Influenza is an airborne infection with a widespread across the globe. Even though the disease has mild symptoms in most people, the World Health Organization reveals that the condition causes approximately 5 to 10% of death cases annually.  While the infection affects individuals of all ages, its prevalence is higher in children, pregnant women, and hospitalized patients. In Saudi Arabia, the prevalence of influenza is high, especially during the cold season. Unfortunately, despite the expansion of influenza contamination each year, individuals refuse to take the influenza vaccination. As such, Al-Jumaili published a study titled “Knowledge and practice toward seasonal influenza vaccine and its barriers at the community level in Riyadh, Saudi Arabia” in 2020 to investigate the people’s practices, knowledge, and barriers concerning the immunization against influenza infection.  Although this study successfully obtained the perception and understanding of influenza in the general population and the barriers to vaccination, the findings were undermined by notable shortcomings in the sample and data collection and analysis.
Summary of the article
Aljamili directed this study to investigate and know the practices and obstacles of the population of Saudi Arabia against influenza. The author led a local area-based cross-sectional study utilizing a survey dispersed online through web-based media applications. The study included 860 adults above 18 years old. The questionnaire comprised of three areas; segment profile including age, sexual orientation, marital status, instruction, the spot of the home, work, smoking and presence of persistent disease, 13 inquiries on information on flu antibody, three inquiries on training toward flu immunization, and 13 inquiries on obstructions for not taking flu antibody. Independent t-test and examination of variety (ANOVA) were used to decide huge contrasts between consistent factors and chi-square tests to analyze age gatherings and other clear-cut segment factors. All investigations were analyzed using the Statistical Package for Social Sciences (SPSS). Version 23.0 (SPSS, IBM, Armonk, New York, USA). All members were educated about the point of the study on the primary page of the electronic survey. To guarantee secrecy, reactions were gathered secretly, and the study was endorsed by an institutional audit leading group of King Fahad Medical City, Riyadh, Saudi Arabia [IRB: H‐ 01-R-012]. A more considerable number of respondents accepted that influenza was profoundly contagious, thus, needs hospitalization. The most widely recognized explanation/deterrent to not having an influenza chance was involved in a past influenza immunization followed by the possibility that they don’t have a place with the gathering of people who should be inoculated against this season’s virus and their feeling of dread toward being vaccinated.
The research was designed as a cross-section study based on an online questionnaire distributed in several social media applications, including Snapchat, Twitter, and WhatsApp. The researchers revealed that the questionnaire targeted adults of both genders living in Riyadh. The authors mentioned that the knowledge of the included people toward influenza vaccination was high, while the percentage of people taking the vaccine was low. Besides, although males showed a better understanding of the influenza vaccine, females were statistically more immunized. In addition, the outcomes showed that older participants were having some issues in the knowledge about the influenza vaccine, and there were many barriers to receiving the vaccination. Also, non-vaccinated participants mainly were described as non-married and non-employed males. Despite the many efforts in this study, several limitations are worthwhile highlighting. Firstly, the enrolment of samples and the collection of data using questionnaires had notable gaps. For instance, the distribution of online questionnaires through social media platforms could lead to selection bias. According to Baeza-Yates, web communication and e-forms are prone to selection bias since the investigators do not actively monitor people who fill the forms.  In addition, the questionnaire was designed without any scoring; therefore, it was difficult to analyze the data and make a perfect interpretation. Simms et al.  argue that failure to include scores in questionnaires limits a definitive collection of information, leading to unreliable findings. Secondly, the data analysis omitted some critical assessments. For instance, there was the absence of P-values in the table that describe the baseline characteristics. Moreover, since there was a significant difference in the number of females compared with males, it was more appropriate to use Welsh’s T-test in the analysis  Also, the authors did not use posthoc analysis after performing ANOVA, as some differences between the age subgroups were unclear . Of course, some researchers may have contrary claims regarding the sampling and data collection mechanisms. For example, some claim that despite the selection bias through e-forms, using the internet to obtain participants creates room for large participation and inclusion of people from all regions. Nonetheless, this claim cannot hold since it is evident that there was a gender imbalance. Therefore, the limitations could sufficiently undermine the general outcomes.
Influenza and influenza vaccine information in Saudi Arabia is generally high, but the interpretation of this information in training is poor. However, this article is not internally or externally valid due to several limitations on the data collection and analysis. The questionnaires were likely to be biased due to a lack of scores that could assist the participants in responding effectively. Besides, failure to include the Welsh’s T-test and posthoc analysis was likely to undermine a comprehensive assessment of findings, leading to inconsistent and unrealistic findings. Therefore, the results of this study should not be implemented in practice and should not be generalized to low educated people. Instead, the research may help other researchers to do better study designs and statistical tools to show better-quality outcomes that could be applied. Also, health professionals and scientists are needed to examine why the Saudi population is not immunized despite flu and influenza vaccinations.
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