision. Declarations Ethics and Consent to Participate declarations The study was approved by the University of Mutah's ethics committee and the Jordanian Ministry of Health Central Ethics Committee. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. Consent to Publish declaration All participants provided written informed consent for publication. 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Tables Table 1: Descriptive demographic characteristics of pregnant women by receiving influenza vaccine. Characteristics Category Have you received an influenza vaccine in the current pregnancy? Yes N=31 No N=351 P value N (%) N (%) Place of residency Urban 20 (64.5) 179(51) <.001 ** Rural 11(35.4) 172(49) Education School Education 13 (41.9) 127(36.1) <.001 ** High Education* 18(58) 224(63.8) Employment status Full Time 19 (61.2) 116(34.4) .997 Part-Time 5 (16.1) 21 (5.9) Unemployed 7 (22.5) 214(59.7) Monthly Income less than 500 JD 10 (32.2) 218(62.1) .612 from 500 to 1000 JD 20 (64.5) 125(35.6) more than 1000 JD 1 (3.2) 8 (2.2) Health Insurance Ministry Of Health 20 (64.5) 197(56.1) .779 Medical Services 3 (9.6) 98 (27.9) Private Sector 1(3.2) 19(5.4) University Hospitals 4(12.9) 5(1.4) Relief Agency UNURWA 0(0.0) 2(0.5) No Health insurance 3(9.6) 30(8.5) Age (year) 18-25 21(67.7) 177(50.4) .179 26-35 9 (29) 161(45.8) 36 or older 1 (3.0) 13 (3.7) para-status 1 3 (9.6) 59 (16.8) .422 2 9 (29.0) 74(21.08) 3 or more 19 (61.2) 218(62.1) gravida status 0 2 (6.4) 20(5.7) .303 1 5 (16.1) 85 (24.2) 2 12 (38.7) 84 (23.9) 3 or more 12 (38.7) 162(46.2) miscarriage history 0 21 (67.7) 247(70.3) .759 1 or more 10 (32.2) 104(29.6) Regular Medications* yes 5 (16.1) 82 (23.3) .249 No 26 (83.8) 269(76.6) Influenza Experience Yes, During Pregnancy 7 (22.5) 51 (14.5) .821 Yes, Before Pregnancy 4 (12.9) 59 (16.8) Before and during pregnancy 1(3.0) 9 (2.5) No 19 (61.2) 232(66.1) Hospitalization due to Influenza complications Yes, During Pregnancy 3 (9.6) 48 (13.5) .821 Yes, Outside Pregnancy 2 (6.4) 21 (5.9) No 26 (38.8) 282(80.3) Perceived Severity of Influenza Vaccine. More Severe 2 (6.4) 69 (19.6) .064 Slightly more intense 15 (48.3) 99 (28.2) same as in previous days 6 (19.35) 110 (31.3) less severe 5 (16.1) 35 (9.9) Have you heard of the influenza vaccine before? Yes 26 (83.8) 277(64.6) .514 No 5 (16.1) 74 (21.0) Have you ever received the influenza vaccine before? Yes 14 (45.1) 100 (28.4) .044 No 17(54.8) 251(71.5) Have you received an influenza vaccine in previous pregnancies? Yes 4 (12.9) 27 (7.6) .236 No 27(87.1%) 324(92.3) Knowledge Score Poor knowledge (<5) 12 (38.7) 173 (49.3) =5) 19 (61.2) 178 (50.7) Trust in healthcare provider advice about vaccine* Low Trust 10(32.2) 162(46.1) .563 High Trust 21(67.7) 189(53.8) Total 31 (8.1) 351(91.8) * High Education = College, University, postgraduate. * e.g., ( Antihypertension medication, Diabetic medications, Thyroid medication …) * trust = How much do you trust your healthcare provider’s advice about influenza? Choose a rating from 0 to 10 ** p < 0.001 Table 2: Association between HBM items and vaccination status. Have you received an influenza vaccine during the current pregnancy? P value Yes N= 31 (%) No N=351 (%) Strongly Disagree /Disagree Neutral Agree /Strongly Agree Strongly Disagree /Disagree Neutral Agree /Strongly Agree Perceived Susceptibility to Influenza 8 (25.8) 10 (32.3) 13 (41.9) 83 (23.6) 105 (29.9) 163 (46.4) .890 I get influenza more easily than other people my age. Without the vaccination, I feel that I am vulnerable to a severe infection with the influenza 11 (35.5) 9 (29.0) 11 (35.5) 108 (30.8) 101 (28.8) 142 (40.5) .827 I am worried about the fetus being affected by the influenza 6 (19.4) 10 (32.3) 15 (48.4) 53 (15.1) 109 (31.1) 189 (53.8) .776 Perceived Severity of Influenza 8 (25.8) 8 (25.8) 15 (48.4) 161 (45.9) 80 (22.8) 110 (31.3) .073 If I get influenza during pregnancy, I may develop severe symptoms If I get influenza during pregnancy, I expose myself to serious complications. 9 (29.0) 10 (32.3) 12 (38.7) 151 (43.0) 85 (24.2) 115 (32.8) .035 * If I get influenza while pregnant, the disease may harm my unborn baby. 11 (35.5) 7 (22.6) 13 (41.9) 171 (48.7) 89 (25.4) 91 (25.9) .148 Perceived Benefits of vaccination 8 (25.8) 6 (19.4) 17 (54.8) 78 (22.2) 91 (25.9) 82 (51.9) .706 I would not have to worry about getting influenza if I received the vaccine Receiving the influenza vaccine during pregnancy will help me. 10 (32.3) 6 (19.4) 15 (48.4) 124 (35.3) 96 (27.4) 131 (37.3) .034 * Receiving the influenza vaccine during pregnancy will benefit the fetus. 11 (35.5) 3 (9.7) 17 (54.8) 118 (33.6) 91 (25.9) 142 (40.5) .105 Influenza vaccine can protect the baby during the first months of life 5 (16.1) 10 (32.3) 16 (51.6) 90 (25.6) 118 (33.6) 143 (40.7) .039 * Perceived Barriers To influenza vaccination 10 (32.3) 13 (41.9) 8 (25.8) 90 (25.6) 104 (29.6) 157 (44.7) .120 I am concerned about the side effects of the vaccine The influenza vaccine can give me the flu 14 (45.2) 9 (29.0) 8 (25.8) 105 (29.9) 103 (29.3) 143 (40.7) .015 * I am worried there might be something I do not know about the influenza vaccine 11 (35.5) 8 (25.8) 12 (38.7) 92 (26.2) 102 (29.1) 157 (44.7) .536 My family, friends, or co-workers did not encourage me to get the vaccine. 12 (38.7) 8 (25.8) 11 (35.5) 88 (25.1) 101 (28.8) 162 (46.2) .243 Cues To Action 11 (35.5) 8 (25.8) 12 (38.7) 114 (32.5) 92 (26.2) 145 (41.3) .038 * My doctor /nurse pharmacist’s recommendation is important for making the right decision about getting the vaccine I trust the guidelines that recommend that all pregnant women get their annual influenza vaccine 8 (25.8) 6 (19.4) 17 (54.8) 115 (32.8) 100 (28.5) 136 (38.7) .020 * I feel like I have had all the information I need to decide if I should get the influenza vaccine 9 (29.0) 6 (19.4) 16 (51.6) 127 (36.2) 104 (29.6) 120 (34.2) .014 * *P<0.05 Table 3: The Association Between Perceived Attitude and Vaccination Status. Total responce N( 382) Have you received an influenza vaccine during the current pregnancy? P value Yes N= 31 (%) No N=351 (%) Strongly Disagree /Disagree Neutral Agree /Strongly Agree Strongly Disagree /Disagree Neutral Agree /Strongly Agree I am against receiving the flu vaccine during pregnancy. 15 (48.4) 8 (25.8) 8 (25.8) 35 (10.0) 100 (28.5) 216 (61.5) <.001 * I don't mind taking the influenza vaccine during pregnancies 7 (22.6) 12 (38.7) 12 (38.7) 233 (66.4) 76 (21.7) 42 (12.0) <.001 * I recommend other women take the influenza vaccine during pregnancy. 6 (19.4) 13 (41.9) 12 (38.7) 213 (60.7) 100 (28.5) 38 (10.8) <.001 * *P<0.001 Table 4: Participants' responses to other factors that may predict vaccination rate. Total responce N( 382) Other Factors Yes No N (%) N (%) Have you ever received advice from a doctor during pregnancy about the influenza vaccine? 170 (44.50) 212 (55.5) Have you ever received advice from the nurse during pregnancy about the influenza vaccine? 153 (40.1) 229 (59.9) Have you ever received advice from the pharmacist during pregnancy about the influenza vaccine? 148 (38.7) 234 (61.3) Have you been advised by anyone (relative, colleague, friend) to receive the influenza vaccine during this pregnancy? 163 (42.7) 219 (57.3) Did any person or source influence not receive influenza vaccination during this pregnancy? 139 (36.4) 243 (63.6) Do you know anyone who has become severely ill with influenza? 180 (47.1) 202 (52.88) Do you know anyone who has had a bad reaction to the influenza vaccine? 184 (48.2) 198 (51.8) Do you have enough information about the safety and side effects of the influenza vaccine? 144 (37.7) 238 (62.3) Table 5 : Knowledge Items Scale Analysis. Total responce N( 382) Items Correct n (%) Wrong n (%) Influenza is a …………. disease (Highly contagious) 143 (37%) 239 (63%) Influenza may lead to (All of the above) 235 (61.5%) 147 (38.5%) Risk of complications from influenza in pregnant women (Greater than non-pregnant women) 203 (53.1%) 179 (46.9%) Immunity during pregnancy ……. (Decreases) 235 (61.5%) 147 (38.5%) Influenza vaccination during pregnancy (Helps protect pregnant women from influenza) 204 (53.4%) 178 (46.6%) Vaccination of pregnant women against influenza (Helps protect the fetus and child after birth) 62 (16.2(% 320 (83.8%) The influenza vaccine is given in (Winter season) 184 (48.2%) 198 (51.8%) The best way to protect against influenza is. (Taking the vaccine with adequate precautions) 223 (58.4%) 159 (41.6%) Give the influenza vaccine during pregnancy. (The vaccine should be given to all pregnant women) 152 (39.8%) 230 (60.2%) Influenza vaccination during pregnancy (Safe during pregnancy) 122 (31.9%) 260 (68.1%) Knowledge categories n (%) 197 (51.6%) 185 (48.4%) (correct answer) Table 6: Odds Ratios for Vaccination during current pregnancy: By HBM Individual variables, Knowledge score, attitude towards the vaccination, other factors B Adjusted OR 95% CI P value Lower Upper Residency (Urban) 1.756 5.792 1.454 23.078 .013* Knowledge score (good Knowledge) .302 1.352 1.097 1.666 .005* Have you ever had the influenza vaccine before? () (yes) .956 2.600 1.149 5.882 .022* Taking the influenza vaccine during pregnancy will help me. (Benefits2) .763 1.466 1.283 1.768 .003* influenza vaccine can protect the baby during the first months of life (Benefit 4) .510 1.665 1.022 2.712 .041* The influenza vaccine can give me the flu (Barrier2) -.375- .687 .446 1.059 .039* My doctor/nurse pharmacist's recommendation is important for making the right decision about getting the vaccine (cause to action 1) .551 1.734 1.462 3.128 .047* I trust the guidelines that recommend that all pregnant women get their annual influenza vaccine (cause to action 2) .753 2.123 1.261 3.574 .005* I feel like I have had all the information I need to decide if I should get the influenza vaccine (cause to action 3) .584 1.794 1.080 2.978 .024* I am against taking the flu vaccine during pregnancy (Attitude 1) -.795- .452 .225 .907 .026* I recommend other women take the influenza vaccine during pregnancy. (Attitude 3) .659 1.932 1.110 3.362 .020* P< 0.05 Additional Declarations No competing interests reported. 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Jaafreh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYFACHgYDBgY5BgYJ5gNAnoQMsVqMgYrZEkBaeIjSwgDRwmMA5+IFuu1nDxT8qDHI55fu+fzqRo0FDwP74aMb8GkxO5OXYNhzzMBy5pyz26xzjgEdxpOWdgOvlgM5BgY8bH8MDG7kbjPOYQNqkeAxw6/l/BsDwz//DAzsb+Q8M875R4yWGzkGxrxtBgYGEjnMj3PbiNLyxsBYtg+o40aaGXNunwQPG0G/nM8xM3zzzcCAf0by48853+rk+NkPH8OrBQjYDGAMCTBJQDkIMD+AMT4QoXoUjIJRMApGIAAAe0RFSW67migAAAAASUVORK5CYII=","orcid":"","institution":"Ministry of Health","correspondingAuthor":true,"prefix":"","firstName":"Mahmoud","middleName":"A","lastName":"Jaafreh","suffix":""},{"id":560218205,"identity":"2414b6b8-f36d-4a3e-affe-2cf34fa1d056","order_by":1,"name":"Munir Abu-Helalah","email":"","orcid":"","institution":"University of Jordan, University of 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16:07:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1659475,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8158468/v1/9e84e5eb-a6fd-4347-9952-44e03fda2f81.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Seasonal Influenza Vaccine During Pregnancy: Uptake, Knowledge, Attitudes and Perceptions in Al-Karak Governorate, Jordan using HBM","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSeasonal Influenza (SI) is caused by a virus that spread through droplets or fomites affecting the respiratory system seasonally. In pregnant women, Influenza infection leads to severe symptoms and complications compared to nonpregnant women and other populations\u003csup\u003e1\u003c/sup\u003e. It significantly impacts pregnant women's respiratory, immune and cardiovascular systems, leading to a high risk for cardiopulmonary hospitalization during the influenza season. Cardiopulmonary hospitalization rates due to influenza were close to 3, 6, and 10 per 10,000 women-months among pregnant women in their first, second, and third trimesters, respectively, as compared with approximately 2 per 10,000 women-months among nonpregnant women during the influenza season\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe effect of influenza infection is not limited to the pregnant mother, but it also poses a threat to the fetus, although the transmission of the virus to the fetus through the placenta is rare\u003csup\u003e3\u003c/sup\u003e. Exposure to influenza during the first trimester of pregnancy increases the risk of any congenital abnormality two times more than the unexposed pregnant\u003csup\u003e4\u003c/sup\u003e. The influenza vaccine is routinely recommended in the northern hemisphere between September and November. It can protect pregnant women and their newborns from influenza-related morbidity and mortality leading to outpatient emergency visits and hospitalization. The protection extends to infants under six months of age by transmitting antibodies from mother to fetus through the placenta\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe influenza vaccine uptake among pregnant women varies from country to country. A systematic review\u003csup\u003e6\u003c/sup\u003eincluded 21 studies (from USA, Australia, UK, Canada, Netherlands, Hong-Kong, and Turkey) noted that the uptake rate of influenza vaccine during pregnancy ranged between 1.7% and 88.4%. Although the influenza vaccine is safe and effective to administer to pregnant women, published data on the uptake and acceptance of the influenza vaccine among pregnant women in the Middle East is limited. Few studies have shown that the rate of pregnant women receiving influenza vaccine during their current pregnancy ranges between 4.6% and 19.8%\u003csup\u003e7, 8\u003c/sup\u003e. This is in addition to poor awareness and knowledge about influenza and vaccines among pregnant women\u003csup\u003e8, 9\u003c/sup\u003e. Only few studies have identified barriers that may affect pregnant women knowledge of the influenza vaccine and their decision to receive it during pregnancy. These factors varied between demographic factors, medical history\u0026nbsp;characteristics, level of knowledge and perceptions of pregnant women toward influenza and vaccines\u003csup\u003e(10)\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e11\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCurrently, there are no published studies that focus on seasonal influenza vaccine uptake during pregnancy in Jordan. Therefore, this study proposes assessing pregnant women uptake, knowledge, attitudes and perceptions in Al-Karak governorate, south of Jordan. Understanding these factors will help address the gaps in vaccine acceptance and guide future public health interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and subjects.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Al-Karak governorate in Jordan, which is divided into three regions (Northern, Central, and Southern), each has three or more comprehensive and primary health centres. Two health centers were selected randomly from each region, in addition to two public hospitals found in the governorate and selected private obstetrics clinics. The study was conducted in postnatal wards and Obstetrics and childhood out-patient clinics. Jordanian women who had been pregnant during the influenza season 2021-2022 in Al-Karak governorate during the study period were eligible to participate in the study, excluding those whoarenot permanent residents in Al-Karak governorate, those who refused to answer the questionnaire and those with a contra-indications to receiving the influenza vaccine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Target Sample size.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTarget sample size N was calculated using OpenEpi Version 3. The total study population is 7274 pregnant women based on the latest birth census over the city\u003csup\u003e[12]\u003c/sup\u003e. The prevalence rate = 50%; because no previous studies have measured the level of knowledge, attitudes and uptake rate of influenza vaccine among pregnant women in Jordan, the default prevalence used is 50%, with a confidence level of 95%, Z \u003cstrong\u003e0.95\u003c/strong\u003e = 1.96 (Normal Distribution Table). Therefore, the calculated sample size = 345. \u0026nbsp;To consider for the non-response rate of the calculated sample size, 10% was added, therefore, a sample size of 380 pregnant women were required to reach the power of 95% with a 0.05 margin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection period was conducted from June 2022 to September 2022, the\u0026nbsp;obstetrics and childhood clinics were usually open for five days per week. Interviews were conducted by a team of female doctors and nurses trained to interview pregnant women. Training included the importance of the topic researched, the study objectives, ethical considerations and training on the questionnaires conduction and handling.\u003c/p\u003e\n\u003cp\u003eThe first phase included selective hospitals and outpatient obstetric clinics during the month of June 2022. The second phase was in conducted in the Maternity and childhood clinics in the primary and comprehensive health centers as of \u0026nbsp; July 2022. Participants were informed that the decision on participation or responses will not affect the standard of care they should be receiving. After approval was obtained from the participant, the interviews took place in a time not exceeding 10 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured Arabic questionnaire was constructed through the combination of items from reliable and valid questionnaires\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e13\u003c/sup\u003e.\u0026nbsp;Backward-forward translation of the questionnaire was done by medical and social experts, additionally, pilot-tested 20 pregnant women were interviewed to test the acceptability, length, clarity, and assess the questions /statements formats of the questionnaire. Pilot interviews were not included in the study sample. The final version is composed of 46 questions/statements other than the demographic data. All questions/statements were close-ended questions addressing five areas of interest; socio-demographic and medical history Information such as \u003cstrong\u003e(\u003c/strong\u003eage, level of education, residency, employment state, total monthly income, and health insurance, para and gravida status, miscarriage, medical history and history of influenza before and during the pregnancy), information related to influenza and influenza vaccine knowledge (10 multiple choice questions), perceptions and attitudes toward the influenza vaccine based on the Health Belief Model (HBM), uptake of influenza vaccine and, finally, factors affecting influenza vaccine uptake.\u003c/p\u003e\n\u003cp\u003eIn this context, the theory of the Health Belief Model\u0026nbsp;(HBM)\u0026nbsp;contributed to explaining women's perceptions about their tendency to adopt healthy behavior that is determined by other factors: perception of disease susceptibility and perceived severity of the consequences of influenza, exposure to information that may prompt a pregnant woman to take the action of receiving the vaccine and the amount of benefit that she thinks she will get.\u003c/p\u003e\n\u003cp\u003eAccording to the HBM, a pregnant woman's readiness to take action (receive influenza vaccine) depends on the following beliefs or conditions: \u0026nbsp;is she susceptible to this influenza? Is the threat of influenza serious to her health? Do the benefits of taking the vaccine outweigh the barriers? Is she confident she can carry out the vaccination successfully? Are there Cues to action present to motivate her to take the vaccine?\u003c/p\u003e\n\u003cp\u003eThe following components of HBM were used in the study: the pregnant woman’s perceived risk of getting influenza (perceived susceptibility), the belief of the resulting consequences for her and the health of the fetus (perceived severity), the potential positive benefits of influenza vaccine (perceived benefits), perceived barriers to influenza vaccine and the exposure to factors which prompt action (cues to action), as well as modifying variables (a person’s characteristics).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo make the process of handling and analyzing the data more effective and easier, each variable and its respective items was coded with unique codes to ensure no duplication and ease of retrieval. This process helps to understand and manage these items for organizing purposes according to their unique codes \u003csup\u003e14\u003c/sup\u003e. Statistical processing was carried out using the statistical package for the social sciences program (SPSS V.22). Data was checked to identify possible entry errors, missing values, incorrect or illogical answers and non-response to statements questions. Chi-square analysis was used to analyze the association between all baseline characteristics, knowledge level and vaccination status. Binary logistic regression was performed to find the predictors of vaccine uptake and Stepwise regression was performed to study the effect of selected baseline characteristics on each item of barrier measure. Multiple linear regression was performed to study the effect of all HBM variables on women’s attitude toward vaccination.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Characteristics and Receiving of SIV Vaccination.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFour hundred fifteen (415) questionnaires were filled out, 33 were excluded because they were incomplete or did not match the inclusion criteria. Of the 382 interviewed pregnant women, 199 (52.1%) were from urban areas. Of the demographic characteristics, the place of residency and educational level were significantly different between pregnant women who received and did not receive influenza vaccine, 114 (29.8%) received influenza vaccine before, while the majority (70.2%) have remained unvaccinated. However, only 34 (8.9 %) received the vaccine during previous pregnancies while 31 (8.1 %) received the vaccine during the current pregnancy (table 1).\u003c/p\u003e\n\u003cp\u003eTable 6 shows the likelihood of vaccination during the current pregnancy depending on HBM individual variables, knowledge score, attitude towards the vaccination, and other factors,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The result revealed that women from urban areas and those with good knowledge of influenza and vaccination were more likely to increase the likelihood of vaccination (OR= 5.792, 1.352) prospectively. Further, being previously vaccinated was significantly and positively predictive of vaccination during the current pregnancy (OR= 2.600).\u003c/p\u003e\n\u003cp id=\"_Toc123084709\"\u003e\u003cstrong\u003eHealth Belief Model HBM And Attitude Towards Vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom each HBM domains except perceived susceptibility, at least one item was predictive of \u0026nbsp; influenza vaccination during pregnancy. One of “Perceived Severity of Influenza” items predicted influenza vaccine uptake during current pregnancy: vaccinated women were more likely to perceive themselves at risk of severe complications from influenza (Table 2). Details of the attitudes according to the HBM are described in Table 3. Table 4 shows the participants' responses to selective factors that may predict vaccination rates.\u003c/p\u003e\n\u003cp\u003eThere were statistically significant predictors for influenza vaccine uptake during pregnancy through the stepwise regression analysis including urban residence (P\u0026lt;.013 OR 5.792), university and high educational level (p\u0026lt;.005 OR 1.35), in addition to previous vaccination (p\u0026lt;.022 OR 2.6). Other predictors revealed by the Health Belief Model were the perceived severity of influenza, perceived benefits of vaccinations, perceived barriers to vaccinations, cues to action and attitudes toward influenza vaccine (table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe influenza vaccine uptake was observed in the study at a rate of (8.1%). In fact, in Jordan, influenza vaccine is provided free of charge only for the elderly with underlying chronic diseases (for example, renal failure) and for healthcare workers in public health provision services. Furthermore, national health insurance does not cover the cost of the vaccine.\u003c/p\u003e\n\u003cp\u003eHowever, Jordan is one of the 14 countries in the Eastern Mediterranean and Western Pacific region that has adopted a national immunization policy or guidelines against seasonal influenza (National Program for Surveillance and Control of Influenza since 1980 as well as Pandemic Influenza Preparedness and Response Plan since 2009)\u003cstrong\u003e\u003csup\u003e15\u003c/sup\u003e\u003c/strong\u003e. It seems that there are no practical steps to improve the uptake rates of the vaccine among the Jordanian community in general and pregnant women in particular. Similar findings of low uptake rates have been reported in other studies conducted in developing countries, which could be explained by the lack of an effective national policy regarding influenza vaccination among pregnant women.\u003c/p\u003e\n\u003cp\u003eFor instance, in a study conducted in Tunisia during the 2018–2019 influenza season, only (4.6%) of the surveyed pregnant women were vaccinated during their pregnancy\u003cstrong\u003e\u003csup\u003e(8)\u003c/sup\u003e\u003c/strong\u003e. Likewise, in another study conducted in Saudi Arabia, only 19.8% of the surveyed pregnant women received the vaccine during their pregnancy\u003cstrong\u003e\u003csup\u003e(7)\u003c/sup\u003e\u003c/strong\u003e. The lack of awareness of pregnant women regarding the importance of receiving vaccinated against influenza during pregnancy and the lack of physician recommendations of influenza vaccine are the main reasons for this low uptake.\u003c/p\u003e\n\u003cp\u003eThe overall knowledge of pregnant women about influenza and its vaccine was intermediate (see Table 5). An intermediate level of knowledge of influenza and the vaccine could be explained by inadequate health education in health centers and maternity clinics, as well as the weak role of audio-visual media in spreading awareness about the importance of vaccination during pregnancy. Moreover, the study shows that women of university degree and high-education have statistically significant more disease and vaccine knowledge than school-educated women. Similar results were reported in an Italian study, in addition to other variables such as age and number of children\u003cstrong\u003e\u003csup\u003e7, 16\u003c/sup\u003e\u003c/strong\u003e, the study showed different results where the educational level was not significantly related to vaccine knowledge, but other variables such as employment status, monthly income, and the number of pregnancies were significantly related.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBM Predictors of Seasonal Influenza Vaccination During Pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults of the multivariable analysis of the HBM items reveal that the significant predictors that are positively associated with influenza vaccine uptake during current pregnancy are their perception of influenza severity, perception of vaccination benefits and cues to act. In parallel, the perception of threats is negatively associated with women's vaccine uptake during pregnancy; pregnant women who feel that their influenza infection during pregnancy could lead to serious complications for their health and the health of the fetus are more likely to receive the influenza vaccine than those who didn’t feel that threat. Based on a similar study, all domains of HBM were found to have significant correlations with the vaccine uptake rates including the perception of disease severity, perception of susceptibility and perception of perceived benefits where they positively correlated with vaccine uptake, in contrast with perceived threats where they negatively correlated with vaccine uptake\u003cstrong\u003e\u003csup\u003e(12)\u003c/sup\u003e\u003c/strong\u003e. Studies have shown that women’s awareness of threats predicts the acceptance and uptake of vaccinations \u003cstrong\u003e\u003csup\u003e(17)\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e(18)\u003c/sup\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eRegarding the aspect of perceived benefits, similar results were encountered in other studies; pregnant women who believed the vaccine would protect them, their fetuses and newborn babies from influenza complications had higher levels of acceptance than other pregnant women\u003cstrong\u003e\u003csup\u003e17\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e18\u003c/sup\u003e\u003c/strong\u003e. Pregnant women who believe that making the right decision about getting the vaccine depends on an HCPs recommendation are also more likely to accept the vaccine than other pregnant women. Similarly finding, in a Chinese study\u003cstrong\u003e\u003csup\u003e(13)\u003c/sup\u003e\u003c/strong\u003e. Trusting guidelines that recommend that all pregnant women receive the annual influenza vaccine makes them more likely to accept the vaccine than other pregnant women. This finding is constant with \u003cstrong\u003e\u003csup\u003e12\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e17\u003c/sup\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eIn addition to HBM barriers, the study identified several barriers that hindered pregnant women from receiving the vaccine; such as concern about mother and baby safety and belief that the vaccine is not effective. These results are consistent with a study conducted in Amman, the capital of Jordan, to understand factors affecting influenza vaccine uptake among Jordan's population, including 1107 adults \u003cstrong\u003e\u003csup\u003e19\u003c/sup\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eConcerning barriers predictors, women in urban areas, having three or more para and having hospitalization experience due to influenza complications -whether during pregnancy or outside pregnancy-, are less likely to perceive barriers to vaccination and don’t believe that the flu vaccine can be dangerous for pregnant women or belief that the influenza vaccine can be dangerous to the fetus (table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Limitations\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThis study has a few limitations. Firstly, it was conducted between June and September, which is after the flu season, limiting the number of participants. Secondly, it coincided with the coronavirus pandemic, requiring the research team to clarify the differences between the coronavirus and influenza vaccines. Thirdly, there is no documented information in the health records to verify the data obtained during the interviews.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eInfluenza vaccine should be provided as part of the protocol for management of pregnant women with monitoring of the uptake rate. The investigation revealed a significant relationship between HCPs recommendation and vaccine uptake. The low rate of influenza vaccine uptake among pregnant women in Al-Karak governorate supports the need to establish health education programs to improve awareness and knowledge about seasonal influenza and the efficacy and safety of vaccines among this population. Vaccination program strategies should primarily target prenatal health care providers because their opinion can significantly influence a woman’s vaccination decision.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and Consent to Participate declarations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Mutah's ethics committee and the Jordanian Ministry of Health Central Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent for publication.\u003c/p\u003e\n\u003ch2\u003eResearch funding\u003c/h2\u003e\n\u003cp\u003eThe research did not receive any funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdullahi H, Elnahas A, Konje JC. Seasonal influenza during pregnancy. European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology. 2021;258:235-9.\u003c/li\u003e\n\u003cli\u003eBuchy P, Badur S, Kassianos G, Preiss S, Tam JS. Vaccinating pregnant women against influenza needs to be a priority for all countries: an expert commentary. International Journal of Infectious Diseases. 2020;92:1-12.\u003c/li\u003e\n\u003cli\u003eRasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. American journal of obstetrics and gynecology. 2012;207(3):S3-S8.\u003c/li\u003e\n\u003cli\u003eLuteijn J, Brown M, Dolk H. Influenza and congenital anomalies: a systematic review and meta-analysis. Human reproduction. 2014;29(4):809-23.\u003c/li\u003e\n\u003cli\u003eDescamps A, Launay O, Bonnet C, Blondel B. Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: results from a national survey. Human Vaccines \u0026amp; Immunotherapeutics. 2020;16(5):1093-100.\u003c/li\u003e\n\u003cli\u003eYuen CYS, Tarrant M. Determinants of uptake of influenza vaccination among pregnant women\u0026ndash;a systematic review. Vaccine. 2014;32(36):4602-13.\u003c/li\u003e\n\u003cli\u003eMayet AY, Al-Shaikh GK, Al-Mandeel HM, Alsaleh NA, Hamad AF. Knowledge, attitudes, beliefs, and barriers associated with the uptake of influenza vaccine among pregnant women. Saudi Pharmaceutical Journal. 2017;25(1):76-82.\u003c/li\u003e\n\u003cli\u003eDhaouadi S, Kharroubi G, Cherif A, Cherif I, Bouguerra H, Bouabid L, et al. Knowledge attitudes and practices toward seasonal influenza vaccine among pregnant women during the 2018/2019 influenza season in Tunisia. PLoS One. 2022;17(3):e0265390.\u003c/li\u003e\n\u003cli\u003eAlMusailhi SA, AlShehri NM, AlHarbi WM. Knowledge, utilization and barriers of pregnant women to influenza vaccine in primary health care centers in Dammam and Al Khobar, Saudi Arabia, 2017\u0026ndash;2018. International Journal of Women's Health. 2019:207-11.\u003c/li\u003e\n\u003cli\u003eEppes C, Wu A, You W, Cameron K, Garcia P, Grobman W. Barriers to influenza vaccination among pregnant women. Vaccine. 2013;31(27):2874-8.\u003c/li\u003e\n\u003cli\u003eTaksdal SE, Mak DB, Joyce S, Tomlin S, Carcione D, Armstrong PK, et al. Predictors of uptake of influenza vaccination: a survey of pregnant women in Western Australia. Australian family physician. 2013;42(8):582-6.\u003c/li\u003e\n\u003cli\u003eHenninger M, Naleway A, Crane B, Donahue J, Irving S. Predictors of seasonal influenza vaccination during pregnancy. Obstetrics \u0026amp; Gynecology. 2013;121(4):741-9.\u003c/li\u003e\n\u003cli\u003eHu Y, Wang Y, Liang H, Chen Y. Seasonal influenza vaccine acceptance among pregnant women in Zhejiang Province, China: evidence based on health belief model. International Journal of Environmental Research and Public Health. 2017;14(12):1551.\u003c/li\u003e\n\u003cli\u003eSekaran U, Bougie R. Research methods for business: A skill building approach: john wiley \u0026amp; sons; 2016.\u003c/li\u003e\n\u003cli\u003eSambala EZ, Ngcobo N, Machingaidze S, Wiyeh AB, Mahasha PW, Jaca A, et al. A global review of seasonal influenza vaccine introduction: analysis of the WHO/UNICEF Joint Reporting Form. Expert review of vaccines. 2019;18(8):859-65.\u003c/li\u003e\n\u003cli\u003eNapolitano F, Napolitano P, Angelillo IF. Seasonal influenza vaccination in pregnant women: knowledge, attitudes, and behaviors in Italy. BMC infectious diseases. 2017;17:1-7.\u003c/li\u003e\n\u003cli\u003eAlalag ZA, Al-Jumaili AA, Al-Hamadani FY. A comprehensive review of drivers influencing flu vaccine acceptance in the Middle East over the last six years: using Health Belief Model. International Journal of Pharmacy Practice. 2022;30(1):5-16.\u003c/li\u003e\n\u003cli\u003eWang R, Tao L, Han N, Liu J, Yuan C, Deng L, et al. Acceptance of seasonal influenza vaccination and associated factors among pregnant women in the context of COVID-19 pandemic in China: a multi-center cross-sectional study based on health belief model. BMC pregnancy and childbirth. 2021;21:1-14.\u003c/li\u003e\n\u003cli\u003eAbu-Rish EY, Elayeh ER, Mousa LA, Butanji YK, Albsoul-Younes AM. Knowledge, awareness and practices towards seasonal influenza and its vaccine: implications for future vaccination campaigns in Jordan. Family practice. 2016;33(6):690-7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Descriptive demographic characteristics of pregnant women by receiving influenza vaccine.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 295px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you received an influenza vaccine in the current\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epregnancy?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=351\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003ePlace of residency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e179(51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;.001 **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e11(35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e172(49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eSchool Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e127(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;.001 **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eHigh Education*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e18(58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e224(63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eFull Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e19\u0026nbsp;(61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e116(34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.997\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003ePart-Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e21 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e7 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e214(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMonthly Income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eless than 500 JD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e10 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e218(62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003efrom 500 to 1000 JD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e125(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003emore than 1000 JD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1\u0026nbsp;(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHealth Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eMinistry Of Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e197(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eMedical Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e98 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003ePrivate Sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e19(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eUniversity Hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e4(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eRelief Agency UNURWA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo Health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3(9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e30(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e21(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e177(50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e9 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e161(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e36 or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003epara-status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e59 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.422\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e9 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e74(21.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e3 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e19 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e218(62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 163px;\"\u003e\n \u003cp\u003egravida status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e20(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e85 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e84 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e3 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e162(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003emiscarriage history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e21 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e247(70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e1 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e10 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e104(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eRegular Medications*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e82 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e26 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e269(76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 163px;\"\u003e\n \u003cp\u003eInfluenza Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes, During Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e7 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e51 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes, Before Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e59 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eBefore and during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e9 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e19 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e232(66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHospitalization due to Influenza complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes, During Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e48 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes, Outside Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e21 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e26 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e282(80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 163px;\"\u003e\n \u003cp\u003ePerceived Severity of Influenza Vaccine.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eMore Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e69 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eSlightly more intense\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e15 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e99 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003esame as in previous days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e6 (19.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e110 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eless severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e35 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHave you heard of the influenza vaccine before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e26 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e277(64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e74 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHave you ever received the influenza vaccine before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e14 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e100 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e17(54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e251(71.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHave you\u0026nbsp;received\u0026nbsp;an influenza vaccine in previous pregnancies?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e27 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e27(87.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e324(92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eKnowledge Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003ePoor knowledge (\u0026lt;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e173 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;.001 **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eGood Knowledge (\u0026gt;=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e19 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e178 (50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eTrust\u0026nbsp;in healthcare provider advice about vaccine*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eLow Trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e10(32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e162(46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eHigh Trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e21(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e189(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e31 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e351(91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* High Education = College, University, postgraduate.\u003c/p\u003e\n\u003cp\u003e* e.g., ( Antihypertension medication, Diabetic medications, Thyroid medication \u0026hellip;)\u003c/p\u003e\n\u003cp\u003e* trust = How much do you trust your healthcare provider\u0026rsquo;s advice about influenza? Choose a rating from 0 to 10\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;** p \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003eTable 2: Association between HBM items and vaccination status.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"768\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 376px;\"\u003e\n \u003cp\u003eHave you received an influenza vaccine during the current pregnancy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eN= 31\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eN=351\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003cp\u003e/Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003cp\u003e/Strongly Agree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003cp\u003e/Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003cp\u003e/Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Susceptibility to Influenza\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003cp\u003e(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003cp\u003e(46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.890\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI get influenza more easily than other people my age.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eWithout the vaccination, I feel that I am vulnerable to a severe infection with the influenza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e(29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003cp\u003e(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003cp\u003e(40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e.827\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI am worried about the fetus being affected by the influenza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003cp\u003e(31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003cp\u003e(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e.776\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Severity of Influenza\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003cp\u003e(45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003cp\u003e(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eIf I get influenza during pregnancy, I may develop severe symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eIf I get influenza during pregnancy, I expose myself to serious complications.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e(29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003cp\u003e(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003cp\u003e(32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.035 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u0026nbsp;If I get influenza while pregnant, the disease may harm my unborn baby.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e(22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003cp\u003e(48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003cp\u003e(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003cp\u003e(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Benefits of vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e(54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003cp\u003e(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003cp\u003e(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003cp\u003e(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI would not have to worry about getting influenza if I received the vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eReceiving the influenza vaccine during pregnancy will help me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003cp\u003e(27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003cp\u003e(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.034 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eReceiving the influenza vaccine during pregnancy will benefit the fetus.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e(9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e(54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003cp\u003e(33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003cp\u003e(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003cp\u003e(40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eInfluenza vaccine can protect the baby during the first months of life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e(16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003cp\u003e(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003cp\u003e(33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003cp\u003e(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.039 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Barriers To influenza vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(41.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003cp\u003e(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003cp\u003e(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI am concerned about the side effects of the vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eThe influenza vaccine can give me the flu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e(45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e(29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003cp\u003e(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003cp\u003e(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003cp\u003e(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.015 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI am worried there might be something I do not know about the influenza vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003cp\u003e(26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003cp\u003e(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003cp\u003e(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eMy family, friends, or co-workers did not encourage me to get the vaccine.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003cp\u003e(25.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003cp\u003e(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003cp\u003e(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCues To Action\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003cp\u003e(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003cp\u003e(26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003cp\u003e(41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e.038 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eMy doctor /nurse pharmacist\u0026rsquo;s recommendation is important for making the right decision about getting the vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI trust the guidelines that recommend that all pregnant women get their annual influenza vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e(54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003cp\u003e(32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e(28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.020 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eI feel like I have had all the information I need to decide if I should get the influenza vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e(29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003cp\u003e(36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003cp\u003e(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.014 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*P\u0026lt;0.05\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3: The Association Between Perceived Attitude and Vaccination Status.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTotal responce N( 382)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"768\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 330px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 373px;\"\u003e\n \u003cp\u003eHave you received an influenza vaccine during the current pregnancy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 65px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eN= 31\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eN=351\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003cp\u003e/Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003cp\u003e/Strongly Agree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003cp\u003e/Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003cp\u003e/Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eI am against receiving the flu vaccine during pregnancy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e(28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003cp\u003e(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;.001 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eI don\u0026apos;t mind taking the influenza vaccine during pregnancies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e(22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003cp\u003e(66.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;.001 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eI recommend other women take the influenza vaccine during pregnancy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003cp\u003e(60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e(28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;.001 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*P\u0026lt;0.001\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Participants\u0026apos; responses to other factors that may predict vaccination rate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Total responce N( 382)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOther Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eHave you ever received advice from a doctor during pregnancy about the influenza vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e170 (44.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e212 (55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eHave you ever received advice from the nurse during pregnancy about the influenza vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e153 (40.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e229 (59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eHave you ever received advice from the pharmacist during pregnancy about the influenza vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e148 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e234 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eHave you been advised by anyone (relative, colleague, friend) to receive the influenza vaccine during this pregnancy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e163 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e219 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDid any person or source influence not receive influenza vaccination during this pregnancy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e139 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e243 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDo you know anyone who has become severely ill with influenza?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e180 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e202 (52.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDo you know anyone who has had a bad reaction to the influenza vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e184 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e198 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDo you have enough information about the safety and side effects of the influenza vaccine?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e144 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e238 (62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 :\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Knowledge Items Scale Analysis. Total responce N( 382)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrect\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWrong\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col\u003e\n \u003cli\u003eInfluenza is a \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. \u0026nbsp;disease (Highly contagious)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e143 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e239 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003eInfluenza may lead to (All of the above)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e235 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e147 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eRisk of complications from influenza in pregnant women\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e(Greater than non-pregnant women)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e203 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e179 (46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eImmunity during pregnancy \u0026hellip;\u0026hellip;. (Decreases)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e235 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e147 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003eInfluenza vaccination during pregnancy\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e(Helps protect pregnant women from influenza)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e204 (53.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e178 (46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"6\"\u003e\n \u003cli\u003eVaccination of pregnant women against influenza\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e(Helps protect the fetus and child after birth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e62 (16.2(%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e320 (83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"7\"\u003e\n \u003cli\u003eThe influenza vaccine is given in (Winter season)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e184 (48.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e198 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"8\"\u003e\n \u003cli\u003eThe best way to protect against influenza is.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e(Taking the vaccine with adequate precautions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e223 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e159 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"9\"\u003e\n \u003cli\u003eGive the influenza vaccine during pregnancy.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (The vaccine should be given to all pregnant women)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e152 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e230 (60.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 449px;\"\u003e\n \u003col start=\"10\"\u003e\n \u003cli\u003eInfluenza vaccination during pregnancy\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; (Safe during pregnancy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e122 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e260 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 449px;\"\u003e\n \u003cp\u003eKnowledge categories n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e197 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e185 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e(correct answer)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 6: \u003cstrong\u003eOdds Ratios for Vaccination during current pregnancy: By HBM Individual variables, Knowledge score, attitude towards the vaccination, other factors\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidency (Urban)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e23.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge score (good Knowledge)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever had the influenza vaccine before? () (yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTaking the influenza vaccine during pregnancy will help me. (Benefits2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003einfluenza vaccine can protect the baby during the first months of life (Benefit 4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.041*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe influenza vaccine can give me the flu (Barrier2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-.375-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMy doctor/nurse pharmacist\u0026apos;s recommendation is important for making the right decision about getting the vaccine (cause to action 1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.047*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI trust the guidelines that recommend that all pregnant women get their annual influenza vaccine (cause to action 2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI feel like I have had all the information I need to decide if I should get the influenza vaccine (cause to action 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI am against taking the flu vaccine during pregnancy (Attitude 1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-.795-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.026*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI recommend other women take the influenza vaccine during pregnancy. (Attitude 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e.020*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP\u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Flu, flu vaccine, knowledge, Uptake, Pregnancy, Health Belief Model, Jordan","lastPublishedDoi":"10.21203/rs.3.rs-8158468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8158468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePregnant women are at an increased risk of developing severe flu and suffering its complications. Many countries recommend annual flu immunization during pregnancy, but in Jordan, it has not been routinely recommended or adopted through local guidelines. Moreover, there is limited data on the influenza vaccine uptake, knowledge, attitudes, and barriers for flu virus vaccinnation during pregnancy. Therefore, this study was proposed to assess flu vaccination rates and associated factors among pregnant women in Al-Karak governorate, south of Jordan, during the 2021-2022 flu season. This study applied the Health Belief Model to investigate factors affecting receiving the influenza vaccine during pregnancy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional study conducted using a reliable questionnaire on a representative sample of pregnant women who had been pregnant between September and November 2021 (N = 382). The Survey consisted of 5 parts to assess pregnant women socio-demographics, knowledge, uptake rate, attitude and perception as well as factors affecting influenza vaccine uptake.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Influenza vaccine coverage among pregnant women was \u003cstrong\u003e(8.1%)\u003c/strong\u003e. An intermediate level of knowledge of influenza and its vaccine was reported among the study participants. There was a statistically significant difference between pregnant women in the vaccinated and non-vaccinated groups in terms of place of residence \u003cstrong\u003e(p\u0026lt;.001)\u003c/strong\u003e, educational level \u003cstrong\u003e(p\u0026lt;.001)\u003c/strong\u003e and past vaccination history \u003cstrong\u003e(p\u0026lt;.044)\u003c/strong\u003e. Predictors of vaccination revealed by logistic regression analysis included urban residence \u003cstrong\u003e(P013.\u0026gt; OR 5.792)\u003c/strong\u003e, university and high educational level \u003cstrong\u003e(p\u0026lt;.005 OR 1.35),\u003c/strong\u003ein addition to previous vaccination \u003cstrong\u003e(p\u0026lt;.022 OR 2.6)\u003c/strong\u003e. Other predictors revealed by the Health Belief Model (HBM) were the perceived severity of influenza, perceived benefits of vaccinations, perceived barriers to vaccinations, cues to action and attitudes toward influenza vaccine.\u003cbr\u003e\n \u003cstrong\u003eConclusions:\u003c/strong\u003e This study provides baseline data necessary to develop strategies for increasing flu vaccination rates aiming to reduce flu burden during pregnancy in the south of Jordan.\u003c/p\u003e","manuscriptTitle":"Seasonal Influenza Vaccine During Pregnancy: Uptake, Knowledge, Attitudes and Perceptions in Al-Karak Governorate, Jordan using HBM","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 06:28:18","doi":"10.21203/rs.3.rs-8158468/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2bcb855b-fb8b-4203-8b74-bde398d558c6","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T03:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 06:28:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8158468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8158468","identity":"rs-8158468","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}