Predictors of influenza vaccination among Iranian pregnant women based on a combined Health Belief Model and Theory of Planned behavior

Abstract

ABSTRACT Influenza poses a significant public health risk, particularly for pregnant women due to physiological and immunological changes. Despite strong recommendations and proven safety of influenza vaccination, uptake remains suboptimal. This study aimed to identify predictors of influenza vaccination among Iranian pregnant women using an integrated Health Belief Model (HBM) and Theory of Planned Behavior (TPB). A cross-sectional analytical study was conducted among 630 pregnant women attending urban and rural health centers and private clinics in Fasa and Shiraz, Iran. Participants were selected using multistage stratified sampling. Data were collected by a validated, researcher-developed questionnaire based on HBM and TPB constructs. Statistical analyses included descriptive statistics, Spearman correlation, logistic regression, and Structural Equation Modeling (SEM). The mean age of participants was 29.36y, and 73% received the influenza vaccine during the current pregnancy. The most common barriers were concerns about side effects (49.4%), limited access (28.2%), lack of provider recommendation (27.1%), and insufficient information (34.1%). SEM results indicated that perceived susceptibility (beta = 0.18), perceived barriers (beta = -0.15), and attitude (beta = 0.13) were significant predictors of behavioral intention. Behavioral intention had a small but significant effect on actual vaccination (beta = 0.08). Subjective norms, self-efficacy, and perceived behavioral control were not significant predictors. Perceived susceptibility, common barriers, and attitude play key roles in shaping vaccination intention, while structural factors limit the translation of intention into action. Interventions focusing on education, improving provider–patient communication, and reducing access barriers may enhance vaccination uptake among pregnant women.