Structural and Behavioral Determinants of Influenza Vaccination Uptake Among Healthcare Students in Greece: A Post-Pandemic Cross-Sectional Study

The estimation of influenza vaccination coverage among healthcare students in Greece and the identification of traditional Knowledge-Attitudes-Practices and behavioral determinants of uptake in the post-pandemic context was the objective of this study. A cross-sectional study was conducted among undergraduate medical and nursing students at the University of Ioannina (February-April 2026). Participants completed a 38-item questionnaire assessing demographics, knowledge, attitudes, practices, habitual vaccination behavior, and awareness of access pathways. Univariable and multivariable binary logistic regression analyses were performed to identify factors associated with influenza vaccination during the 2025-2026 season, with knowledge and attitude scores analyzed as continuous variables. Among 416 participants, vaccination coverage was 20.7%. In adjusted analyses, nursing students had lower odds of vaccination than medical students, while more positive attitudes were associated with higher odds of vaccination. Students not vaccinated in the previous season and those unaware of free pharmacy-based vaccination had lower odds of current-season vaccination. Knowledge was associated with vaccination in univariable analysis but not after adjustment. In conclusion, influenza vaccination uptake among healthcare students remains low despite relatively high knowledge and generally positive attitudes. Vaccination uptake was independently associated with attitudes, field of study, previous-season vaccination, and awareness of access pathways. Interventions that strengthen positive vaccination attitudes, reinforce continuity of seasonal vaccination, and improve awareness of convenient vaccination pathways within clinical training may enhance coverage.