Background: Annual influenza vaccination is the most effective method for preventing influenza virus infections and its associated complications among kidney transplant recipients. Vaccine uptake is also important in the context of the coronavirus disease 2019 (COVID-19) pandemic. In South Korea, the influenza vaccination rate in kidney recipients remains low. It is crucial to apply interventions that consider theoretical mechanisms to increase vaccination rates. To date, studies employing the health belief model have not analyzed the intricate pathways among constructs due to the limitations of the statistical analysis method. This study examined the pathway linking constructs of the health belief model and explored how these constructs affect influenza vaccine uptake in kidney transplant recipients.
Methods: A cross-sectional design, guided STROBE. A total of 180 recipients were recruited at an organ transplant center in Korea in 2016. A nonlinear generalized structural equation model was used to conduct the path analysis and nonlinear combination.
Results: Previous influenza vaccination directly affected vaccine uptake. Cues to action had no direct effect on actual vaccine uptake. Previous influenza vaccination and cues to action had significant indirect effects on vaccine uptake via the mediation of perceived benefits.
Conclusions: This is the first study to investigate the mechanisms of the health belief model using nonlinear generalized structural equation modeling. This study suggests that only perceived benefits completely mediate the association between cues to action and vaccine uptake and partially mediate the relationship between previous vaccination and vaccine uptake. Health professionals and media recommending the vaccine should provide cues to action that emphasize the vaccines benefits while maintaining a positive tone. Sharing the experiences of other recipients who saw benefits from vaccination will be useful in practice as well.