Investigator(s)
| Submitter |
Cheten Zangmo Department of Public Health, Ministry of Health Cheten Zangmo 
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| Principal Investigator |
Cheten Zangmo Department of Public Health, Ministry of Health Cheten Zangmo
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| Co-Investigator(s) |
Dorji Tshering Phuentsholing General Hospital, National Medical Services Dorji Tshering
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| Co-Investigator(s) |
Tashi Dawa Ministry of Health Tashi Dawa
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| Co-Investigator(s) |
Sonam Wangchuk Royal Center for Disease Control Sonam Wangchuk
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| Co-Investigator(s) |
Dhrupthob Sonam Jigme Dorji Wangchuck National Referral Hospital, National Medical Services Dhrupthob Sonam
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| Co-Investigator(s) |
Ugyen Tshering Ministry of Health Ugyen Tshering
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| Co-Investigator(s) |
Ugyen Zangpo Ministry of Health Ugyen Zangpo
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| Co-Investigator(s) |
Tshering Samdrup Ministry of Health Tshering Samdrup
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| Co-Investigator(s) |
Eva Bazant The Taskforce for Global Health, USA Eva Bazant
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| Co-Investigator(s) |
Anna Chard Centers for Disease Control & Prevention (CDC), USA Anna Chard
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| Co-Investigator(s) |
Aslesh Prabhakaran US Centers for Disease Control and Prevention, New Delhi India Aslesh Prabhakaran
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| Co-Investigator(s) |
Chelsey Griffin Centers for Disease Control & Prevention (CDC), USA Chelsey Griffin
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Title(s) and abstract
| Scientific title | Knowledge, Attitudes, and Practices Regarding Seasonal Influenza Vaccination Among Healthcare workers in Bhutan: A Mixed-Methods Approach |
| Public title | Knowledge, Attitudes, and Practices Regarding Seasonal Influenza Vaccination Among Healthcare workers in Bhutan: A Mixed-Methods Approach |
| Background | Influenza is a major global public health concern, with influenza A and B viruses causing seasonal epidemics and occasional outbreaks. Transmission occurs mainly via respiratory droplets and aerosols from infected individuals, and sometimes through contaminated surfaces (1,2). Annually, 5–10% of adults and 20–30% of children worldwide are infected, leading to 3–5 million severe cases and up to 650,000 respiratory-related deaths. Illness can range from asymptomatic to severe disease and death. The WHO recommends annual vaccination for high-risk groups—children, pregnant women, the elderly, people with chronic conditions, and healthcare workers (HCWs) (1). HCWs face elevated occupational risk and may transmit influenza to vulnerable patients, especially the immunocompromised or critically ill (3). Such infections can cause nosocomial outbreaks and increase mortality among hospitalized patients (4). Annual vaccination protects HCWs, their families, and patients, reduces absenteeism, and indirectly safeguards those unable to be vaccinated (5). Bhutan introduced its national seasonal influenza vaccination program in 2019 (6), targeting the five WHO-recommended high-risk groups. This followed Royal Centre for Disease Control (RCDC) assessments in 2015–2016 identifying high influenza-related hospitalizations, particularly among children and older adults (7). The program, integrated into the national immunization schedule, administers the vaccine every October, ahead of influenza season. Seasonal influenza vaccination also strengthens adult immunization systems and pandemic preparedness (6). Despite this, HCW vaccine uptake in Bhutan remains 60–80%, below the 80% national target. Similar trends are reported in Lebanon, Pakistan, Singapore, and Spain (8-11). As trusted health advisors, HCWs influence public vaccine acceptance (12). Addressing vaccine hesitancy—defined as “delay in acceptance or refusal of vaccination despite availability” (13)—requires understanding HCWs’ knowledge, attitudes, and practices (KAP) to develop targeted interventions and improve uptake (14). |
| Objectives | Aim: To assess the knowledge, attitudes, and practices of healthcare workers regarding influenza vaccination in Bhutan, using a convergent mixed-methods approach. Specific objectives: 1. To assess the knowledge of Bhutanese healthcare workers on influenza vaccination 2. To understand healthcare workers’ attitudes toward influenza vaccination. 3. To identify factors influencing influenza vaccination uptake among healthcare workers and their recommendations. 4. To provide evidence-based recommendations to policymakers and program managers to enhance influenza vaccine uptake in this key population. |
| Study Methods | This study will employ a Convergent mixed-methods design, comprising a cross-sectional quantitative survey, and qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to gain deeper insights into healthcare workers’ KAP regarding influenza vaccination in Bhutan. Quantitative and qualitative data will be collected concurrently, analyzed separately, and then converged or integrated during interpretation to provide a comprehensive understanding. This study will be guided by the Health Belief Model, which posits that individuals' health-related behaviors are influenced by their perceptions of the severity of a health threat, the benefits of taking a health action, and the barriers to taking that action. Another resource will be the World Health Organization’s Behavioral and Social Drivers (BeSD) of vaccine uptake model, which has been focused on influenza vaccination (15). |
| Expected outcomes and use of results | The expected outcome of this study is to generate a comprehensive understanding of healthcare workers’ knowledge, attitudes, and practices regarding seasonal influenza vaccination in Bhutan. By identifying key barriers and facilitators influencing vaccine uptake, the study will generate evidence to guide targeted, data-driven, and educational strategies aimed at improving vaccination coverage. These insights will help policymakers design context-specific interventions, strengthen communication strategies, optimize resource allocation, and enhance national preparedness for seasonal influenza outbreaks and future respiratory pandemics. |
| Keywords | Influenza, seasonal epidemics, influenza vaccination, WHO recommendations, high-risk groups, and healthcare workers. |
Research Details
| Student research | No |
| Start Date | 23-Jun-2025 |
| End Date | 05-Feb-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Immunization/Vaccine Preventable Disease |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | No |