Knowledge and Attitudes of Adult Diabetic Patients Attending Primary Health Care in Bahrain about Seasonal Influenza and Influenza Vaccination - A Cross-Sectional Study

Introduction: Influenza is a highly contagious respiratory viral illness that is vaccine-preventable and occurs seasonally. While most cases present with mild respiratory symptoms, influenza can lead to severe complications in vulnerable populations, such as diabetics. Despite the protective benefits of annual vaccination, its uptake remains inconsistent worldwide, including among diabetic patients. Various factors, including knowledge, attitudes, and practices toward vaccination, may contribute to this low adoption. Aim: This study aimed to assess the knowledge and attitudes of diabetic patients attending primary health care in Bahrain about seasonal influenza and the determinants of vaccine uptake or refusal. Methods: A cross-sectional study was conducted between 6th and 17th February 2022 in five health centers in Bahrain. Utilizing an online calculator, a sample size of 357 was determined. The study was conducted using a convenience sampling method, which may restrict its generalizability. A self-administered questionnaire was used to assess patients’ knowledge and attitudes about seasonal influenza and influenza vaccination. Results: A total number of 393 participants (208 males and 185 females) were enrolled in the study with a mean age 58.8 years (SD = 10.1). Most participants in the present study had poor levels of knowledge towards seasonal influenza and influenza vaccine (56.7% and 64.1%, respectively). Furthermore, advice from doctors about the importance of vaccination was the most decisive of vaccine uptake (72.9%), while patients’ perception that the vaccine is unnecessary as flu is just a minor illness was the most determinant of vaccine refusal (40.2%). A significantly strong association was found between patients’ knowledge and attitudes towards influenza vaccine uptake (P < 0.001). Additionally, the results showed that around 49.4% of the patients did not get the vaccine. Uptake of influenza vaccine was significantly higher among female participants (Odds ratio; OR = 1.8), participants with diabetes duration above 6 years (OR = 2) and participants with good, combined knowledge of influenza and its vaccine (OR = 2.9). Conclusion: In conclusion, this study found significant gaps in knowledge towards seasonal influenza and influenza vaccine. Nonetheless, most patients showed significant positive attitudes in favor of the vaccine. Significant association was found between patients’ knowledge and their attitudes toward influenza vaccine uptake. Urgent interventions to improve influenza vaccine uptake and knowledge are needed. Keywords: Influenza, Influenza vaccine, Diabetes mellitus, Knowledge, Attitudes