Introduction: Influenza virus is a global concern. In temperate regions, influenza follows a seasonal pattern and annual immunization in advance of the epidemic curve is recommended (WHO, 2025). The Reasoned Action Approach (RAA) has been used to predict health behaviors, including influenza vaccination. According to the RAA, behavior is predicted by intention, while intention is predicted by affective and cognitive attitudes, descriptive and injunctive norms, confidence, and control. The purpose of the present study was to evaluate the stability of the RAA, and test predictors of vaccine uptake after accounting for stability.


Method: Participants were recruited online for a longitudinal survey study assessing factors associated with seasonal influenza vaccine uptake at the beginning and end of the 2019-2020 and 2020-2021 influenza seasons (T1-T4) in the United States. Participants (N=1082; M age=43.98 years, 60.37% female, 80.38% White, non-Hispanic, 89.35% postsecondary graduates) were included in analyses if they had participated at the beginning and end of the 2019-2020 flu season (T1 and T2).


Results: A random-intercept cross lagged panel model was estimated to examine how each construct of the RAA, measured at each time point (T1-T4), were related to vaccine uptake at the end of each influenza season (T2 and T4). Results indicated that, overall, each construct was stable across the four time points. After accounting for that within-person stability, greater intention (β=.32-.34) and cognitive attitudes (β=.23-.39) at each time point (T1-T3) were related to greater intentions at subsequent time points (T2-T4). Additionally, greater intention (β=.36) at T1 and (β=.37) T3 were related to vaccine uptake at T2 and T4, respectively.


Conclusions: The RAA constructs predicting influenza vaccination are stable over time. Intention consistently predicts seasonal influenza vaccine uptake, while cognitive attitudes predict intention. Health promotion efforts should focus on utility of the seasonal influenza vaccine and strategies to support intention to vaccinate.