Vaccine hesitancy and healthcare providers

Vaccine knowledge, attitudes, and recommendation practices among health care providers in New York State

Community-wide vaccine uptake remains sub-optimal. Healthcare provider (HCP) vaccine recommendations influence patient vaccination; however, provider vaccine recommendation behavior is highly influenced by one's own vaccine attitudes and/or knowledge. We aim to describe vaccine knowledge, attitudes, and recommendation practices (KAP) among New York State HCPs. A survey to assess HCP KAP was developed and electronically distributed to NYS members of national medical organizations via their local chapter administrators. Descriptive statistical methods were used to define provider KAP. A total of 864 surveys were included, 500 (60%) and 336 (40%) primary and specialty care providers, respectively. Eighty-one percent (402/499) of primary care providers (PCPs) report encountering vaccine hesitant patients daily or weekly. Of the 500 PCPs who responded, only 204 (41%) stated strong agreement with confidence in their communications with vaccine hesitant patients. HCPs who correctly answered all four knowledge questions were more likely to self-report routine recommendations of standard vaccines to all patients when compared to those who correctly answered fewer questions (489/588 (83%) vs 135/241 (56%), p < .05). HCPs were more likely to routinely recommend standard vaccines to all patients if they also report initiating vaccine discussion (476/485 (98%) vs 148/344 (43%), p < .05) and reviewing and recommending vaccinations at each encounter (315/320 (98%) vs 308/508 (61%), p < .05). Vaccine hesitancy exists across healthcare specialties and provider roles. Focused interventions should include reaching all HCPs to promote vaccinations for disease prevention, tailoring messages to reduce HCP vaccine misperceptions, and increasing awareness of evidence-based office strategies known to facilitate immunizations.

Knowledge and attitude towards Covid-19 vaccine in Ethiopia: Systematic review and meta-analysis

The biggest threat to the effectiveness of vaccination initiatives is a lack of information about and trust in immunization. This study aimed to determine the prevalence of knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. PubMed, Web of Science, Google Scholar, EMBASE, and the Ethiopian University online library were searched. To look for heterogeneity, I² values were computed and an overall estimated analysis was carried out. Although 2108 research articles were retrieved, only 12 studies with a total of 5,472 participants met the inclusion criteria for this systematic review and meta-analysis. The pooled estimates of participants with good knowledge of and positive attitudes toward the COVID-19 vaccine were found to be 65.06% (95% CI: 56.69-73.44%; I² = 82.3%) and 60.15% (95% CI: 45.56-74.74%; I² = 89.4%), respectively, revealing that there is a gap in knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. A holistic and multi-sectoral partnership is necessary for a successful COVID-19 vaccination campaign.

Acceptance of COVID-19 vaccine and associated factors among healthcare workers in Katsina state: a cross-sectional study in Northwest Nigeria

OBJECTIVES

Healthcare workers were prioritised to receive the COVID-19 vaccine in Nigeria. Administration of COVID-19 vaccination in Nigeria was challenging because of a lack of trust in vaccine safety and vaccine effectiveness among healthcare workers, who are expected to provide reliable information about vaccines and vaccine-preventable diseases in the communities. Hence, their acceptance and attitudes towards COVID-19 preventive practices could influence the acceptance of the vaccine by the local population. This cross-sectional study assessed the acceptance of the COVID-19 vaccine among healthcare workers in Katsina State. We predicted the variables that increased the vaccine acceptance using logistic regression analysis.

SETTING

This hospital-based study was conducted at primary, secondary and tertiary healthcare facilities in Nigeria.

PARTICIPANTS

A total of 793 healthcare workers were included in this study. Of these, 65.4% (n=519) were male.

OUTCOME MEASURES

To assess acceptance of COVID-19 vaccine measures, and factors increasing acceptance among healthcare workers.

RESULTS

Of the healthcare workers, 80% (638) were tested for the SARS-CoV-2, of whom 10.8% (n=65) tested positive. Approximately 97% (n=765) of them believed that the COVID-19 vaccine was safe, and 90% (n=714) received the first dose of the vaccine. Healthcare workers between 30 and 39 years were more likely to accept the vaccine (aOR: 7.06; 95% CI 2.36 to 21.07; p<0.001). Those who had been tested for COVID-19 were more likely (aOR:7.64; 95% CI 3.62 to 16.16; p<0.001) to accept the vaccine.

CONCLUSIONS

Our findings showed that the age and prior COVID-19 testing were the main factors influencing the acceptance of the COVID-19 vaccine. There was high acceptance of the COVID-19 vaccine among healthcare workers in Katsina State, Nigeria. Future studies should focus on the completion of doses and serological testing for immunity.

High vaccine confidence and strong approval of the mandatory immunization schedule among Bulgarian general practitioners in 2022

In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients' attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96-99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96-99%) that vaccines are effective, and 341 (95%,95%CI93-97%) that vaccines are safe. 347 respondents (97%,95%CI95-98%) affirmed that "it's good that vaccines from the children's immunization schedule are mandatory", and 331 (92%,95%CI89-95%) agreed with the statement "Bulgaria's childhood immunization has my approval". Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents' vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs' vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

The decline in children's vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents' vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach's alpha test (α) and McDonald's omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study

Background

Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines.

Methods

This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine.

Conclusion

The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

A review of health worker vaccination programs in low, middle and upper middle-income countries

Objectives

Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Study design

A PubMed Literature search.

Methods

A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Results

The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW.

Conclusions

The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.

Attitudes and perceptions about COVID-19 vaccination in the population with chronic HIV infection: A systematic review

Background and Aims

The coronavirus disease 2019 (COVID-19)-infected population has been increasing during the last 3 years worldwide. Moreover, simultaneously, COVID-19 vaccine clinical trials were launched. By the end of 2020, the Food and Drug Administration had authorized the emergency use of two messenger RNA vaccines against COVID-19. These fast-track vaccine approvals have produced controversy about their safety and efficacy. The purpose of this research was to discover attitudes and perceptions regarding vaccination against COVID-19 disease among vulnerable groups such as human immunodeficiency virus (HIV)-infected patients.

Methods

Between June 2, 2021 and March 4, 2022, we conducted a cross-sectional study through a survey of high-risk patients with severe COVID-19, such as HIV-infected patients in the Infectious Diseases Unit (Hospital Clínico Universitario San Juan, Alicante). For the data collection strategy, a nonprobabilistic snowball sampling was adopted. A structured, anonymous, self-administered questionnaire was developed in which questions and statements were designed to evaluate their attitudes and perceptions about COVID-19 vaccination. Descriptive and bivariate analyses were performed for the obtained data.

Results

Forty-eight participants were recruited with a mean age of 51.5 ± 11.9 years. Thirty-nine of them (81.3%) were male. The acceptance rate of COVID-19 vaccination was extremely high (95.7%). Bivariate analysis showed older patients significantly received a higher proportion of vaccine doses at the time of the survey (p = 0.047). Older patients were more aware of the vaccine safety controversy (61.1%) compared to younger patients (p = 0.054). There were no other significant differences between groups among questions regarding safety, efficacy, or attitudes about COVID-19 vaccination.

Conclusion

An extremely high degree of acceptance for COVID-19 vaccination was reported. Older patients were more aware of the vaccine safety controversy. Medical staff is the most trustworthy source of information, far above all other sources. Social networks and opinion leaders have not been shown to significantly influence our population.

Factors associated with COVID-19 vaccination among healthcare workers in an Algerian University Teaching Hospital: A cross-sectional study

Background

The global COVID-19 pandemic has deeply impacted health systems, emphasizing the need for effective vaccination campaigns. However, vaccine hesitancy, particularly among healthcare workers, challenges achieving comprehensive immunization coverage. The primary objective of this study is to elucidate the factors influencing COVID-19 vaccine uptake among healthcare workers at an Algerian University Teaching Hospital.

Methods

A cross-sectional survey was conducted at the University Teaching Hospital of Oran, Algeria, from February 17 to April 11, 2022. We investigated factors associated with COVID-19 vaccine uptake among 196 hospital staff members, including 98 physicians and 98 nurses. Factors independently associated with vaccination were identified using a multivariable logistic regression analysis, and adjusted odds ratios with 95% confidence intervals were provided.

Results

The COVID-19 vaccination rate among HCWs was 32.1%. Several factors were significantly associated with COVID-19 vaccination in the multivariable analysis. These include the belief that even healthy individuals should be vaccinated against COVID-19 (aOR = 3.13; 95% CI: 1.13-8.63), the perception that comprehensive vaccination coverage against COVID-19 could support the healthcare system in future epidemics (aOR = 4.15; 95% CI: 1.68-10.23), endorsement of mandatory COVID-19 vaccination (aOR = 4.37; 95% CI: 1.42-13.45), and adherence to all recommended vaccines for HCWs or compliance with the recommended immunization schedules for their children (aOR = 4.75; 95% CI: 1.47-15.36).

Conclusion

This study highlights key beliefs influencing COVID-19 vaccine uptake among healthcare workers, including the necessity of vaccinating healthy individuals, the perceived importance of comprehensive vaccination in supporting the healthcare system during future epidemics, agreement with mandatory vaccination policies, and adherence to recommended vaccine schedules.

Association between administration or recommendation of the human papillomavirus vaccine and primary care physicians' knowledge about vaccination during proactive recommendation suspension: a nationwide cross-sectional study in Japan

OBJECTIVE

The Japanese government suspended the proactive recommendation of the human papillomavirus vaccine (HPVv) in 2013, and the vaccination rate of HPVv declined to <1% during 2014-2015. Previous studies have shown that the recommendation by a physician affects a recipient's decision to receive a vaccine, and physicians' accurate knowledge about vaccination is important to increase vaccine administration. This study aimed to evaluate the association between physicians' knowledge of vaccination and the administration or recommendation of HPVv by primary care physicians (PCPs) in the absence of proactive recommendations from the Japanese government.

DESIGN

Cross-sectional study analysed data obtained through a web-based, self-administered questionnaire survey.

SETTING

The questionnaire was distributed to Japan Primary Care Association (JPCA) members.

PARTICIPANTS

JPCA members who were physicians and on the official JPCA mailing list (n=5395) were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary and secondary outcomes were the administration and recommendation of HPVv, respectively, by PCPs. The association between PCPs' knowledge regarding vaccination and each outcome was determined based on their background and vaccination quiz scores and a logistic regression analysis to estimate the adjusted ORs (AORs).

RESULTS

We received responses from 1084 PCPs and included 981 of them in the analysis. PCPs with a higher score on the vaccination quiz were significantly more likely to administer the HPVv for routine and voluntary vaccination (AOR 2.28, 95% CI 1.58 to 3.28; AOR 2.71, 95% CI 1.81 to 4.04, respectively) and recommend the HPVv for routine and voluntary vaccination than PCPs with a lower score (AOR 2.17, 95% CI 1.62 to 2.92; AOR 1.88, 95% CI 1.32 to 2.67, respectively).

CONCLUSIONS

These results suggest that providing accurate knowledge regarding vaccination to PCPs may improve their administration and recommendation of HPVv, even in the absence of active government recommendations.

The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon's Expanded program on Immunization

BACKGROUND

Immunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon.

METHODS

Through a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software.

RESULTS

Overall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part.

CONCLUSION

This study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.

Effective Vaccination and Education Strategies for Emerging Infectious Diseases Such as COVID-19

Social isolation and control owing to coronavirus disease 2019 (COVID-19) are easing; however, concerns regarding new infectious diseases have not disappeared. Given epidemic experiences such as severe acute respiratory syndrome (SARS), the influenza pandemic, Middle East respiratory syndrome (MERS), and COVID-19, it is necessary to prepare for the outbreak of new infectious diseases and situations in which large-scale vaccinations are required. Although the development of vaccines against COVID-19 has contributed greatly to overcoming the pandemic, concerning vaccine side effects from the general public, including medical personnel, and decreased confidence in vaccine efficacy and side effects, present many challenges in promoting and educating vaccinations for new infectious diseases in the future. In addition to plans to develop vaccines for the outbreak of new infectious diseases, education and promotion plans are necessary to administer the latest developments of vaccines to the general public. Moreover, efforts are needed to secure the necessity, legitimacy, and evidence for rapid vaccination on a large scale at the national level. It is also necessary to carefully prepare scientific bases and explanatory statements so that the general public can easily understand them. This study aimed to establish vaccine strategies and vaccination education plans for new infectious diseases that may occur in the future. Many ways to promote vaccination to the general public and healthcare workers should be prepared to ensure that the latest vaccines against new infectious diseases are administered safely. Thus, education and promotion of vaccine efficacy and safety based on specific data from clinical studies are necessary.

A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff

During the pandemic, nurses experienced anger that stemmed from a sense of threat, frustration, or even a sense of injustice. The purpose of this study was to examine the relationship between vaccination hesitancy, anger, cynicism, and medical mistrust among nurses, as there are no relevant studies in the literature. This study was conducted online by completing self-report questionnaires. The Dimensions of Anger Reactions-5, the 8-item "Cynical Distrust" scale, and the Medical Mistrust Multiformat Scale were used. For vaccination hesitancy, two questions with a 5-point scale were used: one question examining hesitancy to get vaccinated with the COVID-19 vaccine, and another question examining hesitancy to get vaccinated with the influenza vaccine. In total, 387 nurses (66 men and 321 women) participated in this study. Nurses showed statistically greater hesitancy toward the COVID-19 vaccine compared to hesitancy toward the influenza vaccine. The variation in vaccine hesitancy was explained by the scores in the Medical Mistrust Multiformat Scale, the Dimensions of Anger Reactions, and the Cynical Distrust Scale. The Medical Mistrust Multiformat Scale mediated the relationship between the Cynical Distrust Scale and total vaccine hesitancy. The Dimensions of Anger Reactions Scale significantly moderated the indirect effect of the Cynical Distrust Scale on total vaccine hesitancy through the Medical Mistrust Multiformat Scale. In conclusion, it is highly likely that anger is involved in reported vaccine hesitancy both by activating schemas of distrust in others and by adopting anti-systemic views of mistrust in the medical system.

How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework

BACKGROUND

Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual.

METHODS

We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience.

RESULTS

Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities.

CONCLUSIONS

Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.

Socioeconomic impact of the COVID-19 crisis and early perceptions of COVID-19 vaccines among immigrant and nonimmigrant people living with HIV followed up in public hospitals in Seine-Saint-Denis, France

The burden of the first year of the coronavirus disease 2019 (COVID-19) pandemic was greater for vulnerable populations, such as immigrants, people living in disadvantaged urban areas, and people with chronic illnesses whose usual follow-up may have been disrupted. Immigrants receiving care for HIV in Seine-Saint-Denis' hospitals have a combination of such vulnerabilities, while nonimmigrant people living with HIV (PLWHIV) have more heterogeneous vulnerability profiles. The ICOVIH study aimed to compare the socioeconomic effects of the COVID-19 crisis as well as attitudes toward COVID-19 vaccination among immigrant and nonimmigrant PLWHIV. A questionnaire assessed vulnerabilities prior to the COVID-19 epidemic and the impact of the early epidemic on administrative, residential, professional, and financial fields. We surveyed 296 adults living with HIV at four hospitals in Seine-Saint-Denis, the poorest metropolitan French department, between January and May 2021. Administrative barriers affected 9% of French-born versus 26.3% of immigrant participants. Immigrants experienced financial insecurity and hunger more often than nonimmigrant participants (21.8% versus 7.1% and 6.6% versus 3%, respectively). Spontaneous acceptance of vaccination was higher among nonimmigrant than among immigrant participants (56.7% versus 32.1%), while immigrants were more likely to wait for their doctor's recommendation or for their doctor to convince them than their French-born counterparts (34.2% versus 19.6%). The trust-based doctor‒patient relationship established through HIV follow-up appeared to be a determining factor in the high acceptance of the COVID-19 vaccine among immigrant participants.

In the Face of a Pandemic: "I Felt the Same as When the War Started"-A Qualitative Study on COVID-19 Vaccine Acceptance in Bosnia and Herzegovina

Objectives: To conduct qualitative study with different target groups in Bosnia and Herzegovina in order to explore their views on barriers and drivers for COVID-19 vaccination, and to see if and how barriers and drivers vary between urban and rural locations, and different professional roles. Methods: The theoretical framework underpinning the study is the capability-opportunity-motivation (COM-B) behavior change framework, which has been adapted to monitor vaccine related behavior and attitudes. Data was collected from June to September 2022 through moderated discussions in focus groups. The total of 162 participants participated in 16 focus groups. Results: Among the key barriers to successful immunization identified across target groups were insufficient knowledge about vaccines, pandemic fatigue, concerns about the rapid development of the vaccine and its effectiveness, lack of confidence in the healthcare system. Some of the main drivers of vaccination against COVID-19 were confidence in science and expert recommendations. Conclusion: The COVID-19 immunization policy undergoes continuous changes, as do the pandemic prospects; we encourage further research to track the evolution of vaccine related attitudes, inform immunization policy, and create evidence-based interventions.

A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff

Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff.

METHOD

We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff.

RESULTS

We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources).

CONCLUSION

Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.

Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy.

METHOD

We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data.

SETTING

The survey was administered online using the survey research firm Dynata.

RESULTS

Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant.

CONCLUSIONS

Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

Measuring Trust in Primary Care

Policy Points Trust in primary care clinicians is essential for effective patient care and is associated with better health outcomes, but it is rarely assessed, and existing measures have not been thoroughly evaluated. This scoping review reveals that research assessing patients' trust in primary care clinicians largely stopped more than a decade ago but offers candidate measures for future testing, implementation, and policy applications.

CONTEXT

Trust is a fundamental aspect of any human relationship, and medical care is no exception. An ongoing, trusting relationship between clinicians and patients has shown demonstrable value to primary care. However, there is currently no measure of trust in general use, and none endorsed for use by most value-based payment programs. This review searched the literature for any existing measures of patient trust in primary care clinicians and assessed their potential to be implemented as a patient-reported outcome measure.

METHODS

A keyword search on PubMed along with scanning references was conducted to find any trust measures in health care. Measures that did not address primary care clinicians were eliminated and the remaining measures were then assessed for their utility to primary care.

RESULTS

This purposeful, scoping review found four tested measures for assessing patients' trust in primary care clinicians that are candidates for general use. Of these four, the revised Trust in Physicians Scale and Wake Forest Physician Trust Scale are the most tested and viable options.

CONCLUSION

Renewed national interest in trust in health care should focus on the capacity to measure it. This review informs the effort to test trust measures for use in research, practice improvement, and value-based payment. Measuring trust, how it relates to outcomes, and learning how it is produced or lost are key to assisting practices and health systems toward earning it.

The role and influence of perceived experts in an anti-vaccine misinformation community

The role of perceived experts (i.e., medical professionals and biomedical scientists) as potential anti-vaccine influencers has not been characterized systematically. We describe the prevalence and importance of anti-vaccine perceived experts by constructing a coengagement network based on a Twitter data set containing over 4.2 million posts from April 2021. The coengagement network primarily broke into two large communities that differed in their stance toward COVID-19 vaccines, and misinformation was predominantly shared by the anti-vaccine community. Perceived experts had a sizable presence within the anti-vaccine community and shared academic sources at higher rates compared to others in that community. Perceived experts occupied important network positions as central anti-vaccine nodes and bridges between the anti- and pro-vaccine communities. Perceived experts received significantly more engagements than other individuals within the anti- and pro-vaccine communities and there was no significant difference in the influence boost for perceived experts between the two communities. Interventions designed to reduce the impact of perceived experts who spread anti-vaccine misinformation may be warranted.

Does Vaccine Confidence Mediate the Relationship between Vaccine Literacy and Influenza Vaccination? Exploring Determinants of Vaccination among Staff Members of Nursing Homes in Tuscany, Italy, during the COVID-19 Pandemic

BACKGROUND

Low coverage of influenza vaccination in nursing home (NH) staff may be attributed to factors such as vaccine confidence (VC) and vaccine literacy (VL). Our study aimed to evaluate the role of VL and VC in predicting the intention to get the influenza vaccine in a sample of employees of NHs in Tuscany, Italy.

METHODS

Data from staff members in Tuscany were collected using an online questionnaire that examined influenza vaccination history, intentions, demographic information, health status, and VL. Statistical analyses explored the relationships between VC, VL, and vaccination intentions.

RESULTS

The study included 1794 respondents, (86.3%) and assistants/aides (58.1%), with a median age of 46 years. The intention to get vaccinated was significantly higher among those with health risk conditions, and there was a positive association between VC and VL, specifically its interactive/critical component. The mediation analysis showed that VC completely mediated the relationship between VL and the intention to get vaccinated, with significant effects observed in different subgroups.

CONCLUSIONS

VC is a key factor that mediates the effect of VL on vaccine intention. These results suggest that interventions aimed at improving VL alone may not be sufficient to increase vaccine uptake unless VC is also addressed.

Attitudes towards COVID Vaccine and Vaccine Hesitancy in Dermatology: A Narrative Review

Vaccine hesitancy has been a contentious issue even before the pandemic. The COVID-19 crisis has further amplified vaccine hesitancy, with worries about adverse effects, cultural and religious beliefs, and misinformation on social media. In dermatology, patients with pre-existing skin conditions may have specific concerns about the impact of the vaccine on their skin health. Factors such as cutaneous reactions, potential flares of underlying conditions, and fears of psoriasis worsening post-vaccination contribute to vaccine hesitancy. Healthcare professionals, including dermatologists, play a crucial role in addressing vaccine hesitancy by providing accurate information, addressing concerns, and understanding the psychological impact on patients. The concept of vaccine fatigue is also explored, noting the challenges in sustaining vaccine acceptance over time, especially with regards to booster vaccinations. Overcoming vaccine hesitancy requires trust-building, effective communication strategies, and collaboration between healthcare workers and non-healthcare individuals to combat misinformation. By recognizing and addressing psychological factors, dermatologists can increase vaccine acceptance and improve public health efforts.

Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study

INTRODUCTION

This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan.

METHODS

The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis.

RESULTS

The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers.

CONCLUSIONS

Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Three-year COVID-19 and flu vaccinations among medical residents in a tertiary hospital in Italy: The threat of acceptance decline in seasonal campaigns

The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant's emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022-2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25-2.17). The dropping in influenza vaccination coverage in 2022-2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.

Bibliometric and visual analysis of vaccination hesitancy research from 2013 to 2022

Although vaccination is regarded as one of the most significant achievements of public health, there also exists the phenomenon of vaccination hesitancy which refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. In this study, we conducted a bibliometric analysis to provide a comprehensive overview of vaccination hesitancy research from 2013 to 2022. All related publications were retrieved from the Web of Science Core Collection Database. Information on annual publications, countries, organizations, journals, authors, keywords, and documents was analyzed adopting the bibliometix R-package, VOSviewer, and CiteSpace software. A total of 4042 publications were enrolled. The annual publications increased slightly before 2020 but had an extremely dramatic increase from 2020 to 2022. The United States contributed the most articles and had the greatest collaboration with other countries and organizations. The London School of Hygiene & Tropical Medicine was the most active institution. Vaccine was the most cited and influential journal while Vaccines was the most productive journal. It was Dube E who was the most productive authors with the highest h-index. The most frequent keywords were "vaccine hesitancy," "COVID-19," "SARS-CoV2," "immunization," "attitudes," and "willingness." Vaccination hesitancy to some extent hinders the achievement of global public health. The influencing factors vary across time, space, and vaccines. The COVID-19 pandemic and the development of COVID-19 vaccines have made this issue the focus of interest. The complexity and specific contexts of influencing factors of vaccination hesitancy require further study and will potentially be the focus of future research direction.

Prevalence and predictors of COVID-19 vaccination hesitancy among healthcare workers in Sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

The COVID-19 vaccination is regarded as an effective intervention for controlling the pandemic. However, COVID-19 vaccine hesitancy is hampering efforts geared towards reducing the burden of the pandemic. Therefore, examining COVID-19 hesitancy and its predictors among healthcare workers is essential to improving COVID-19 uptake. In sub-Saharan Africa, the pooled proportion of COVID-19 vaccine hesitancy is yet to be known.

PURPOSE

The present study was to estimate the pooled proportion of COVID-19 vaccine hesitancy and its predictors among healthcare workers in Sub-Saharan Africa.

METHODS

A systematic search of articles was conducted in PubMed, Science Direct, African Journal Online, and Google Scholar. Data was extracted with the help of Excel. Data analysis was conducted using STATA 17. Heterogeneity in the studies was assessed using Cochrane Q and 12 tests. A random effects model was used to examine the pooled estimates to determine if heterogeneity was exhibited.

RESULTS

A total of 15 studies involving 7498 participants were included in the final analysis. The pooled prevalence of COVID-19 vaccination hesitancy among healthcare workers was 46%, 95% CI (0.38-0.54). The predictors of COVID-19 hesitancy were negative beliefs towards vaccine 14.0% (OR = 1.05, 95% CI: 1.04, 1.06), perceived low risk of COVID-19 infection 24.0% (OR = 1.25, 95% CI: 1.23, 1.28), and vaccine side effects 25.0% (OR = 1.23, 95% CI: 1.21, 1.24).

CONCLUSION

The data revealed generally high hesitancy of COVID-19 vaccine among health workers in Sub-Saharan Africa. Future COVID-19 adoption and uptake should be improved by national and individual level efforts. In Sub-Saharan Africa, it is crucial to address the myths and obstacles preventing healthcare professionals from accepting the COVID-19 vaccination as soon as feasible since their willingness to get the vaccine serves as an important example for the broader public.

Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021

Introduction

During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs.

Methods

In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers).

Results

Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake.

Discussion

Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.

Influenza vaccination from the perspective of health care workers at university hospitals

BACKGROUND

The influenza vaccination rate of healthcare workers (HWs) in Poland is low. Before implementing methods for promoting influenza vaccination, it is crucial to identify attitudes towards vaccination. We aimed to examine the knowledge and attitudes towards influenza vaccination of HWs at university hospitals. Moreover, we evaluated the incentives for getting influenza vaccination among HWs.

METHODS

From September 2020 to October 2020, we surveyed HWs in one children's hospital and two adults' hospitals in Warsaw (Poland). We included only fully and correctly completed surveys into final analysis.

RESULTS

A total of 950 questionnaires (85% women, 45% <40 years old, 33% physicians and 48% nurses, 56% working in a children's hospital) were evaluated. Of all HWs, 25% declared they were vaccinated and 54% planned to get vaccinated in the next season. We have analyzed attitudes towards influenza vaccination and motivations to get vaccinated.

CONCLUSIONS

Among HWs in academic hospitals, males, people <40 years old, physicians and those working in children's hospital are more likely to get vaccinated and their attitudes towards influenza vaccination are more positive. Of those less likely to get vaccinated, people >40 years old and nurses could be effectively persuaded by free and on-site influenza vaccination. Moreover, free access to vaccination is the strongest motivator for vaccination among all HWs. The attitudes towards mandatory influenza vaccination differ sharply among HWs-while physicians are ready to accept it, nurses are not.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04569019.

An updated review on oral protein-based antigen vaccines efficiency and delivery approaches: a special attention to infectious diseases

Various infectious agents affect human health via the oral entrance. The majority of pathogens lack approved vaccines. Oral vaccination is a convenient, safe and cost-effective approach with the potential of provoking mucosal and systemic immunity and maintaining individual satisfaction. However, vaccines should overcome the intricate environment of the gastrointestinal tract (GIT). Oral protein-based antigen vaccines (OPAVs) are easier to administer than injectable vaccines and do not require trained healthcare professionals. Additionally, the risk of needle-related injuries, pain, and discomfort is eliminated. However, OPAVs stability at environmental and GIT conditions should be considered to enhance their stability and facilitate their transport and storage. These vaccines elicit the local immunity, protecting GIT, genital tract and respiratory epithelial surfaces, where numerous pathogens penetrate the body. OPAVs can also be manipulated (such as using specific incorporated ligand and receptors) to elicit targeted immune response. However, low bioavailability of OPAVs necessitates development of proper protein carriers and formulations to enhance their stability and efficacy. There are several strategies to improve their efficacy or protective effects, such as incorporation of adjuvants, enzyme inhibitors, mucoadhesive or penetrating devices and permeation enhancers. Hence, efficient delivery of OPAVs into GIT require proper delivery systems mainly including smart target systems, probiotics, muco-adhesive carriers, lipid- and plant-based delivery systems and nano- and microparticles.

Decision-Making about COVID-19 Vaccines among Health Care Workers and Their Adolescent Children

Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children (N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents' or adolescents' choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one's vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent's decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients' and parents' vaccine decisions.

COVID-19 Virus and Vaccination Attitudes among Healthcare Workers in Michigan: A Cross-Sectional Study

BACKGROUND

Defining the characteristics of healthcare worker (HCW) attitudes toward the coronavirus disease 2019 (COVID-19) vaccine can provide insights into vaccine hesitancy. This study's goal is to determine HCWs' attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy.

METHODS

This cross-sectional study surveyed HCWs working in institutions in Saginaw, Sanilac, and Wayne counties in Michigan (N = 120) using tipping-scale questions. Analysis of variance and t-test were used to measure HCWs' attitudes toward the COVID-19 virus and vaccines.

RESULTS

Most HCWs received (95.9%) and recommended (98.3%) a COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine were: (1) efficacy of the vaccine, (2) current exposure to patients with active COVID-19 infection and risk of virus spread, and (3) safety of vaccine and long-term follow-up. Female HCWs or HCWs aged 25-54 years were more concerned about contracting COVID-19. Physicians or HCWs aged 55-64 were less concerned regarding the effectiveness and side effects of the vaccine.

CONCLUSIONS

Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among COVID-19 attitudes. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review

Herd immunity through vaccination is a key measure to control COVID-19 pandemic. However, vaccine hesitancy remains a public health threat, which is still common among healthcare workers (HCWs). This systematic review aimed to synthesise evidence on HCWs' attitudes towards COVID-19 vaccination and analyse associated factors to provide information for vaccine policy development and practice. We searched PubMed, Embase, ScienceDirect, Web of Science and three Chinese databases for literature published on 12 February 2021. Two researchers screened the literature independently, and 13 studies were included in the systematic review. Vaccine acceptance varied widely and ranged from 27.7% to 77.3%. HCWs had positive attitudes towards future COVID-19 vaccines, while vaccine hesitancy was still common. Demographic variables such as men, older age and physicians were positive predictive factors. Women and nurses had more vaccine hesitancy. Previous influenza vaccination and self-perceived risk were facilitators. Concerns for safety, efficacy and effectiveness and distrust of the government were barriers. Influences of direct (COVID-19) patient care towards vaccination intention were less conclusive. Tailored communication strategies were needed to increase the uptake rate of COVID-19 vaccines among HCWs. More importantly, more data and information on the safety and efficacy of vaccines should be provided with transparency.

COVID-19 Vaccine Acceptance, Attitude, Hesitancy, and Its Associated Factors among Wolaita Sodo University Students: A Mixed-Method Study

Background

Countries in the world have been experiencing the ongoing impact and spread of the coronavirus disease (COVID-19) virus pandemic. The health and financial burden of the pandemic has prompted the need for timely and effective vaccination to be considered as the best strategy for controlling disease transmission. However, vaccine acceptability remains an area of concern in developing countries like Ethiopia.

Objective

To assess attitude, hesitancy in the COVID-19 vaccine acceptance, and associated factors among health science students at Wolaita Sodo University.

Methods

A triangulated mixed-method study was conducted. Quantitative data were entered into SPSS Windows version 25 for analysis, and the qualitative data were transcribed using open code version 4.3. A binary logistic regression model was used to establish the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the strengths of the association. Thematic approach was used for qualitative data analysis.

Results

A total of 352 students participated in this study. Having family members who were infected with COVID-19, information about COVID-19 vaccine, the need for a vaccine with the level of concern, intention to take COVID-19 vaccine, and academic year were strongly associated with vaccine acceptability. Graduating class and other senior students were about 4 and 2 times more likely to accept vaccination as compared to freshman-year students (AOR = 4.128; 95% CI: 1.351-12.610;P = 0.012) and (AOR = 2.195; 95% CI: 1.182-4.077; P value = 0.013), respectively. Even if 67% of students had a good attitude towards the vaccine, 56% of the students hesitated to take the vaccine.

Conclusion

The majority of respondents had a constructive attitude towards the COVID-19 vaccine, and only a few of them were vaccinated against the COVID-19 virus. It is of utmost importance to design an evidence-based strategy to increase the uptake of vaccination for healthcare students and other nonhealth science students in universities.

Human Papillomavirus (HPV) Education and Knowledge Among Medical and Dental Trainees

Persistent human papillomavirus (HPV) infection is responsible for the majority of oropharyngeal and cervical cancers in the USA. Currently, HPV curricula within medical and dental schools are not standardized. As such, we implemented a brief online educational intervention to increase medical and dental trainees' knowledge of the HPV vaccine and the association between HPV and cancer. The objectives of this study were to (1) assess medical and dental trainees' baseline knowledge regarding HPV and HPV vaccine, (2) determine the willingness to recommend the HPV vaccine to patients, and (3) evaluate the impact of an online intervention on HPV-related knowledge. Medical and dental trainees from two large academic centers in the USA were asked to fill out an online pre-intervention questionnaire, followed by a 10-min HPV educational intervention based on the Center of Disease Control and Prevention (CDC) resources, and then a post-intervention questionnaire. There were 75 participants (67.4% females; median age 18-30 years). When asked about HPV-related cancer types, the correct response increased from 28.4% (pre-intervention) to 51.9% (post-intervention; p < 0.01). When asked about the prevalence of HPV infections, the correct response improved from 36 to 72% (p < 0.01). There was also a 25.2% improvement in identifying the correct HPV vaccination dosing schedule (p < 0.01). Eighty-seven percent of the participants mentioned that the online education improved their HPV knowledge, and 68.5% reported that they were more likely to recommend HPV vaccine after the online intervention. The proposed online educational intervention was effective at improving HPV-related cancer and HPV vaccine knowledge as well as attitudes towards vaccine recommendation among dental and medical trainees and could be implemented in medical and dental school curricula in the future.

COVID-19 Vaccination and Community Management: A Qualitative Study

BACKGROUND

Nurses play key roles as vaccination agents and frontline workers who deal with prejudice and misinformation. This study examined the attitudes and perceptions of nursing students regarding corona-virus disease 2019 (COVID-19) vaccination and its social and institutional management.

METHOD

This qualitative study consisted of an exploratory phase involving first- and fourth-year nursing students and a second phase using the PhotoVoice tool SHOWED mnemonic method followed by discussion groups with second-year nursing students.

RESULTS

Three themes emerged: (1) hope tinged with fear; (2) too much information generating fear, uncertainty, and mistrust; and (3) leaders without recognition or voice.

CONCLUSION

The results inform the body of knowledge in nursing science and enhance changes in clinical practice by providing new insights regarding the perceptions of nursing students on vaccination and its management, highlighting the need to train future nurses in health literacy and new ways to interact with community members. [J Nurs Educ. 2023;62(6):343-350.].

Physician Trust in the News Media and Attitudes toward COVID-19

CONTEXT

Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust.

METHODS

The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists.

FINDINGS

Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists.

CONCLUSIONS

Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates

BACKGROUND

Reaching the public health organizations targets of influenza vaccination in at-risk patient groups remains a challenge worldwide. Recognizing the relationship between the healthcare system characteristics and the economic environment of the population with vaccination uptake can be of great importance to improve.

METHODS

Several characteristics were correlated in this retrospective ecological study with data from 6.8 million citizens, 15,812 healthcare workers across 258 primary care health centers, and average income by area of the care center in Spain.

RESULTS

No correlation between HCW vaccination status and patient vaccination was found. A weak negative significant correlation between the size of the population the care center covers and their vaccination status did exist (6 mo.-59 yr., r = 0.19, p = 0.002; 60-64 yr., r = 0.23, p < 0.001; ≥65 yr., r = 0.23, p ≥ 0.001). The primary care centers with fewer HCWs had better uptake in the at-risk groups in the age groups of 60-64 yr. (r = 0.20, p = 0.002) and ≥65 (r = 0.023, p ≥ 0.001). A negative correlation was found regarding workload in the 6 mo.-59 yr. age group (r = 0.18, p = 0.004), which showed the at-risk groups that lived in the most economically deprived areas were more likely to be vaccinated.

CONCLUSIONS

This study reveals that the confounding variables that determine influenza vaccination in a population and in HCWs are complex. Future influenza campaigns should address these especially considering the possibility of combining influenza and SARS-CoV-2 vaccines each year.

Vaccine hesitancy among health-care professionals in the era of COVID-19

Health-care professionals (HCPs) are key trusted figures in addressing coronavirus disease 2019 (COVID-19) challenges. They are thought to influence others' health decisions by personal example. However, during the COVID-19 crisis, some HCPs hesitated to be vaccinated. We examined factors contributing to that decision. We performed 12 semi-structured interviews, between February and May 2021, with Israeli HCPs who had declined or delayed COVID-19 vaccination. Three coders conducted a combined top-down and bottom-up analysis. We identified four main themes shaping vaccine decision-making: (i) sources of information, (ii) perceptions of necessity and risks of the vaccine, (iii) individual versus collective responsibility and (iv) political climate and media influence. Participants were worried about long-term effectiveness and safety, and while many agreed that high-risk populations should be vaccinated, all considered themselves to be at low risk for serious disease. Some felt they should avoid taking a perceived risk (accepting a new vaccine) to protect society, although they felt pressured to do so. Vaccination campaign politization and the way the media approached the subject also contributed to mistrust and hesitancy to be vaccinated. These findings help us understand HCP beliefs and uncertainties about COVID-19 vaccinations. This study can help inform future campaigns targeted at HCPs to promote the acceptance of vaccines.

Individual and Contextual Determinants of Flu Vaccination Adherence: A University Nudge Intervention

INTRODUCTION

The University of Salerno has implemented a nudge intervention with the aim of promoting vaccine adherence among employees of academia and identifying individual and contextual determinants that influence adherence.

METHOD

A purpose-built questionnaire was used during the reference period of October-December 2022 in order to assess levels of state anxiety (STAI-Y1), perceived stress (PSS-10), and public sentiments, which influence vaccination behavior, with consequences for the whole population (VCI).

RESULTS

Analysis of the results revealed a difference in mean scores on the PSS: those who have always adhered to the vaccination campaign compared to those who have never been vaccinated perceived higher levels of stress (12.01 vs. 11.33; F = 4.744, p = 0.031); furthermore, there was a relationship between the presence/absence of pathologies and VCI (F = 3,93; df = 1; p = 0.04).

CONCLUSIONS

The University of Salerno's nudge intervention made its employees more responsible for protecting the health of the academic community and encouraged good adherence to the flu vaccination campaign. University employees, equipped with high cultural tools, sought information primarily from institutional sources indicated by the university during the free vaccination campaign at the university's vaccine center.

"I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.

Knowledge and Attitudes towards Human Papillomavirus Vaccination (HPV) among Healthcare Providers Involved in the Governmental Free HPV Vaccination Program in Shenzhen, Southern China

No research has been conducted to explore the variables associated with healthcare providers' (HCPs) knowledge and attitudes toward the human papillomavirus vaccine (HPV) since the vaccine was approved for free use in some Chinese cities. In Shenzhen, southern China, a convenience sample strategy was used to distribute questionnaires to HCPs involved in the government's HPV vaccination program from Shenzhen. There were 828 questionnaires collected in total, with 770 used in the analysis. The mean HPV and HPV vaccine knowledge score was 12.0 among HCPs involved in the government HPV vaccination program (with a total score of 15). the average scores for HPV and HPV vaccine knowledge varied among different types of medical institutions. District hospitals had the highest mean score of 12.4, while private hospitals ranked fourth with a mean score of 10.9. Multivariate logistic regression results revealed significant disparities in the type of license and after-tax annual income across HCPs (p < 0.05). The future education and training for HCPs should focus on private community health centers (CHCs), HCPs whose license type is other than a doctor, and HCPs with low after-tax annual income.

Qualitative assessment of COVID-19 vaccination acceptance among healthcare workers in Pima County

In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.

Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS)

Vaccine hesitancy is a barrier to improving childhood vaccination rates in Canada, but the scope of this problem is unclear due to inconsistent measurement of vaccine uptake indicators. Using 2017 data from a Canadian national vaccine coverage survey, this study analyzed the impact of demographics and parental knowledge, attitudes and beliefs (KAB) on vaccine decisions (refusal, delay and reluctance) in parents of 2-year-old children who had received at least one vaccine. The findings show that 16.8% had refused a vaccine, specifically influenza (73%), rotavirus (13%) and varicella (9%); female parents or those from Quebec or the Territories more likely to refuse. 12.8% were reluctant to accept a vaccine, usually influenza (34%), MMR (21%) and varicella (19%), but eventually accepted them upon advice from a health care provider. 13.1% had delayed a vaccine, usually because their child had health issues (54%) or was too young (18.6%) and was predicted by five or six person households. Recent immigration to Canada decreased likelihood of refusal, delay, or reluctance; however, after 10 years in Canada, these parents were as likely to refuse or be reluctant as parents born in Canada. Poor KAB increased likelihood of refusal and delay by 5 times, and reluctance by 15 times, while moderate KAB increased likelihood of refusal (OR 1.6), delay (OR 2.3) and reluctance (OR 3.6). Future research into vaccine decisions by female and/or single parents, and predictors of vaccine KAB would provide valuable information and help protect our children from vaccine preventable diseases.

Supporting US healthcare providers for successful vaccine communication

BACKGROUND

While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges.

OBJECTIVE

To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education.

METHODS

7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied.

RESULTS

44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment.

CONCLUSIONS

While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.

Provider confidence in counseling preconception, pregnant, and postpartum patients regarding COVID-19 vaccination: A cross-sectional survey study

Background and Aims

Healthcare provider counseling surrounding COVID-19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID-19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling.

Methods

A web-based anonymous survey was distributed via email to a cross-sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution-specific variables were included in the survey along with questions assessing both attitudes toward COVID-19 illness and confidence in counseling regarding the use of the vaccine in pregnancy.

Results

Almost all providers (151, 98.1%) reported that they received a COVID-19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty-one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English-speaking. Forty-three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID-19 vaccination in pregnancy were the Centers for Disease Control (112, 74.2%), hospital-specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists (82, 54.3%).

Conclusion

Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients.

Perspectives Associated with Human Papillomavirus Vaccination in Adults: A Qualitative Study

BACKGROUND

In the last several decades, vaccine hesitancy has become a significant global public health concern. The human papillomavirus (HPV) vaccine has been on the United States of America (USA) market since 2006, with extended approval up to age 45 granted in 2018. To date, there is limited research evaluating barriers and facilitators related to HPV vaccine initiation among adults and the influence of the COVID-19 pandemic on individuals' vaccine-related behaviors. This study's main objective was to characterize the contributing factors that could promote or inhibit HPV vaccine uptake for adults.

METHODS

A qualitative approach consisting of focus group discussions (FGDs) was used for this study. The FGD guide was informed by concepts from the Transtheoretical Model, Health Belief Model, and Social Cognitive Theory. All virtual FGDs were led by two researchers, who recorded audio for data collection. The data were transcribed by a third party, and the transcripts were imported into Dedoose^® software and analyzed using the six steps recommended by thematic analysis.

RESULTS

A total of 35 individuals participated in 6 focus groups over a 6-month period. Thematic analysis revealed four themes: (1) Intrinsic motivators for HPV vaccination, (2) Extrinsic motivators for HPV vaccination, (3) Vaccine promotion strategies, and (4) Impact of COVID-19 Pandemic on vaccine hesitancy.

CONCLUSION

Both intrinsic and extrinsic factors play a role in influencing HPV vaccine uptake, and such considerations can guide efforts to improve the odds of HPV vaccination in working-age adults.

Health workers' beliefs in COVID-19 conspiracy theories, level of trust in government information and their willingness to take COVID-19 vaccines: A survey from Nigeria

BACKGROUND

The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. The novel coronavirus disease 2019 (COVID-19) vaccines have been proven efficacious and central to combatting the pandemic. However, many - including skilled healthcare workers (HCWs) - have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy.

OBJECTIVE

The objective of this study was to investigate HCWs' beliefs in COVID-19 vaccines conspiracy theories (that the vaccines could alter one's DNA or genetic information; and that vaccines contain microchips) and trust in government information on COVID-19 vaccines.

METHODS

Healthcare workers in Ondo-State, Nigeria, representing different healthcare professions, were asked to participate anonymously in an online survey. The participants were asked about their beliefs in two viral conspiracy theories, and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and the beliefs in (a) DNA alteration, (b) microchip implant through the vaccine, and (c) willingness to accept the vaccine.

RESULTS

A total of 557 HCWs (28.0% men, 70.9% women) were included in the study. 26.4% (147/557) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30.0% (167/557) believed the vaccine could alter one's DNA or genetic information. The beliefs varied especially according to professional group, with 45.8% and 50.0% of the nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3% and 37.5% of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4% of HCWs. In total 76.2% of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines when compared to those with a high level of trust (OR 4.6, 95%CI 2.6-8.0). We observed a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95%CI 3.1-8.8).

CONCLUSIONS

Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips, and or that the vaccines could alter recipients' DNA and genetic information. This might have negative consequences in terms of their own COVID-19 vaccination and on their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for healthcare stakeholders in Nigeria and around the world to actively counteract misinformation especially on social media and give HCWs necessary scientifically sound information.

Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study

The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.