Archives of

1. Introduction
Influenza is a contagious viral disease of the respiratory tract [1]. Severe acute respiratory viral infections, including influenza, are the leading causes of global morbidity and mortality [2]. The epidemic and pandemic of this disease occur in autumn and winter [3]. Influenza is one of the leading causes of death worldwide [4], thus it is responsible for 2-5 million severe illnesses and 250 thousand to 500 thousand deaths per year [4,5]. Due to the weakened immune system [6] and the possibility of risk factors, children and the elderly [7,8] are vulnerable to the poor outcomes of influenza over both short- and long-term time horizons [9]. Some ways of preventing and controlling the flu include performing vaccination, washing hands, especially after coughing, sneezing, and touching the nose and mouth, covering the mouth when coughing or sneezing, using a mask and properly disposing it afterward, avoiding crowded places, reducing contact with infected others, and staying at home during the disease outbreak [10].
Different studies have estimated the population’s knowledge about ways of influenza transmission and prevention below moderate level [2]. In some other studies, different proportions of participants had positive attitudes toward the effectiveness of recommended ways of preventing influenza so that in some studies, more than 60% of participants had positive attitudes in this regard [11,12], while some other studies reported weak attitudes of study participants toward influenza prevention [13]. Similarly, the findings of studies demonstrated different levels of intentions or adherence to influenza preventive behaviors, and the most common behaviors were hand washing and using a face mask, [14-17]. However, Loulergue et al in South Korea reported a low willingness to receive the vaccine [18].
Educational interventions are one of the most important strategies to promote influenza prevention behaviors, and planning for such interventions requires the identification of factors affecting such behaviors. Most studies conducted in this field have focused only on vaccination behavior, and a few studies have been performed on the elderly, especially in rural communities. Thus, this study examined the knowledge, attitudes, and behaviors of rural elderly in all the dimensions of
Knowledge, Attitude, and Intention of Rural Elderly About Influenza Preventive Behaviors, Fasa, Iran, 2019
Asghar Keshavarz1*ID, Mahin Nazari2ID, Sanaz Dastmanesh1ID
1MSc in Geriatric Health, Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
2Associate Professor of Health Education and Promotion, Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
*Corresponding Author: Asghar Keshavarz, Email: keshavarz191288@gmail.com
Received: December 26, 2021, Accepted: June 6, 2022, ePublished: March 18, 2023
https://jhygiene.muq.ac.ir/
10.34172/AHS.12.1.1.374
Vol. 12, No. 1, 2023, 43-49
Original Article
Keshavarz et al
44 Arch Hyg Sci. Volume 12, Number 1, 2023
influenza prevention behaviors in different genders and
literacy level groups.
2. Materials and Methods
2.1 Study design and setting
This descriptive cross-sectional study was conducted
on rural elderly in Fasa, 2020. Fasa is the fourth most
populous city of Fars province in the south of Iran.
2.2. Population and participant selection
Based on a previous study [19] and the use of NCSS
PASS 15, a sample size of 140 was calculated for the study
(P = 40%, α = 0.05, d = 0.18, non-response rate = 10%).
Hence, a sample of 140 rural elderly people was selected
by multi-stage random sampling. To this end, five
villages were randomly selected among the 30 villages
in Fasa. The list of the names of all the elderly over 60
years old in these five villages was prepared, and then 28
people were randomly chosen from each village. Showing
satisfaction to participate in the study and having no
cognitive impairments were considered as the inclusion
criteria, and participants who did not completely answer
the questionnaires were excluded from the study.
2.3. Instruments
The data collection tool was a researcher-made
questionnaire that was designed based on a literature
review [11,19,20] and a panel of experts, including five
specialists in health education and health promotion and
a gerontologist. The designed questionnaire consisted of
two parts; the first part included demographic information
(age, gender, and level of literacy of participants) and the
second part contained questions about the knowledge,
attitude, intention, and past behaviors of participants.
The knowledge questionnaire included 10 questions with
Yes/No/I do not know answers, and each correct answer
scored 1, while incorrect or I do not know answers scored
0, thus the total score of knowledge ranged from 0 to
10. The attitude questionnaire contained 18 questions
for measuring attitudes on a 4-point scale, including
much (3 points)/a little (2)/not at all (1)/no idea (0) item.
The items were related to the areas of risk of getting
influenza (2 questions), probable severity of influenza
(4), the effectiveness of proposed methods for influenza
prevention (4), and obstacles to do preventive measures
(8), and the total range of attitude was 0-54. Intention
to perform preventive behaviors was assessed through
4 questions on a 3-point scale, including definitely (2
points), maybe (1), and not at all scale (0) with a total
score range of 0-8. The study was conducted during June
2019, which was not the time of the flu epidemic, thus
participants were asked about the influenza vaccination
behavior of participants in the last year and their lifetime.
The questionnaires were completed by the researcher
through 30-minute interviews with participants.
The face and content validity of the questionnaire
were confirmed through a panel of 10 experts in health
education and health promotion. The calculated content
validity ratio for the questionnaire items was more
than 0.91, and the content validity index of knowledge,
attitude, and intention constructs were 0.93, 0.91,
and 0.95, respectively, indicating appropriate content
validity according to Lawshe’s criterion 22. The internal
reliability of the questionnaire constructs was measured
by the Cronbach’s alpha method, and values between
0.61 and 0.95 indicated the acceptable reliability of the
questionnaire. The external reliability of the questionnaire
was evaluated by test-retest on a pilot sample of 30 elderly
people with a two-week interval, and the correlation
coefficient of 0.76 (P < 001) demonstrated the appropriate
external reliability of the questionnaire.
2.4. Data analysis
Data were analyzed using SPSS statistical software (version
22) at P < 0.05. Frequency descriptive statistics were used
to report the frequency of participants’ responses, and
the Chi2 test was employed to compare the frequencies
between groups participating in the study. The mean
scores of the constructs between the participating groups
were compared by independent t-test.
2.5 Ethical considerations
This study is part of a thesis on an MSc in geriatric health
approved by the Ethics Committee of Shiraz University of
Medical Sciences (ethics code: IR.SUMS.REC.1398.521).
Before completing the questionnaire, the informed
consent form was signed by the elderly. However, their
participation in the study was also declared voluntarily,
and they could refuse to participate in the research project
if they did not wish to.
3. Results
A total of 61 men with a mean age of 69.32 ± 6.81 and 71
women with a mean age of 69.04 ± 7.52 participated in
the study (95% response rate). 73.5% of the participants
were illiterate. The mean score of knowledge in women
(6.8 ± 2.1) was significantly higher than men (5.8 ± 2.7,
P = 0.035). The mean score of knowledge in illiterate
people (6.45 ± 2.43) compared to literate people
(6.08 ± 2.58) represented no significant difference. Based
on data in Table 1, in most knowledge questions, less
than 50% of women and men answered the questions
correctly, and only in the case of high-risk groups of
influenza between men and women, there were significant
differences between those who gave the correct answer.
The frequency distribution of the correct answer to
other questions demonstrated no significant differences
between men and women, as well as literate and illiterate
people.
The mean score of attitudes in both men (5.67 ± 5.67)
Arch Hyg Sci. Volume 12, Number 1, 2023 45
Knowledge, attitude of rural elderly about influenza preventive behaviors
and women (6.05 ± 29.59) was at the moderate level,
and there was no significant difference between the two
genders. Table 2 compares the frequency distribution of
participants’ answers to attitude-related questions. Based
on the findings, only in the field of the effectiveness of
using a mask (P = 0.025) and avoiding crowded places
(P = 0.001) in the prevention of influenza, men further
significantly believed in the effectiveness of these
Table 1. Comparing the frequency distribution of correct answers to knowledge questions based on gender and education levels
Question
Gender
P (χ2)
Literacy Level
P (χ2)
Male n (%) Female n (%)
Illiterate (Unable to
read and write)
Literate (Able to
read and write)
Flu is contagious (correct/incorrect) 39 (63.9) 45 (63.4) 0.95 62 (62.9) 23 (65.7) 0.76
Is the flu transmitted through the following ways? (Yes/No)
Hand shaking with a person with the flu 28 (45.9) 30 (42.3) 0.67 45 (46.4) 13 (37.1) 0.345
Contact with objects infected with the flu virus 37 (60.7) 42 (59.2) 0.86 60 (61.9) 19 (54.3) 0.431
Coughing and sneezing 39 (63.9) 42 (59.2) 0.57 58 (59.8) 23 (65.7) 0.541
Rubbing with a person with the flu 41 (67.2) 52 (73.2) 0.45 71 (73.21) 22 (62.9) 0.252
Eat contaminated food or water 36 (59.0) 50 (70.4) 0.17 63 (64.9) 23 (65.7) 0.930
Which of the following is dangerous for the flu?
Pregnant women 31 (50.8) 57 (80.3) < 0.001 62 (63.9) 26 (74.3) 0.265
Children 35 (57.4) 52 (73.2) .05 66 (68.0) 21 (60.0) 0.391
Older adult 26 (42.9) 54 (76.1) < 0.001 60 (61.9) 20 (57.1) 0.632
Elderly 46 (75.4) 53 (74.6) 0.41 76 (78.4) 23 (65.7) 0.162
Table 2. Comparing the frequency distribution of answers to attitude questions based on gender
Item
Male n (%) Fe male n (%)
P (χ2)
Much A Little Not at All No Idea Much A Little Not at All No Idea
How likely are you to get the flu in the next year
given your age?
20 (32.8) 4 (6.6) 0 (0) 37 (60.7) 23 (32.4) 9 (12.7) 0 (0.0) 39 (54.9) 0.488
How likely are you to get the flu next year given
your hand hygiene habits?
20 (45.0) 6 (9.8) 0 (0.0) 35 (57.4) 25 (35.2) 8 (11.3) 0 (0.0) 38 (53.5) 0.901
If you catch the flu, how likely are you to:
Need to be visited by a doctor 15 (24.6) 24 (39.3) 9 (14.8) 13 (21.3) 25 (35.2) 21 (29.6) 14 (19.7) 11 (15.5) 0.360
Be hospitalized 16 (26.2) 19 (31.1) 8 (13.1) 18 (29.5) 20 (28.2) 24 (33.8) 11 (15.5) 16 (22.5) 0.830
Cannot pay the costs of treatment 20 (32.8) 21 (34.4) 9 (14.8) 11 (18.0) 23 (32.4) 19 (26.8) 20 (28.2) 9 (12.7) 0.272
Die 13 (21.3) 22 (36.1) 6 (9.8) 20 (32.8) 25 (35.2) 23 (32.4) 3 (4.2) 20 (28.2) 0.252
To what extent do you think each of the following measures is effective in preventing influenza?
Washing hands with soap and water 7 (11.5) 30 (49.2) 16 (26.2) 8 (13.1) 12 (16.9) 29 (40.8) 23 (32.4) 7 (9.9) 0.59
Receiving influenza vaccine 8 (23.1) 24 (39.3) 15 (24.6) 14 (23.0) 22 (31.0) 22 (31.0) 19 (26.8) 8 (12.3) 0.05
Using a face mask in public places 18 (29.5) 24 (39.3) 12 (19.7) 7 (11.5) 20 (28.2) 13 (18.3) 27 (38.0) 11 (15.5) 0.025
Avoiding crowded places 17 (27.9) 31 (50.8) 6 (9.8) 7 (11.5) 31 (43.7) 13 (18.3) 18 (25.4) 9 (12.7) 0.001
To what extent do any of the following make you avoid getting the influenza vaccine?
Vaccine prices 16 (26.2) 6 (9.8) 0 (0.0) 39 (63.9) 15 (21.1) 9 (12.7) 0 (0.0) 47 (66.2) 0.731
The unavailability of the vaccine on where you live 24 (39.3) 15 (24.6) 0 (0.0) 22 (36.1) 20 (28.2) 13 (18.3) 0 (0.0) 38 (53.5) 0.133
Pain from the vaccine injection 17 (27.9) 30 (49.2) 0 (0.0) 14 (23.0) 37 (52.1) 26 (36.6) 0 (0.0) 9 (11.3) 0.013
Concern about the side effects of the vaccine 15 (24.6) 33 (54.1) 0 (0.0) 13 (21.3) 22 (31.0) 30 (42.3) 0 (0.0) 19 (26.8) 0.397
To what extent is each of the following true for you?
It is difficult for me to wash my hands regularly
with soap and water in the cold season
39 (63.9) 16 (26.2) 0 (0.0) 6 (9.8) 28 (39.4) 32 (45.1) 0 (0.0) 11 (15.5) 0.193
Using a mask makes me short of breath 22 (36.1) 19 (31.1) 0 (0.0) 20 (32.8) 23 (32.4) 25 (35.2) 0 (0.0) 23 (32.4) 0.863
I’m embarrassed to wear a mask outside the
house
22 (36.1) 19 (31.1) 0 (0.0) 20 (32.8) 12 (16.9) 25 (35.2 0 (0.0) 34 (47.9) 0.036
I’m worried that if I distance myself from the
person with the flu, he or she will be upset
17 (27.5) 29 (47.5) 0 (0.0) 15 (24.6) 21 (29.6) 36 (50.7) 0 (0.0) 14 (19.7) 0.797
Keshavarz et al
46 Arch Hyg Sci. Volume 12, Number 1, 2023
behaviors than women. Regarding barriers to these
behaviors, women were significantly more concerned
about the pain of vaccination than men (P = 0.013), and
men were significantly more than women embarrassed to
wear a mask outside the house (P = 0.036).
The mean score of attitudes in both groups of literate
(28.74 ± 5.74) and illiterate (29.87 ± 5.89) elders was
moderate, and there was no significant difference between
the two groups. The only difference observed between the
literate and illiterate groups was related to their attitudes
toward the possible consequences of the flu. Literate
people were more concerned about treatment costs
(P = 0.002), while illiterate people were more concerned
about the possibility of hospitalization (P = 0.016).
Literate people also stated that it is difficult for them to
wash their hands regularly in the cold weather, which
was significantly more than illiterate people (P = 0.005).
Table 3 compares the frequency distribution of answers
to attitude questions in literate and illiterate groups.
The mean score of the intention of the study participants
in the two groups of men and women was 6.18 ± 1.76 and
6.13 ± 1.53, respectively, which was evaluated as moderate,
and there was no significant difference between the two
groups in this regard. The only significant difference
was in the intention to wash hands with soap and water,
and women were more likely than men to do it (0.044).
The important point is that less than 20% of the study
participants intended to get a vaccine during the next flu
season. More than 70% of men and 80% of women did
not intend to use the mask, and more than 50% of people
in both men and women did not intend to avoid crowded
places during the flu epidemics (Table 4).
The mean scores of literate (5.85 ± 2.14) and illiterate
(6.25 ± 1.42) participants were not significantly different
and were evaluated as moderate in both groups. Based on
the obtained data (Table 5), literate people significantly
less than illiterates reported that they intended to wash
their hands with soap and water to prevent the flu
(P = 0.001).
In terms of vaccine injection in previous years, there
was no significant difference between the participating
groups in terms of gender and literacy. Study results
revealed that only 23.5% of study participants had
received the flu vaccine in the previous year, and 75.2% of
Table 3. Comparing the frequency distribution of answers to attitude questions based on education levels
Item
Illiterate (Unable to read and write) n (%) Literate (Able to read and write) n (%)
P (χ2)
Much A Little Not at All No Idea Much A Little Not at All No Idea
How likely are you?
How likely are you to get the flu based on your
age?
33 (34.0) 9 (9.3) 0 (0.0) 55 (56.7) 10 (28.6) 4 (11.4) 0 (0.0) 21 (66.0) 0.817
How likely are you to get the flu next year given
your hand hygiene habits?
32 (33.0) 12 (12.4) 0 (0.0) 53 (54.6) 13 (37.1) 2 (5.7) 0 (0.0) 20 (57.1) 0.542
If you catch the flu, how likely are you to:
Need to be visited by a doctor 31 (32.0) 37 (38.1) 16 (16.5) 13 (13.4) 9 (25.7) 8 (22.9) 7 (20.0) 11 (31.4) 0.076
Be hospitalized 28 (28.9) 36 (37.1) 15 (15.5) 18 (18.6) 8 (22.9) 7 (20.0) 4 (11.4) 16 (45.7) 0.016
Cannot pay the costs of treatment 35 (36.1) 21 (21.6) 26 (26.8) 15 (15.5) 8 (22.9) 19 (54.3) 3 (8.6) 5 (14.3) 0.002
To die 30 (30.9) 34 (35.1) 7 (7.2) 26 (26.8) 8 (22.9) 11 (31.4) 2 (5.7) 14 (40.0) 0.523
To what extent do you think each of the following measures is effective in preventing influenza?
Washing hands with soap and water 14 (14.4) 45 (46.4) 31 (32.0) 7 (7.2) 5 (14.3) 14 (40.0) 8 (22.9) 8 (22.9) 0.090
Receiving influenza vaccine 22 (22.7) 38 (39.2) 21 (21.6) 16 (16.5) 8 (22.9) 8 (22.9) 13 (37.1) 6 (17.1) 0.224
Using a face mask in public places 31 (32.0) 22 (22.6) 31 (32.0) 13 (13.4) 7 (20.0) 15 (42.9) 8 (22.9) 15 (14.3) 0.124
Avoiding crowded places 40 (41.2) 27 (27.8) 17 (17.5) 13 (13.4) 8 (22.9) 17 (48.6) 7 (20.0) 3 (8.6) 0.098
To what extent do any of the following make you avoid getting the influenza vaccine?
Vaccine prices 19 (19.6) 10 (10.3) 0 (0.0) 68 (70.1) 12 (34.3) 5 (14.3) 0 (0.0) 18 (5.4) 0.129
The unavailability of the vaccine on where you live 30 (30.9) 24 (24.7) 0 (0.0) 43 (44.3) 14 (40.0) 4 (11.4) 0 (0.0) 17 (48.6) 0.236
Pain from the vaccine injection 40 (41.2) 40 (41.2) 0 (0.0) 17 (17.5) 14 (40.0) 16 (45.7) 0 (0.0) 5 (14.3) 0.864
Concern about the side effects of the vaccine 30 (30.9) 45 (46.4) 0 (0.0) 22 (22.7) 7 (20.0) 18 (51.4) 0 (0.0) 10 (28.6) 0.449
To what extent is each of the following true of you?
It is difficult for me to wash my hands regularly
with soap and water in the cold season
41 (42.3) 41 (42.3) 0 (0.0) 15 (15.5) 26 (74.3) 7 (20.0) 0 (0.0) 2 (5.7) 0.005
Using a mask makes me short of breath 33 (34.0) 34 (35.1) 0 (0.0) 30 (30.9) 12 (34.3) 10 (28.8) 0 (0.0) 13 (37.1) 0.730
I’m embarrassed to wear a mask outside the house 27 (27.8) 32 (33.0) 0 (0.0) 38 (39.2) 7 (20.0) 12 (34.3) 0 (0.0) 16 (45.7) 0.639
I’m worried that if I distance myself from the
person with the flu, he or she will be upset
24 (24.7) 50 (51.5) 0 (0.0) 23 (23.7) 14 (40.0) 15 (42.9) 0 (0.0) 6 (17.1) 0.225
Arch Hyg Sci. Volume 12, Number 1, 2023 47
Knowledge, attitude of rural elderly about influenza preventive behaviors
them did not receive the flu vaccine in years before that.
In addition, less than 3% of participants had received the
flu vaccine more than once.
4. Discussion
Influenza is a well-known viral disease that has killed
many people throughout the world through its epidemics
and outbreaks. This study aimed to investigate the
knowledge, attitude, and practices of rural elderly toward
influenza prevention behaviors.
The findings of the present study represented that the
mean score of knowledge was higher in women than
men (P = 0.035), but less than 50% of women and men
correctly answered the questions related to knowledge.
In line with the results of the current study, Ren et al
demonstrated that about 70% of the participants knew
the ways of influenza transmission and its symptoms [21].
Likewise, Rezaeipandari et al [22] and AlMarzooqi et al
[23] reported that public awareness was at a high level.
On the other hand, the knowledge of the participants in
the studies of Albattat et al [24] and Rezaeian et al [25]
was at low and desirable levels, respectively. However,
education level was known as one of the social factors
affecting knowledge and health status [26]. In the present
study, the mean of knowledge was not significantly
different in illiterate and literate people.
The mean score of attitudes in the studied elderly
was moderate, and there was no significant difference
between the two genders in the present study. However,
men more than women believed that using a face mask
was effective in preventing the flu (P = 0.025). Although
Ermenlieva et al [27] and Loulergue et al [18] reported
weak attitudes of study participants toward influenza
prevention behaviors, in the study of Ren et al, 70%
of participants considered hand washing and using
a mask to be effective in preventing influenza [21].
In some studies, the most common reasons for not
being vaccinated against the flu are the impossibility or
insignificance of the risk of catching the flu, doubts about
the effectiveness and efficacy of the flu vaccine, and the
fear of complications from the vaccine [28]. In the current
study, most literate elderly were concerned about the cost
of treatment and most illiterate people were concerned
about hospitalization. Manski et al found that the use
of medical care and referral to care centers increased in
the elderly [29]. Khan et al [28] and Mehrara et al [30]
also confirmed aging itself as a factor in increasing health
costs. Grossman [31] and Diop et al [32] indicated that
the cost of health care often increases simultaneously
with an increase in the level of income and education of
individuals. The results of these studies are consistent
with those of the present study regarding the concern of
literate people about the cost of treatment.
In the current study, more than 70% of men and 80%
of women did not intend to use the face mask. More than
50% of the elderly did not intend to avoid crowded places,
and less than 20% of the elderly intended to be vaccinated.
Similarly, Rikin et al reported a low willingness to receive
the vaccine. They considered the lack of confidence
in the effectiveness of the vaccine, distribution of the
vaccine at the wrong time, overconfidence in their health
and non-acceptance of their mediating role in disease
transmission, and fear of the side effects of vaccine as
the possible reasons for this reluctance [33]. This is
somewhat in line with the findings of this study about
the attitude of the elderly toward influenza prevention
ways. The results of Srivastav et al [34] showed that
hand washing is the most common preventive behavior.
In the present study, the intention to wash hands was
at a moderate level and was more evident in women
Table 4. Comparing the frequency distribution of intention to do preventive behaviors based on gender
Item
Male n (%) Female n (%) P (χ2)
Definitely Maybe Not at All Definitely Maybe Not at All
To what extent do you plan to do any of the following in the event of a flu outbreak?
Getting the flu vaccine 12 (19.7) 7 (11.5) 42 (68.9) 14 (19.7) 7 (9.9) 50 (70.4) 0.955
Using a face mask in public places 5 (8.2) 11 (18.0) 45 (73.8) 5 (7.0) 7 (9.9) 59 (83.1) 0.363
Avoiding crowded places 11 (18.0) 13 (21.3) 37 (60.7) 13 (18.3) 20 (28.2) 38 (53.5) 0.634
Washing your hands with soap and water regularly 7 (11.5) 32 (52.5) 22 (36.1) 5 (7.0) 43 (60.6) 23 (32.4) 0.044
Table 5. Comparing the frequency distribution of intention to do preventive behaviors based on education levels
Item
Illiterate (Unable to read and write) n (%) Literate (Able to read and write) n (%)
P (χ2)
Definitely Maybe Not at All Definitely Maybe Not at All
To what extent do you plan to do any of the following in the event of a flu outbreak?
Getting the flu vaccine 15 (15.5) 13 (13.4) 69 (71.1) 11 (31.4) 1 (2.9) 23 (65.7) 0.05
Using a face mask in public places 7 (7.2) 14 (14.4) 76 (78.4) 3 (8.6) 4 (11.4) 28 (80.0) 0.886
Avoiding crowded places 18 (18.6) 28 (28.9) 51 (52.6) 6 (17.1) 5 (14.3) 24 (68.6) 0.185
Washing your hands with soap and water regularly 12 (12.4) 60 (61.9) 25 (25.8) 0 (0.0) 15 (42.9) 20 (57.1) 0.001
Keshavarz et al
48 Arch Hyg Sci. Volume 12, Number 1, 2023
than men (P = 0.044). In the study of Rezaeipandari et
al, washing hands with soap and water and covering
the mouth and nose when coughing and sneezing were
the most common preventive behaviors of influenza,
respectively [22]. Liu et al also found that participants’
hand washing performance to prevent influenza was
good and accounted for a significant percentage of people
[35]. In another study by Torner et al, the highest mean
score of influenza prevention behaviors was related to
repeated hand washing behaviors with soap and water
[36]. Washing hands and face seems to be a habit among
the elderly in Iran, and considering that women spend
more time at home and facilities of hand washing were
more available for them, they intend to further do this
preventative method.
4.1. Study strengths and limitations
In the present study, it was attempted to pay attention to
different aspects of influenza prevention methods as much
as possible, and the frequency of participants’ answers to
the questions of the questionnaire was reported instead
of mentioning only the average scores of the constructs.
This provides the researchers and health professionals the
possibility to identify the most important weaknesses and
design educational content accordingly. However, the
low sample size and a limited number of investigations on
the rural population are the most important limitations
of this study.
5. Conclusion
The results of the study revealed that the knowledge,
attitude, intention, and practice of rural elderly about
influenza prevention behaviors were at moderate levels,
which were not satisfactory. Based on the findings, no
significant differences were found between men and
women and literacy levels, thus large-scale educational
interventions, are necessary, especially in rural areas.
Acknowledgements
The researchers appreciate Shiraz University of Medical Sciences
and Fasa University of Medical Sciences for their support, as well
as the employees of the selected health centers and the elderly for
their collaboration with the study.
Competing Interests
The authors declare that they have no conflict of interests.
Funding
This study was supported and funded by Shiraz University of
Medical Sciences (Grant number: 16759).
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