This cross-sectional study evaluated the prevalence of and factors associated with influenza vaccine uptake and intention among public transportation drivers (PTDs) in Lebanon. The investigation was conducted in 2023 and used a face-to-face questionnaire administered to 509 PTDs. The study rationale cited PTDs as a workforce at elevated risk of exposure and potential contributors to community transmission, making vaccine uptake in this group a public health priority.
A face-to-face survey was completed by 509 PTDs. Data collected included socio-demographic characteristics, health-related variables, environmental factors, social norms, and knowledge about influenza and vaccination. The survey incorporated established instruments to measure attitudes and hesitancy: the Vaccine Hesitancy scale and the Vaccination Attitudes Examination scale. Key outcome measures were self-reported influenza vaccine uptake and expressed intention to receive the vaccine under improved conditions (specifically affordability or availability via a mobile clinic).
The reported influenza vaccine uptake rate among participating PTDs was 28.9%. When asked about intention to receive the influenza vaccine if it were affordable or available through a mobile clinic, 56.2% of respondents expressed that intention. These two figures quantify current coverage and potential increased coverage under conditions that reduce financial and access barriers.
Hierarchical logistic regression identified several factors independently associated with actual vaccine uptake.
Positive associations (higher likelihood of uptake):
Negative associations (lower likelihood of uptake):
These results highlight that social exposure to vaccination (knowing vaccinated peers) and direct advice from others correlate with higher uptake, while attitudinal hesitancy domains reduce the probability of vaccination.
Separate hierarchical logistic regression models examined predictors of expressed intention to vaccinate under improved availability or affordability.
Positive associations with intention:
Negative associations with intention:
These findings indicate that social influences and prior behaviors increase willingness to vaccinate, while multiple hesitancy dimensions—confidence, distrust of commercial motives, and preference for natural immunity—decrease it.
The study used chi-square tests to examine bivariate associations and hierarchical logistic regression models to identify independent predictors of both vaccine uptake and vaccine intention. Adjusted odds ratios and 95% confidence intervals were reported for the variables retained in the multivariable models. The presence of multiple hesitancy-related subdomains (confidence, risk calculation, commercial profiteering, natural immunity preference) allowed the authors to identify which attitudinal factors most strongly related to behavior and stated intention.
Among 509 PTDs surveyed in Lebanon, influenza vaccine uptake was relatively low at 28.9%, while over half (56.2%) indicated they would be willing to vaccinate under improved affordability or access conditions. Independent positive drivers of both uptake and intention included social exposure to vaccinated peers and prior vaccination or infection experience. Key negative drivers were attitudinal hesitancy domains—particularly lack of confidence, concerns about commercial motives, risk-calculation behaviors, and preference for natural immunity.
The authors recommend interventions focused on improving accessibility and affordability of the influenza vaccine for PTDs, such as mobile clinics, and tailored educational campaigns that address specific hesitancy concerns and misinformation. These approaches are proposed as potential strategies to increase influenza vaccine coverage in this occupational group and reduce transmission risk in the community.
Note: All numerical results, odds ratios, confidence intervals, sample size, instruments used, and recommended actions are reported as presented in the source abstract.