Table 2 Detailed overview of HCP answers, grouped into similarities and differences among HCP from different countries

Reasons to (not) get vaccinated

Self-protection; patient protection; family protection German & Belgian HCP: Pressure Dutch & Belgian HCP: Medical condition

German HCP: Having to wear a mask Belgian HCP: Vulnerable people to care for; protection of colleagues; preventing work-absenteeism; pregnancy; flu shot is free of charge

Fear of side-effects (own experience + other’s reports); (almost) Never had the flu; feeling healthy; no active consideration (emotional decision-making); forgetfulness German & Dutch HCP: Absence; time issues; disbelief in effectiveness flu shot; pregnancy German & Belgian HCP: Still possible to get ill when vaccinated Dutch & Belgian HCP: Body can deal with flu [mostly combinations of reasons]

German HCP: Belief in other prevention means (hand hygiene); no (close) patient contact Dutch HCP: Hospital wants to prevent work-absenteeism; annual vaccination too often Belgian HCP: Afraid of needles

Attitude

Mostly positive attitude

Belgian HCP: One negative attitude (does it because of felt pressure)

Dutch & Belgian HCP: Mostly positive attitude (acknowledging importance for high risk-group); Several negative attitude; some ambivalent

German HCP: Mostly neutral/ambivalent attitude (acknowledging importance for high risk-group);

Outcome expectations

Advantages: Prevention of influenza infection; weaken symptoms in case of flu or cold; prevention of transmission to patients, family members and colleagues Dutch & Belgian HCP: Less work absenteeism Disadvantages: Side-effects; serious risks; some none

Advantages: German HCP: Herd immunity

Advantages: Prevention of influenza infection; patient protection; some none German & Dutch HCP: advantageous for others Dutch & Belgian HCP: less work-absenteeism

Advantages: German HCP: No mask necessary

Disadvantages: German HCP: Flu from vaccine Belgian HCP: Time-consuming

Disadvantages: Dutch HCP: Own antibodies cannot develop; time-consuming

Disadvantages: Getting ill from the flu shot (side-effects/flu); uncertainty German & Belgian HCP: developing resistance to vaccine

Subjective norm

German & Belgian HCP: Most talk to colleagues about vaccination; impression that most do (not) get vaccinated divided Most talk to family about vaccination; recommend it when risk group

Dutch HCP: Most do not talk to colleagues about vaccination; impression that majority also get vaccinated; decision dependent on engagement & motivation Belgian HCP: some do not talk to family about vaccination

Dutch & Belgian HCP: Many do not talk to colleagues about vaccination, or superficially Most have impression that their colleagues do not get vaccinated either German & Dutch HCP: (not) Talking to family is divided equally Many recommend it when risk group

German HCP: (not) Talking to colleagues is divided Dutch HCP: Some against vaccination of family members Belgian HCP: Most talk to family members about vaccination (do not get vaccinated either)

Perceived behavioural control

Free choice for most German & Belgian HCP: Some see it as a less free choice because of pressure Dutch & Belgian HCP: Moral responsibility

German HCP: One feels forced

Free choice for majority Dutch & Belgian HCP: important that it stays free

German HCP: Some see it as a less free choice because of their profession; few feel forced Dutch HCP: one sees it as a less free choice because of responsibility for patients Belgian HCP: only high risk groups cannot freely decide; or has to be social necessity

Responsibility

Majority feels responsible as HCP to protect patients by getting vaccinated

German HCP: Other means of protection show also responsibility Dutch HCP: Rather self-protection Belgian HCP: Should be mutual; no patient contact; unsure

Most do not think it is HCP responsibility to protect patients by getting vaccinated, hand disinfection and staying at home when ill instead; vaccination no guarantee; some feel responsible Dutch & Belgian HCP: Protection should be mutual

German HCP: Personal decision; not thought about before Dutch HCP: Physicians should be good examples; would be mandatory if it would be their responsibility; still susceptible to other bacteria/viruses

Experiences with the flu shot

Majority had positive experiences with the flu shot; several had pain at site of injection or local swelling Dutch & Belgian HCP: mild side-effects

German HCP: bronchitis after vaccination

Several never had flu shot before, but heard a lot from colleagues; some had side-effects German & Dutch HCP: several had positive experiences

Dutch HCP: No difference with vs. without flu shot

Intention

Majority intend to get vaccinated again German & Belgian HCP: Few unsure

Most do not intend to get vaccinated; some do German & Dutch HCP: unsure/doubts about necessity

German HCP: More who intend to get vaccinated compared to Belgian & Dutch HCP

Possible barriers

Organizational issues (time + administration); none; pregnancy Dutch & Belgian HCP: Being ill/having flu

German HCP: Fear of side-effects; long-lasting illness

Organizational issues; forgetfulness

German HCP: None; side-effects; being ill

Patient advice

Several would recommend vaccination to patients (belonging to the high risk group); free choice of patients German & Belgian HCP: Some would recommend vaccination to patients; few not because of time constraints/practitioner’s task

German HCP: Recommendation only if patients ask about it; lack of knowledge

Many would only recommend vaccination to patients (belonging to the high risk group) German & Dutch HCP: Some would not German & Belgian HCP: Few unsure Dutch & Belgian HCP: Practitioner’s task

German HCP: Patients should not get vaccinated; other vaccinations more important Dutch HCP: generally no recommendations; wanting to be neutral Belgian HCP: Practitioners sometimes also do not recommend it