Discussion

This study explored influences on university students’ intentions to receive a recommended vaccine. We found that past vaccine receipt, needle fear and country of residence until at least the age of four were significant predictors of vaccine intention.

Past vaccine receipt had the strongest influence on intention. Students who had received all recommended childhood vaccines were over three times more likely to be high vaccine intenders than students who had not. This is consistent with a previous systematic review which found that receiving all childhood vaccinations was a positive predictor for human papillomavirus vaccine initiation in teenage girls.12

Furthermore, students who were less afraid of needles were more than twice as likely to be high vaccine intenders than students who were more afraid. This supports a previous study which reported needle fear to be a primary reason for vaccine avoidance among adolescent boys.13 Interventions addressing vaccine uptake in a student population could therefore benefit from focusing on psychological targets such as reducing needle fear by using interventions to reduce pain on immunisation. Moreover, interventions could target students who did not complete their childhood immunisation schedules.

Participants who did not live in the UK before the age of 4 were significantly less likely to be high vaccine intenders compared with participants who had. To our knowledge, there is no previous research investigating the influence of country of childhood residence on intention to vaccinate as an adult. This could be an interesting direction for future research which could assess differences in immunisation schedules between countries and the effects of disparities on uptake.

The five most commonly reported sources of vaccine-related information were the internet, doctor/healthcare provider, family, brochures/pamphlets and friend/coworker. The popularity of these sources is consistent with a critical appraisal reviewing 38 studies.22 The findings of this study indicate that the most common vaccine-related source for students is the internet, which corroborates previous research which found the internet to be the most common health and medicine source used in the UK.23 However, previous studies suggest that the internet is perceived as less trustworthy than sources such as a general practitioner and a medically qualified friend or relative.23 It is therefore unlikely to supplant the role of these sources, but may be used to supplement them.24 Official websites (ie, NHS website, Web MD) were reported more frequently than blogs and Wikipedia. This substantiates previous findings suggesting that official websites are trusted more than less well-moderated websites.22 No students reported social media as a source of online vaccine-related health information. Campaigns could therefore benefit from disseminating information on official web pages. Additionally, university students in the UK often live away from home so re-register with a local health provider. Healthcare providers should use this opportunity to provide information in consultations and use pamphlets as a tool to offer further information.

There are several limitations to this study. Due to the cross-sectional design, findings are correlational. It is therefore difficult to infer the direction of causality between outcome and predictor variables. A future prospective cohort design investigating factors predicting vaccine uptake could therefore be insightful. Intention to vaccinate in the present study may not be directly predictive of behaviour. Previous research has demonstrated an intention–behaviour gap.7 Moreover, we cannot be sure of the response rate as it is not clear how many university departments circulated the recruitment email. Consequently, we are unable to assess non-response bias and there may have been a response bias towards students more interested in this subject. Some survey items relied on participants’ knowledge of vaccinations received during childhood and perception of past adverse reactions, which may also have occurred during childhood. There is therefore the potential for inaccuracies in participant reporting, though it could be argued that perceptions of vaccine-related events in childhood would be stronger predictors of subsequent vaccine attitudes than objectively measured events. In addition, the high proportion of participants who lived outside the UK until the age of 4 suggests an over-representation of non-UK-born participants. It is therefore uncertain whether the findings would be directly generalisable to the wider student population in the UK. Finally, due to time restrictions, we were unable to pilot the survey prior to data collection and there is the potential that some items may lack clarity. A strength of the study is that the sample was large and so we can draw useful conclusions about this sample.

These findings are timely in view of the recent introduction of MenACWY vaccine for 14–18-year olds and for young people up to the age of 25 years attending university for the first time. It is of concern that uptake of the MenACWY vaccine in the first two cohorts of 18-year olds offered the vaccine has not exceeded 39%, leaving many young people at risk of these potentially severe infections.25 The findings provide an indication of where to focus future interventions to raise university students’ awareness of the importance of this and other vaccination programmes.