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Camargo ELS, de Sousa ÁFL, dos Reis AS, Fortunato MDR, Gouveia IDS, Mendes IAC, Ventura CAA. Determining factors for COVID-19 vaccine hesitancy among Brazilians: a study using structural equation modeling. Rev Bras Enferm 2024; 77Suppl 2:e20240112. [PMID: 39230099 PMCID: PMC11370770 DOI: 10.1590/0034-7167-2024-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES to investigate the factors influencing vaccine hesitancy against COVID-19 among Brazilians. METHODS this research employed an observational and analytical approach, utilizing a web-based survey. Data collection took place in 2020, and data analysis was conducted using structural equation modeling. RESULTS the prevalence of vaccine hesitancy was found to be 27.5% (1182 individuals). There is a negative correlation between belief in conspiracy theories and social influence. Among the various beliefs associated with vaccination intentions, only conspiracy beliefs exhibited significant predictive value. Thus, the findings suggest that personal beliefs significantly impact hesitancy towards vaccination, and also indicate that trust in governmental bodies is inversely related to hesitancy. CONCLUSIONS vaccine hesitancy emerges as a multifaceted phenomenon influenced by a complex array of factors, including personal beliefs, trust in governmental bodies, and healthcare systems.
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Affiliation(s)
| | - Álvaro Francisco Lopes de Sousa
- Instituto Sírio-Libanês de Ensino e Pesquisa. São Paulo, São Paulo, Brazil
- University Lisbon, Public Health Research Center, Comprehensive Health Research Center. Cidade Universitária, Alameda da Universidade Lisbon, Potugal
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2
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Neriya-Ben Shahar R, Yuval F, Tur-Sinai A. "I Would Consult a Doctor, But What the Rabbi Says Goes": Ultra-Orthodox Jews' Relationships with Rabbis and Doctors in Israel. JOURNAL OF RELIGION AND HEALTH 2024; 63:1905-1933. [PMID: 38424387 PMCID: PMC11061032 DOI: 10.1007/s10943-024-02014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
We examine relationships among ultra-Orthodox Israeli Jews, their doctors, and rabbis when medical decisions are made. Analyzing excerpts from sixteen focus groups with 128 ultra-Orthodox Jews, we determine how their belief system affects their decisions about whom to trust and follow when the doctor's instructions contradict the rabbi's advice. We argue that the strict behaviors described here with regard to relations among doctors, rabbis, and patients, function as social capital that raises the status of ultra-Orthodox Jews as members of an exclusive club that balances health decisions with the social demand to obey their religious leaders.
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Affiliation(s)
| | - Fany Yuval
- Department of Public Policy and Management, Chairwoman, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Tur-Sinai
- School of Public Health, University of Haifa, Haifa, Israel.
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel.
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3
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Peleg O, Hadar E, Boniel-Nissim M. A novel questionnaire for evaluating digital tool use (DTUQ-D) among individuals with type 2 diabetes: exploring the digital landscape. Front Public Health 2024; 12:1374848. [PMID: 38645461 PMCID: PMC11026855 DOI: 10.3389/fpubh.2024.1374848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Effective healthcare currently incorporates a patient-centric system and accessible technology for patient self-management. This study aimed to develop and validate a novel questionnaire titled the Digital Tool Use Questionnaire for Diabetes (DTUQ-D) - a screening tool identifying the type, number, and frequency of digital tools used by Type 2 Diabetes Mellitus (T2DM) patients with within HMOs, online, and via applications. Methods The questionnaire was administered to two ethnic groups and both genders. A mixed-methods approach was used. In the qualitative phase, the questionnaire was developed through phone surveys of 29 T2DM patients, two endocrinologists and two technology experts. In the quantitative phase, involving 367 participants, convergent validity, construct validity, and reliability were examined. Results Findings indicated that the DTUQ-D is valid and reliable, successfully identifying digital tools utilized by T2DM patients, notwithstanding variations in factor structures between ethnic groups. This questionnaire provides a foundation for future research, offering a standardized approach to evaluating digital tool usage. Discussion The study enhances understanding of the role of digital tools in healthcare, especially for T2DM self-management. It also can be easily adapted to assess digital tool use for other illnesses by adjusting instructions and the wording of certain items.
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Affiliation(s)
- Ora Peleg
- Max Stern Academic College of Emek Yezreel, Emek Yezreel, Israel
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4
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Dopelt K, Abudin A, Yukther S, Shmukler T, Davidovitch N. The Association between Levels of Trust in the Healthcare System and Influenza Vaccine Hesitancy among College Students in Israel. Vaccines (Basel) 2023; 11:1728. [PMID: 38006060 PMCID: PMC10674655 DOI: 10.3390/vaccines11111728] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Influenza is a contagious respiratory disease caused by the influenza virus. Vaccination proves an effective approach to preventing influenza and minimizing the risk of experiencing associated complications. However, the influenza vaccine coverage rate among Israeli college students is low due to a sense of complacency, lack of knowledge, and vaccine hesitancy. The current study examined the relationship between the level of trust in the healthcare system and influenza vaccine hesitancy among college students in Israel. This cross-sectional study was conducted via an online questionnaire in April-May 2023. In total, 610 students were surveyed, of whom 57% had been vaccinated against influenza in the past; however, only 12% were vaccinated this year. Negative, significant, and moderate relationships were found between the level of trust in the healthcare system and influenza vaccine hesitancy. Students who had been vaccinated in the past had a higher level of trust in the healthcare system and a lower level of vaccination hesitancy. The linear regression model revealed that the variables of being a woman, not Jewish, vaccinated, and trusting the Ministry of Health, family doctor, and health professionals were associated with a decrease in vaccine hesitancy. These findings are in line with previous research in the field. Based on the present results, it may be advisable to develop intervention programs aimed at increasing confidence in the healthcare system and vaccinations by providing knowledge and addressing students' concerns regarding vaccination.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel, (S.Y.)
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Anuar Abudin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel, (S.Y.)
| | - Sophie Yukther
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel, (S.Y.)
| | - Tatyana Shmukler
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel, (S.Y.)
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel;
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5
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Wortsman J, Glaser Chodik N, Chodick G. Correlations of HPV vaccine uptake among eight-grade students in Israel: the importance of ethnicity and level of religious observance. Women Health 2023:1-9. [PMID: 37315958 DOI: 10.1080/03630242.2023.2223721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
In Israel, human papilloma virus (HPV) vaccines are included in the national childhood immunization program for eight-grade students, but uptake remains relatively low. This article explores which demographic factors are correlated with HPV vaccination rates. HPV vaccination data for the school year 2017-2018 was assessed among members of Maccabi Healthcare Services, the second largest health service provider in Israel. By matching eighth grade students to their family members' demographic data via an electronic medical records (EMR) system, we assessed vaccination rates by taking into account sex, socioeconomic status (SES), ethnic categorization, and maternal characteristics. In a total of 45,160 eligible students, 55.3 percent of girls and 48.5 percent of boys were vaccinated for HPV. In a multivariable model, students in Arab communities had a significantly (p < .001) higher odds ratio (2.02; 95 percent CI:1.55-2.64) of being vaccinated, while ultra-orthodox (UO) Jewish students were much less likely to be vaccinated compared to all other students (OR = 0.05; 95 percent CI:0.05-0.06). Ethnicity and level of religious practice are major determinants of HPV vaccine uptake in Israel. This should be taken into account when planning intervention programs in order to improve the uptake of the vaccine.
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Affiliation(s)
- Joshua Wortsman
- Maccabi Healthcare Services, Maccabitech Institute for Research and Innovation, Tel Aviv, Israel
| | | | - Gabriel Chodick
- Maccabi Healthcare Services, Maccabitech Institute for Research and Innovation, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Freiman O. Vaccine Hesitancy and the Concept of Trust: An Analysis Based on the Israeli COVID-19 Vaccination Campaign. MINERVA 2023; 61:1-25. [PMID: 37359300 PMCID: PMC10256572 DOI: 10.1007/s11024-023-09498-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
This paper examines the trust relations involved in Israel's COVID-19 vaccination campaign, focusing on vaccine hesitancy and the concept of 'trust'. The first section offers a conceptual analysis of 'trust'. Instead of analyzing trust in the vaccination campaign as a whole, a few objects of trust are identified and examined. In section two, the Israeli vaccination campaign is presented, and the focus is placed on vaccine hesitancy. In section three, different trust relations are examined: public trust in the Israeli government and health institutions, interpersonal trust in healthcare professionals and experts, trust in the pharmaceutical companies that make the COVID-19 vaccine, the US FDA, and trust in the new vaccine and the new technology. Through this complexity of trust relations, I argue that it is impossible to completely separate the trust that the vaccine is safe and effective from social aspects of mistrust. Additionally, practices of silencing and censoring the concerns of vaccine hesitaters - both experts and among the public, are pointed out. I contend that these cases further minimize vaccine hesitaters' trust in vaccine-related entities. In contrast, in section four, I suggest the 'trust-based approach': since vaccine hesitancy is not solely the result of knowledge deficiency but also a lack of trust relations, any campaign that addresses vaccine hesitancy should also focus on trust. The advantages of this approach are spelled out. For governments, a discussion based on trust is, ultimately, the best democratic way to encourage hesitaters to take the plunge and get vaccinated.
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Affiliation(s)
- Ori Freiman
- Digital Society Lab, McMaster University, Hamilton, ON Canada
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Atanga Adongo C, Anamaale Tuoyire D, Azuug M, Baffour Appiah A, Taale F, Amadu I. DECOLONISING VACCINE PRODUCTION: UNPACKING GHANAIANS’ SUPPORT FOR MADE-IN-AFRICA VACCINES. Vaccine X 2023; 14:100283. [PMID: 37008957 PMCID: PMC10064421 DOI: 10.1016/j.jvacx.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Localisation of vaccine production is essential worldwide, but it is particularly crucial for Africa. This continent is more vulnerable to disease burdens and also lags behind other continents regarding access to vaccines. Moreover, many people in Africa have a long-standing apathy towards locally made products and services. This mindset raises the question of whether Africans will support African-made vaccines and what the associated reasons are. Guided by the theories of nationalism and import substitution industrialisation, we formulated and tested eight hypotheses. To answer these, we analysed survey data from 6,731 residents backed by key informant interviews in Ghana. Our findings identified three types of local vaccine consumers: Afrocentric-ethnocentrics, Apathetic-Afrocentrics and Afrocentric-Fence Sitters. Four out of the eight hypothesised factors explain why some individuals have a positive attitude towards locally made vaccines, compared to those who are unsure of their stance. The proposed typology of local vaccine consumers and their defining characteristics can help design public health campaigns to mobilize support for locally produced vaccines.
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8
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Cohen C, Rinot Levavi L. A Game-Theory-Based Approach to Promoting Health Policy among Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4335. [PMID: 36901344 PMCID: PMC10001858 DOI: 10.3390/ijerph20054335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The importance of designing policy measures that government and other public bodies apply to different populations has been escalating in recent decades. This study seeks the best way to induce conservative minority groups to cooperate with healthcare policy. The case study focuses on the Bedouin population of Israel and its willingness to accept COVID-19 vaccination. The study is based on vaccination data from the Israel Ministry of Health for the country's entire Bedouin population, twenty-four semi-structured in-depth interviews with relevant key stakeholders, and the use of game-theory tools to profile the players, the utility functions, and various equilibrium combinations. By comparing the groups and integrating game-theory tools into the process, we reveal variables that may affect healthcare processes among conservative minority communities. Finally, cross-tabulating the results with the interview findings strengthens the insights and allows a culturally adjusted policy to be adopted. The different starting points of different minority populations have implications for the design of requisite policies in both the short and the long terms. The analysis of the game allowed us to indicate the strategy that policymakers should adopt in consideration of variables that should be taken into account in order to improve cooperation and the ability to apply policy. To increase vaccination rates among conservative minority communities in general and the Bedouin population in particular, trust in the government must be increased in the long term. In the short term, trust in the medical profession must be increased, and also health literacy.
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9
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Fadda M, Bezani K, Amati R, Fiordelli M, Crivelli L, Albanese E, Suggs LS, Caiata-Zufferey M. Decision-making on COVID-19 vaccination: A qualitative study among health care and social workers caring for vulnerable individuals. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100181. [PMID: 36267682 PMCID: PMC9561372 DOI: 10.1016/j.ssmqr.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023]
Abstract
In January 2021, the Swiss government introduced the first COVID-19 vaccines and prioritized allocation to at-risk individuals and professionals working with them. Despite this opportunity, vaccine uptake among staff employed in retirement homes and institutes for people with disabilities was suboptimal. This study aimed to capture real-time decision-making about COVID-19 vaccine among staff employed in nursing homes and institutes for people with disabilities in Southern Switzerland. We conducted semi-structured phone-interviews with 25 staff employed in retirement homes and institutes for people with disabilities between February and May 2021, i.e., when participants had to decide whether they wanted to adhere to the priority vaccination programme. Among participants, 21 either signed up for the COVID-19 vaccination or were fully or partly vaccinated at the time of the interview. For most participants, the vaccination choice was a challenging process: information appeared to be lacking and conflicting; numerous moral principles were at stake and contradictory; the way vaccination was organized clashed with the health values to which respondents had been previously exposed; finally, the fear of discrimination for those who decided not to get vaccinated loomed over the vaccination choice. Participants decided for or against vaccination based on principles, traditions, emotions, and a reflexive assessment of the personal vs. collective benefit of the vaccination, the latter being the most common within the investigated sample. This study shows that deciding to get vaccinated against COVID-19 is a nuanced process and that individuals cannot simply be categorized as "novax" or "provax" based on their vaccination decision.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland,Corresponding author
| | - Kleona Bezani
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Maddalena Fiordelli
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928, Manno, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - L. Suzanne Suggs
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928, Manno, Switzerland
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10
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Boas H, Davidovitch N. Into the "New Normal": The Ethical and Analytical Challenge Facing Public Health Post-COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8385. [PMID: 35886236 PMCID: PMC9316285 DOI: 10.3390/ijerph19148385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
Even though various countries' overall policy for dealing with the pandemic was not particularly innovative, the pandemic was perceived as a unique crisis. "COVID exceptionalism" has seemed to create "a new normal" that we all need to "learn to live with". The main change in perspective, while not new for public health experts, is that health exists within a social and political context. While public health ethics has turned out to be an important discipline, there is a long way to its wider acceptance. Entering the "new normal" calls for a wider embrace of public health approaches to ethics. The renewed emphasis on understanding health as a social concept encompasses central normative implications in relation to dealing with COVID-19 and in relation to dealing with other global crises, chiefly climate change. We argue that entering the era of "the new normal" in healthcare requires a nuanced understanding of the relationship between the individual and society and demands the formulation of a new system of bioethics focused on the concept of solidarity as a central value in public health. Such a concept should refer to the fact that in the "new normal", risks require new social and political formations of standing together in confronting risks that cross national, cultural, and identity borders. Forming and expanding solidarity in health and healthcare, we argue, is the main normative challenge for public health today.
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Affiliation(s)
- Hagai Boas
- Department of Politics and Government, Ben-Gurion University of the Negev and Van Leer Jerusalem Institute, Jerusalem 9214116, Israel
| | - Nadav Davidovitch
- Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
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11
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Boas H, Davidovitch N. Into the “New Normal”: The Ethical and Analytical Challenge Facing Public Health Post-COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8385. [DOI: ; https:/doi.org/10.3390/ijerph19148385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Even though various countries’ overall policy for dealing with the pandemic was not particularly innovative, the pandemic was perceived as a unique crisis. “COVID exceptionalism” has seemed to create “a new normal” that we all need to “learn to live with”. The main change in perspective, while not new for public health experts, is that health exists within a social and political context. While public health ethics has turned out to be an important discipline, there is a long way to its wider acceptance. Entering the “new normal” calls for a wider embrace of public health approaches to ethics. The renewed emphasis on understanding health as a social concept encompasses central normative implications in relation to dealing with COVID-19 and in relation to dealing with other global crises, chiefly climate change. We argue that entering the era of “the new normal” in healthcare requires a nuanced understanding of the relationship between the individual and society and demands the formulation of a new system of bioethics focused on the concept of solidarity as a central value in public health. Such a concept should refer to the fact that in the “new normal”, risks require new social and political formations of standing together in confronting risks that cross national, cultural, and identity borders. Forming and expanding solidarity in health and healthcare, we argue, is the main normative challenge for public health today.
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12
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Abed Elhadi Shahbari N, Gesser-Edelsburg A, Davidovitch N, Brammli-Greenberg S, Mesch GS. Risk perceptions regarding inclusion of seasonal influenza vaccinations in the school immunization program in Israel: Arab vs. Jewish mothers. PLoS One 2022; 17:e0267279. [PMID: 35436312 PMCID: PMC9015128 DOI: 10.1371/journal.pone.0267279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background The issue of whether to include seasonal influenza vaccinations in school-located vaccination programs (SLIV) has been examined in many countries, mainly in the context of economic effectiveness and morbidity prevention. Yet not enough studies have examined the impact of parental risk perceptions, health literacy and SLIV on parental vaccination uptake. Objectives The most recent statistics in Israel point to a higher rate of seasonal influenza vaccination among Arab children (aged 7–9 years) than among Jewish children in the same age group. The present study attempts to explain this high vaccination uptake among mothers from Arab society by comparing their risk perceptions regarding seasonal influenza vaccination and disease to those of Jewish mothers. The study further examines the impact of SLIV on parental risk perceptions and influenza vaccination uptake. Methods This cross-sectional study included mothers of children in the second and third grades faced with the decision of whether their children should receive the seasonal influenza vaccination at school. The study population included a stratified sample of Jewish mothers (n = 159) and Arab mothers from all the Arab population sub-groups: Muslim, Christian, Druse and Bedouin (n = 534). Results A comparison of the Arab and Jewish populations revealed a significant difference in vaccination rates; 61.7% among Arab mothers compared to 33.5% among Jewish mothers (χ2(1) = 39.15, P<0.0001). Moreover, significant differences emerged between the Arab and Jewish populations in health literacy and ability to seek information regarding the seasonal influenza vaccination (t (691) = -5.81, p < 0.0001). While no differences emerged in mothers’ perceptions regarding influenza as a disease (t (691) = 1.20, p = 0.2318), Arab mothers perceived the vaccination to be safer than Jewish mothers (t (691) = 2.74, p = 0.0063) and saw its inclusion in the school-located vaccination program as providing more legitimacy (Z = -6.6719, P < .0001). Conclusion This study showed that the factors influencing vaccination uptake among both the Arab and the Jewish populations include perceived influenza risk, perceived vaccination risk, inclusion in the school-located vaccination program and health literacy. Moreover, influenza vaccination uptake is higher among those who have positive attitudes toward vaccinations, low risk perceptions regarding the vaccine, and low health literacy that impedes their ability to seek information. The research also points to the need for education and tools to boost health literacy among minority groups so that mothers can make independent and informed decisions about whether or not to vaccinate their children.
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Affiliation(s)
| | - Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Lab, University of Haifa, Haifa, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of The Negev, Beer Sheva, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gustavo S. Mesch
- Department of Sociology and Anthropology, University of Haifa, Haifa, Israel
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Ben-David BM, Keisari S, Palgi Y. Vaccine and Psychological Booster: Factors Associated With Older Adults’ Compliance to the Booster COVID-19 Vaccine in Israel. J Appl Gerontol 2022; 41:1636-1640. [PMID: 35379029 PMCID: PMC8984597 DOI: 10.1177/07334648221081982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Israel became the first country to offer the booster COVID-19 vaccination. The study tested for the first time the role of sense of control (SOC) due to vaccinations, trust and vaccination hesitancy (VH), and their association with compliance to the booster COVID-19 vaccine among older adults, during the first 2 weeks of the campaign. 400 Israeli citizens (≥ 6 years old), eligible for the booster vaccine, responded online. They completed demographics, self-reports, and booster vaccination status (already vaccinated, booked-a-slot, vaccination intent, and vaccination opposers). Multinomial logistic regression was conducted with pseudo R 2 = .498. Higher SOC and lower VH were related to the difference between early and delayed vaccination (booked-a-slot, OR = 0.7 [0.49‐0.99]; 2.2 [1.32‐3.62], intent OR = 0.6 [0.42‐0.98]; 2.7 [1.52‐4.86]), as well as to rejection ( OR = 0.3 [0.11‐0.89]; 8.5 [3.39‐21.16]). Increased trust was only related to the difference between early vaccinations and vaccine rejection ( OR = 0.3 [0.11‐0.89]). We suggest that SOC, as well as low VH, can be used as positive motivators, encouraging earlier vaccinations in older age.
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Affiliation(s)
- Boaz M. Ben-David
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada
| | - Shoshi Keisari
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Haifa, Israel
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14
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Shahbari NAE, Gesser-Edelsburg A, Davidovitch N, Brammli-Greenberg S, Grifat R, Mesch GS. Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel. Int J Equity Health 2021; 20:201. [PMID: 34493294 PMCID: PMC8423338 DOI: 10.1186/s12939-021-01523-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Parents in the Arab population of Israel are known to be “pro-vaccination” and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza. Objectives This study seeks to identify and compare variables associated with mothers’ uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel. Methods A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13–14 years old) who had younger siblings in second (7–8 years old) or third (8–9 years old) grades. Results Arab mothers exhibited a higher rate of uptake for both vaccinations (p < .0001, HPV – 90%; influenza – 62%) than Jewish mothers (p = 0.0014, HPV – 46%; influenza – 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers’ vaccination uptake revealed differences between the ethnic subgroups. Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers’ intake of both vaccinations: school-located vaccination and mothers’ perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups. Conclusions This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01523-1.
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Affiliation(s)
- Nour Abed Elhadi Shahbari
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.
| | - Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.,School of Public Health, Founding Director of the Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, 84105, Beer Sheva, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, P.O. Box 12272, 9112102, Jerusalem, Israel
| | - Rami Grifat
- Ziv Medical Center, 1 Derech HaRambam, 13100, Safed, Israel
| | - Gustavo S Mesch
- Department of Sociology, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel
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Fernández-Basanta S, Lagoa-Millarengo M, Movilla-Fernández MJ. Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147584. [PMID: 34300041 PMCID: PMC8306550 DOI: 10.3390/ijerph18147584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included.
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Affiliation(s)
- Sara Fernández-Basanta
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain;
- Correspondence: ; Tel.: +34-981-337400-3544
| | - Manuel Lagoa-Millarengo
- Galician Health Service (SERGAS), University Hospital Complex of Ferrol, Av. da Residencia, S/N, 15405 Ferrol, Spain;
| | - María-Jesús Movilla-Fernández
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain;
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Saechang O, Yu J, Li Y. Public Trust and Policy Compliance during the COVID-19 Pandemic: The Role of Professional Trust. Healthcare (Basel) 2021; 9:151. [PMID: 33540762 PMCID: PMC7913086 DOI: 10.3390/healthcare9020151] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/23/2022] Open
Abstract
Previous research has shown that public trust is vital for promoting policy compliance, particularly in times of crisis. However, the literature supporting this notion remains scarce, especially in countries which have successfully contained a pandemic despite showing a generally low level of public trust in the government. To address this topic, we conducted a cross-sectional study between February and March of 2020 to examine the relationship between public trust and the compliance of the general public in adopting personal protective measures introduced during the early phase of the coronavirus disease 2019 (COVID-19) outbreak in Thailand. We report our result from a hierarchical regression. We find a positive and significant relationship between public trust in the government and the likelihood of respondents adopting these precautions, more importantly, this relationship was fully mediated by the professional trust as the effect of public trust in the government on policy compliance was reduced by 0.118, namely from (β = 0.133, p < 0.001) to (β = 0.015, p > 0.05). Married respondents residing in the capital city, with a higher degree of worry were also more likely to comply with these safety measures. In conclusion, the finding sheds light on the dynamic relationship between public trust and policy compliance and offers some implications in times of a global health crisis.
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Affiliation(s)
- Orachorn Saechang
- School of Public Affairs, Zhejiang University, 866 Yuhangtang Rd., Hangzhou 310058, China; (O.S.); (J.Y.)
| | - Jianxing Yu
- School of Public Affairs, Zhejiang University, 866 Yuhangtang Rd., Hangzhou 310058, China; (O.S.); (J.Y.)
- Zhejiang Gongshang University, No. 18, Xuezheng Str, Hangzhou 310018, China
| | - Yong Li
- School of Marxism, Shanghai Maritime University, 1550 Haigang Avenue, Pudong New Area, Shanghai 201306, China
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Trust in the Israeli Healthcare System Among Arabs, Jewish Immigrants, and Non-immigrants. Int J Behav Med 2020; 27:647-659. [DOI: 10.1007/s12529-020-09902-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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