Assessment of the impact of vaccine literacy on influenza vaccination practices among diabetic patients in Iraq

Abstract

Diabetes mellitus (DM) increases susceptibility to infections and severe outcomes, making vaccination a critical preventive strategy. Despite this, vaccine uptake among patients with DM remains suboptimal. Vaccine literacy (VL), the ability to find, understand, evaluate, and use vaccine information, is a key determinant of acceptance, yet evidence from Iraq is scarce. This study assessed VL among diabetic adults in Iraq and examined its association with influenza vaccination. A cross-sectional study was conducted between January and August 2025 among adults with DM. Participants completed the Arabic Vaccine Literacy Assessment tool (HLVa-Ar), a sociodemographic survey, and vaccination history. Logistic regression identified factors associated with influenza vaccination, and quantile regression examined predictors of VL scores. Among 473 participants (median age 50 y; 53.1% female), the median VL score was 36 (IQR 30–41). Influenza vaccination coverage was 52.2%. Higher VL scores were positively associated with uptake (OR = 1.062, 95% CI [1.031–1.093], p