Influenza vaccination intention among emergency medical service personnel: examining the role of health perception within the theory of planned behavior

Influenza vaccination is a key preventive measure for healthcare personnel; however, vaccination uptake remains suboptimal despite the elevated occupational risk faced by emergency medical service (EMS) personnel. The Theory of Planned Behavior (TPB) has been widely applied to explain vaccination intention, yet the role of broader health-related self-evaluations within this framework remains insufficiently explored. This study aimed to examine influenza vaccination intention among EMS personnel by extending the TPB with health perception. A cross-sectional study was conducted among EMS personnel affiliated with the Muğla Provincial Ambulance Service in Türkiye. Data were collected from 474 participants using a convenience sampling approach. The survey included a demographic questionnaire, the Theory of Planned Behavior Scale for Influenza Vaccination, and the Health Perception Scale. Structural equation modeling using Partial Least Squares (PLS-SEM) was employed to examine the relationships among TPB constructs, health perception, and influenza vaccination intention, including the potential moderating role of health perception. Attitude toward influenza vaccination was positively associated with vaccination intention (β = 0.541, p < .001), while health perception showed a smaller but statistically significant positive association (β = 0.161, p < .001). Perceived behavioral control (β = 0.051, p = .234) and subjective norm (β = 0.026, p = .544) were not significantly associated with intention. Moderation analysis indicated that health perception significantly strengthened the relationship between attitude and vaccination intention (β = 0.204, p < .001), whereas its moderating effects on perceived behavioral control (β = 0.039, p = .142) and subjective norm (β = −0.058, p = .186) were not statistically significant. The structural model explained 45% of the variance in vaccination intention (R² = 0.454). Influenza vaccination intention among EMS personnel appears to be primarily shaped by attitudinal factors, while health perception exerts both a direct and a moderating influence. These findings suggest that interventions aimed at increasing vaccination uptake among EMS personnel should prioritize strengthening positive attitudes toward vaccination while also considering how individuals’ perceptions of their own health shape preventive decision-making.