Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey

Variables Associated With COVID-19 Vaccination Among Israeli Adolescents and the Need for Targeted Interventions

BACKGROUND

We aimed to elucidate variables associated with coronavirus disease 2019 (COVID-19) vaccine compliance in adolescents and devise targeted interventions. Our secondary aim was to compare the rates of severe acute respiratory syndrome coronavirus 2 infection, hospitalizations and deaths between vaccinated and unvaccinated adolescents.

METHODS

A retrospective review of electronic medical records was performed on all adolescents 12-17 years of age registered at Clalit Health District in Israel during January 1, 2021, to November 18, 2021, with characterization by vaccination status against COVID-19. Univariate and multivariable analyses were employed to identify predictors of vaccination.

RESULTS

Of the 43,919 subjects included in the study, 28,207 (64.2%) were vaccinated. Non-ultraorthodox Jewish adolescents had a higher vaccination rate than the minorities Arabs or ultraorthodox Jews (72.5%, 66.2% and 40.5%, respectively, P < 0.001). Adolescents of high socioeconomic status had nearly 2-fold higher vaccination rates than those of low socioeconomic status (80.4% vs 42.3%; P < 0.0001). Adolescents 16-17 years old had a higher rate of COVID-19 vaccination than those 12-15 years old (72.5% vs 60.6%, P < 0.001), as were girls versus boys (64.7% vs 63.8%, P = 0.047). Multivariate analysis identified 3 independent variables that were significantly ( P < 0.001) associated with low vaccination: ultraorthodox sector, Arab population, and underlying obesity (hazard rations 0.42, 0.72 and 0.84, respectively). Vaccination was significantly associated with reduced severe acute respiratory syndrome coronavirus 2 infection, hospitalization and death ( P < 0.001).

CONCLUSION

This study highlights several pediatric populations with low COVID-19 vaccine compliance. Targeted interventions aimed at these populations are suggested with consideration of their special cultural, social and societal characteristics.

Parental health beliefs, intention, and strategies about covid-19 vaccine for their children: A cross-sectional analysis from five Arab countries in the Middle East

BACKGROUND

The issue around vaccination of children has brought divergent opinions among the populations across the globe and among the Arab population. There has been a low response rate to the calls for vaccination of children and this is reflective of the sentiments which parents may have towards their children being vaccinated. This study aims to explore the parents' health beliefs, intentions, and strategies towards the COVID-19 vaccine for their children among Arab population.

METHODS

A cross-sectional study using an online survey from October to December 2021, was carried out in five Arab countries in the Middle East. A reliable health belief model (HBM) including five domains: severity, susceptibility, benefits, barriers and cues to action, was adopted. Chi-square, Mann-Whitney test, and multivariable logistic regression were performed for data analysis.

RESULTS

The survey response rate was 58 % (1154/2000). Only 56 % of Arab parents are intended to vaccinate their children against COVID-19. The mean scores of parental health belief are largely driven by their concern over the vaccine's side effect (p = 0.001) followed by its efficacy, safety (p < 0.001), and scheduling difficulty (p = 0.029). However, strategies that were statistically encouraged parents to vaccinate their children included doctor's recommendation, adequate information being provided, and acceptance of the vaccine by public (p < 0.001). Parents with one child were almost three times most likely to vaccinate their children (OR = 2.660, 95 %CI = 1.572-4.504, p < 0.001). Parents' desire to vaccinate their children is also influenced by other factors such as job loss owing to COVID-19 and the presence of a health worker in the family.

CONCLUSION

Intention of Arab parents to vaccinate their children via COVID-19 vaccine is still limited. Thus, it is essential for health care authorities to avail the information which will debunk the erroneous beliefs which some parents have developed towards the vaccination of children against COVID-19.

Intolerance of Uncertainty and Attitudes towards Vaccination Impact Vaccinal Decision While Perceived Uncertainty Does Not

The COVID-19 pandemic illustrated that intolerance of uncertainty (IU) can hinder problem-solving and lead to avoidance of ambiguous situations. Furthermore, people tend to lack confidence in decisions made in ambiguous contexts. We wanted to investigate the impact of IU on intentions to get vaccinated, to vaccinate one’s children, and to recommend the vaccine in situations with varying degrees of perceived uncertainty. We first conducted a pretest to select six scenarios with different levels of perceived uncertainty. In the core study, 485 participants answered for each of the six scenarios whether they would get vaccinated, vaccinate their children (or imagine doing so, for individuals without children), and whether they would recommend the vaccine. They also completed the IUS-12 (Intolerance of Uncertainty scale) and the VAX (Vaccination Attitudes Examination). Results showed that perceived uncertainty did not influence our measures, but the IUS-12 and VAX predicted the difference in score between the most and least uncertain scenarios. An indirect effect of the IUS-12 on decision confidence through the VAX was found, but with no direct effect. We conclude that, even if future studies should refine these results, Public Policies should be more focused on factors such as IU and attitudes toward vaccination.

Global COVID-19 vaccine acceptance rate: a systematic review and meta-analysis

Aim

Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates.

Subject and methods

International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to pool estimate vaccine acceptance rates.

Results

The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1-70.1; P < 0.001, I2 = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5-74.5; P < 0.001, I2 = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8-64.1; P < 0.001, I2 = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1-57.0)), and the highest coverage rate was (85% (71-99.1)) in South America.

Conclusion

COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate.

Answers to common questions about COVID-19 vaccines in children with cancer

BACKGROUND

The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public.

METHODS

A 12-member global COVID-19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four-member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A "pass" recommendation corresponded to an agreement ≥7.5.

RESULTS

We selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4-9.6).

CONCLUSION

Top COVID-19 vaccine-related questions could be answered using available information. Reports on COVID-19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website.

Changes in Parents' COVID-19 Vaccine Hesitancy for Children Aged 3-17 Years before and after the Rollout of the National Childhood COVID-19 Vaccination Program in China: Repeated Cross-Sectional Surveys

China started to implement COVID-19 vaccination programs for children in July 2021. This study investigated the changes in parents’ COVID-19 vaccine hesitancy for children before and after the vaccination program rollout. Repeated cross-sectional online surveys among full-time adult factory workers were conducted in Shenzhen, China. This analysis was based on 844 (first round) and 1213 parents (second round) who had at least one child aged 3−17 years. The prevalence of vaccine hesitancy for children aged 3−11 years dropped from 25.9% (first round) to 17.4% (second round), while such a prevalence for children aged 12−17 years dropped from 26.0% (first round) to 3.5% (second round) (p < 0.001). Positive attitudes, a perceived subjective norm, and perceived behavioral control related to children’s COVID-19 vaccination were associated with lower vaccine hesitancy in both rounds. In the second round and among parents with children aged 3−11 years, negative attitudes and exposure to information on SARS-CoV-2 infection after receiving a primary vaccine series were associated with higher vaccine hesitancy, while exposure to experiences shared by vaccine recipients and infectiousness of variants of concern were associated with lower vaccine hesitancy. Regular monitoring of vaccine hesitancy and its associated factors among parents should be conducted to guide health promotion.

Understanding CDC's Vaccine Communication during the COVID-19 Pandemic and Its Effectiveness in Promoting Positive Attitudes toward the COVID-19 Vaccine

The COVID-19 pandemic has imposed many communication challenges for public health authorities, especially communicating the safety, effectiveness, and importance of the COVID-19 vaccine. This study takes an integrative approach that includes a content analysis of COVID-19 vaccine-related messages from the CDC Facebook page and an experimental test of the effectiveness of the same types of vaccine-related messages on participants' attitudes toward the COVID-19 vaccine. Our findings from the content analysis show that gain-frame was used significantly more than loss-frame, and statistical evidence was more prevalent than narrative evidence in the CDC's COVID-19 vaccine-related messaging. Results from the experiment indicated that loss-framed, and messages with statistical evidence, may be more successful in promoting positive attitudes toward the COVID-19 vaccine.

The acceptance of COVID-19 vaccine at early stage of development and approval: A global systematic review and meta-analysis

Background

Vaccination seems to be the most effective way to prevent and control the spread of COVID-19, a disease that has adversely impacted the lives of over 7 billion people across the globe. Vaccine hesitancy represents an important threat to combat infectious diseases worldwide. This study aims to inspect the COVID-19 vaccine acceptance rate worldwide and the regional variation of the acceptance rates among the general population and healthcare workers across different territories of the world. In addition, it compares the vaccine acceptance rates between the pre- and post-vaccine approval periods.

Method

A comprehensive systematic review was conducted using PRISMA statements. After quality evaluation, the data from eligible studies were analyzed using the random effect model. Q-test and I2 statistics were used to search for heterogeneity. The publication bias was assessed by using Egger’s test and funnel plot.

Results

The combined COVID-19 vaccine acceptance rate among the general population and healthcare workers (n = 1,581,562) was estimated at 62.79% (95% CI: 58.98–66.60). The acceptance rate substantially decreased from 66.29% (95% CI: 61.24–71.35) to 56.69% (95% CI: 48.68–64.71) among the general population from the pre-to post-vaccine approval periods but remained almost constant at 58.25% (95% CI: 46.52–69.97) among healthcare workers. The acceptance rates also varied in different regions of the world. The highest acceptance rate was found in the South-East Asia region at 70.18% (95% CI: 58.12–82.25) and the lowest was found in African Region at 39.51% (95% CI: 23.42–55.59).

Conclusion

Low COVID-19 vaccine acceptance rate might be a massive barrier to controlling the pandemic. More research is needed to address the responsible factors influencing the low global rate of COVID-19 vaccine acceptance. Integrated global efforts are required to remove the barriers.

Parents’ and guardians’ acceptability of COVID-19 vaccination for children in Ghana: An online survey

Few studies have examined the intentions of parents and guardians to vaccinate their children younger than 18 years against COVID-19 in Ghana. Parents are the decision makers for children younger than 18 years; therefore, we examined parents’ and guardians’ intentions to accept the COVID-19 vaccines for their children. An online survey was conducted among 415 parents and guardians in Ghana. The Statistical Package for Social Sciences version 25 was used to analyse the data. We found that 73.3% of parents/guardians would allow their children to be vaccinated against COVID-19. The binary logistic regression analysis shows that parents/guardians with Senior High School education, those who believed COVID-19 could not be cured, and those who agreed and those who neither agreed nor disagreed with the statement “once the vaccine is available and approved, it would be safe” were less likely to accept COVID-19 vaccine for their children. Also, parents/guardians who neither agreed nor disagreed that “the best way to avoid the complications of COVID-19 is by being vaccinated”, those who agreed that “I am of the notion that physiological/natural community is better compared to vaccine-induced immunity” and “I believe the vaccine programming may be likened to the new world order” were less likely to accept COVID-19 vaccine for their children. There is a need for public health practitioners to intensify education on the benefits and side effects of COVID-19 vaccines, as well as provide regular and up-to-date information about vaccines’ safety to parents and guardians.

Parental Attitudes Towards Vaccination Against COVID-19 in China During Pandemic

Purpose

The Chinese government has authorized the emergency use of an inactivated vaccine for COVID-19 in children and adolescents aged 3 to 17 years. This study aimed to investigate parents' attitudes towards vaccinating their children against COVID-19 and influencing factors.

Patients and Methods

Through an online questionnaire survey, we collected self-reported children's demographic characteristics, physical conditions and parents' attitudes towards COVID-19 vaccination for children. The parents in the unwilling group received online consultation about the benefits and risks of COVID-19 vaccine and were asked to complete the questionnaire again.

Results

A total of 868 participants were recruited from July 2021 to August 2021 in Nanjing, China. Overall, 76.0% of parents were willing to accept vaccination for children. Parents' willingness increased with children's age (P=0.018) and height (P=0.034), but decreased if the children fell sick within previous one month (P=0.030). Most of the unwilling parents gave a higher score to the risk of vaccination (53.76 VS 40.18). Unsafety (63.8%) and unfamiliarity (24.0%) were their major concerns. After consultation with a health worker, 24% of the unwilling parents turned willing.

Conclusion

Children's age and recent physical condition are related to parents' attitudes towards vaccination for children against COVID-19. The major concerns of parents are unsafety and unfamiliarity. Parents view health workers as a reliable source of vaccine information. A successful consultation with health workers to understand the benefits and risks of vaccination can increase parents' willingness. This study provides insight into parents' attitudes towards vaccination for children against COVID-19 in China and related influencing factors. Our findings could be referenced in establishing policies for vaccinating children against COVID-19 in China.

Views on COVID-19 vaccination of young children in Ireland, results from a cross-sectional survey of parents

Vaccination of children aged 5 years and older is recommended as part of a multifaceted strategy to protect children against SARS CoV-2 infection and serious disease, and to control the spread of infection. COVID-19 vaccine trials in children aged less than5 years are underway, however, parental acceptance of vaccines for this age group is unknown. Between June and August 2021, a cross-sectional national survey of parental attitudes towards childhood vaccination in Ireland was conducted. Parents of children aged 0–48 months were surveyed to determine their attitudes towards COVID-19 vaccines for their children. A total of 855 parents were surveyed. Overall, 50.6 % reported that they intend to vaccinate their child, 28.7 % reported that they did not intend to vaccinate and 20.2 % were unsure. Among those who stated that they did not intend to vaccinate their child, concern about risks and side effects of vaccination was the primary reason reported (45.6 %). The most frequently reported information needs related to side effects of the vaccine (64.7 %) and vaccine safety (60.3 %). Results of the multivariable analysis showed that believing COVID-19 can be a serious illness in children was a strong predictor of parental intention to vaccinate (aOR 4.88, 95 % CI 2.68, 8.91, p-value < 0.001). In comparison with Irish-born parents, parents born in a Central and Eastern European country were less likely to report intention to vaccinate (aOR 0.21, 95 % CI 0.09, 0.47, p-value, <0.001). Parental belief in vaccine importance and safety and parental trust in official vaccine information sources were associated with increased parental intention to vaccinate. Understanding parental attitudes to vaccination of young children against COVID-19 is important to tailor the provision of information to parents’ needs, and to inform the development of vaccination information and communication campaigns for current and future COVID-19 immunisations programmes for children.

Factors Influencing Parental and Individual COVID-19 Vaccine Decision Making in a Pediatric Network

Aspects of the COVID-19 vaccination campaign differed from routine vaccines, including emergency use authorizations, the prioritization of access, and the politicization of messaging. Subsequently, many parents reported lower vaccine confidence relative to routine vaccines, and vaccination coverage stalled below targets. This study aimed to understand parental vaccine decision making and compare COVID-19 versus routine vaccine decision making. We conducted nine virtual focus groups between 25 February 2022-11 March 2022 with parents (n = 41) of the Children's Hospital of Philadelphia's patients, recruited via email and stratified by vaccine hesitancy status (non-hesitant vs. hesitant). Transcripts were analyzed using the vaccine hesitancy matrix domains. Of 41 total participants, 25 (61.0%) were non-hesitant, 16 (39.0%) were hesitant or their children were not up-to-date on adolescent vaccines, and most self-identified as female (95.1%) and White/Caucasian (61.0%). Most participants (87.5%) were fully vaccinated against COVID-19 and many of their first children (n = 26, 63.4%) were vaccinated against influenza. Several themes emerged regarding decision making: individual influences, group influences, vaccine and vaccine program influences, and contextual influences. While some influences were similar for routine and COVID-19 vaccine decision making (e.g., needing evidence-based information), other factors were vaccine- or situation-specific. Building trust requires a multi-faceted concerted effort that involves addressing the complex vaccine decision-making process.

Parents'Attitudes, Their Acceptance of the COVID-19 Vaccines for Children and the Contributing Factors in Najran, Saudi Arabia: A Cross-Sectional Survey

Background: The COVID-19 pandemic is still ongoing, so it is critical to immunize the majority of people, including children, to achieve herd immunity against the pandemic. As parents are the ones who ultimately decide whether or not to vaccinate their children, this study was conducted to determine parental acceptance and hesitancy toward vaccinating their children against COVID-19, as well as their knowledge of and concerns regarding vaccination against COVID-19, as well as factors that might influence their willingness to vaccinate in Najran city, Saudi Arabia. Methods: In February 2022, a cross-sectional, questionnaire-based study using a convenientand snowball sampling technique was carried out. Parents of children between the ages of 5 and 11 were given access to an online self-administered survey. The poll was, however, open to parents of children under the age of 5. Using the Raosoft sample size calculator, the minimum necessary sample size was determined to be 384 under the assumptions of a 5% margin of error and a 95% confidence level. A p value of less than 0.05 was deemed significant for the statistical analysis, which was carried out using SPSS version 27. To examine the relationship between demographic factors and how drivers affect parents’ willingness to vaccinate their children against COVID-19, a chi-square test was performed. Through multivariate regression analysis, the predictors of vaccine hesitancy were identified. Results: A total of 464 responses were collected and subjected to data analysis. More than half of the parents were male (56.9%) and between the ages of 26 and 40 (56.7%). Most parents have children aged between 5–11 years (73.5%). Of parents, 72.2% showed vaccine hesitancy and were 9.5 times less likely to immunize their children against COVID-19. About 27.8% of the parents were ready to vaccinate their children against COVID-19 as soon as possible, compared to 15.51% of parents who were not at all interested in vaccinating their children. Parents under 25 (34.48%) and over 41 (37.79%), non-Saudi (40.59%), holding postgraduate and higher degrees (39.5%), earning more than 10,000 SAR per month (34.96%), working as healthcare professionals (40.36%) and in government sectors (33.93%), self-employed (33.33%), with three to five children (35.26%) and male (31.33%) demonstrated significantly high willingness to vaccinate their children against the COVID-19 vaccine compared to their counterparts. Parents who concur that COVID-19 vaccination may have serious adverse effects in children, who believe that COVID-19 is an uncommon disease and does not require vaccination, have had a family member infected withCOVID-19 with severe symptoms, who were unvaccinated and had severe to moderate symptoms after vaccination, showed significantly higher unwillingness to vaccinate their children against COVID-19. Parents who take safety precautions and do not believe that new vaccines provide an increased risk had higher vaccination intentions for their children. A positive impact of mandatory childhood vaccination was noted on the COVID-19 vaccination. Parents with children suffering from any chronic disease exhibited a 9.9 times higher hesitancy to vaccinate their children against COVID-19. A total of 47.8% of parents had come across or heard about anti-COVID-19 vaccination campaigns. A lack of adequate safety data, potential future consequences, and vaccine efficacy were the main concerns with COVID-19 vaccines. The primary information source for COVID-19-related information was the Saudi Ministry of Health (MOH). Conclusions: Parents’ hesitation to get the COVID-19 vaccine at a significant rate may compromise the success of the ongoing vaccination campaign. The development and implementation of multi-component interventions are required. Hospital- and community-based programs must be used to get in touch with parents.

Attitudes towards COVID-19 Booster Vaccines, Vaccine Preferences, Child Immunization, and Recent Issues in Vaccination among University Students in Jordan

Although COVID-19 vaccines have been available in Jordan for more than a year, Jordan suffers from a low vaccination rate. The aim of this study was to explore attitudes towards recent issues in vaccination among university students in Jordan. We adopted a cross sectional study design using an online questionnaire distributed in a Jordanian university with a medical school chosen at random. The survey asked about COVID-19 vaccine preferences, factors affecting COVID-19 vaccine preferences, child vaccination, and booster vaccines. A total of 417 students completed the survey. Most respondents (54.7%) preferred the Pfizer vaccine, and 6.2% refused to take any vaccine. Pfizer’s efficacy against new strains is a main factor in preferring Pfizer over other vaccines (p < 0.01). Most respondents (71%) believed that vaccination is crucial to prevent COVID-19 surges from new COVID-19 strains, while 44.6% of respondents believed that children should be included in vaccination campaigns, and 70% believed that booster vaccines required more studies to prove their efficacy. Students had mixed attitudes towards many recent issues concerning COVID-19 vaccination. Studying these factors and attitudes in more depth and in different populations can pave the way towards improving vaccination rates worldwide.

Parental COVID-19 Vaccine Hesitancy in the United States

Objective:

Little is known about parents’ willingness to vaccinate their children against COVID-19. We assessed the prevalence of vaccine hesitancy among parents with a child or adolescent aged 12-15 years, examined predictors of parents’ COVID-19 vaccine hesitancy, their reasons for resisting a pediatric COVID-19 vaccine, and the correlation between parents’ intentions to vaccinate their child and the acceptance of a vaccine for themselves.

Methods:

We conducted a national online survey of 637 parents of a child or adolescent aged 12-15 years in March 2021, before COVID-19 vaccines had been approved for this age group. We assessed univariate predictors of vaccine hesitancy, and we used logistic regression analysis to assess independent effects of variables on vaccine hesitancy.

Results:

Nearly one-third (28.9%; 95% CI, 25.5%-32.5%) of respondents reported pediatric vaccine hesitancy. Vaccine-hesitant parents were less knowledgeable about vaccines, more accepting of vaccine conspiracies, and less worried about COVID-19 risks to their child’s health than vaccine-accepting parents were. Vaccine hesitancy was higher among female (vs male), single (vs married/living as married), older (vs younger), low income (vs high income), non–college graduates (vs college graduates), and Republican (vs Democrat) parents. The primary concerns expressed by vaccine-hesitant parents pertained to vaccine safety rather than vaccine effectiveness. One-quarter of vaccine-hesitant parents preferred that their child obtain immunity through infection rather than vaccination. Non–vaccine-hesitant parents’ reasons for vaccinating focused on protecting the health of their child and others. Childhood COVID-19 vaccine acceptance was strongly associated with parents’ intentions to get the vaccine for themselves.

Conclusion:

A messaging strategy for effective public health interventions that includes educating the public about vaccination, countering misinformation about vaccine development and safety, and stressing the safety of approved COVID-19 vaccines may boost vaccine acceptance among vaccine-hesitant parents.

COVID-19 Vaccine for Children: Vaccination Willingness of Parents and Its Associated Factors—A Network Analysis

Different COVID-19 vaccines have been approved for underage children, so parents and caregivers currently face the decision of whether to vaccinate their children against COVID-19 or not. Due to the rather moderate vaccine acceptance among parents across different countries, the objective of the present study was to investigate the relationship between different psychological, demographic, and behavioral factors related to the acceptance of the COVID-19 vaccine for underage children among parents. In particular, vaccination attitudes, whether parents have been vaccinated against COVID-19 themselves, COVID-19 fear, attitude towards COVID-19 policy measures, governmental trust, subjective level of information, perceived risk of disease progression, and perceived risk of vaccine side effects were the variables of interest. The study adopted a cross-sectional study design, and the sample consisted of 2405 participants. A network analysis was conducted to investigate the associations and interconnection among these variables. The results showed that, in particular, compliance, confidence in the safety of vaccines, whether parents have been vaccinated against COVID-19 themselves, trust in the governmental system, fear of COVID-19, and the parents’ age were directly related to the acceptance of the COVID-19 vaccine for children. To increase compliance and confidence in the vaccines’ safety among parents, promotion campaigns should provide more information concerning the vaccines’ safety, particularly for younger parents who are not vaccinated against COVID-19 themselves.

Trust in Science as a Possible Mediator between Different Antecedents and COVID-19 Booster Vaccination Intention: An Integration of Health Belief Model (HBM) and Theory of Planned Behavior (TPB)

As the literature highlights, many health behavior theories try to explain both social and psychological variables influencing an individual’s health behavior. This study integrates insights relative to the antecedents of getting vaccinated from health behavior theories, particularly including the health belief model (HBM), the theory of planned behavior (TPB), and the different socio-demographic factors. Furthermore, we considered the possible mechanism of impact of distrust in science on individuals’ hesitance and resistance to taking up SARS-CoV-2 vaccination in subjects living in Italy. A correlational study of 1095 subjects enrolled when the national vaccination campaign for the third dose was launched. A questionnaire was used to measure: Italian Risk Perception; subjective norm; trust in science, trust in the vaccine; fear of COVID-19; fear of the vaccine; perceived knowledge about SARS-CoV-2; booster vaccination intention. Principal results show that: (i) the positive relationship provided by HBM theory between perceptions of SARS-CoV-2 risk (vulnerability and severity) and intention to have the vaccine, through fear of COVID-19; (ii) the positive relationship between subjective norms and both trust in science and vaccination intention; (iii) that trust in science plays a crucial role in predicting vaccination intention. Finally, the results provided indications about a positive relationship between subjective norms and fear of COVID-19, and a full mediation role of trust in science in the relationships between determinants of both TPA and HBM, fear of COVID-19, and vaccination intention. In conclusion, an individual’s intention (not) to get vaccinated requires the consideration of a plethora of socio-psychological factors. However, overall, trust in science appears to be a key determinant of vaccination intention. Additional strategies promoting healthy behavior are needed.

Awareness of Covid-19 and attitudes toward vaccination in parents of children between 0 and 18 years: A cross-sectional study

PURPOSE

Many countries are struggling with the covid-19 pandemic. Although many measures have been adopted to reduce the transmission of the virus, vaccination is the only solution for controlling and ending the pandemic. The purpose of this study is to evaluate the awareness of covid-19 and attitudes toward covid-19 vaccination in parents.

DESIGN AND STUDY

The research is a descriptive and cross-sectional study. The online survey was conducted. The population of the study consisted of parents of children aged 0-18 who agreed to participate through the social media (Facebook and Instagram) between May 26 and July 7, 2021. With the community research model, the minimum sample size was determined as 384. A parent description form and the Coronavirus (Covid-19) Awareness Scale (CAS) were used for data collection.

RESULTS

The mean Contagion Precaution Awareness sub-factor score of the CAS was 28.84 ± 10.55, the mean Awareness of Following Current Developments sub-factor score was 10.27 ± 4.63, and the Hygiene Precaution Awareness sub-factor score was 9.54 ± 3.55. Thirty-seven percent of the parents wanted their child/children to be vaccinated against Covid-19. A statistically significant association was determined between wished to have their child/children vaccinated against covid-19 and the mean CAS sub-factors scores (p < 0.05).

CONCLUSIONS/PRACTICE IMPLICATIONS

Parents' awareness of covid-19 in this study was moderate. The willingness of parents to have their children vaccinated against covid-19 was also low. In order to increase Covid-19 vaccination rates, doubts and lack of information concerning the vaccine need to be overcome by identifying reasons for vaccine hesitancy.

Behavioral Intention and Its Predictors toward COVID-19 Booster Vaccination among Chinese Parents: Applying Two Behavioral Theories

The booster vaccination of COVID-19 is being implemented in most parts of the world. This study used behavioral psychology to investigate the predictors of parents' intentions regarding the COVID-19 booster vaccination for their children. This is a cross-sectional study with a self-designed questionnaire based on two behavioral theories-protective motivation theory (PMT) and theory of planned behavior (TPB). A stratified multi-stage sampling procedure was conducted in Nanjing, China, and multivariable regression analyses were applied to examine the parents' intentions. The intention rate was 87.3%. The response efficacy (ORa = 2.238, 95% CI: 1.360-3.682) and response cost (ORa = 0.484, 95% CI: 0.319-0.732) in the PMT, were significant psychological predictors of parents' intentions, and so were the attitude (ORa = 2.619, 95% CI: 1.480-4.636) and behavioral control (ORa = 3.743, 95% CI: 2.165-6.471) in the TPB. The findings of crucial independent predictors in the PMT and TPB constructs inform the evidence-based formulation and implementation of strategies for booster vaccination in children.

Influence of Information Sources on Chinese Parents Regarding COVID-19 Vaccination for Children: An Online Survey

(1) Aims: This study explored the mechanism by which exposure to different information sources on social media influences Chinese parents' intention to vaccinate their children against COVID-19. (2) Methods: We developed a research framework based on the Stimulus-Organism-Response (SOR) theory to illustrate how exposure to information sources on social media increases vaccine confidence and, as a result, parents' intentions regarding pediatric vaccination. The partial least square structural equation modeling (PLS-SEM) method was used to test the data collected through an online survey (687 valid samples). (3) Results: The government approval of vaccines fuels vaccination confidence and acts as a mediator between (a) mass media, government new media, and key opinion leaders, and (b) perceived effectiveness and side effects (safety) of vaccines. (4) Conclusions: The mass media, government new media, and key opinion leaders are crucial sources for encouraging parents to vaccinate their children since they boost the vaccination trust. The focus of COVID-19 vaccination promotion should be to strengthen parents' trust in the government, combined with publicizing the effectiveness and side effects (safety) of vaccines.

Parents' Intentions and Associated Factors to Vaccinating Their Children Aged 12-17 Years with COVID-19 Vaccines: A Cross Sectional Study

No available vaccine against COVID-19 had yet been proven for 12-17-year-olds in Egypt during the study period. This is the first study to assess Egyptian parents' intentions and associated factors in relation to vaccinating their children with COVID-19 vaccines. A cross-sectional study using a questionnaire was conducted between 17 October and 17 November 2021, via social media platforms. The target group was parents with children aged 12-17 years. Parents' intention to vaccinate their children and factors associated with vaccinating their children, reasons for not intending to vaccinate their children, and circumstances whereby the parents would change their mind were recorded. Among the 1458 parents recruited, 65.6% were planning to vaccinate their children. The main concerns were fear of the vaccine's side-effects (68.3%) and conspiracy theories (18%). The factors associated with parents' intention to vaccinate their children were mother's older age (40-49 years: aOR = 1.45, 95% CI = 1.05-1.99; ≥50 years: aOR = 2.09, 95% CI = 1.16-3.75), high family income (aOR = 1.99, 95% CI = 1.41-2.79), and children with a history of chronic conditions (aOR = 2.02, 95% CI = 1.25-3.25), while higher mother's education level was negatively associated (aOR = 0.41, 95% CI = 0.27, 0.64). A comprehensive health education program regarding vaccinating children with COVID-19 vaccines is highly recommended for parents, particularly for young and highly educated mothers, to enhance children vaccination rate when the vaccine becomes available.

A socio-ecological perspective on parents' intentions to vaccinate their children against COVID-19

INTRODUCTION

Vaccinating children against COVID-19 protects children's health and can mitigate the spread of the virus to other community members.

OBJECTIVE

The primary objective of this study was to use a socio-ecological perspective to identify multi-level factors associated with US parents' intention to vaccinate their children.

METHODS

This study used a longitudinal online cohort. Multinomial logistic regression models assessed socio-ecological predictors of negative and uncertain child COVID-19 vaccination intentions compared to positive intentions.

RESULTS

In June 2021, 297 parents were surveyed and 44% reported that they intended to vaccinate their children while 25% expressed uncertainty and 31% did not intend to vaccinate their children. The likelihood of reporting uncertain or negative intention, compared to positive intention to vaccinate their children was higher among parents who had not received a COVID-19 vaccination and those who did not have trusted information sources. Parents who talked to others at least weekly about the COVID-19 vaccine were less likely to endorse uncertain compared to positive vaccine intentions (aRRR: 0.44; 95% CI: 0.20-0.93). A sub-analysis identified that parents had significantly higher odds of intending to vaccinate older children compared to younger children (children ages 16-17 years v. 0-4 years OR: 2.01, 95% CI: 1.05-3.84). An additional sub-analysis assessed the stability of parents' intention to vaccinate their children between March 2021 and June 2021 (N=166). There was transition within each intention group between the study periods; however, symmetry and marginal homogeneity test results indicated that the shift was not statistically significant. Parents expressing uncertainty in March 2021 were the most likely to change their intention, with 24% transitioning to positive intention and 23% to negative intention in June 2021.

CONCLUSION

Study findings suggest that programs to promote vaccination uptake should be dyadic and work to promote child and parent vaccination. Peer diffusion strategies may be particularly effective at promoting child vaccination uptake among parents expressing uncertainty.

Willingness and Influencing Factors to Receive COVID-19 Vaccination Among Chinese Medical Students

Objectives

The aim of this study is to evaluate the desire of medical students in China to get vaccinated or not get vaccinated and the reasons for either decision.

Methods

A cross-sectional survey was conducted from 11 March and 12 March 2021, by administering an online questionnaire to the Chinese medical students. Data entry and analysis were conducted using IBM SPSS ver. 26.0.

Results

Of 3,047 students who completed the survey, 37.9% (1,154) of participants indicated that they would be vaccinated against COVID-19, while 62.1% (1,893) declared that they would not. Attitudes to the COVID-19 vaccine (p = 0.000), levels of eHealth Literacy (p = 0.000), the impact of COVID19 (p = 0.000), concerns about the COVID-19 vaccine (p = 0.000) and gender (p = 0.000) strong associations with willingness to receive the COVID-19 vaccine.

Conclusion

The willingness to receive COVID-19 vaccination was sub-optimal among medical students in China. Educational interventions to improve medical students' perceptions and acceptance toward the COVID-19 vaccine are needed.

Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature

BACKGROUND

Vaccine hesitancy continues to limit global efforts in combatting the COVID-19 pandemic. Emerging research demonstrates the role of social media in disseminating information and potentially influencing people's attitudes towards public health campaigns. This systematic review sought to synthesize the current evidence regarding the potential role of social media in shaping COVID-19 vaccination attitudes, and to explore its potential for shaping public health interventions to address the issue of vaccine hesitancy.

METHODS

We performed a systematic review of the studies published from inception to 13 of March2022 by searching PubMed, Web of Science, Embase, PsychNET, Scopus, CINAHL, and MEDLINE. Studies that reported outcomes related to coronavirus disease 2019 (COVID-19) vaccine (attitudes, opinion, etc.) gathered from the social media platforms, and those analyzing the relationship between social media use and COVID-19 hesitancy/acceptance were included. Studies that reported no outcome of interest or analyzed data from sources other than social media (websites, newspapers, etc.) will be excluded. The Newcastle Ottawa Scale (NOS) was used to assess the quality of all cross-sectional studies included in this review. This study is registered with PROSPERO (CRD42021283219).

FINDINGS

Of the 2539 records identified, a total of 156 articles fully met the inclusion criteria. Overall, the quality of the cross-sectional studies was moderate - 2 studies received 10 stars, 5 studies received 9 stars, 9 studies were evaluated with 8, 12 studies with 7,16 studies with 6, 11 studies with 5, and 6 studies with 4 stars. The included studies were categorized into four categories. Cross-sectional studies reporting the association between reliance on social media and vaccine intentions mainly observed a negative relationship. Studies that performed thematic analyses of extracted social media data, mainly observed a domination of vaccine hesitant topics. Studies that explored the degree of polarization of specific social media contents related to COVID-19 vaccines observed a similar degree of content for both positive and negative tone posted on different social media platforms. Finally, studies that explored the fluctuations of vaccination attitudes/opinions gathered from social media identified specific events as significant cofactors that affect and shape vaccination intentions of individuals.

INTERPRETATION

This thorough examination of the various roles social media can play in disseminating information to the public, as well as how individuals behave on social media in the context of public health events, articulates the potential of social media as a platform of public health intervention to address vaccine hesitancy.

FUNDING

None.

Misinformation about Covid-19 Vaccines on Social Media: Rapid Review

Background

The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19.

Objective

We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms.

Methods

We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group.

Results

The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines.

Conclusions

To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277524

International Registered Report Identifier (IRRID)

RR2-10.31219/osf.io/tyevj

Iraqi Parents' Knowledge, Attitudes, and Practices towards Vaccinating Their Children: A Cross-Sectional Study

The focus of coronavirus disease 2019 (COVID-19) vaccination campaigns has been the adult population, particularly the elderly and those with chronic diseases. However, COVID-19 can also affect children and adolescents. Furthermore, targeting this population can accelerate the attainment of herd immunity. The aim of the current study was to evaluate parental intentions to vaccinate their children and the variables associated with them. An online questionnaire was circulated via generic Iraqi Facebook groups to explore parental intentions regarding the vaccination of their children. Multinomial regression analysis was conducted to evaluate variables associated with parental vaccination acceptance. A total of 491 participants completed the study questionnaire. Only 38.3% of the participants were willing to vaccinate their children against COVID-19, while the rest either refused to vaccinate their children (35.6%) or were unsure whether they would (26.1%). Participants’ perceptions about the effectiveness (OR = 0.726, 95% CI = 0.541−0.975, p = 0.033) and safety (OR = 0.435, 95% CI = 0.330−0.574, p < 0.0001) of COVID-19 vaccines were significantly associated with parental acceptance of having children vaccinated. Participants who had received or who were planning to receive the COVID-19 vaccine were significantly less likely to reject vaccinating their children (OR = 0.156, 95% CI = 0.063−0.387, p < 0.0001). There is high refusal/hesitancy among Iraqi parents to vaccinate their children, which is associated with concerns related to the safety and efficacy of COVID-19 vaccines. More efforts, including educational and awareness campaigns to promote the safety and efficacy of COVID-19 vaccines, should be made to increase parental acceptance of childhood COVID-19 vaccinations in Iraq.

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India

Background

Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.

Methods

A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.

Results

Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects.

Conclusion

Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

Second Wave of the Study of Taiwanese Caregivers of Children with ADHD in the COVID-19 Pandemic: Intentions to Vaccinate Their Children for COVID-19, and Related Factors

The second wave of the Study of Taiwanese Caregivers of Children with Attention-Deficit/Hyperactivity Disorder (ADHD) in the COVID-19 Pandemic was conducted at the time of a severe COVID-19 outbreak. The aims of this study were to compare the level of the intentions of caregivers of children with ADHD to vaccinate their children between the first and second waves of study, as well as to examine the COVID-19 pandemic and non-COVID-19 pandemic factors related to caregivers' intentions. In total, 252 caregivers of children with ADHD completed the structured questionnaires, including the Drivers of COVID-19 Vaccination Acceptance Scale; the Risk Perception of the COVID-19 Scale; caregivers' Difficulties in Asking Their Children to Adopt Self-Protective Behavior Scale; the Brief Symptom Rating Scale; the Parental Bonding Instrument; the Swanson, Nolan, and Pelham version IV Scale; and the questionnaires for the intentions to vaccinate their children and child's medication use for treating ADHD. The results demonstrated that 82.5% of caregivers reported their willingness to vaccinate their children definitely or under doctors' recommendation; the level of intentions to vaccinate significantly increased compared with that of caregivers in the first wave of the study. Caregivers' drivers of COVID-19 vaccination uptake, namely, values, impact, and autonomy but not knowledge; being male caregivers; being caregivers of girls; and the older age of the children were positively associated with caregiverscaregivers' intentions. The specific intervention programs for enhancing caregivers' intentions should be specified according to the sex and age of caregivers and of the children with ADHD. The Drivers of COVID-19 Vaccination Uptake should be also the target of intervention for enhancing caregivers' intentions through strengthening caregivers' acceptance of the COVID-19 vaccines' values, positive impact and autonomy to vaccinate their children.

Parental Willingness to Vaccinate Their Children Against SARS-CoV-2 in Jordan: An Explanatory Cross-Sectional Study

Background

Successful control of the COVID-19 pandemic is largely dependent on vaccine administration to epidemiologically influential groups, including children. Considering that pediatric population comprises a significant portion on the population in developing countries, and their risk of infection and spreading the disease has been underestimated, it is crucial to investigate parental willingness to administer SARS-CoV-2 vaccine to their children between 5 and 11 years old. This study investigates the prevalence and determinants of parental willingness towards vaccinating their children (5–12 years old) against COVID-19 in a developing country setting, Jordan.

Methods

A cross-sectional study, conducted between October and November 2021, utilized online Google Forms to collect data on parents’ background characteristics, willingness to vaccinate their children, SARS-CoV-2, infection and vaccine, risk perception, and factors affecting decision to vaccinate.

Results

A total of 564 parents completed the questionnaire; 82.8% were mothers, 85.3% were 30 years of age or older, and 75.9% had bachelor’s degrees or higher. Only 25.4% of parents reported willingness to vaccinate their 5–12 years old children against SARS-CoV-2. Lower parental age, higher income, and having health insurance coverage increased parental willingness. Among participants vaccinated against COVID-19, only 29.0% were willing to vaccinate their children. Healthcare providers’ trust and vaccine recommendations by pediatricians increased parental willingness. COVID-19 risk perception seems to have negative effects on parental willingness.

Conclusion

A significant proportion of parents in Jordan indicated hesitancy towards administering COVID-19 vaccine for their children. Concerns about vaccine safety and trust in the healthcare system appear to be the most important predictors of parents’ hesitancy. Effective vaccine campaigns should focus on risk perception and communication and should consider parental socio-demographic characteristics.

Acceptance and Attitude of Parents Regarding COVID-19 Vaccine for Children: A Cross-Sectional Study

Background

The coronavirus disease 2019 (COVID-19) pandemic has claimed millions of lives worldwide. India also launched a COVID-19 vaccination drive, and clinical trials for a pediatric COVID-19 vaccine are in development.

Objectives

The study aims to assess the acceptance and attitude of parents regarding the COVID-19 vaccine for children in India. The study also aims to find the association between selected demographic variables and acceptance and attitudes in parents regarding the COVID-19 vaccine for children.

Materials and methods

We conducted a cross-sectional descriptive study with 204 participants, and data were collected online using Google Forms. The study participants were parents of children aged two to 15 years. A self-structured tool was used to assess parents' acceptance regarding vaccinating their children, and a modified vaccination attitudes examination scale was used to assess parents' attitudes toward pediatric vaccination against COVID-19. We used IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, New York) to analyze the data. Demographic data were represented as frequency and percentage. Binary logistic regression analysis was used to determine the associations between sociodemographic data and parents' levels of acceptance and attitude. For all the data, p<0.05 was considered significant.

Results

The majority of the participants (85%) reported acceptance of the COVID-19 vaccine for children. More than 80% of parents agree that vaccines are essential to halt the COVID-19 pandemic and are mandatory for children. Most parents (62%) also believed that complementary medicine is better than vaccines for children. While most parents (95%) reported trusting the vaccine, but more than half (59%) reported concerns regarding the unknown future effects of the vaccine.

Mothers (odds ratio (OR), 2.963; p=0.015) and parents of children who received routine vaccination (OR, 0.175; p=0.039) were willing to vaccinate their children when a COVID-19 vaccine became available. Mothers (OR, 3.294; p=0.002) and respondents whose family member or close relative suffered from COVID-19 (OR, 0.420; p=0.029) accepted the COVID-19 vaccine irrespective of the child's age. Study participants who had previously tested positive for COVID-19 (OR, 0.275; p=0.012) believed vaccines for children were necessary to halt the COVID-19 pandemic.

Conclusion

We sought to assess parents' acceptance and attitudes regarding the COVID-19 vaccine for children in India. According to our results, while parents have a high acceptance of a pediatric COVID-19 vaccine, they also have a few apprehensions. Therefore, for a successful mass vaccination drive among the pediatric age group, there should be rigorous communication regarding the vaccine and staunch health campaigns to create more awareness and acceptance toward the COVID-19 vaccine for children.

Behavioral Intention to Get a Booster Dose of COVID-19 Vaccine among Chinese Factory Workers

China started to offer a booster dose of COVID-19 vaccine to members of the adult population in October 2021. This study investigated the behavioral intention to receive a booster dose of COVID-19 vaccine among factory workers who had completed their primary vaccination series. Participants were full-time factory employees at least 18 years of age in Shenzhen, China. In Shenzhen, factory workers need to receive a physical examination every year. The study sites covered all six organizations providing physical examinations for factory workers. All eligible workers attending these sites between 26 and 31 October 2021 were invited to complete an online survey. This study was based on 2329 participants who had completed the primary COVID-19 vaccination series. Two-level logistic regression models were fitted. Among the participants, 84% intended to receive a free booster dose of COVID-19 vaccine within the next six months. After controlling for significant background characteristics, we found that perceptions related to a booster dose as well as interpersonal level factors such as information exposure on social media, thoughtful consideration of the veracity of the information, and satisfaction with vaccine-related promotional materials were determinants of behavioral intention. Factory workers in China reported a high level of behavioral intention to receive a booster dose of the COVID-19 vaccine.

COVID-19 vaccine acceptance among cold-chain workers in Shenzhen, China: A cross-sectional survey

Given the high level of exposure to SARS-CoV-2, cold-chain workers are considered priority vaccination groups. To date, many studies have reported on the willingness within distinct populations to be vaccinated against COVID-19, whereas it has not been reported among cold-chain workers worldwide. To address this void, we conducted a cross-sectional survey to gather general information, COVID-19-related knowledge, attitudes, and practices (KAP), and willingness to receive a COVID-19 vaccine among cold-chain workers in Shenzhen, China. Binary logistic analyses were conducted to explore the associations between COVID-19-related KAP factors and the willingness for COVID-19 vaccination. Among 244 cold-chain workers, 76% indicated that they were willing to be vaccinated. Knowledge about SARS-CoV-2, comprehending the most effective prevention, understanding the transmission routes, and recognizing the priority vaccination groups were positively associated with willingness to be vaccinated against COVID-19. Regarding attitude factors, perceiving the social harmfulness and severity of COVID-19 were related to a higher willingness to vaccination. Participants considering themselves a priority group for COVID-19 vaccination were more likely to get vaccinated. For practice factors, attaining more knowledge and higher self-reported compliance with maintaining adequate ventilation were also positively associated with the dependent variable. Agreement on the importance of COVID-19 vaccination was the most frequent reason for accepting the COVID-19 vaccine; additionally, concerns about side effects and insufficient understanding of efficacy were the main factors contributing to vaccine refusal. Enhancing KAP levels related to COVID-19 helps promote vaccine acceptance. Health authorities should promptly implement educational activities following the updated vaccine status among cold-chain workers.

Intention to vaccinate young children against COVID-19: a large-scale survey of Hong Kong parents

COVID-19 vaccines (Sinovac and Pfizer/BioNTech) have recently been approved for Hong Kong children. Understanding parental intentions to vaccinate children against COVID-19 is important to the development of an effective COVID-19 vaccine campaign. From a large-scale, geographically representative dataset in Hong Kong (N = 11,141), we examined parents' intentions to vaccinate their children against COVID-19 under three conditions: (1) no policy restrictions, (2) vaccination rate considered for school resumption, and (3) more choices of vaccine. Results showed that levels of vaccine hesitancy in Hong Kong parents are high. Hong Kong parents' intention to vaccinate their children was highest when there were more vaccines to choose from, followed by when vaccination rate was considered to resume school, and when there was no policy restrictions. Finally, Hong Kong parents with higher education backgrounds and family income were less willing to vaccinate their children. Together, these findings indicate that effective vaccines campaign should consider the characteristics and preferences of parents who have little intention to vaccinate within a specific social context.

Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: A systematic review and meta-analysis

We aimed to estimate parents' willingness and refusal to vaccinate their children against the COVID-19, and to investigate the predictors for their decision. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched Scopus, Web of Science, Medline, PubMed, CINAHL and medrxiv from inception to December 12, 2021. We applied a random effect model to estimate pooled effects since the heterogeneity was very high. We used subgroup analysis and metaregression analysis to explore sources of heterogeneity. We found 44 studies including 317,055 parents. The overall proportion of parents that intend to vaccinate their children against the COVID-19 was 60.1%, while the proportion of parents that refuse to vaccinate their children was 22.9% and the proportion of unsure parents was 25.8%. The main predictors of parents' intention to vaccinate their children were fathers, older age of parents, higher income, higher levels of perceived threat from the COVID-19, and positive attitudes towards vaccination (e.g. children's complete vaccination history, history of children's and parents' vaccination against influenza, confidence in vaccines and COVID-19 vaccines, and COVID-19 vaccine uptake among parents). Parents' willingness to vaccinate their children against the COVID-19 is moderate and several factors affect this decision. Understanding parental COVID-19 vaccine hesitancy does help policy makers to change the stereotypes and establish broad community COVID-19 vaccination. Identification of the factors that affect parents' willingness to vaccinate their children against COVID-19 will provide opportunities to enhance parents' trust in the COVID-19 vaccines and optimize children's uptake of a COVID-19 vaccine.

Parents' Willingness to Vaccinate Their Children With COVID-19 Vaccine: Results of a Survey in Italy

PURPOSE

This cross-sectional study was conducted to assess the parents' willingness to vaccinate their children with the COVID-19 vaccine and related determinants with specific attention to willingness for adolescents as compared to younger children.

METHODS

Data were collected through a confidential online questionnaire.

RESULTS

A total of 607 parents agreed to participate. More than two-thirds of the parents had good knowledge about the modes of transmission of COVID-19, knew that subjects of any age may be susceptible to SARS-CoV-2 infection, and 85.5% correctly indicated the main behavioral preventive measures against COVID-19. With regard to attitudes, 78.7% agreed that COVID-19 is a serious disease, whereas only 42.3% agreed that it is preventable. Overall, 68.5% were willing to vaccinate their children with the COVID-19 vaccine, specifically 74.5% of parents of adolescents and 65.5% of those of younger children, and the results of the multivariate analysis showed that parents of adolescents aged 12-15 years or 16-18 years compared to those of children aged 11 years or less, those who had more than two children, those who reported that their children had been visited by the primary care pediatrician/physician in the previous 12 months, those who agreed that COVID-19 is a serious disease, considered very useful the COVID-19 vaccine, had been vaccinated against influenza in the previous season, and had received at least one shot of COVID-19 vaccine were more likely to be willing to vaccinate their children.

CONCLUSION

In conclusion, a relevant proportion of parents are willing to vaccinate their children, with the parents of adolescents showing a higher willingness compared to those of younger children. However, there is still room for reducing hesitancy and refusal of the COVID-19 vaccine in this strategic population group by promoting communication to mitigate concerns toward the COVID-19 vaccine.

Individual Preferences for COVID-19 Vaccination under the China’s 2021 National Vaccination Policy: A Discrete Choice Experiment Study

(1) Background: Since China’s national vaccination policy announcement in January 2021, individual vaccination preferences related to vaccine characteristics, social relationships, sociodemographic characteristics and cognition remain opaque. This study aims to investigate vaccination preferences regarding these attributes, and to assess changes in individual vaccine preferences since the pre-2021 emergency vaccination phase. (2) Methods: The two-part questionnaire surveyed 849 individuals between May and June 2021 in Qingdao, China. The survey contained eight binary choice tasks that investigated preference trade-offs. Respondents’ sociodemographic characteristics, including age, sex, urban/rural residence, income, education and whether living with the young or old, were also collected. Conditional logit, mixed logit and latent class models were used to quantify preference utility and identify preference heterogeneity. (3) Results: Vaccine effectiveness, vaccine side effects, duration of protection and probability of infection all significantly affected vaccination utility. Preference heterogeneity based on individual social relationships and sociodemographic characteristics were also established. Marginal analysis showed that compared to the pre-2021 phase, individuals’ preferences had shifted towards vaccines with longer protection periods and better accessibility. (4) Conclusion: This study will inform the full rollout of China’s 2021 national vaccination program and provide valuable information for future vaccination policy design to meet resurgent COVID-19 risks.

Determinants of COVID-19 Vaccine Uptake in Adolescents 12–17 Years Old: Examining Pediatric Vaccine Hesitancy Among Racially Diverse Parents in the United States

As of December 8, 2021, 9.9 million U.S. adolescents ages 12–17 years old remain unvaccinated against COVID-19 (SARS-CoV-2) despite FDA emergency approval of the Pfizer-BioNTech COVID-19 vaccine for use among this age group in May 2021. A slow-down in adolescent vaccine uptake and increased likelihood of hospitalization among unvaccinated youth highlight the importance of understanding parental hesitancy in vaccinating their adolescent children against COVID-19. Racial/ethnic disparities in pediatric COVID-19 infection and hospitalization further underscore the need to examine parental vaccine acceptance and hesitancy among diverse U.S. parent populations. In October 2021, 242 Hispanic and non-Hispanic Asian, Black, and White parents of adolescents ages 12–17 years participated in a national online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to Asian, Black, and Hispanic parents, non-Hispanic White parents reported reduced odds of having vaccinated their adolescent. Bivariate analyses and a multivariable binomial logistic regression indicated that identification as non-Hispanic White, parental COVID-19 vaccine status and safety measures, COVID-19 misconceptions, general vaccine mistrust and COVID-19 related collectivist and individualist attitudes accounted for 45.5% of the variance in the vaccine status of their adolescent children. Our findings draw attention to the urgent need to consider the COVID-19 beliefs, attitudes, and behaviors of parents from diverse racial/ethnic groups in developing population tailored public health messaging to increase adolescent COVID-19 vaccine uptake.

Exploring the attitudes, concerns, and knowledge regarding COVID-19 vaccine by the parents of children with rheumatic disease: Cross-sectional online survey

Background

Vaccination programs are effective strategies in preventing infectious diseases and controlling epidemics. Vaccination against SARS-CoV-2 in children has not yet been approved globally, and it is unclear what attitude families will take when it is approved in children. We aimed to investigate the underlying causes of vaccine acceptance, hesitation, and refusal, as well as concerns about the acceptability of the COVID-19 vaccine by parents of children with rheumatic diseases.

Methods

Parents of children followed up with a diagnosis of rheumatic disease in the pediatric rheumatology outpatient clinic of a university hospital were included in the study. We applied a closed web-based online survey conducted cross-sectionally and sent to the participants via mobile smartphones.

Results

For fathers, mothers, and their children, acceptance rates for a COVID-19 vaccine were 64.2%, 57.7%, and 41.8%, respectively. In the multivariate analysis, factors affecting parents' acceptance of vaccines for their children were as follows: “Receiving antirheumatic medications regularly (AOR 5.40, 95% CI 1.10–26.33, p = 0.03), the previous history of getting special recommended vaccines (AOR 4.12, 95% CI 1.12–27.85, p = 0.03), relying on vaccines for ending pandemic (AOR 8.84, 95% CI 2.80–27.85, p = 0.001), complying with the pandemic measures entirely (AOR 5.24, 95% CI 1.46–18.74, p = 0.01)“. The two most common reasons for vaccine rejection were fear of the side effects of the vaccine and its possible interaction with rheumatic drugs used by children.

Conclusion

According to our survey, parents were more likely to accept a COVID-19 vaccine for themselves than their children. The success of COVID-19 vaccination programs sources highly on people's willingness to accept the vaccine. It is crucial to vaccinate children for achieving herd immunity and in terms of avoiding vaccine hesitancy. Larger data examining the causes of concerns in parents of both healthy children and children with chronic diseases should be delineated.

Why Do Hong Kong Parents Have Low Intention to Vaccinate Their Children against COVID-19? Testing Health Belief Model and Theory of Planned Behavior in a Large-Scale Survey

COVID-19 vaccines have been authorized for use in children in some societies. Parents’ intention to vaccinate their children is context-specific. Drawing upon health belief model (HBM) and theory of planned behavior (TPB), this study contributed to a timely topic by examining the extent to which parents intended to vaccinate their children and its associated factors in Hong Kong, where the government announced children as young as five could take COVID-19 vaccines starting from 21 January 2022. A large-scale, online survey was conducted among 11,141 Hong Kong parents (86% mothers) of children aged 5–12 (N = 14,468, 49.5% girls). They reported on measures that assessed HBM constructs (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action), TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control), and their intention to vaccinate each of their children. Results of descriptive statistics showed that Hong Kong parents’ intention to vaccinate their children was very low (1.55 out of 5.00). Multilevel regression showed that after controlling for parents’ and children’s demographic variables (e.g., sex and age), parents’ intention to vaccinate their children was higher if parents had higher levels of perceived susceptibility, perceived benefits, positive attitudes, and subjective norms and if they had lower levels of perceived barriers. Positive attitudes were the strongest correlate of parents’ intention. These findings have important implications for public health by informing which factors authorities should address in order to boost Hong Kong parents’ intention to vaccinate their children.

Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance

INTRODUCTION

Vaccination is an essential intervention to curb the coronavirus disease 2019 (COVID-19) pandemic. This review aimed to estimate the pooled proportion of COVID-19 vaccine acceptance worldwide.

METHODS

A systematic search of the MEDLINE (PubMed) database using "COVID-19," "vaccine" and "acceptance" to obtain original research articles published between 2020 and July 2021. Only studies with full text and that were published in English were included. The Joanna Briggs Institute meta-analysis was used to assess the data quality. The meta-analysis was performed using generic inverse variance with a random-effects model using the Review Manager software.

RESULTS

A total of 172 studies across 50 countries worldwide were included. Subgroup analyses were performed with regard to vaccine acceptance, regions, population, gender, vaccine effectiveness, and survey time. The pooled proportion of COVID-19 vaccine acceptance was 61% (95% CI: 59, 64). It was higher in Southeast Asia, among healthcare workers, in males, for vaccines with 95% effectiveness, and during the first survey.

CONCLUSION

COVID-19 vaccine acceptance needs to be increased to achieve herd immunity to protect the population from the disease. It is crucial to enhance public awareness of COVID-19 vaccination and improve access to vaccines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2021, identifier CRD42021268645.

Predictors of Real-World Parents’ Acceptance to Vaccinate Their Children Against the COVID-19

Background:

As the COVID-19 pandemic continues to threaten public health, the vaccination of children against the disease appears to be a key factor to control the pandemic. Our aim was to investigate the prevalence of parents who have vaccinated their children against the COVID-19 and the factors influencing this decision.

Materials and Methods:

We conducted a web-based cross-sectional study in Greece during the first week of September 2021. The study questionnaire was distributed through social media and a convenience sample was obtained. Only parents with children aged 12–17 years old could participate in the study. We collected socio-demographic data of parents and we measured their attitudes towards vaccination and COVID-19 pandemic.

Results:

Study population included 656 parents. Regarding vaccination, 27.1% of parents had their children vaccinated against the COVID-19, while almost all children had a complete vaccination history (98.9%). The most important reasons for decline of COVID-19 vaccination were doubts about the safety and effectiveness of COVID-19 vaccines (45.3%) and fear of side effects (36.6%). Regarding the information about the COVID-19 vaccines, parents showed more trust in family doctors than in scientists and the government. We found that increased parents’ age, increased trust in COVID-19 vaccines, and positive attitude of parents towards vaccination had a positive effect on children’s vaccination.

Conclusions:

Understanding the factors influencing parents’ decision to vaccinate their children against the COVID-19 is crucial to increase the COVID-19 vaccination coverage rate. Implementation of public health policies is necessary to spread knowledge about COVID-19 vaccines and to regain vaccine confidence.

National COVID-19 Vaccine Program and Parent's Perception to Vaccinate Their Children: A Cross-Sectional Study

Vaccinating children against COVID-19 is an essential public health strategy in order to reach herd immunity and prevent illness among children and adults. Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. In this study, we aimed to investigate parents' perceptions and acceptance of the COVID-19 vaccine for their children in Saudi Arabia. A well-designed, pre-validated, Google questionnaire was distributed to parents through social media websites. The selection of the participants was based on the simple random sample technique. The study sample size was 1304 participants, with 342 males (26.2%), and 962 females (73.8%). The personal information, perception about COVID-19, and their children's vaccination status were obtained. Among the participants, 602 (46.1%) were willing to get the COVID-19 vaccination for their children, whereas 382 (29.3%) were hesitant to inoculate their children for COVID-19 and 320 (24.4%) were unsure. Age (p = 0.004), gender (p = 0.001), occupation (0.004), income (p = 0.030), and vaccination status (p = 0.001) had an influence on the parents' acceptance of COVID-19 vaccination of their children. On the other hand, education level, number of children, and having been previously infected with COVID-19 had no statistically significant effect on the parent acceptance. The correlation of parents' knowledge about COVID-19 and their agreement to the vaccination of their children was statistically significant, along with gender (males were more knowledgeable, with p < 0.001), occupation, income (higher income showed a statistical difference, with p < 0.001), and vaccination status (p < 0.001). There was a decrease in parents' acceptance toward the COVID-19 children vaccine in Saudi Arabia, which requires more attention and focus from health providers to eliminate fear and anxiety among the parents through additional educational programs and events to decrease the resistance toward the vaccination of children. More emphasis is required to increase the awareness of parents and convey the importance of the vaccine for children. In addition, more studies are needed to ensure the vaccine's safety.

Parents’ Willingness to Vaccinate Children against COVID-19 in Saudi Arabia: A Cross-Sectional Study

Objectives: The present study aimed to investigate parents’ willingness to vaccinate their children under the age of 18 with a COVID-19 vaccine. Methods: This cross-sectional study was conducted in Saudi Arabia from January 2021 to March 2021. The univariate analysis using Mann–Whitney U-test, t-test, and chi-squared/Fisher’s exact test was performed to identify sociodemographic factors associated with the acceptance of COVID-19 vaccine in children. Factors with statistical significance (p < 0.05) were analyzed using multivariate regression analysis to determine the variables affecting parents’ decisions to vaccinate children. Results: Overall, 44% (167) of parents reported that they would accept vaccinating their children with a COVID-19 vaccine. Young (86; 22.7%), married (135; 35.6%), and Saudi (114; 30%) parents seemed to be more concerned about their children being infected. Parents who intended to vaccinate themselves (OR: 0.599, 95% CI: 0.367–0.980) and who trust the healthcare system (OR: 0.527, 95% CI: 0.327–0.848) reported greater acceptance of children’s vaccination. Among parents, the most frequent (40.9%) reason for vaccinating children was to prevent infection in other family members. What may underlie this result is that some parents understand that children can carry pathogens from persons in school to thoseat home. The most frequent (22.2%) reason for refusing vaccination was concerns about the side effects of the vaccine. Conclusions: Parents have differing opinions on frequencies and risks of coronavirus disease transmission and medical complications and of effectiveness and adverse effects of a vaccine. These results could be of use in designing public health information campaigns and health promotion programs based on perceived parental behavior and positive attitudes.

Global COVID-19 Vaccine Acceptance: A Systematic Review of Associated Social and Behavioral Factors

COVID-19 vaccines have met varying levels of acceptance and hesitancy in different parts of the world, which has implications for eliminating the COVID-19 pandemic. The aim of this systematic review is to examine how and why the rates of COVID-19 vaccine acceptance and hesitancy differ across countries and continents. PubMed, Web of Science, IEEE Xplore and Science Direct were searched between 1 January 2020 and 31 July 2021 using keywords such as “COVID-19 vaccine acceptance”. 81 peer-reviewed publications were found to be eligible for review. The analysis shows that there are global variations in vaccine acceptance among different populations. The vaccine-acceptance rates were the highest amongst adults in Ecuador (97%), Malaysia (94.3%) and Indonesia (93.3%) and the lowest amongst adults in Lebanon (21.0%). The general healthcare workers (HCWs) in China (86.20%) and nurses in Italy (91.50%) had the highest acceptance rates, whereas HCWs in the Democratic Republic of Congo had the lowest acceptance (27.70%). A nonparametric one-way ANOVA showed that the differences in vaccine-acceptance rates were statistically significant (H (49) = 75.302, p = 0.009*) between the analyzed countries. However, the reasons behind vaccine hesitancy and acceptance were similar across the board. Low vaccine acceptance was associated with low levels of education and awareness, and inefficient government efforts and initiatives. Furthermore, poor influenza-vaccination history, as well as conspiracy theories relating to infertility and misinformation about the COVID-19 vaccine on social media also resulted in vaccine hesitancy. Strategies to address these concerns may increase global COVID-19 vaccine acceptance and accelerate our efforts to eliminate this pandemic.

The association between entrapment and depression among migrant workers in China: a social rank theory based study

BACKGROUND

Migrant workers are a group susceptible for depression evolution due to occupational maladaptive triggers. The social rank theory illustrates the pathology process from defensive adaptation to depression, pointing out the early prevention of depression by discovering entrapment. This study aims to reveal the relationship between migrant workers' entrapment and depressive symptoms.

METHODS

A total of 1805 migrant workers in Shenzhen were recruited by stratified multi-stage sampling. Sample's demographic, behavioral and psychosocial characteristics were described and analyzed to reveal the relationship between entrapment and depressive symptoms. The Receiver Operator Characteristic was performed to find the optimal cut-off point of Entrapment Scale for predicting depressive symptoms.

RESULTS

In the binary logistic regression of sociodemographic variables, migrant workers who were married (univariate odds ratio (ORu) = 0.69, 95% Confidence Interval (CI) = 0.56-0.84), owned 1 or 2 children (ORu = 0.71, 95% CI = 0.58-0.86), had been working over 10 years (ORu = 0.71, 95% CI = 0.54-0.95), earned > 4999 yuan per month (ORu = 0.68, 95% CI = 0.47-0.99; multivariate odds ratio (ORm) = 0.57, 95% CI = 0.38-0.87) or with low risks of alcohol use disorders (ORu = 0.51, 95% CI = 0.34-0.75) had lower risks of depressive symptoms. After adjusted the aforementioned significant sociodemographic variables, migrant workers with severer entrapment were more likely to have depressive symptoms (adjusted odds ratio (ORa) = 1.13, 95% CI = 1.12-1.15). Besides, the study proved the reliability and validity of the Chinese version Entrapment Scale, preferring a two-dimensional structure, and 11 was the optimal cut-off value of this scale for predicting depressive symptoms among migrant workers.

CONCLUSIONS

This result indicates the potential value of entrapment according to the social rank theory on facilitating early prevention of migrant works' depression and the application value of Entrapment Scale for effectively measuring mental status among migrant workers.

Chinese parents' willingness to vaccinate their children against COVID-19: A systematic review and meta-analysis

Introduction

To evaluate Chinese parents' willingness to vaccinate their children against COVID-19, identify its predictors, and provide a reference for raising the COVID-19 vaccination rate for children.

Method

PubMed, Cochrane Library, Embase, and the databases in Chinese, including CNKI, WanFang, VIP, CBM, were searched from December 2019 to June 2022, and citation tracking was used to identify relevant studies. To calculate the rate with 95% confidence intervals (CI), a random-effects model was used. To explore sources of heterogeneity, sensitivity analysis and subgroup analysis were conducted. This analysis was registered on PROSPERO (CRD42022346866) and reported in compliance with the PRISMA guidelines.

Result

Overall, 80 studies were screened, and 13 studies with 47994 parents were included after removing duplicates and excluding 19 studies that did not meet the selection criteria by title, abstract and full-text screening. The pooled willingness rate of Chinese parents to vaccinate their children against COVID-19 was 70.0% (95% CI: 62.0~78.0%). Level of education, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination (such as perceived efficacy and safety of the COVID-19 vaccines, parental willingness to vaccinate themselves, parental vaccination hesitancy, and the history of children's vaccination against influenza) were the main predictors of parents' intention to vaccinate their children.

Discussion

Chinese parents' willingness to vaccinate their children against COVID-19 is moderate, and factors including parental education level, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination affect this decision. Fully identifying these factors and their mechanism will be essential to further raise the willingness rate.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022346866.

Providing children with COVID-19 vaccinations is challenging due to lack of data and wide-ranging parental acceptance

Aim

Vaccines are vital to ending the COVID‐19 pandemic and we reviewed the data on vaccinating children, and including them in clinical trials, as most of the activity has focused on adults.

Methods

English and Chinese databases, including PubMed, Elsevier Scopus, Web of Science, CNKI and CQVIP were searched, along with websites such as the World Health Organization and the University of Oxford.

Results

We identified 44 papers and 16 news items about vaccinating children against the virus, published from 10 February 2020 to 14 July 2021. Child vaccination has been slow and only a few countries have included children in Phase II or III clinical trials. The data on children were much more limited than on adults, but most children were asymptomatic or had mild symptoms and some deaths had been recorded. More clinical trials are needed to assess the safety and efficacy of vaccinating children, as higher vaccination levels can help to build up herd immunity. The percentage of parents willing to vaccinate their children against the virus ranged from 48.2% to 72.6%, with much lower rates for letting them participate in clinical trials.

Conclusion

Vaccines should be offered to children as soon as their safety and efficacy are established.

Parents' Knowledge, Attitude, and Practice on Childhood Vaccination During the COVID-19 Pandemic in Indonesia

BACKGROUND

Vaccination is known to have an enormous impact on improving child health. In Indonesia, the government has included several vaccines in the national immunization program.

OBJECTIVE

This study aimed to investigate parents' knowledge, attitude, and practice on childhood immunization during the COVID-19 pandemic in Indonesia.

METHODS

A valid and reliable questionnaire was delivered to approximately 276 parents in Jakarta and Bandung, representing the epicenter of the pandemic. This study was conducted from June 2020 to February 2021. The correlations between parents' knowledge, attitudes, and practice with the characteristics of the respondents were investigated. In addition, multiple regression analysis was performed to identify the variables associated with good vaccination practice.

RESULTS

The results showed that the mean scores of parents' knowledge, attitude, and practice on childhood vaccinations were 7.22 (± 1.30) out of 9 points, 3.93 (± 0.31) out of 4 points, and 3.59 (± 0.97) out of 5 points, respectively. Respondents graduated from university were more knowledgeable than those graduated from senior high school (p-value <0.05). Employed participants had better scores in knowledge and practice, compared to unemployed participants (p-value <0.05).

CONCLUSION

In conclusion, this study found positive correlations between participants' knowledge and attitude, knowledge and practice, and attitude and practice on childhood vaccination during the COVID-19 pandemic in Indonesia.

Parents' intention for their children to receive COVID-19 vaccine: Implications for vaccination program in Macao

INTRODUCTION

The decision about vaccinating children is subject to their parents' decision. To inform strategies that support full vaccination coverage, it is important to understand the parents' vaccination attitude and tendency to act. This study aims to investigate the intention and the factors affecting parents' decision-making about vaccinating their children.

METHODS

A cross-sectional, self-administered online questionnaire was completed by parents of children aged 3-12 yeas in Macao between 7 March and 17 April 2022. The survey tool was informed by the Theory of Planned Behavior (TPB) which composes of the variable "intention" and three TPB constructs (Attitude, Subjective Norm, and Perceived Behavioral Control). Respondents rated their level of agreement on the construct statements using a 5-point Likert scale. Multiple linear regression analysis was used to determine if the TPB constructs were predictors of parents' intention.

RESULTS

A total of 1,217 parents completed the questionnaire. The majority of participants were mothers (83.2%), aged 31-40 years (62.7%), having two or more children (74.1%), had at least one dose of COVID-19 vaccine (84.4%) and considered themselves knowledgeable about the vaccine (62.1%), all of which were significantly associated with the intention to vaccinate their children (all p < 0.05). Their intention varied from negative (19.1%), neutral (38.4%) to positive (42.5%). Respondents were mostly concerned about the serious side effects that the COVID-19 vaccine (mean = 3.96 ± 1.23), highly acknowledged the expectation by the school (mean = 3.94 ± 1.15) and the community (mean = 3.90 ± 1.19) of children vaccination, and rated highly the ease of making necessary arrangement (mean = 3.93 ± 1.25). In the multiple linear regression model which explained 63.5% of the variance in the intention-to-vaccinate their children, only Attitude (B = 0.52, p < 0.001) and Subjective Norm (B = 0.39, p < 0.001) were identified as strong predictors. The major reasons for not having intention were safety concerns (n = 646/699, 92.4%). Participants' most trusted local information sources were doctors (n = 682), government (n = 426) and healthcare professional organizations (n = 416).

CONCLUSIONS

Vaccinating children with COVID-19 vaccine is a complex decision-making for parents. A key to a successful COVID-19 vaccination program is effective communication about the safety profile and the usage experiences warranting the integration of reliable information sources across different healthcare sectors.