Knowledge, attitudes and beliefs of pharmacy students towards influenza vaccination in South Africa

Abstract

Background: Influenza poses a great threat due to its prevalence, severity, and tendency for antigenic shifts that increase pandemic potential. This virus causes a respiratory illness that spreads quickly through droplets or contact with contaminated surfaces. Outbreaks are seasonal, and vaccination (ideally before the season begins) remains the most effective preventive measure, along with cough etiquette, handwashing, and avoiding ill individuals. Globally, influenza causes millions of severe infections annually, and in South Africa, it places a significant burden on healthcare systems and individual households. Healthcare workers' (HCWs) risk is elevated, and their vaccination is recommended to protect vulnerable patients and maintain uninterrupted medical services. Pharmacy students are future pharmacists and custodians of medicines who will advise and assist various communities. Therefore, there is a need to assess influenza vaccine acceptability in this priority group since HCWs are widely involved in and are significant advocates for different vaccination initiatives, especially now that the world is still dealing with the residual effects of the coronavirus disease (COVID-19) pandemic. Aim of study: To investigate the knowledge, attitudes and beliefs of pharmacy students at nine pharmacy schools in South Africa regarding the influenza vaccine. Methods: A descriptive quantitative study was conducted among undergraduate Bachelor of Pharmacy (BPharm) students in universities across various provinces including Limpopo, KwaZulu-Natal, Western Cape, North-West, Gauteng and Eastern Cape in South Africa. While nine pharmacy schools were approached, only eight universities participated. The inclusion criteria was limited to those in the BPharm programme and 18 years old and above. Those that had participated in the pilot study as well as participants that had more than ten unanswered questions were excluded from the study. A participant information sheet with details on the purpose of the study was adapted from a WITS template to provide further information to those invited to participate in the study. A questionnaire was adapted from a similar survey to suit the needs of this study and used to collect data. The questionnaire was piloted prior to administration to a sample population for study data collection. To assess the pharmacy students' knowledge, affected by their year of study and Work Based Learning (WBL) experience, a nominal scale (correct and incorrect) was used. The participants had to decide which answer most applied to the specific question. A five-point Likert scale was used to examine students' attitudes and beliefs about influenza vaccination. This method had five viii options: “strongly disagree, disagree, neutral, agree and strongly agree” to assess students’ agreement with the statements provided. All analyses were performed using STATA version 14 (StataCorp, USA), and statistical significance was determined at a 5% level. Results: A total of 278 pharmacy students participated in the study. There were 77 questionnaires excluded, resulting in a total of 201 participants. Just over sixty percent were between 18 and 21 (123, 61.2%) years of age, with most participants being female (150, 74.6%). The study identified good knowledge among all participants with a mean average score of 5.7 out of 7. Almost all of the participants (195, 97.0%) expressed that they believed the influenza vaccine to be safe. The participants showed a positive attitude towards influenza with a mean score of 16.2 out of 20. Among the 83 participants who reported to have medical aid, 46 (55.40%) had been vaccinated for influenza. Among those who had been vaccinated before (102, 50.70%), only 47 (46.10 %) indicated that they had received influenza vaccines regularly while growing up. Of the 99 participants that did not vaccinate, (44; 44.44%) indicated that they did not vaccinate due to the low priority assigned to influenza prevention and 29 (29.29%) believed that their natural immune system offers sufficient protection from the flu. Conclusion: There is a disconnect between knowledge and action regarding influenza vaccination among pharmacy students. Despite above-average understanding of influenza and vaccines, vaccination rates remain low. This may affect their advocacy for vaccination amongst patients attended to during WBL. While factors like medical aid coverage play a role, the study suggests the potential for long-term benefits from childhood vaccination. Limited support for mandatory vaccination policies highlights a distinct perspective within pharmacy education. This underscores the need for multifaceted interventions that dispel misconceptions, emphasise the crucial role of pharmacists in promoting vaccination and foster discussions around policy considerations. Further research is needed to pinpoint barriers and design tailored strategies to increase vaccination uptake among pharmacy students for improved public health outcomes.