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. 2025 Jan 9;22(1):84.
doi: 10.3390/ijerph22010084.

Physicians' Intentions to Recommend Influenza Vaccine: A Multi-Centered Hospital-Based Study Using the Theory of Planned Behavior in Bangladesh

Md Abdullah Al Jubayer Biswas  1   2 , Mahbubur Rahman  3 , Sazzad Hossain Khan  1 , Ahamed Khairul Basher  1 , Md Ariful Islam  1   4 , Ashrak Shad Pyash  1 , Homayra Rahman Shoshi  1 , Md Altaf Ahmed Riaj  1 , Md Nazrul Islam  5 , Md Arif Rabbany  5 , Md Azizul Haque  6 , Shishir Ranjan Chakraborty  7 , Syeda Rukhshana Parvin  8 , Mahmudur Rahman  9 , Fahmida Chowdhury  1 , Tahmina Shirin  3 , Md Zakiul Hassan  1   10
Affiliations

Physicians' Intentions to Recommend Influenza Vaccine: A Multi-Centered Hospital-Based Study Using the Theory of Planned Behavior in Bangladesh

Md Abdullah Al Jubayer Biswas et al. Int J Environ Res Public Health. .

Abstract

Background: Influenza remains a significant public health challenge in low- and middle-income countries (LMICs) like Bangladesh, where vaccine uptake remains low despite the substantial disease burden. Physicians play a vital role in promoting vaccination, yet their intentions and influencing factors are not well understood.

Methods: We conducted a cross-sectional study from June to October 2022 across four tertiary-level hospitals in Bangladesh using a questionnaire grounded in the Theory of Planned Behavior (TPB). Hierarchical logistic regression was employed to identify factors associated with vaccine recommendation intentions.

Results: Among 972 physicians with an average age of 32.1 years, 40.1% intended to recommend and administer the influenza vaccine. Most (85.3%) agreed vaccination reduces risk, 65.5% desired vaccination for self-protection, 63.5% would vaccinate if available at work, and 85.3% anticipated Ministry of Health support. Male (OR = 1.9, 95% CI: 1.5-2.3) and married (OR = 1.5, 95% CI: 1.1-1.9) physicians were more likely to recommend vaccination. Each unit increase in attitude score doubled the likelihood of recommending the vaccine (OR = 2.0, 95% CI: 1.4-3.0).

Conclusions: Physicians' influenza vaccine recommendations in Bangladesh are suboptimal, influenced by gender, marital status, and attitudes. Targeted educational interventions addressing attitudinal barriers and leveraging institutional support could improve recommendation practices.

Keywords: Bangladesh; Theory of Planned Behavior (TPB); influenza vaccine; intention to recommend; physician attitudes and behaviors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
TPB framework to investigate physicians’ intention to recommend and administer influenza vaccine.
Figure 2
Figure 2
Physicians’ responses across TPB-component-related questions for influenza vaccination attitudes, subjective norms, and perceived behavioral control.
See this image and copyright information in PMC

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