Personal Influenza Vaccination and Willingness to Receive Vaccination in Community Pharmacies Among Pharmacists and Family Physicians in Northwestern Romania: A Cross-Sectional Study

Abstract

Highlights What are the main findings? Family physicians reported substantially higher annual influenza vaccination uptake, whereas pharmacists showed markedly greater willingness to receive influenza vaccination in community pharmacies. Professional category showed the strongest independent association with high willingness to use pharmacy-based vaccination; awareness of the service and annual personal vaccination were also associated with the outcome. What are the implications of the main findings? Personal influenza vaccination behaviour and acceptance of the vaccination setting were related but distinct dimensions in this sample; the formal interaction test did not confirm effect modification. Implementation strategies should be profession-specific, combining improved awareness, stronger pharmacist vaccination engagement, and clearer collaborative and organisational frameworks for family physicians. Abstract Background: Community pharmacy-based influenza vaccination may improve access, but healthcare professionals may evaluate the service differently according to professional role, previous vaccination behaviour, and awareness. This study assessed the association between personal influenza vaccination behaviour and willingness to receive influenza vaccination in a community pharmacy among pharmacists and family physicians in Northwestern Romania. Methods: We analysed a cross-sectional, voluntary, non-probability convenience sample of 700 returned questionnaires from professionals active in six Northwestern Romanian counties. After exclusion of 22 blank records, 678 responses remained (340 pharmacists and 338 family physicians); one out-of-range willingness response was excluded from outcome analyses (n = 677). The study-specific anonymous questionnaire included demographic, professional, vaccination behaviour, awareness, and willingness items. Formal expert-panel content validation, pilot testing, test–retest reliability, construct validation, and a content-validity index were not documented; the primary outcome was a single Likert item, for which internal consistency is not estimable. Between 1 October 2025 and 30 April 2026, 761 questionnaires were distributed, and 700 were returned. After exclusion of 22 blank records, 678 completed questionnaires remained. Because recruitment was non-probability-based and a complete sampling frame was unavailable, the return proportion should not be interpreted as a population response rate. Ordinal comparisons used the Mann–Whitney U and the Kruskal–Wallis tests; high willingness (scores 4–5) was analysed with multivariable logistic regression. A 10-fold internal cross-validation and a sensitivity ordinal-logistic model were also performed. Results: Women comprised 85.5% of respondents. Annual influenza vaccination was more frequent among family physicians than pharmacists (71.9% vs. 32.6%), whereas mean willingness to be vaccinated in a pharmacy was higher among pharmacists (3.41 ± 1.40 vs. 2.08 ± 1.28). High willingness was reported by 201/339 pharmacists (59.3%) and 57/338 family physicians (16.9%). In the adjusted binary model, pharmacist profession (aOR 7.39, 95% CI 4.60–11.89), awareness of pharmacy vaccination (aOR 3.71, 95% CI 2.01–6.85), and annual personal vaccination (aOR 2.07, 95% CI 1.16–3.69) were associated with high willingness. Apparent discrimination was good (AUC 0.804), while mean 10-fold cross-validated AUC was 0.789. The profession × vaccination behaviour interaction was not statistically significant (likelihood-ratio p = 0.472). Conclusions: In this regional, non-probability sample, pharmacists were more willing than family physicians to receive influenza vaccination in a community pharmacy despite lower annual personal uptake. Professional category, service awareness, and annual vaccination were associated with willingness, but measurement validity, causality, and generalisability cannot be established. The findings support profession-specific implementation hypotheses and require confirmation with a formally validated instrument, transparent sampling, and multi-region prospective studies.