A Mixed-Methods Normative Case Study of Undergraduate Students\u27 Attitudes and Behaviors towards Influenza and Vaccination in the Post-2009 Influenza A(H1N1) Pandemic Era

The 2009 influenza A(H1N1) pandemic caused high morbidity and mortality in young adults, prompting recommendation for extension of routine annual flu vaccination to all healthy adults younger than 65 years old who do not have contraindications. But despite this recommendation, flu vaccination rates remained suboptimal in university students. The purpose of this study was to determine (a) how undergraduate students perceive influenza as a risk in light of risk information communicated by authoritative bodies; (b) where they seek advice and access educational information about influenza and methods of flu protection; (c) what attitudes they hold towards influenza and vaccination; and (d) when and why they engage in risk response behavior? This social science study, which involved 303 undergraduate students, included a written questionnaire, infographics, and interviews. Four theories (cultural theory of risk perception; structural constructivism; symbolic interactionism; and applied phronesis) were used to interpret the data. The coding of students’ answers allowed for the identification of ten themes, such as authoritative powers, identity, beliefs, infoglut, and reacting to risk. Students ranked influenza at the lower end of various risks discussed, considered their personal doctors as the most trusted source for influenza information, and were against mandatory flu vaccination. Although 48.6% of students self-reported flu vaccination during the 2014-2015 influenza season, vaccination was inconsistent in prior years. Perceived good health, vaccine complacency, a busy class schedule, vaccination confidence and convenience, were identified as factors contributing to vaccine hesitancy. Students developed a habit of using non-pharmaceutical flu interventions during their middle/high schools years, which was seen as a reason why flu vaccination was not their primary choice to protect against influenza. Students reported that they would seek information pieces that matter to them in case of a major flu outbreak close to or on campus. However, infoglut would make it difficult to them to find the right information online. This study suggests a need for a stronger focus of influenza education on undergraduate students by considering the needs and wants of these young adults. Numerous suggestions were made for how authorities, especially the university, can play here a stronger role