COVID-19 vaccination acceptance among older adults: A qualitative study in New South Wales, Australia

The experience of traumatic events, psychological distress, and social support: links to COVID-19 vaccine hesitancy and trends with age in a group of older Australians

BACKGROUND

Vaccination is important to reduce disease-associated morbidity and mortality in an ageing global population. While older adults are more likely than younger adults to accept vaccines, some remain hesitant. We sought to understand how traumatic events, psychological distress and social support contribute to older adults' intention to receive a COVID-19 vaccine and whether these experiences change with age.

METHODS

We analysed survey data collected as part of the Sax Institute's 45 and Up Study in a population of Australian adults aged 60 years and over. Data were derived from the COVID Insights study; a series of supplementary surveys about how participants experienced the COVID-19 pandemic.

RESULTS

Higher intention to receive a COVID-19 vaccine was associated with greater social support (adjusted odds ratio (aOR):1.08; 95%CI:1.06-1.11; p <.001) while lower intention was associated with personally experiencing a serious illness, injury or assault in the last 12 months (aOR:0.79; 95% CI:0.64-0.98; p =.03). Social support and the experience of traumatic events increased significantly with age, while psychological distress decreased.

CONCLUSIONS

There may be factors beyond disease-associated risks that play a role in vaccine acceptance with age. Older Australians on the younger end of the age spectrum may have specific needs to address their hesitancy that may be overlooked.

Prevalence and determinants of COVID-19 vaccine acceptance among vulnerable populations in Thailand: An application of the health belief model

Background

Assessing the acceptance of vaccinations among vulnerable populations is essential to ensure proper coronavirus disease 2019 (COVID-19) control. This study used the Health Belief Model to examine the intention to vaccinate against COVID-19 among vulnerable populations in Thailand.

Methods

This analytical cross-sectional study was conducted in Thailand between October and November 2021. Using multistage random sampling, 945 individuals from vulnerable populations (i.e., older adults, pregnant women, market or street vendors, and individuals with chronic diseases) were selected and invited to complete a self-reported questionnaire. The questionnaire assessed participants' socioeconomic characteristics, COVID-19 preventive measures, knowledge, preventative health beliefs, and vaccine intention. A generalized linear mixed model was used to identify factors associated with the intention to receive the vaccine.

Results

The prevalence of intent to accept the COVID-19 vaccine was 75.03% (95% confidence interval [CI]: 72.16-77.68). The Health Belief Model factors associated with vaccine acceptance were cue to action (adjusted odds ratio [AOR] = 3.13; 95% CI: 2.07-4.71), perceived benefits (AOR = 2.04; 95% CI: 1.38-3.01), and perceived severity (AOR = 1.77; 95% CI: 1.18-2.65). Significant other covariates were wearing a face mask in the previous month (AOR = 2.62; 95% CI: 1.59-4.31), being 1-2 m away from other people (AOR = 1.58; 95% CI: 1.11-2.24), trust in government (AOR = 1.44; 95% CI: 1.03-2.02). Additionally, women were more likely to accept the COVID-19 vaccine compared to men (AOR = 1.43; 95% CI: 1.02-2.01).

Conclusions

Approximately one quarter of vulnerable individuals do not intend to be vaccinated. Health Belief Models can explain vaccine acceptance, and aid the Ministry of Public Health in planning future efforts to increase vaccine uptake. Healthcare professionals' advice, village health volunteers' information, and partnership collaborations are critical. Facilitating mobile community units, launching educational campaigns, maintaining a distance of 1-2 m from others, and wearing masks may increase COVID-19 vaccine acceptability. This research can help prepare for future pandemics.

"Provided a window on the world and lessened my feeling of isolation": older adults' perceived COVID-19 impact and technology use in Australia during recurrent lockdowns

BACKGROUND

An informed understanding of older adults' perceptions of the impact (positive or negative) of recurrent COVID-19 long lockdowns is important for the development of targeted interventions and resources for future restrictions. This study aimed to understand self-reported impacts of COVID-19 recurrent restrictions on older adults and how technology has been used to mitigate these.

METHODS

A cross-sectional national study of 257 community-dwelling older Australians based in Victoria (mean age = 67.6 years [SD = 7.2]; 20.6% male) completed an online or postal survey as part of a larger study examining the physical and mental health impacts of a second extended COVID-19 lockdown period. This secondary analysis reports on the findings from free-text responses to two open-ended questions included in that survey that asked participants to comment on the greatest impacts of the COVID-19 lockdowns (positive or negative) and the role of technology in supporting their wellbeing during this time. Responses were collected between July and September 2020. Data were analysed using content (COVID-19 impacts) and thematic (role of technology) analysis.

RESULTS

Respondents gave more negative responses (75.5%) than mixed (15.2%) and positive responses (6.2%) in reporting on the biggest impact of COVID-19 lockdowns. Inductive content analysis revealed two first-order main categories (Positive impacts and Negative impacts). Axial coding of main categories showed five second-order categories (Environmental, Physical Health, Social, Mental Health, and Personal) for both negative and positive main categories (totalling 10 second-order categories). Overall, respondents highlighted social loss as the key negative experience (70%), with acute feelings of social isolation contributing to negative impacts on mental wellbeing. The most commonly reported positive impact reported (11%) was having more time for relationships, relaxation, and new hobbies. Technology was primarily used to sustain socialisation and provide access to essential resources, services, and goods, which respondents perceived to contribute to maintaining their wellbeing.

CONCLUSIONS

Findings suggest a critical need for interventions that address the social loss experienced by older adults during COVID-19 recurrent lockdowns, particularly to alleviate the associated negative impact on mental wellbeing. Recognising the positive aspect of increased time for relationships and leisure activities indicates potential areas for resilience-building strategies. The pivotal role of technology in mitigating adverse effects highlights its significance in building social connections and supporting overall wellbeing during challenging times. These implications can guide future efforts to enhance older adults' resilience, mental health, and holistic wellbeing in future public health crises.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

Mass vaccination against COVID-19 is the best method to ensure herd immunity in order to curb the effect of the pandemic on the global economy. It is therefore important to assess the determinants of COVID-19 vaccine acceptance and hesitancy on a global scale. Factors were recorded from cross-sectional studies analyzed with t-Test, ANOVA, correlation, and meta-regression analyses and synthesized to identify global trends in order to inform policy. We registered the protocol (ID: CRD42022350418) and used standard Cochrane methods and PRISMA guidelines to collect and synthesize cross-sectional articles published between January 2020 and August 2023. A total of 67 articles with 576 studies from 185 countries involving 3081,766 participants were included in this synthesis. Global COVID-19 vaccine acceptance was 65.27% (95% CI; 62.72-67.84%), while global vaccine hesitancy stood at 32.1% (95% CI; 29.05-35.17%). One-Way ANOVA showed that there was no significant difference in the percentage Gross Domestic Product spent on vaccine procurement across the World Bank income levels (p < 0.187). There was a significant difference of vaccine acceptance (p < 0.001) and vaccine hesitancy (p < 0.005) across the different World Bank Income levels. World Bank income level had a strong influence on COVID-19 vaccine acceptance (p < 0.0004) and hesitancy (p < 0.003) but percentage Gross Domestic Product spent on vaccine procurement did not. There was no correlation between percentage Gross Domestic Product spent on vaccine procurement and COVID-19 vaccine acceptance (r = -0.11, p < 0.164) or vaccine hesitancy (r = -0.09, p < 0.234). Meta-regression analysis showed that living in an urban setting (OR = 4.83, 95% CI; 0.67-212.8), rural setting (OR = 2.53, 95% CI; 0.29-119.33), older (OR = 1.98, 95% CI; 0.99-4.07), higher education (OR = 1.76, 95% CI; 0.85-3.81), and being a low income earner (OR = 2.85, 95% CI; 0.45-30.63) increased the odds of high COVID-19 vaccine acceptance. Factors that increased the odds of high COVID-19 vaccine hesitancy were no influenza vaccine (OR = 33.06, 95% CI; 5.03-1395.01), mistrust for vaccines (OR = 3.91, 95% CI; 1.92-8.24), complacency (OR = 2.86, 95% CI; 1.02-8.83), pregnancy (OR = 2.3, 95% CI; 0.12-141.76), taking traditional herbs (OR = 2.15, 95% CI; 0.52-10.42), being female (OR = 1.53, 95% CI; 0.78-3.01), and safety concerns (OR = 1.29, 95% CI; 0.67-2.51). We proposed a number of recommendations to increase vaccine acceptance and ensure global herd immunity against COVID-19.

Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine

BACKGROUND

Many travellers do not receive vaccines pre-travel. Tools such as vaccine decision aids could support informed vaccine decision-making. We aimed to characterise Australians' pre-travel vaccine attitudes, behaviours and information needs and examine the role for decision aids in travel medicine.

METHODS

Online cross-sectional survey of Australian adults in December 2022. We included questions on demographics, pre-travel health-seeking behaviour, and information needs. We measured vaccine confidence (Vaccine Confidence Index Index) and used hypothetical disease scenarios to evaluate behavioural and social drivers of vaccination. We used multivariable logistic regression models to identify predictors of vaccine uptake and thematically analysed free-text responses.

RESULTS

We received complete survey responses from 1223/1326 Australians (92% response rate). Amongst those reporting previous overseas travel, 67% (778/1161) reported past pre-travel health encounter(s) and 64% (743/1161) reported past pre-travel vaccination. Half (50%) strongly agreed that vaccines were important for their health; fewer strongly agreed that vaccines were safe (37%) and effective (38%). In multivariable analyses, past pre-travel vaccine uptake was associated with increasing age (OR = 1.17 [95% CI 1.08-1.27] p < 0.001 per ten-year increase) and travel to higher-risk destinations (OR = 2.92 [2.17-3.93] p < 0.001); travellers visiting friends and relatives (VFRs) were less likely to have received pre-travel vaccines (OR = 0.74 [0.56-0.97] p = 0.028). Predictors for wanting vaccination against hypothetical diseases included past pre-travel vaccination (Disease X: OR 2.60 [1.91-3.56] p < 0.001) and confidence in vaccine safety (Disease X: OR 7.18 [5.07-10.18], p < 0.001); past VFR travel was predictive of not wanting vaccination (Disease X: OR 0.72 [0.52-1.00], p = 0.049). Most (63%) were interested in using a vaccine decision aid, generally together with a trusted health professional.

CONCLUSIONS

Health professionals play an important role in supporting pre-travel vaccine decision-making. However, our findings indicate that reliable, accurate and engaging digital resources, such as decision aids, could support travellers to make informed pre-travel vaccine decisions.

Testing persuasive messages about booster doses of COVID-19 vaccines on intention to vaccinate in Australian adults: A randomised controlled trial

INTRODUCTION

Achieving high COVID-19 vaccine booster coverage is an ongoing global challenge. Health authorities need evidence about effective communication interventions to improve acceptance and uptake. This study aimed to test effects of persuasive messages about COVID-19 vaccine booster doses on intention to vaccinate amongst eligible adults in Australia.

METHODS

In this online randomised controlled trial, adult participants received one of four intervention messages or a control message. The control message provided information about booster dose eligibility. Intervention messages added to the control message, each using a different persuasive strategy, including: emphasising personal health benefits of booster doses, community health benefits, non-health benefits, and personal agency in choosing vaccination. After the intervention, participants answered items about COVID-19 booster vaccine intention and beliefs. Intervention groups were compared to the control using tests of two proportions; differences of ≥5 percentage points were deemed clinically significant. A sub-group analysis was conducted among hesitant participants.

RESULTS

Of the 487 consenting and randomised participants, 442 (90.8%) completed the experiment and were included in the analysis. Participants viewing messages emphasising non-health benefits had the highest intention compared to those who viewed the control message (percentage point diff: 9.0, 95% CI -0.8, 18.8, p = 0.071). Intention was even higher among hesitant individuals in this intervention group compared to the control group (percentage point diff: 15.6, 95% CI -6.0, 37.3, p = 0.150). Conversely, intention was lower among hesitant individuals who viewed messages emphasising personal agency compared to the control group (percentage point diff: -10.8, 95% CI -33.0, 11.4, p = 0.330), although evidence in support of these findings is weak.

CONCLUSION

Health authorities should highlight non-health benefits to encourage COVID-19 vaccine booster uptake but use messages emphasising personal agency with caution. These findings can inform communication message development and strategies to improve COVID-19 vaccine booster uptake. Clinical trial registration: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001404718); trial webpage: https://www.anzctr.org.au/ACTRN12622001404718.aspx.

STUDY OF POPULATION ADHERENCE TO COVID-19 VACCINATION

OBJECTIVE

The aim: To study population adherence to COVID-19 vaccination and to identify factors influencing people's decision to vaccinate, and to develop of possible ways to increase the rate of COVID-19 vaccination.

PATIENTS AND METHODS

Materials and methods: Individuals of different social groups were surveyed about adherence to COVID-19 vaccination.

RESULTS

Results: Results of the study are the determination of the factors influencing the decision on vaccination. The most important were the opinion that the vaccine is not safe; fear of developing a side effect after vaccination and opinions about the low effectiveness of the vaccine. However, the almost 53% of unvaccinated persons doubted their decision or even expressed a desire to be vaccinated in the future. A possible way to increase the population's adherence to vaccination will be to increase awareness of the effectiveness and safety of vaccination.

CONCLUSION

Conclusions: The results revealed the factors that influenced the positive and negative decision about COVID-19 vaccination, which made it possible to propose ways to increase the population's adherence to vaccination.