Keywords: Influenza Vaccination, Vaccine hesitancy, Vaccine refusal, Risk perception, Rural vs Urban Dispairities

Background:

Influenza remains a significant cause of severe respiratory illness, despite advancements in vaccinology. Vaccine hesitancy is posing a major challenge, especially in rural populations, who face barriers such as limited healthcare access and lower health literacy.

Aim of the study:

This study aimes to explore vaccine hesitancy using a 13-item questionnaire distributed to family doctors.

Methodology:

The study took place in Romania between October 4 and October 30, 2024, involving 16 family medicine practices, seven of which were in rural areas. Physicians recorded reasons for influenza vaccine refusal and gathered anamnestic data, with a particular focus on rural disparities. A 13-item questionnaire explored factors contributing to vaccine hesitancy, highlighting common barriers such as distrust, fear of side effects, and exposure to misinformation among 272 respondents. Latent Class Analysis (LCA) was used to identify distinct hesitancy profiles, while Chi-square and odds ratio analyses were used to evaluate geographic variations.

Results:

Among 272 patients refusing influenza vaccination, refusal rates were significantly higher in rural areas, despite a greater number of consultations in urban settings. Latent Class Analysis identified three hesitancy subgroups: Class 1 displayed a low-hesitancy and fear-driven profile, class 2 showcased a high-hesitancy and distrust-driven profile, while class 3 displayed intermediate hesitancy and focused more on questioning the necessity of vaccines. Key predictors of refusal included fear (higher in females and parents), distrust (higher in unmarried individuals), and distorted risk perception.

Conclusions:

This study provides valuable insights into the key reasons behind vaccine refusal in Romania, revealing distinct patterns of hesitancy, with a clear discrepancy between rural and urban populations.Targeted public health interventions are essential to bridge this gap, enhance vaccine education, and build trust in rural communities.