eHealth Literacy and Professional Attitudes as Predictors of Influenza Vaccination and Recommendation Among Spanish Primary‑Care Nurses

Abstract

Background: Influenza vaccination among Spanish Healthcare Workers (HCWs) remains below the 75.00% benchmark. Primary‑care nurses are both recipients and gatekeepers, yet the roles of digital competence and professional attitudes remain unclear. We examined how eHealth literacy (eHL) and professional attitudes predict influenza vaccination uptake and recommendation among Spanish primary‑care nurses. Materials and Methods: We conducted a nationwide cross‑sectional online survey (November 2024 to March 2025) of 526 primary‑care nurses. Instruments included the Questionnaire on Professional Attitudes Toward Official Influenza Vaccination (CAPSVA), and the eHealth Literacy Scale (eHEALS). The statistical analysis was performed using Jamovi version 2.4. Results: Vaccination coverage was 89.40% (n = 470). Higher eHEALS, CVF, and IIO scores were independently associated with vaccination (adjusted OR per point = 1.07, 1.46, and 1.32, respectively). These factors, together with recent training and online information seeking, explained 26.90% of the variance in recommendation strength. Online information seeking mediated 16.00% of the association between eHL and vaccination. Conclusions: Digital skills and favorable professional attitudes, rather than sociodemographic or incentives, appear to drive both vaccination and advocacy among Spanish primary‑care nurses. Interventions combining eHealth‑literacy training with evidence‑based education and supportive workplaces may further boost coverage.