Abstract
Understanding the behavioural factors influencing flu vaccination is crucial for mitigating seasonal infection outbreaks. This study utilised the Precaution Adoption Process Model (PAPM) to examine the public's decision-making about seasonal flu vaccination through an online cross-sectional survey with 2004 participants in England, UK. Results showed varying stages of decision-making: 7% in Stage 2 (unengaged), 10% in Stage 3 (undecided), 7% in Stage 4 (decided not to vaccinate), 39% in Stage 5 (decided to vaccinate) and 38% in Stage 6 (vaccinated). Regression modelling revealed factors common across stages and unique to certain stages, such as flu vaccination history distinguishing those who received the vaccine. Vaccine knowledge (Stage 2), perceived benefits (Stage 4), perceived control and fear of needles (Stage 5) were uniquely associated with specific PAPM stages. The study discusses policy implications for integrating these findings to improve flu vaccination uptake, highlighting the importance of tailored strategies based on decision-making stages.