Abstract
BACKGROUND: Influenza infection poses significant risks to pregnant women, including complications for both the mother and fetus. Despite global recommendations promoting influenza vaccination during pregnancy, uptake remains low in many regions. This study aimed to assess the knowledge and attitudes of pregnant women in Palestine toward seasonal influenza vaccination and to identify factors associated with these perceptions. METHODS: A cross-sectional study was conducted among 302 pregnant or previously pregnant women aged 18–55 years across Palestinian governorates. Data were collected using a structured, self-administered questionnaire consisting of 33 items covering socio-demographic, knowledge, and attitude domains. Descriptive statistics were calculated, and inferential analyses included t tests, one-way ANOVA, and Pearson’s correlation coefficient. Statistical significance was set at p < .05. RESULTS: The mean knowledge score was M = 2.35 (SD = 1.57) and the mean attitude score was M = 15.32 (SD = 3.20); 75.2% of participants had poor knowledge and 65.9% exhibited negative attitudes. Attitude was significantly associated with the number of prior influenza vaccinations (p = .018), while knowledge was significantly related to healthcare facility type (p = .012) and pregnancy trimester (p = .020). A strong positive correlation was found between knowledge and attitude (r = .41, 95% CI [0.29, 0.52], p < .001). CONCLUSIONS: Pregnant women in Palestine demonstrated limited knowledge and generally negative attitudes toward influenza vaccination. Misconceptions about vaccine safety and a lack of healthcare-provider recommendations were key barriers to vaccine uptake. Integrating influenza vaccination counseling into routine antenatal care and strengthening provider–patient communication may improve awareness and acceptance among this high-risk group.