Italian healthcare workers’ perspectives on strategies to enhance vaccination coverage: A national cross-sectional survey
Keywords:
Vaccine, Vaccination, Healthcare workers, Public healthAbstract
Background: Healthcare workers (HCWs) are trusted advisors in vaccination promotion, yet little is known about which strategies they consider most effective. This study evaluated Italian HCWs' preferences for vaccination promotion strategies across different professions and age groups.
Methods: A cross-sectional survey was conducted among 3,000 HCWs (physicians, nurses, pharmacists, and midwives) in Italy between August and September 2025 using computer-assisted telephone interviews. Stratified quota sampling ensured representativeness by region, profession, and gender. Participants rated nine vaccination promotion strategies on a 10-point scale. Descriptive statistics and ANOVA were used to compare mean endorsement scores and endorsement rates (≥6/10) across professional categories and age groups.
Results: All strategies received moderate to strong endorsement (mean scores 5.2-6.6). The two priority strategies were free pre-vaccination laboratory tests and paid time off for vaccination (6.6). Economic incentives (5.2) and improved scheduling access (5.3) received the lowest support. No significant differences emerged across professional categories or age groups, indicating remarkable consensus among HCWs.
Discussion: Italian HCWs prioritize strategies addressing structural and psychological barriers over financial incentives. This consensus suggests policy makers should focus on competence-building, accessibility, and trust-enhancing interventions rather than economic approaches to improve vaccination coverage.
References
Global immunization efforts have saved at least 154 million lives over the past 50 years [Internet]. [cited 2025 Oct 1]. Available from: https://www.who.int/news/item/24-04-2024-global-immunization-efforts-have-saved-at-least-154-million-lives-over-the-past-50-years
2. Zimmerman T, Shiroma K, Fleischmann KR, Xie B, Jia C, Verma N, et al. Misinformation and COVID-19 vaccine hesitancy. Vaccine. 2023 Jan 4;41(1):136–44. doi:10.1016/j.vaccine.2022.11.014
3. Lanza TE, Paladini A, Marziali E, Gianfredi V, Blandi L, Signorelli C, et al. Training needs assessment of European frontline health care workers on vaccinology and vaccine acceptance: a systematic review. Eur J Public Health. 2023 Aug 1;33(4):591–5. doi:10.1093/eurpub/ckad101
4. Bianchi FP, Stefanizzi P, Brescia N, Lattanzio S, Martinelli A, Tafuri S. COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis. Expert Rev Vaccines. 2022 Sep;21(9):1289–300. doi:10.1080/14760584.2022.2093723
5. Clari M, Albanesi B, Comoretto RI, Conti A, Renzi E, Luciani M, et al. Effectiveness of interventions to increase healthcare workers’ adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022. Euro Surveill Bull Eur Sur Mal Transm Eur Commun Dis Bull. 2024 Feb;29(9):2300276. doi:10.2807/1560-7917.ES.2024.29.9.2300276
6. Marbán-Castro E, Nedic I, Ferrari M, Crespo-Mirasol E, Ferrer L, Noya B, et al. Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain. Vaccines. 2022 Nov 15;10(11):1930. doi:10.3390/vaccines10111930
7. Charmasson A, Ecollan M, Jaury P, Partouche H, Frachon A, Pinot J. Perceived impact of discussions with a healthcare professional on patients’ decision regarding COVID-19 vaccine. Hum Vaccines Immunother. 20(1):2307735. doi:10.1080/21645515.2024.2307735
8. Kaur M, Coppeta L, Olesen OF. Vaccine Hesitancy among Healthcare Workers in Europe: A Systematic Review. Vaccines. 2023 Oct 28;11(11):1657. doi:10.3390/vaccines11111657
9. Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, et al. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine. 2015 Aug;2(8):891–7. doi:10.1016/j.ebiom.2015.06.018
10. EpiCentro. Italian National Institute of Health (ISS). Vaccination coverage in Italy. EpiCentro. [Internet]. [cited 2025 Oct 1]. Available from: https://www.epicentro.iss.it/vaccini/dati_ita
11. Signorelli C, Oleari F, Greco D, Ruocco G, Guerra R, Rezza G, et al. The Italian National Vaccine Prevention Plans, 1999/2020-2023/2025: challenges and obstacles to vaccine coverage goals. Commentary. Ann Ist Super Sanita. 2024;60(4):247–51. doi:10.4415/ANN_24_04_02
12. Ministry of Health. Comparisons of influenza vaccination coverage 1999-2025; 2025. Available from: https://www.salute.gov.it/new/sites/default/files/2025-09/2025_0035314_Confronti_CV_Antinfluenzali_1999_2025.pdf [Internet]. [cited 2025 Oct 1]. Available from: https://www.salute.gov.it/new/sites/default/files/2025-09/2025_0035314_Confronti_CV_Antinfluenzali_1999_2025.pdf
13. Ministry of Health. National Vaccine Prevention Plan 2023-2025; 2023. Available from: https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2023&codLeg=95813&parte=1&serie [Internet]. [cited 2025 Oct 1]. Available from: https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2023&codLeg=95813&parte=1&serie
14. Pennisi F, Silenzi A, Mammone A, Siddu A, Odone A, Sabbatucci M, et al. Childhood Immunization Coverage Before, During and After the COVID-19 Pandemic in Italy. Vaccines. 2025 Jun 25;13(7):683. doi:10.3390/vaccines13070683
15. Odone A, Vecchio R, Brogonzoli L, Sala E, Vigezzi GP, Muzzi A, et al. Vaccination strategies for high-risk and fragile populations in Lombardy (Italy): a region-wide assessment of hospital-based models and best practices. Ann Ig Med Prev E Comunita. 2024;36(2):215–26. doi:10.7416/ai.2024.2607
16. Pennisi F, Borlini S, Cuciniello R, D’Amelio AC, Calabretta R, Pinto A, et al. Improving Vaccine Coverage Among Older Adults and High-Risk Patients: A Systematic Review and Meta-Analysis of Hospital-Based Strategies. Healthc Basel Switz. 2025 Jul 10;13(14):1667. doi:10.3390/healthcare13141667
17. Ricciardi GE, Cuciniello R, Raimondi V, Vaia F, Signorelli C, Renzi C. Preventive Healthcare and Disability: Challenges and Opportunities. Healthc Basel Switz. 2025 Aug 23;13(17):2099. doi:10.3390/healthcare13172099
18. de Koning R, Gonzalez Utrilla M, Spanaus E, Moore M, Lomazzi M. Strategies used to improve vaccine uptake among healthcare providers: A systematic review. Vaccine X. 2024 Aug;19:100519. doi:10.1016/j.jvacx.2024.100519
19. Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, et al. Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis. J Travel Med. 2023 Dec 28;30(8):taad138. doi:10.1093/jtm/taad138
20. Cataldi JR, Kerns ME, O’Leary ST. Evidence-based strategies to increase vaccination uptake: a review. Curr Opin Pediatr. 2020 Feb;32(1):151–9. doi:10.1097/MOP.0000000000000843
21. Liu J, Zhang Y, Zhang H, Tan H. Estimating the effects of interventions on increasing vaccination: systematic review and meta-analysis. BMJ Glob Health. 2025 Apr 9;10(4):e017142. doi:10.1136/bmjgh-2024-017142
22. Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine. 2021 Oct;40:101113. doi:10.1016/j.eclinm.2021.101113
23. Riccio M, Marte M, Imeshtari V, Vezza F, Barletta VI, Shaholli D, et al. Analysis of Knowledge, Attitudes and Behaviours of Health Care Workers towards Vaccine-Preventable Diseases and Recommended Vaccinations: An Observational Study in a Teaching Hospital. Vaccines. 2023 Jan 16;11(1):196. doi:10.3390/vaccines11010196
24. Shaw J, Stewart T, Anderson KB, Hanley S, Thomas SJ, Salmon DA, et al. Assessment of US Healthcare Personnel Attitudes Towards Coronavirus Disease 2019 (COVID-19) Vaccination in a Large University Healthcare System. Clin Infect Dis Off Publ Infect Dis Soc Am. 2021 Nov 16;73(10):1776–83. doi:10.1093/cid/ciab054
25. Jankowska-Polańska B, Sarzyńska K, Czwojdziński E, Świątoniowska-Lonc N, Dudek K, Piwowar A. Attitude of Health Care Workers and Medical Students towards Vaccination against COVID-19. Vaccines. 2022 Mar 29;10(4):535. doi:10.3390/vaccines10040535
26. Gianfredi V, Pennisi F, Lume A, Ricciardi GE, Minerva M, Riccò M, et al. Challenges and Opportunities of Mass Vaccination Centers in COVID-19 Times: A Rapid Review of Literature. Vaccines. 2021 Jun 1;9(6):574. doi:10.3390/vaccines9060574
27. Parcesepe AM, Nash D, Shen J, Kulkarni SG, Zimba R, You W, et al. The Impact of COVID-19 Vaccination on Symptoms of Anxiety and Depression before and after COVID-19 Vaccines Were Universally Available for Adults in the United States. Depress Anxiety. 2024;2024:9682710. doi:10.1155/2024/9682710
28. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS One. 2018;13(12):e0208601. doi:10.1371/journal.pone.0208601
29. Wang K, Wong ELY, Cheung AWL, Dong D, Yeoh EK. Loss-framing of information and pre-vaccination consultation improve COVID-19 vaccine acceptance: A survey experiment. Front Public Health. 2023;11:1063444. doi:10.3389/fpubh.2023.1063444
30. Matjasko JL, Cawley JH, Baker-Goering MM, Yokum DV. Applying Behavioral Economics to Public Health Policy: Illustrative Examples and Promising Directions. Am J Prev Med. 2016 May 1;50(5, Supplement 1):S13–9. doi:10.1016/j.amepre.2016.02.007
31. DeRigne L, Stoddard-Dare P, Collins C, Quinn L. Paid sick leave and preventive health care service use among U.S. working adults. Prev Med. 2017 Jun;99:58–62. doi:10.1016/j.ypmed.2017.01.020
32. Pennisi F, Genovese C, Gianfredi V. Lessons from the COVID-19 Pandemic: Promoting Vaccination and Public Health Resilience, a Narrative Review. Vaccines. 2024 Aug 7;12(8):891. doi:10.3390/vaccines12080891
33. Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016 Dec 20;34(52):6700–6. doi:10.1016/j.vaccine.2016.10.042
34. Largent EA, Persad G, Sangenito S, Glickman A, Boyle C, Emanuel EJ. US Public Attitudes Toward COVID-19 Vaccine Mandates. JAMA Netw Open. 2020 Dec 1;3(12):e2033324. doi:10.1001/jamanetworkopen.2020.33324
35. Pennisi F, Mastrangelo M, De Ponti E, Cuciniello R, Mandelli A, Vaia F, et al. The role of pharmacies in the implementation of vaccination cover- age in Italy. Insights from the preliminary data of the Lombardy Region. Ann Ig Med Prev E Comunita. 2024;36(3):363–9. doi:10.7416/ai.2024.2611
36. Signorelli C, Pennisi F, D’Amelio AC, Conversano M, Cinquetti S, Blandi L, et al. Vaccinating in Different Settings: Best Practices from Italian Regions. Vaccines. 2024 Dec 28;13(1):16. doi:10.3390/vaccines13010016
37. Peterson CJ, Lee B, Nugent K. COVID-19 Vaccination Hesitancy among Healthcare Workers-A Review. Vaccines. 2022 Jun 15;10(6):948. doi:10.3390/vaccines10060948
38. Biswas N, Mustapha T, Khubchandani J, Price JH. The Nature and Extent of COVID-19 Vaccination Hesitancy in Healthcare Workers. J Community Health. 2021 Dec;46(6):1244–51. doi:10.1007/s10900-021-00984-3
39. Signorelli C, Pennisi F, Rezza G. Vaccinations and regional inequalities in Italy. Lancet Public Health. 2025 Jul;10(7):e546. doi:10.1016/S2468-2667(25)00140-9
40. Odone A, Ferrari A, Spagnoli F, Visciarelli S, Shefer A, Pasquarella C, et al. Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage. Hum Vaccines Immunother. 2015;11(1):72–82. doi:10.4161/hv.34313
41. Moucheraud C, Phiri K, Whitehead HS, Songo J, Lungu E, Chikuse E, et al. Uptake of the COVID-19 vaccine among healthcare workers in Malawi. Int Health. 2023 Jan 3;15(1):77–84. doi:10.1093/inthealth/ihac007
42. Freeman D, Lambe S, Yu LM, Freeman J, Chadwick A, Vaccari C, et al. Injection fears and COVID-19 vaccine hesitancy. Psychol Med. 2023 Mar;53(4):1185–95. doi:10.1017/S0033291721002609
43. Schneider FH, Campos-Mercade P, Meier S, Pope D, Wengström E, Meier AN. Financial incentives for vaccination do not have negative unintended consequences. Nature. 2023 Jan;613(7944):526–33. doi:10.1038/s41586-022-05512-4
44. Savulescu J, Pugh J, Wilkinson D. Balancing incentives and disincentives for vaccination in a pandemic. Nat Med. 2021 Sep;27(9):1500–3. doi:10.1038/s41591-021-01466-8
45. Fishman J, Schaefer KA, Scheitrum D, Robertson CT, Albarracin D. Common measures of vaccination intention generate substantially different estimates that can reduce predictive validity. Sci Rep. 2024 Oct 1;14(1):1–9. doi:10.1038/s41598-024-69129-5
46. Pennisi F, Lo Presti T, Ricciardi GE, Dalla Valle Z, Minerva M, Privitera G, et al. Training and career opportunities for residencies in Hygiene and Preventive Medicine: results of a survey on 39 Italian schools. Ig E Sanita Pubblica. 2023;80(4):94–100. PMID: 37782813.
47. Pennisi F, Minerva M, Dalla Valle Z, Odone A, Signorelli C. Genesis and prospects of the shortage of specialist physicians in Italy and indicators of the 39 schools of hygiene and preventive medicine. Acta Bio-Medica Atenei Parm. 2023 Aug 30;94(S3):e2023159. PMID: 37695180.
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Copyright (c) 2026 Giovanni Emanuele Ricciardi, Angela Ancona, Rita Cuciniello, Greta Chiecca, Antonella Castagna, Cristina Renzi, Giovanni Rezza, Matteo Moro (Author)

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