Societal and economic impact of influenza is mainly due to influenza infection of specific groups, who are at higher risk of health complications leading up to hospitalisation or death. In this study we applied the health belief model (HBM) to evaluate beliefs and attitudes towards influenza disease and vaccine in community-dwelling high-risk individuals (aged 65 or more or having a chronic disease). We conducted a mixed-method study using data collected through a telephone survey of a household unit sample. We used thematic analysis to map responses to HBM dimensions and Poisson regression to model vaccine non-uptake prevalence. The main self-reported reason not to take the vaccine referred to the susceptibility dimension: 'considering oneself to be a healthy person' (29·8%, (95% confidence interval (CI) 22·1-38·7)). Bad experiences after vaccination - barriers dimension - were also commonly reported (17·0%, (95% CI 10·8-23·8)). Vaccine non-uptake prevalence was 22% higher in those who did not consider themselves susceptible to contract flu (Prevalence Ratio (PR) = 1·22, (95% CI 1·0-1·5)) and 18% lower in those who did not consider that the vaccine causes flu symptoms (PR = 0·82, (95% CI 0·68-0·99)). Results suggest that high-risk individuals do not think of themselves susceptible to influenza infection and fear adverse events following immunisation.
Keywords: Chronic disease; elderly; health belief model; high-risk; influenza vaccine; vaccine non-uptake.