There is a gap in understanding specific features of health literacy that might be associated with adherence to influenza immunization. The aim of this study was to examine the association of health literacy with avoidance of influenza immunization and beliefs about the influenza vaccine among people with chronic diseases. Selection of study participants was based on a case-control study design in a population of people with chronic illnesses living in the Foča region (Republic of Srpska, Bosnia and Herzegovina) and who were entitled to receive a free influenza shot in season 2017/2018. The cases represented all non-vaccinated people (a total of 146) and the controls were vaccinated people (a total of 149) matched according to town of residence. Participants were interviewed in person from April to December 2018 using a socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Health Belief Model Applied to Influenza (HBMAI). Better score on 'Feeling understood and supported by healthcare providers', 'Social support for health' and 'Ability to actively engage with healthcare providers' was associated with more perceived benefits of influenza immunization in men, but not in women. Perceiving more Barriers to influenza immunization was associated with lower scores on 'Feeling understood and supported by healthcare providers', 'Have sufficient information to manage health', 'Social support for health' and 'Ability to actively engage with healthcare providers' in both men and women. Health literacy may be associated with the perception of susceptibility to influenza, benefits and barriers to influenza immunization and motivations to receive influenza vaccine.
Keywords: Health Belief Model; chronic diseases; health literacy; immunization; influenza.
We aimed to examine the association between health literacy with missing free influenza immunization. This research focused on people with chronic illnesses living in the Foča region (Republic of Srpska, Bosnia and Herzegovina) and who were entitled to receive a free influenza shot in season 2017/2018. All non-vaccinated people (cases) and corresponding number vaccinated people (controls) were included. People were interviewed using the socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Health Belief Model Applied to Influenza (HBMAI). Mathematical model suggested potential difference between men and women, so the analyses were performed separately for each gender. People who had better health literacy were not more likely to receive the influenza vaccine. Men who felt better understood and supported by healthcare providers, who had more social support and were actively engaging with healthcare providers were more likely to perceive benefits of influenza immunization. People who felt less understood and supported by healthcare providers, who felt that they did not have sufficient information to manage health and social support and were not actively engaging with healthcare providers were more likely to perceive barriers to influenza immunization. People with chronic diseases should be encouraged to improve their health literacy to better understand influenza immunization.
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