A cross-sectional study on attitudes and behaviors toward influenza vaccination among Italian adults

Abstract Background Seasonal influenza imposes a significant clinical and economic burden on healthcare systems. Although annual vaccination effectively reduces morbidity, mortality, and costs, coverage remains suboptimal. This study investigated attitudes and behaviors toward influenza vaccination. Methods Data was collected using a structured questionnaire through a web-based survey involving adults aged ≥ 18. Descriptive and univariate analysis, and two multivariable logistic regression models were performed to identify determinants of flu attitudes and vaccination practices. The study was supported by EU funding: Project no. PE00000007, INF-ACT. Results A total of 1,821 adults were enrolled, 36% were aged ≥ 65 years and 52% reported chronic conditions. Among those with chronic diseases, 52% received at least one influenza vaccine dose in the past five years; among those aged ≥ 65 years, only 38%. Multivariable analysis revealed that having a chronic condition (OR 1.5; 95% CI 1.2-2.2) and a high perceived risk of influenza (OR 8.8; 95% CI 6.2-12.4) significantly increased the likelihood of perceiving the disease as severe, whereas relying on non-institutional web sources reduces it (OR 0.4; 95% CI 0.2-0.8). Predictors of vaccination in the past five years included: having children (OR 1.5; 95% CI 1.1-1.9), high income (OR 3.1; 95% CI 1.6-6.1), being a healthcare worker (OR 2.7; 95% CI 1.4-5.2) or retired (OR 3.1; 95% CI 2.4-4.2), the presence of chronic disease (OR 2.1; 95% CI 1.6-2.6), perceived high healthcare system quality (OR 1.7; 95% CI 1.2-2.6) and positive attitudes toward influenza (OR 4.8; 95% CI 3.5-6.7) and its vaccine (OR 3.8; 95% CI 3.0-4.9). Conclusions Our findings revealed key predictors offering insights to guide tailored interventions. Public health initiatives should focus on evidence-based communication through trusted sources, addressing individual attitudes and beliefs, reducing accessibility barriers, and actively engaging at-risk populations. Key messages • Strengthening influenza vaccination requires addressing complacency, improving convenience, and promoting evidence-based communication. • Identifying contextual, individual, and group-level factors, such as trust in healthcare systems and vaccines, can inform targeted prevention strategies.