Willingness to get the COVID-19 vaccine with and without emergency use authorization

The Association Between the We Can Do This Campaign and Vaccination Beliefs in the United States, January 2021-March 2022

Public health campaigns addressing COVID-19 vaccination beliefs may be effective in changing COVID-19 vaccination behaviors, particularly among people who remain vaccine hesitant. The "We Can Do This" COVID-19 public education campaign (the Campaign) was designed to increase COVID-19 vaccine confidence and uptake. This study aims to evaluate whether Campaign dose was associated with changes in vaccination beliefs related to COVID-19 vaccine concerns and perceived risks, the importance of COVID-19 vaccines, the perceived benefits of COVID-19 vaccination, normative beliefs about COVID-19 vaccination, and perceptions about general vaccine safety and effectiveness. The study linked data from four waves of a nationally representative longitudinal panel of U.S. adults (January 2021-March 2022) with Campaign paid digital media data (April 2021-May 2022). We used mixed-effects linear regressions to examine the association between Campaign paid digital impressions and changes in vaccination beliefs. The results provide evidence that Campaign digital impressions were significantly associated with changes in respondent beliefs regarding COVID-19 vaccine concerns and perceived risks, perceived benefits of COVID-19 vaccination, and perceptions about general vaccine safety and effectiveness. Findings suggest that public education campaigns may influence vaccine confidence and uptake by increasing positive vaccination beliefs and reducing vaccine concerns.

Gendered (SDG5) and other perspectives on COVID-19 vaccination status: a focus on South Africa's Limpopo province

One of the key issues embedded in the 2030 Agenda for Sustainable Development is the need for disaggregated data. Given the nature of the Coronavirus disease 2019 (COVID-19), studies on such should respond to this call. This paper investigates gendered and other perspectives on COVID-19 vaccination status in South Africa's Limpopo Province. The work utilises a household survey (n = 4,571), data from Our World in Data and Johns Hopkins University, as well as policy documents and academic literature. The findings are that the government moved away from a goal to attain 67% herd immunity, to the containment strategy. While the country attained 35% of population fully vaccinated, the current study reveals 72.84% of the respondents fully vaccinated in Limpopo (including those receiving a booster). Noteworthy findings include 7.1% of the respondents reporting partial vaccination and 19.8% expressing vaccine hesitancy. Gender differences were significant, with females exhibiting higher vaccination rates than males, and age-related variations were observed, particularly among the youngest participants. Further analysis stratified by gender and age groups unveiled substantial disparities, emphasizing the need for targeted interventions. Additionally, the study highlights patterns in COVID-19 vaccine uptake based on education levels, with higher education associating with increased vaccination rates. Significant gender-based differences in vaccine uptake across education levels indicate potential areas for focused public health efforts. The findings emphasise the complexity of factors influencing vaccination behaviour, providing valuable insights for policymakers, public health practitioners, and researchers aiming to enhance vaccine uptake and address disparities in diverse demographic groups.

COVID-19 Vaccine Intention Among Iranian Health Workers: Application of the HBM Model

The study aimed to determine the application of the health belief model (HBM) in the acceptance of COVID-19 vaccination among health workers in 2021. The cross-sectional study was conducted on 3600 health workers from February to March 2021. Data was collected using a researcher-made questionnaire that included the intention to receive vaccines based on the health belief model constructs. Data were analyzed using descriptive statistics indicators, Chi-square, ANOVA test, and logistic regression model at a 95% confidence level. More than 62% of the participants intended to receive the vaccine. The odds of intention to receive the vaccine among people who worked in the health center and did not have a history of hospitalization due to COVID-19 disease were 1.50 and 2.10 units more than the others. Intention to receive the vaccine in individuals with high perceived sensitivity was 1.10 units. Furthermore, in terms of perceived benefits, self-efficacy, and cue-to-action constructs were 1.15, 1.34, and 1.65 units respectively. The rate of vaccine acceptance among Iranian health care workers was relatively good and the constructs of HBM in predicting the rate of intention to receive the vaccine had good applicability.

Factors predicting primary and booster COVID-19 vaccination in a community sample of African American men and women in the United States Midwest

COVID-19 has disproportionately burdened impoverished minority communities. This study recruited an age- and gender-diverse community sample of 541 Black adults in a United States Midwestern city with large racial health disparities, with the aim of examining factors associated with COVID-19 vaccination. All participants completed measures assessing their COVID-19 vaccination status (unvaccinated, received primary vaccination, or received primary plus booster vaccination) as well as demographic characteristics, socioeconomic factors, health and health system factors, and health behavior theory constructs related to vaccination. In this predominantly low-income sample, 55% of participants had received primary COVID-19 vaccination and 31% of the sample had received a booster dose. Multiple regression analyses established that having primary vaccination was significantly predicted by older age, political identification as Democrat, education beyond high school, barriers to accessing health care, as well as higher trust of vaccine benefits, less preference for natural immunity, stronger social norms favoring vaccination, and perceiving higher levels of collective responsibility. Surprisingly, higher global medical mistrust and difficulty with healthcare access were associated with vaccination. The model explained 76% of the variance in primary COVID-19 vaccination. Having received a COVID-19 booster was predicted by older age, previous COVID-19 infection, higher trust in vaccine benefits, and fewer worries about unforeseen future effects of vaccination. Study findings identified factors associated with COVID-19 vaccine uptake in racial minority communities, and support the benefits of interventions that harness social network supports for vaccination, address community vaccine concerns, and appeal to collective responsibility to promote vaccine uptake.

Vaccination intentions of hypertensive Chinese individuals during the COVID-19 epidemic: a structural equation modeling study

OBJECTIVE

Given the high prevalence of hypertension among Chinese adults, this population is at a significantly increased risk of severe COVID-19 complications. The purpose of this study is to assess the willingness of Chinese hypertensive adults to receive the COVID-19 vaccine and to identify the diverse factors that shape their vaccination decisions.

METHODS

Sampling was conducted utilizing multistage stratified random sampling, and ultimately, a total of 886 adult hypertensive patients from Luzhou City in Southwest China were included in this study. The questionnaire design was based on the Theory of Planned Behaviour and was used to investigate their willingness to be vaccinated with COVID-19. Structural equation modeling was employed for data analysis.

RESULTS

The results showed that 75.6% of hypertensive individuals were willing to receive COVID-19 vaccination. The structural equation modeling revealed that Subjective Norms (path coefficient = 0.361, CR = 8.049, P < 0.001) and Attitudes (path coefficient = 0.253, CR = 4.447, P < 0.001) had positive effects on vaccination willingness, while Perceived Behavioral Control (path coefficient=-0.004, CR=-0.127, P = 0.899) had no significant impact on Behavioral Attitudes. Mediation analysis indicated that Knowledge (indirect path coefficient = 0.032, LLCI = 0.014, ULCI = 0.058), Risk Perception (indirect path coefficient = 0.077, LLCI = 0.038, ULCI = 0.124), and Subjective Norms (indirect path coefficient = 0.044, LLCI = 0.019, ULCI = 0.087) significantly influenced vaccination willingness through Attitudes as a mediating factor.

CONCLUSION

The willingness of hypertensive individuals to receive the COVID-19 vaccination is not satisfactory. The Theory of Planned Behavior provides valuable insights into understanding their vaccination intentions. Efforts should be concentrated on enhancing the subjective norms, attitudes, and knowledge about vaccination of hypertensive patients.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19

BACKGROUND

Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake.

METHODS

The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted.

RESULTS

Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents.

CONCLUSIONS

Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

Intention to vaccinate for Lyme disease using the Health Belief Model

AIMS

Lyme disease (LD) cases in the United States are estimated to be approaching 500,000 annually. Protective measures, such as repellent use and wearing protective clothing are recommended by public health officials. However, no protective measure has been proven to be consistently effective, partly because they require consistent and persistent behaviour change. While safe and effective vaccines are in development, it is unclear what factors influence the intention to vaccinate against LD. This study uses the Health Belief Model (HBM) framework to determine key drivers associated with vaccine intention. The HBM is widely applied in public health research and uses the following constructs: perceived susceptibility and severity of disease, perceived benefits and barriers to disease prevention, and cues to action for disease prevention to predict health behaviours. To date, the HBM framework has not been applied to vaccination intention for LD.

METHODS AND RESULTS

Data were collected from 874 adults and 834 caregivers of children residing in US states endemic to LD. Sampling adults and caregivers allows us to explore how the intention to vaccinate differs among those at-risk. Estimates from structural equation modelling (SEM) show that the HBM constructs explain much of the variation in intention to vaccinate against LD. Both adult and caregiver intentions to vaccinate are positively influenced by cues to action, perceived susceptibility of LD, and perceived benefits to vaccination. However, there is variation in the influence of constructs across the samples. Caregiver's intention to vaccinate is positively influenced by the perceived severity of LD and negatively influenced by safety concerns about the vaccine, whereas adult intention is negatively influenced by perceived barriers to vaccination.

CONCLUSION

A strong relationship of cues to action on vaccine intention in samples of adults and caregivers suggests the importance of a recommendation from a healthcare provider or the Centers for Disease Control and Prevention (CDC).

Effect of chronic diseases on willingness to receive the second COVID-19 vaccine booster dose among cancer patients: A multicenter cross-sectional survey in China

BACKGROUND

Cancer patients and those with chronic diseases face severe outcomes from SARS-CoV-2 infection. However, their willingness to receive a second booster dose remains low. This study identified factors affecting the willingness of cancer patients with chronic diseases (CPCD) and cancer patients without chronic diseases (non-CPCD) to receive the second COVID-19 booster vaccine dose.

METHODS

A multicenter cross-sectional study was conducted across 4 tertiary care hospitals in China. Based on the Health Belief Model, a questionnaire assessed respondents' perceptions of the second booster dose. Multivariable logistic regression analyzed factors influencing the willingness to receive a second vaccine dose.

RESULTS

Out of 171 CPCD and 722 non-CPCD, CPCD showed a higher willingness to receive the second booster dose than non-CPCD (46.8% vs 32.3%, P < .001). Factors influencing CPCD's willingness included the belief that vaccination was detrimental to cancer treatment and the perceived higher infection risk compared to healthy individuals. Fear of vaccination's negative impact on cancer treatment was the main factor affecting non-CPCD's willingness (each P < .05).

CONCLUSIONS

Different factors influenced the willingness of the 2 groups. Health education interventions should be implemented alongside vaccination, involving patients' relatives and medical staff, for both CPCD and non-CPCD populations. Additionally, health management service interventions should emphasize the benefits of vaccination for CPCD to improve their second dose coverage.

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

Using behavioral theory to understand partisan differences in COVID-19 vaccination and booster intentions

In 2020, the Food and Drug Administration granted emergency use authorization for two COVID-19 vaccines. Two years later, the Centers for Disease Control and Prevention estimated that more than 250 million individuals had received at least one dose of the vaccine. Despite the large numbers of individuals vaccinated against COVID-19, partisan differences surrounding the COVID-19 vaccine emerged, creating a potential challenge for health communications aimed at increasing vaccine uptake. A better understanding of partisan differences in attitudes and intentions towards vaccination may help guide public health strategies aimed at increasing vaccine uptake. To determine whether a commonly used theory of behavioral intentions used to craft public health messages explains partisan differences in intentions. Data were drawn from a national panel of US adults and collected between February 21, 2022, and March 3, 2022, using an online survey (n = 1845). Among respondents identifying as either Democrat or Republican (n = 1466), path analysis models were estimated to test whether partisan differences in vaccination or booster intentions were explained by the theoretical constructs of protection motivation theory (PMT). PMT accounted for approximately half of the covariate-adjusted mean difference in COVID-19 vaccination intentions between Democrats and Republicans, and nearly all the mean difference in booster intentions. Party affiliation indirectly affected intentions via its association with perceived susceptibility to COVID-19, vaccine/booster efficacy, and perceived costs of getting a COVID-19 vaccine or booster dose. Compared with Democrats, Republicans may be less likely to get vaccinated or receive a booster dose because of beliefs that they are less susceptible to COVID-19, that the vaccine is less effective, and that vaccination comes with disadvantages. Theories of behavioral intentions can help to identify the underlying theoretical determinants driving behavioral differences between political groups.

A study on the factors influencing the intention to receive booster shots of the COVID-19 vaccine in China based on the information frame effect

Introduction

In the response to and prevention and control of the Novel coronavirus pneumonia, the COVID-19 vaccine does not provide lifelong immunity, and it is therefore important to increase the rate of booster shots of the COVID-19 vaccine. In the field of information health science, research has found that information frames have an impact in changing individual attitudes and health behaviors.

Objective

This study focuses on the effects of different influencing factors on the public's willingness to receive the booster shots of the COVID-19 vaccine under two information frameworks.

Methods

An online questionnaire was conducted to explore the effects of demographic characteristics, personal awareness, social relationships, risk disclosure, perceived booster vaccination protection rate, and duration of protection under the assumption of an information framework. T test and one-way analysis were used to testing the effect of variables.

Results

(1) The persuasion effect under the gain frame is higher than that under the loss frame (B = 0.863 vs. B = 0.746); (2) There was no significant difference in subjects' intention of booster vaccination in terms of gender, age, income, occupation, educational background and place of residence. Whether family members received booster vaccination was strongly correlated with their intention of vaccination under the loss framework (p = 0.017, M = 4.63, SD = 0.664). (3) The higher the understanding of COVID-19, the higher the degree of compliance with the government's COVID-19 prevention and control measures, and the higher the willingness to strengthen vaccination; (4) Risk disclosure has a significant impact on people's willingness to receive COVID-19 booster shots (M = 2.48, under the loss framework; M = 2.44, under the gain framework); (5) Vaccine protection rate and duration of protection have an impact on people's willingness to vaccinate. Increased willingness to vaccinate when the protection rate of booster vaccine approaches 90% (M = 4.76, under the loss framework; M = 4.68, under the gain framework). When the vaccine protection period is 2 years, people are more willing to receive a booster vaccine; and the willingness to receive a booster shot is stronger under the loss framework (M = 4.60, SD = 0.721, p = 0.879).

Conclusion

The impact of the information framework on COVID-19 vaccination intentions is different, and the disclosure of relevant health information should focus on the impact of the information framework and content on the public's behavior toward strengthening vaccination. Therefore, in the face of public health emergencies, public health departments, healthcare institutions, and other sectors can consider adopting the Gainful Information Framework tool to disseminate health information to achieve better persuasion and promote public health behavior change enhancing public health awareness, and promoting universal vaccination.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

Impact of the COVID-19 pandemic on behavioral changes in healthcare workers in Italy

Introduction

During the COVID-19 pandemic, adherence to wearing face mask and washing hands procedures and achieving high COVID-19 vaccine coverage among healthcare workers (HCWs) were essential to minimize morbidity and possible death and limit the transmission of the virus. The objectives of the cross-sectional survey were to explore the influence of COVID-19 on the use of preventive measures and vaccination willingness among HCWs in the southern part of Italy and the associated factors.

Methods

The survey was carried out from 15 June 2023 to 15 July 2023 among 521 HCWs who worked in three randomly selected public hospitals. All data were collected through a self-administered questionnaire.

Results

HCWs had a positive change in the use of preventive measures if they did not often/always use them before the pandemic, but they are using in the current epidemiologic context and they were willing to use in a future epidemic situation. A positive change in the adherence to face mask-wearing (24.6%) was more likely among those with at least 5 years of university degree, nurses/midwives, and who had worked in COVID-19 wards. A positive change in alcohol-based hand rubbing (3.1%) was more likely in HCWs in Emergency/Critical/Infectious Diseases wards compared with medical wards. HCWs who were more likely to believe that the COVID-19 vaccine should be mandatory for them (58.1%) had at least 5 years of university degree, in Emergency/Critical/Infectious Diseases wards compared with surgical and medical wards, had received more than three doses of this vaccine, were more concerned to get infected during their activity, and had received information from scientific journals. HCWs more willing to receive the COVID-19 vaccine every year (39.8%) were males, physicians, those in Emergency/Critical/Infectious Diseases wards compared with medical wards, who had received more than three doses of this vaccine, who believed that this vaccine should be mandatory for HCWs, and who needed additional information.

Discussion

The survey showed that the COVID-19 pandemic had an impact on the use of preventive measures among HCWs, not necessarily for the improvement or increase. Educational messages on the importance of these measures regarding the promotion and recommendation of the vaccine need to be investigated and applied among HCWs in order to reduce vaccination gaps and the spread of the infection.

Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review

INTRODUCTION AND BACKGROUND

Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations.

METHODS

A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom.

RESULTS AND ANALYSIS

Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups.

CONCLUSIONS AND IMPLICATIONS

The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.

Ideological differences in COVID-19 vaccine intention: the effects of trust in the healthcare system, in complementary and alternative medicine, and perceived threat from the disease

Introduction

Politically left-leaning individuals are more likely to get vaccinated against COVID-19, although little is known about the mechanisms underlying the ideological differences in vaccination intentions. Understanding the extent to which trust in the healthcare system, in complementary and alternative medicine, and the perceived threat from the disease contribute to these disparities is crucial, as it could inform targeted interventions to address vaccine hesitancy across the political spectrum.

Methods

The present cross-sectional study conducted among adults living in Slovenia (n = 858) examined the mediating role of trust in the healthcare system, trust in complementary and alternative medicine (CAM), and the perceived threat from the virus on COVID-19 vaccination intention.

Results

We found that leftist ideology and trust in the healthcare system positively predicted vaccination intention, whereas CAM negatively predicted this intention. In addition, left-leaning individuals expressed greater trust in the healthcare system and lower trust in CAM, resulting in higher levels of COVID-19 vaccination intention. The serial mediation model confirmed that trust in CAM was a negative predictor, while trust in the healthcare system positively predicted perceived threat.

Discussion

When dealing with vaccine hesitancy among right-oriented individuals, strategies should focus on enhancing trust in the healthcare system and critically evaluating the reliance on CAM.

COVID-19 Vaccine Acceptance and Hesitancy among Nurses in Thailand: Implications, Challenges, and Future Prospects for Attitudes and Vaccine Literacy

Nurses are healthcare workers at high risk of contracting COVID-19 and are prioritized for COVID-19 vaccination. This study aimed to explore COVID-19 vaccine acceptance, vaccine literacy, and attitudes toward COVID-19 vaccines, and determine factors associated with COVID-19 vaccine acceptance among nurses in Thailand. A cross-sectional survey was conducted using online questionnaires between May and June 2021. A total of 510 nurses were recruited during the pandemic's third wave in Thailand. Data were analyzed using descriptive and inferential statistics. Ten percent (n = 51) of the participants were men, all of whom showed COVID-19 vaccine acceptance. Of the 459 female nurses, 94.8% (n = 435) accepted COVID-19 vaccination and 91.3% (n = 419) reported previous influenza vaccination. In multiple logistic regression models, previous influenza vaccination, interactive-critical vaccine literacy, and attitudes toward COVID-19 vaccines were significant predictors of COVID-19 vaccine acceptance among female nurses in Thailand. Those who had previously received influenza vaccination were more likely to accept COVID-19 vaccination. Higher scores for interactive-critical vaccine literacy and positive attitudes toward the COVID-19 vaccine increased the odds of accepting vaccination, while negative attitudes were associated with decreased vaccine acceptance. Vaccine literacy, together with attitudes toward the COVID-19 vaccine, had a strong positive effect on increasing vaccination acceptance and reducing vaccine hesitancy. The results suggest that policymakers should consider both attitudes and vaccine literacy when establishing prospective strategies for promoting vaccine acceptance among nurses beyond the COVID-19 pandemic.

Strengthening COVID-19 vaccine confidence & demand during the US COVID-19 emergency response

In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses.

Impact of leisure satisfaction on perceived risk of infectious disease during the COVID-19 pandemic: evidence from new worker classes

Introduction

This study examines how job market changes affect individuals' leisure choices and satisfaction, focusing on worker classes that have undergone daily life changes (e.g., economic and social activities) due to the coronavirus disease-2019 (COVID-19) pandemic.

Methods

A population-based cross-sectional study design was employed. South Korean workers aged 20-59 years answered an online survey administered from September 14 to October 4, 2021. Ultimately, 764 responses were used in the analysis. The measures used in this study consisted of factors affecting infectious disease risk perception and leisure satisfaction among the six new worker classes that emerged during the pandemic, according to socio-demographic status.

Results

The results showed that among male participants, social, emotional, physical, environmental, and educational factors of leisure satisfaction were more strongly affected, with higher social, physical, and interpersonal relationships being factors in the perception of infectious disease risk. Among female participants, the interpersonal relationship factor of perceived risk was significantly affected by the social, emotional, and educational factors of leisure satisfaction. Interpersonal relationships, affected leisure satisfaction among members of Classes 1-3, who experienced no change in pay. However, for the members of Class6 who experienced a decrease in pay, the economic factor negatively affected leisure satisfaction and played a pivotal role in our findings.

Conclusion

This study verified the risk factors that inhibit leisure satisfaction among new worker classes that emerged during the COVID-19 pandemic. Furthermore, the psychological health of people suffering pandemic-related financial constraints was affected, as they experienced a lower quality of life owing to reduced leisure activities and satisfaction.

Is decision-making based on the internet during pregnancy a predictive factor for vaccine hesitancy in pregnant women during the pandemic?

Pregnant women frequently use the Internet to get information, and the information they receive is effective in their decision-making. It is known that pregnant women get information about COVID-19 vaccines from the Internet. This study aims to determine whether decision-making based on Internet sources during pregnancy is a predictive factor for vaccine hesitancy in pregnant women during the pandemic. A descriptive, cross-sectional research design was used. The data were collected by using an online survey instrument. There was a positive, moderate, and significant relationship between the self-efficacy perception sub-dimension of the internet decision-making during pregnancy scale and the risk sub-dimension of the vaccine hesitancy in pandemics scale (r: .584, p < .05) and between the self-control sub-dimension of the internet decision-making during pregnancy scale and the risk sub-dimension of the vaccine hesitancy in pandemics scale (r: .546, p < .05). The perception of self-control (β: .291) affected the lack of confidence, and the perception of self-efficacy (β: .481) affected the risk perception more than other variables. There was a relationship between internet decision-making and COVID-19 vaccine hesitancy in pregnant women. Health professionals, information specialists, and librarians should orient people to reliable sources about vaccines.

Investigation of COVID-19 vaccination among maintenance hemodialysis patients in Sichuan, China

AIM

To investigate the current status of COVID-19 vaccination in maintenance hemodialysis (MHD) patients and its influencing factors.

METHODS

In total, 585 patients undergoing regular hemodialysis in Sichuan Province of China from January to March 2022 were selected to complete a questionnaire survey on their knowledge, attitudes and practices regarding COVID-19 vaccination. Independent t tests and logistic multivariate analysis were used to analyze the influencing factors of COVID-19 vaccination in hemodialysis patients.

RESULTS

The survey showed that 37.44% of MHD patients had been vaccinated with the COVID-19 vaccine. Being married was associated with COVID-19 vaccination in patients with MHD (odds ratio [OR] = 1.969 95% CI 0 .870 ~ 4.453). MHD patients living in county areas have higher rates of COVID-19 vaccination (OR = 0.572 95% CI 0.301 ~ 1.087). Family /relatives/friends who are healthcare workers are associated with COVID-19 vaccination for MHD patients (OR = 1.840 95% CI 1.140 ~ 2.970). Other vaccination history within 5 years was a factor in COVID-19 vaccination for MHD patients (OR = 5.592 95% CI 2.997 ~ 10.434). Attitude (OR = 0.885 95% CI 0.808 ~ 0.905), and practice (OR = 0.756 95% CI 0.697 ~ 0.819) scores on the COVID-19 vaccination knowledge and practice questionnaire were related to the vaccination status of MHD patients.

CONCLUSIONS

MHD patients had lower rates of COVID-19 vaccination. Marital status, living environment, whether family/relatives/friends were medical workers, and the score of the COVID-19 vaccine knowledge and practice questionnaire were the factors influencing their vaccination status. Clinical attention should be given to the adverse reactions of COVID-19 vaccination in MHD patients to improve the awareness of primary medical staff on hemodialysis, and families and society should pay more attention to COVID-19 vaccination in MHD patients.

Willingness to Embrace COVID-19 Vaccination Amongst Residents in a Low-Income Nation: Insights From a Cross-Sectional Study on a Limited Cohort

The global pandemic had a significant impact on countries around the world, both politically and socioeconomically. It is crucial that swift decisions and actions need to be taken to prevent negative outcomes. The development of vaccines has emerged as a potential necessity for countries worldwide. Ethiopia began vaccinating health professionals and high-risk individuals in March 2021, according to a report from the World Health Organization citing the Ethiopian Federal Ministry of Health. This study aimed to assess the determinants of willingness to receive the COVID-19 vaccine among Debre Markos city administration residents. A community-based cross-sectional study design was employed to recruit 845 individuals as a sample. Descriptive statistics and logistic regression were used as statistical analysis techniques. Among the total 845 samples, the overall response rate was 98.34%. Two hundred forty-two participants showed their willingness to receive vaccines. Age (AOR = 2.56; 95%CI = [1.87-3.23]), sex (Female) (AOR = 3.45; 95% CI = [2.07-5.26]), having children (AOR = 1.21; 95% CI = [1.02-1.90]), and Chronic Disease (AOR = 2.98; 95% CI = [1.67-3.50]) were significantly and positively associated with willingness to receive COVID 19 vaccines at 95% CI. Although most of the participants were aware of the possibility of COVID-19 to cause fever; and its transmission, only a small percentage of the total participants showed their willingness to receive the vaccine if it was available to them. Elderly and individuals with chronic diseases need to get a priority of taking those vaccinations.

Longitudinal study of theory-based predictors of COVID-19 vaccination

Efforts to mitigate the impact of COVID-19 now focus primarily on encouraging vaccination. These efforts have been hampered, however, by vaccine hesitancy. A better understanding of the factors associated with vaccination may help identify those most likely to experience hesitancy and inform the content of public health outreach efforts. The aims of this study were to evaluate whether two theory-based factors (perceived vaccine efficacy and vaccination intention) and political party affiliation were associated with vaccination in the United States (US) and to provide descriptive analysis of factors shaping vaccination decisions. A longitudinal online survey was conducted with 108 adults in the US. Participants completed surveys in July 2020 (Time 1) and October 2021 (Time 2). As hypothesized, greater vaccination intention and perceived vaccine efficacy were significant predictors of vaccine uptake. The second hypothesis was also supported as political party affiliation was associated with vaccination (i.e. Democrats were more likely to vaccinate than Republicans). Descriptive data indicated that vaccinated participants (including those reluctant to vaccinate at Time 1) had been motivated by a desire to protect themselves and others from COVID-19. Participants who had chosen not to vaccinate were influenced by a variety of factors including concerns about vaccine safety and efficacy. Understanding the predictors of vaccination is critical to identifying those unlikely to vaccinate and creating effective interventions to encourage the uptake of this essential public health strategy. Messaging should emphasize the efficacy of COVID-19 vaccines and be delivered by those seen as trustworthy in communities prone to vaccine hesitancy.

Factors Associated With COVID-19 Vaccine Hesitancy in Rheumatology Outpatients in New York City

OBJECTIVE

The aim of this study was to measure COVID-19 vaccine hesitancy among rheumatology outpatients from an early COVID-19 "hotspot" during the initial period of vaccine availability.

METHODS

In March 2021, a Web-based survey was sent to 7505 adults seen at a Rheumatology Division in New York City. We evaluated characteristics associated with 3 categories of COVID-19 vaccination status: declined, undecided, and willing/already received. We used multinomial logistic regression models to calculate relative risk ratios assessing predictors of vaccination status.

RESULTS

Among 2384 (32%) respondents (80% female, 87% White, 59% with systemic rheumatic disease), 2240 (94.0%) were willing/already received COVID-19 vaccination, 88 (3.7%) were undecided, and 56 (2.3%) declined. Compared with those willing/already vaccinated, those declining or undecided were younger, more likely identified as Black or Hispanic/Latinx, and had lower household income and educational attainment. Immunosuppressive medication use did not differ among groups. After multivariable adjustment, every 1-year increase in age was associated with a 0.96 lower relative risk of declining or being undecided versus willing/already vaccinated. Respondents identifying as Black versus White had a higher relative risk ratio of being undecided (4.29 [95% confidence interval, 1.96-9.36]), as did those identifying as Hispanic/Latinx versus non-Hispanic/non-Latinx (2.81 [95% confidence interval, 1.29-6.09]). Those declining vaccination were least likely to believe in general vaccine importance or the safety and efficacy of the COVID-19 vaccine.

CONCLUSIONS

Among rheumatology patients in New York City with and without systemic rheumatic disease, COVID-19 vaccine uptake was high after its initial availability. Sociodemographic but not medication-related factors were associated with vaccine hesitancy; these findings can inform future rheumatology vaccination programs.

Let Us Just Ask People What They Think: Community Perceptions and Recommendations about Coronavirus Vaccination

Introduction

Despite widespread efforts to promote coronavirus disease 2019 vaccination in the United States, a significant segment of the population is still unvaccinated or incompletely vaccinated.

Objective

The objective of this study was to understand attitudes toward the vaccine in patients presenting to an urban emergency department.

Methods

We used a qualitative analysis and semistructured interviews with a convenience sample of patients presenting to an urban emergency department from January 18, 2021, to March 14, 2021. Our final sample consisted of 32 people.

Results

We found that people trusted their own medical providers rather than popular or political figures. Critiques of the vaccination program highlighted difficulties in navigation and perceptions of inequity.

Conclusions

Equitable distribution strategies and honest messaging may facilitate acceptance of the coronavirus disease 2019 vaccine. Trustworthy sources for vaccine knowledge should be used to target populations in which vaccine hesitancy is a persistent concern.

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

BACKGROUND

Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada.

METHODS

Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations.

RESULTS

The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information.

DISCUSSION

We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

Extracting factors associated with vaccination from Twitter data and mapping to behavioral models

Social media platform, particularly Twitter, is a rich data source that allows monitoring of public opinions and attitudes toward vaccines.Established behavioral models like the 5C psychological antecedents model and the Health Belief Model (HBM) provide a well-structured framework for analyzing shifts in vaccine-related behavior. This study examines if the extracted data from Twitter contains valuable insights regarding public attitudes toward vaccines and can be mapped to two behavioral models. This study focuses on the Arab population, and a search was carried out on Twitter using: ' تلقيحي OR تطعيم OR تطعيمات OR لقاح OR لقاحات' for two years from January 2020 to January 2022. Then, BERTopicmodeling was applied, and several topics were extracted. Finally, the topics were manually mapped to the factors of the 5C model and HBM. 1,068,466 unique users posted 3,368,258 vaccine-related tweets in Arabic. Topic modeling generated 25 topics, which were mapped to the 15 factors of the 5C model and HBM. Among the users, 32.87%were male, and 18.06% were female. A significant 55.77% of the users were from the MENA (Middle East and North Africa) region. Twitter users were more inclined to accept vaccines when they trusted vaccine safety and effectiveness, but vaccine hesitancy increased due to conspiracy theories and misinformation. The association of topics with these theoretical frameworks reveals the availability and diversity of Twitter data that can predict behavioral change toward vaccines. It allows the preparation of timely and effective interventions for vaccination programs compared to traditional methods.

Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID-19

BACKGROUND

Vaccination against COVID-19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5-17 years against COVID-19 by applying the Theory of Planned Behavior.

METHODS

Participants in this cross-sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID-19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling.

RESULTS

Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non-Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID-19 vaccine. Over one-third (37.5%) of caregivers reported disagreement or indecision about future COVID-19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID-19 information-seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID-19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms.

CONCLUSIONS

Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy.

Vaccine Hesitancy in India: Facilitators and Inhibitors

COVID-19 is yet not completely over; however, many people are hesitant to take COVID-19 vaccines despite their availability. Vaccine hesitancy is a major roadblock to attaining normalcy and controlling the spread of the COVID-19 virus. The present research used a multitheoretical framework (Health Belief Model, 3Cs framework, fatalism, and religious fatalism) to comprehend the complexity of vaccine hesitancy. Thus, the present study aimed at exploring vaccine hesitancy in India by using key components of the Health Belief Model, 3Cs framework, fatalism, religious fatalism, and some demographics as predictors. Data were collected electronically with the help of Google Forms from 639 Indian adults following snowballing and convenience sampling techniques with standardized measures (albeit some modifications to suit the context of the study). Descriptive analysis and hierarchical regression analysis were run in SPSS (V-22) to analyze the data. Results revealed that participants of the present study scored relatively high on vaccine hesitancy. Muslims as compared with Hindus and vaccination status emerged as significant predictors of vaccine hesitancy out of the demographic factors. Fear of COVID-19, vaccine convenience, and religious fatalism also significantly predicted vaccine hesitancy. Thus, a comprehensive approach is needed to strategically use these predictors to control vaccine hesitancy.

COVID-19 vaccine hesitancy in rural and metropolitan Western Australia: A mid-rollout cross-sectional analysis of why it exists and potential solutions

INTRODUCTION

Vaccine hesitancy represents a state of uncertainty before a decision about vaccination is made. It can lead to limited vaccine uptake despite adequate supply and an efficacious product. Western Australia (WA) presents a unique challenge with a population widely spread across metropolitan and rural sites and diverse opinions regarding vaccination.

OBJECTIVE

To elicit and compare the common COVID-19 vaccine concerns in rural and metropolitan WA, and to identify proposed solutions to vaccine hesitancy.

DESIGN

A voluntary online survey was distributed via social media over a 2-week period in August 2021 during Phase 2A of the National COVID-19 Vaccine Rollout Strategy. General practitioners and members of the public living in rural and metropolitan WA over the age of 18 were surveyed regarding COVID-19 vaccine concerns (blood clots; long- and short-term side effects; lack of testing; and other concerns) and suggested methods to address vaccine hesitancy. Data were analysed with a sequential mixed methods and thematic analysis approach.

FINDINGS

There were 468 general population respondents to our survey, of whom 19.0% (n = 89) lived rurally. A majority (52.6% [n = 246]) of general respondents expressed concerns about COVID-19 vaccine safety. The commonest concerns were long- and short-term side effects, blood clots and inadequate testing. There was a positive correlation between rurality and vaccine concerns; an inverse relationship between rurality and vaccine uptake; and an inverse relationship between vaccine concerns and uptake. Improved media coverage was the commonest solution suggested to address COVID-19 vaccine hesitancy.

DISCUSSION

A significant proportion of respondents had concerns about vaccine safety; concerns were more common in rural respondents. Rural communities may benefit from location-targeted media campaigns with a focus on breaking down barriers specific to these members of the population. Vaccine access is more challenging, and consistent messaging from trusted sources is of utmost importance to improve uptake.

CONCLUSION

COVID-19 vaccine hesitancy is more common in rural populations. Targeted media-based education regarding vaccine safety may improve COVID-19 vaccine uptake.

COVID-19 Vaccination Among Diverse Population Groups in the Northern Governorates of Iraq

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors. Methods: Through a cross-sectional study conducted in five governorates in April-May 2022, 4,564 individuals were surveyed. Data were collected through an adapted questionnaire designed to gather data on participants. Results: 4,564 subjects were included (59.55% were 19-45 years old; 54.51% male). 50.48% of the participants (51.49% of host communities, 48.83% of IDPs, and 45.87% of refugees) had been vaccinated with at least one dose of COVID-19 vaccine. 40.84% of participants (42.28% of host communities, 35.75% of IDPs, and 36.14% of refugees) had been vaccinated by two doses, and 1.56% (1.65% of host communities, 0.93% of IDPs, and 1.46% of refugees) were vaccinated with three doses. Conclusion: Sociodemographic factors including age, gender, education, occupation, and nationality could affect vaccination coverage. Moreover, higher acceptance rate of vaccination is associated with belief in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent complications.

Perception of beneficiaries on motivating factors and challenges of COVID-19 vaccination: An institute-based study

Background

The novel coronavirus disease 2019 (COVID-19) caused by a newly discovered SARS-CoV-2, led to COVID-19 pandemic across the world. Vaccination played an important role in reduction in morbidity and mortality concerning the current pandemic, but there was a lack of awareness and motivation to get vaccinated during the pandemic.

Objective

This study was aimed at assessing the motivating factors and finding out the challenges perceived among the beneficiaries receiving the vaccine at the COVID-19 immunization center of Bankura Sammilani Medical College and Hospital (BSMCH).

Materials and Methods

This institution-based descriptive cross-sectional study was conducted from June 2021 to October 2021 at the COVID-19 Vaccination Centre of Bankura Sammilani Medical College, West Bengal, among 158 beneficiaries. The study population was selected through a systematic random sampling method, and data were collected by interview with a predesigned, pretested structured questionnaire. To identify the predictor (s), variables that were found statistically significant in binary logistic regression analysis were considered for multiple logistic regression.

Results

Motivation for vaccination was significantly (P < 0.05) higher among participants who were educated up to the secondary level. Challenges perceived were significantly (P < 0.05) higher among participants aged less than 60 years and the participants who were coming from a distance of more than or equal to three kilometers.

Conclusion

Awareness generation program, frequent Information, education and communication (IEC) activities, etc., may alleviate these challenges and can improve vaccination coverage in the future.

Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana

Objectives

Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana.

Methods

A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18 years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system.

Results

Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus.

Conclusion

Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.

Racial and Ethnic Differences in Maternal and Child COVID-19 Vaccination Intent Among Pregnant and Postpartum Women in the USA (April-June 2020): an Application of Health Belief Model

This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49 years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.

Role of Trust, Risk Perception, and Perceived Benefit in COVID-19 Vaccination Intention of the Public

COVID-19 vaccination is an effective method for dealing with the COVID-19 pandemic. This study proposed and validated a theoretical intention model for explaining the COVID-19 vaccination intention (CVI) of the public. The theoretical intention model incorporated trust in vaccines, two types of risk perception (risk perception of COVID-19 and risk perception of COVID-19 vaccination), and perceived benefit into a theory of planned behavior (TPB). Structural equation modeling was utilized to test the theoretical intention model with data collected from 816 Chinese adults in China. The results confirmed the crucial role of trust in vaccines, risk perception, and perceived benefit in shaping the CVI of the public. In addition, TPB was found to be applicable in a research context. The theoretical intention model accounted for 78.8% of the variance in CVI. Based on the findings, several practical recommendations for improving COVID-19 vaccination rates were discussed.

Barriers and Intention to Get Vaccinated for COVID-19 and Associated Factors Among Adults in Southwest Ethiopia: A Theory of Planned Behavior Approach

Background

Different vaccines have been approved for use against coronavirus disease and distributed globally in different regions. Efforts should be made on the vaccination to control the spread and impacts of the coronavirus pandemic. However, the general population's attitudes and intention to uptake coronavirus disease 2019 (COVID-19) vaccinations were poor.

Objective

This study aimed to assess the barriers to and intention to be vaccinated against COVID-19 and the associated factors among adults in the Jimma zone, Ethiopia.

Methods

A community-based cross-sectional study with multistage sampling was conducted with 621 participants from 16 April to 17 May 2022. Multivariable logistic regression was used to identify factors associated with the outcome of interest. Statistical p-value ≤0.05 was set at p ≤ 0.05. Qualitative data were supplemented with quantitative results.

Results

The majority of the study participants (382 [61.5%]) intended to uptake the COVID-19 vaccine. In this study, travel history (Adjusted Odds Ratio (AOR) = 2.18, 95% CI 1.23-3.87), vaccination history (AOR = 2.64, 95% CI 1.69-4.12), perceptions of infection prevention for COVID-19 (AOR = 1.97, 95% CI 1.28-3.03), subjective norm (AOR = 2.27, 95% CI 1.52-3.39), and perceived behavioral control (PBC) (AOR = 2.30, 95% CI 1.55-3.41) were significantly associated with the intention to be vaccinated against COVID-19.

Conclusion

More than half of the adult participants intended to be vaccinated against COVID-19. The study participant's traveling history, vaccination history, perception of infection prevention for COVID-19, subjective norms, and Perceived Behavioral Control were significantly associated with the intention to be vaccinated.

Influences of COVID-19 vaccination policy on students' vaccine acceptance

Background

Higher education institutions (HEIs) developed and implemented a mandatory COVID-19 vaccination policy to facilitate vaccine acceptance and vaccination among universities' staff and students. However, little is known about influences of the mandatory vaccination policy on health science students at a university and they tend to result in vaccine hesitancy.

Aim

To explore the influences of the mandatory COVID-19 vaccine policy on health sciences students' vaccine acceptance at HEIs in South Africa.

Setting

The study was conducted in one of the universities in the Western Cape Province, South Africa.

Methods

An interpretive qualitative exploratory-descriptive research was conducted with 10 participants who were selected using the purposive sampling method to participate in semi-structured interviews. Data were audio-recorded, transcribed verbatim and thematically analysed.

Results

Two themes and 12 sub-themes were identified during the data analysis, namely individual and group influencing factors, as well as contextual influencing factors.

Conclusion

This study revealed that the COVID-19 vaccination mandatory policy influenced the students' quality of life, academic performance and well-being. The findings from this study indicate that there were perceived barriers related to personal and contextual influencing factors than benefits of COVID-19 vaccination.

Contribution

The understanding of and insight into the influences of the mandatory vaccination policy provided a basis for further strategies that may be developed to address COVID-19 vaccine infodemic, vaccine hesitancy and its risk effects. This can be done through collaboration with different stakeholders to educate health science students about the perceived benefits of COVID-19 vaccination.

Using the Health Belief Model to assess COVID-19 perceptions and behaviours among a group of Egyptian adults: a cross-sectional study

BACKGROUND

It is crucial to study the public's perceptions and behaviour during a pandemic as this will be the driving force for practicing recommended precautions. The current study aimed to identify perceptions of a group of Egyptian adults to COVID-19 using the Health Belief Model (HBM), to measure self-reported practice of preventive behaviours and to identify influencing factors.

METHODS

Cross sectional study was used, including Egyptian adults aged 18 + years. A structured anonymous online questionnaire was used including: a demographic section, the modified MERS- CoV Health Belief Model scale after addition of questions related to COVID-19 and questions on preventive behaviours to COVID-19.

RESULTS

Of the 532 study participants, 28.6% were males, age ranges (18 to 74 years). There was a statistically significant positive correlation between total practice score and all COVID-19 Health Belief Model constructs total scores except for perceived barriers score showing negative correlation (P value < 0.05). Linear regression analysis showed that older age, male gender and living inside Cairo were associated with lower practice score (P value < 0.01).

CONCLUSIONS

Increased perceived susceptibility, perceived benefits, cues to action and perceived self-efficacy scores were associated with higher practice score in the current study. Additionally, results revealed that social media and websites can play an important role in shaping risk perception in the community. Stressing risk perception and efficacy beliefs prevention message can drive people to practice preventive behaviors.

Using the theory of planned behavior to assess willingness and attitudes towards COVID-19 vaccination among a predominantly white U.S. college sample

Objective

Through the lens of behavioral models such as the Theory of Planned Behavior (TPB) and the Health Belief Model, the present study (1) investigated U.S. university students' willingness to receive the COVID-19 vaccine and (2) examined predictors (e.g. demographics, past vaccine experience, TPB constructs) of vaccine willingness.

Method

University students (n = 170) completed a survey assessing demographics, health behaviors, attitudes, perceived severity/susceptibility, norms, and vaccine intentions related to the COVID-19 pandemic. Data were collected from April 2020 through July 2020.

Results

Overall, 56.5% of participants indicated that they would be willing to receive the COVID-19 vaccine once it is available, 39.4% were unsure of whether they would receive the vaccine, and 4.1% indicated they would not receive the vaccine. Multinomial logistic regression indicated that greater adherence to CDC guidelines (p = .030) and greater perceived pro-vaccine norms (p < .001) predicted greater vaccine willingness.

Conclusions

Results from this study are consistent with previous literature on vaccine hesitancy, whereby normative beliefs and adherence to CDC guidelines were found to be determinants of vaccine willingness. To reduce transmission of the COVID-19 pandemic, interventions aimed at promoting positive attitudes towards vaccination should aim to incorporate these observed determinants.

COVID-19 Vaccine Hesitancy and Implications for Economic Recovery: Evidence from Nelson Mandela Bay Municipality in South Africa

The phenomenon of vaccine hesitancy is a growing threat to public health with far-reaching implications. The widening gap between the vaccinated and the proportion of vaccinated people needed for herd immunity raises two critical research questions that are of interest to practitioners, researchers, and policymakers: (1) What determines one's decision to be vaccinated? (2) What is the implication of COVID-19 vaccine hesitancy for economic recovery? In this study, we use empirical data in the context of South Africa to investigate factors affecting COVID-19 vaccine hesitancy and their implications for economic recovery. Findings reveal key socio-demographic and institutional drivers of COVID-19 vaccine hesitancy, which include age (the youth are more hesitant), inadequate information on the vaccine (those who perceive they have adequate information are vaccinated), trust issues in government institutions, conspiracy beliefs, vaccine-related factors, and perceived side effects associated with the vaccine. Additionally, an individual's decision to remain hesitant about COVID-19 vaccination has implications for businesses and the economy by limiting movement and trade, increasing unemployment, and causing a resurgence of new variants. Based on the findings, action plans such as information dissemination, convenience vaccination centers, consistent communications, and targeted campaign strategies are recommended for improving vaccine uptake and a positive economic recovery.

Determinants for COVID-19 vaccination intention in Mexico

This investigation aims to determine the predictors that have the most significant influence over COVID-19 vaccination intention for the population of 18 years or above in Mexico. This will be done through a comprehensive theoretical model comprising: the theory of planned behaviour, the health belief model, and the model of goal-directed behaviour. An exploratory, cross-sectional study with a quantitative approach was carried out. The structured questionnaire was applied to 1085 adults in the first trimester of 2021 through Google Forms in social media groups. The data analysis was carried out through partial least square structural equation modelling. Positive anticipated emotions, desire, subjective norms, attitude, and perceived behavioural control were the most significant predictors of intention. The model that combines the theoretical perspectives explains mostly the vaccination intention. The study can be a valuable theoretical perspective for understanding similar behavioural intentions related to health risks. The results are also valuable for public health decision-makers to design strategies that promote vaccination.

The disease or the vaccination: Which is more important when deciding whether to vaccinate?

RATIONALE

Vaccinations provide adequate protection against many virus-related diseases. Nonetheless, many individuals refuse voluntary vaccinations, and their refusal could contribute to the spread of diseases. Previous research on the intention to vaccinate has been limited by focusing on a single target group.

OBJECTIVE

In this study, we develop an integrated theoretical framework incorporating the dual approach with relevant theories related to both disease and vaccination. Our objective is to examine the behavioral reasons for the decision to vaccinate or not. The vaccination-related appraisals concern aspects of vaccination and the disease-related appraisals concern aspects of COVID-19. The framework is applied to the much-discussed context of COVID-19 vaccination.

METHOD

We investigate the intention to vaccinate of two target groups, unvaccinated individuals and twice-vaccinated individuals, with a partial squares structured equation model.

RESULTS

Our results show that unvaccinated individuals are driven in their intention to vaccinate by their attitude (toward vaccination); factors relating to the disease have no impact. In contrast, when deciding whether to be revaccinated, twice-vaccinated individuals balance factors relating to vaccination and factors relating to disease.

CONCLUSIONS

We conclude that the proposed integrated theoretical model is appropriate for investigating diverse target groups and deriving implications.

Examining health sciences students' intention to uptake COVID-19 vaccination using the theory of planned behavior

To examine the association between the theory of planned behavior (TPB) constructs and Health Sciences students' intentions to receive COVID-19 vaccination. A cross-sectional study was conducted in Saudi Arabia by recruiting Health Sciences students as participants. Using Structural Equation Modeling (SEM), the proposed TPB model was evaluated. The sample of 505 individuals consisted of more males (n = 275; 54.5%) than females and was relatively young (88% were between the ages of 18 and 30). The suggested TPB model explained 78.2% of the variation in intention to get COVID-19 immunization. We found that greater levels of perceived behavioral control (β = 1.58, p < .001) and attitude (β = .44, p < .001) strongly predicted increased vaccination intentions. The subjective norm construct was not a significant predictor of vaccination intentions (β = 0.06, p = .34). The findings of this study indicate that the TPB can be utilized effectively to obtain insight into the factors associated with COVID-19 adherence and help in the development of effective COVID-19 intervention strategies.

Modelling the Factors That Predict the Intention to Take COVID-19 Vaccine in Nigeria

This study developed a model that predicted factors that prompt the intention to take the COVID-19 vaccine among Nigerians. Data were collected from 385 respondents across Nigeria using snowball sampling technique with online questionnaire as instrument. Results indicated that cues to action, health motivation, subjective norms, and perceived behavioural control positively predicted the intention to take COVID-19 vaccine in Nigeria. However, perceived susceptibility, severity, and COVID-19 vaccine benefits did not predict the intention to take the COVID-19 vaccine. Further findings showed that COVID-19 vaccine barrier and attitude was negatively associated with the intention to take the COVID-19 vaccine.

Understanding factors influencing healthcare workers' intention towards the COVID-19 vaccine

Globally, healthcare workers (HCWs) are at high risk of acquiring Coronavirus infection. In addition, they are role models for the general public concerning attitudes towards the COVID-19 vaccine. In addition, they play a critical role in successfully promoting practices aiming to reduce the transmission of COVID-19 infection. Therefore, this study broadly based on the theory of planned behavior (TPB) explores the factors influencing HCWs' intention to be vaccinated. An online survey was administered using Google Form to collect data from HCWs working in the public health sector of Pakistan. The sample included 813 participants, two-thirds were female, and one-third were male. In addition, 41.5% of them were aged between 26-35 years, 32.6% had master's level education, 25% were nurses, and 57.7% of them were living in urban areas. Data analysis was run using Partial Least Squares Structural Equation Modeling (PLS-SEM). The research findings reveal the positive and significant effect of the TPB factors (attitude, subjective norms, and perceived behavioral control) and the extended factor of vaccine confidence on HCWs' intention to be vaccinated. This study's model explains 66.4% of variations in HCWs' intention to be vaccinated.

Credibility of vaccine-related content on Twitter during COVID-19 pandemic

During national COVID-19 vaccine campaigns, people continuously engaged on Twitter to receive updates on the latest public health information, and to discuss and share their experiences. During this time, the spread of misinformation was widespread, which threatened the uptake of vaccines. It is therefore critical to understand the reasons behind vaccine misinformation and strategies to mitigate it. The current research aimed to understand the content of misleading tweets and the characteristics of their corresponding accounts. We performed a machine learning approach to identify misinformation in vaccine-related tweets, and calculated the demographic, engagement metrics and bot-like activities of corresponding accounts. We found critical periods where high amounts of misinformation coincided with important vaccine announcements, such as emergency approvals of vaccines. Moreover, we found Asian countries had a lower percentage of misinformation shared compared to Europe and North America. Our results showed accounts spreading misinformation had an overall 10% greater likelihood of bot activity and 15% more astroturf bot activity than accounts spreading accurate information. Furthermore, we found that accounts spreading misinformation had five times fewer followers and three times fewer verified badges than fact-sharing accounts. The findings of this study may help authorities to develop strategies to fight COVID-19 vaccine misinformation and improve vaccine uptake.

Perceptions of the impact of COVID-19 in Tennessee, USA: a retrospective study

Background

Despite high incidence and mortality risks associated with COVID-19 during the pandemic, stay-at-home orders and vaccination recommendations were met with varying levels of acceptance in Tennessee. Understanding perceptions of individuals regarding the health and economic impacts of COVID-19 is necessary to address public concerns while ensuring appropriate public health response. Therefore, the objectives of this study were to (a) investigate differences in opinions among residents of Tennessee regarding the impacts of COVID-19; and (b) identify socioeconomic and demographic predictors/determinants of these opinions.

Methods

This retrospective cross-sectional study was conducted using survey data collected in nine waves during 2020. Distributions of survey-weighted sociodemographic characteristics and respondent perceptions of the impact of COVID-19 were computed. Weighted logistic models were used to investigate predictors of a number of perceptions: whether the health or economic impact was greater, concern for respondent's health, concern for family's health, and willingness to accept COVID-19 vaccine.

Results

The study included a total of 9,754 survey respondents. Approximately equal percentages considered COVID-19 to have a greater economic (48.4%) versus health impact (51.6%). Just 40.1% of the respondents reported that they would definitely accept a COVID-19 vaccine. Age group, race, educational attainment, and household composition were significant (p < 0.05) predictors of all investigated perceptions regarding COVID-19. Lack of prior infection was the strongest predictor of the perception of COVID-19 having a greater impact on health (OR = 2.40, p < 0.001), concern for respondent's health (OR = 1.86, p = 0.002), and concern for family members' health (OR = 1.90, p = 0.001). Compared to males, females had higher odds of identifying the health impact of COVID-19 as greater (OR = 1.09, p = 0.041) and reporting concern for family health (OR = 1.14, p = 0.003). However, they had lower odds (OR = 0.63, p < 0.001) of willingness to accept vaccine than males.

Conclusion

These findings improve our understanding of the drivers of health behaviors, including vaccine hesitancy, and are useful for guiding public health outreach/education programs.

Does personal experience with COVID-19 impact investment decisions? Evidence from a survey of US retail investors

This paper explores the link between personal experience with COVID-19 and US retail investors' financial decision-making during the first COVID-19 wave. Do retail investors that have personally experienced COVID-19 change their investments after the pandemic outbreak, and if so, why? We use a cross-sectional dataset from an online survey of US retail investors collected in July and August 2020 to assess if and how respondents change their investment decisions after the COVID-19 outbreak. On average retail investors increase their investments during the first wave of COVID-19 by 4.7%, while many of them decrease their investments suggesting a high heterogeneity of investor behaviours. We provide the first evidence that personal experience with the virus can have unexpected positive effects on retail investments. Investors who have personal experience with COVID-19, who are in a vulnerable health category, who tested positive, and who know someone in their close circle of friends or family who died because of COVID-19, increase their investments by 12%. We explain our findings through terror management theory, salience theory and optimism bias, suggesting that reminders of mortality, focussing on selective salient investment information, and over-optimism despite personal vulnerable health contribute to the increase in retail investments. Increased levels of savings, saving goals and risk capacity are also positively associated with increased investments. Our findings are relevant to investors, regulators, and financial advisors, and highlight the importance of providing retail investors with access to investment opportunities in periods of unprecedented shocks such as COVID-19.

Exploration into the Influencing Factors for the Intention of the Public to Vaccinate against Infectious Diseases Based on the Theory of Planned Behavior-Example of the COVID-19 Vaccine

OBJECTIVES

The coronavirus disease 2019 (COVID-19) was applied as an example, and the Theory of Planned Behavior (TPB) was used as a conceptual model. This study aimed to explore the impact of subjective norms (SNs), attitude towards the behavior (ATT), and perceived behavioral control (PBC) on the intention of the public for regular vaccination during COVID-19. The outcomes can provide certain recommendations for relevant policymakers in developing targeted health education intervention programs in the event of similar events.

METHODS

An online survey was performed between 17 April and 14 May 2021, via the online survey platform "WENJUANXING". The multistage stratified cluster sampling was employed, and 2098 participants (1114 males; 53.10%) with a mean age of 31.22 years (SD = 8.29) completed the survey. The survey covered the factors influencing the public's intention to receive future regular vaccinations during COVID-19 based on TPB. The effects of different variables on the public's vaccination intention were analyzed using hierarchical stepwise regression.

RESULTS

The public's intention to receive the COVID-19 vaccine (i.e., behavioral intention) in the future was taken as the dependent variable. Gender, age, marital status, education level, per capita monthly household income, vaccine-related knowledge, whether the COVID-19 vaccine was received, subjective norms (SNs), attitude towards the behavior (ATT), and perceived behavioral control (PBC) were used as independent variables. In this way, a hierarchical stepwise multiple regression model was developed. It can be seen from the final model that gender, age, vaccine-related knowledge, vaccination, attitude, SNs, and PBC were all influential factors in the public's intention to get vaccinated in the future, with R² = 0.399 and adjusted R² = 0.397 (p < 0.001).

CONCLUSION

TPB explains the intention of the public to receive future vaccinations to a large extent, and ATT and SNs are the most important influencing factors. It is suggested that vaccine intervention programs be developed to enhance public awareness and acceptance of vaccination. This can be achieved in three aspects, namely, improving the ATT of the public, SNs, and PBC. Furthermore, the influence of gender, age, vaccine knowledge, and previous vaccination behavior on vaccination intention should be taken into account.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

How does the vaccine approval procedure affect COVID-19 vaccination intentions?

People's willingness to vaccinate is critical to combating the COVID-19 pandemic. We devise a representative experiment to study how the design of the vaccine approval procedure affects trust in newly developed vaccines and consequently public attitudes towards vaccination. Compared to an Emergency Use Authorization, choosing the more thorough Conditional Marketing Authorization approval procedure increases vaccination intentions by 13 percentage points. The effects of the increased duration of the approval procedure are positive and significant only for Emergency Use Authorization. Treatment effects do not differ between relevant subgroups, such as respondents who had (did not have) COVID-19, or between vaccinated and unvaccinated respondents. Increased trust in the vaccine is the key mediator of treatment effects on vaccination intentions.