Testing an integrative theory of health behavioural change for predicting seasonal influenza vaccination uptake among healthcare workers

Analyzing Changes in Attitudes and Behaviors towards Seasonal Influenza Vaccination in Spain's Adult Population over Three Seasons

Background/Objectives: The experience of the COVID-19 pandemic has turned the spotlight on the importance of public health measures and disease prevention. Despite this, the acceptance of influenza vaccination has remained low in most countries (and far from the 75% target set by the World Health Organization). The objective of this study has been to investigate how attitudes and behaviors regarding influenza vaccination in the Spanish adult population have changed over the last three years (from 2021 to 2024) in order to analyze trends in influenza vaccination. Methods: To this end, a cross-sectional study was conducted through 2206 telephone interviews, and the results were compared with those obtained in previous campaigns. Results: The findings indicate a significant decline in overall vaccination intent. Healthcare professionals remain the most influential factor in encouraging vaccination, yet there is a notable increase in the lack of vaccine recommendations, contributing to the decision not to vaccinate. This study also reveals low awareness of the influenza vaccine campaign, emphasizing the need for improved public health communication. Conclusions: To counteract these trends, this study recommends intensifying awareness campaigns, strengthening the role of healthcare providers in vaccine advocacy, and tailoring communication strategies. These efforts are crucial to enhancing vaccination coverage and protecting vulnerable populations against influenza.

Are vaccination uptake and non-uptake influenced by our emotions? An experimental study on the role of emotional processes and compassion

OBJECTIVE

This study examined the effects of emotional arousal, emotional competence, emotion regulation (ER), and compassion on COVID-19 and flu vaccination intentions (VI) among the French population.

DESIGN

Data were collected online from October to December 2020. Altogether, 451 participants (Mage = 35.8, SD = 16.4) were allocated to four groups. High positive (n = 104) or negative (n = 103) emotional arousal were induced into two groups using pictures and music, and compared against a control group (flu group; n = 116) and a reference group (COVID-19 group; n = 114). All groups completed questionnaires on emotional arousal, ER, emotional competence, compassion, and VI.

RESULTS

The findings indicated a significant effect of group on VI, h2=.023, 95% CI [-.002, .09]. The Group*Gender interaction on emotional arousal was non-significant, η p 2 =.015, 95%CI [.000, .041]. However, emotional arousal was observed to have a significant main effect on VI, η p 2 =.09, 95% CI [.043, .238]. The ER type*Emotional arousal*Gender interaction on ER use was trend, η p 2 = .002, 95% CI [.000, .005]. The emotional competence*ER type interaction on ER use was significant, η p 2 = .028, 95% CI [.011, .049]. Only experiential avoidance mediated the relationship between emotional arousal and VI, p < .018, 95% CI [.015, .18].

CONCLUSION

Emotional arousal impacts VI. High emotional competence only reduces the use of dysfunctional ER strategies.

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States: The contribution of vaccine-related attitudes

OBJECTIVE

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States have been documented. This study assessed the contribution of vaccine-related attitudes to coverage disparities.

METHODS

Surveys were conducted following the 2019-2020 and 2020-2021 influenza seasons in a US research network. Using electronic health record data to identify pregnant women, random samples were selected for surveying; non-Hispanic Black women and influenza-unvaccinated women were oversampled. Regression-based decomposition analyses were used to assess the contribution of vaccine-related attitudes to racial and ethnic differences in influenza vaccination. Data were combined across survey years, and analyses were weighted and accounted for survey design.

RESULTS

Survey response rate was 41.2% (721 of 1748) for 2019-2020 and 39.3% (706 of 1798) for 2020-2021. Self-reported influenza vaccination was higher among non-Hispanic White respondents (79.4% coverage, 95% CI 73.1%-85.7%) than Hispanic (66.2% coverage, 95% CI 52.5%-79.9%) and non-Hispanic Black (55.8% coverage, 95% CI 50.2%-61.4%) respondents. For all racial and ethnic groups, a high proportion (generally >80%) reported being seen for care, recommended for influenza vaccination, and offered vaccination. In decomposition analyses, vaccine-related attitudes (e.g., worry about vaccination causing influenza; concern about vaccine safety and effectiveness) explained a statistically significant portion of the observed racial and ethnic disparities in vaccination. Maternal age, education, and health status were not significant contributors after controlling for vaccine-related attitudes.

CONCLUSIONS

In a setting with relatively high influenza vaccination coverage among pregnant women, racial and ethnic disparities in coverage were identified. Vaccine-related attitudes were associated with the disparities observed.

Factors influencing staff attitudes to COVID-19 vaccination in care homes in England: a qualitative study

BACKGROUND

The COVID-19 pandemic disproportionately affected people living and working in UK care homes causing high mortality rates. Vaccinating staff members and residents is considered the most effective intervention to reduce infection and its transmission rates. However, uptake of the first dose of the COVID-19 vaccine in care homes was variable. We sought to investigate factors influencing uptake of COVID-19 vaccination in care home staff to inform strategies to increase vaccination uptake and inform future preparedness.

METHODS

Twenty care home staff including managerial and administrative staff, nurses, healthcare practitioners and support staff from nine care homes across England participated in semi-structured telephone interviews (March-June 2021) exploring attitudes towards the COVID-19 vaccine and factors influencing uptake. We used thematic analysis to generate themes which were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. The Behavioural Change Wheel (BCW) was used to identify potential intervention strategies to address identified influences.

RESULTS

Enablers to vaccine uptake included the willingness to protect care home residents, staff and family/friends from infection and the belief that vaccination provided a way back to normality (reflective motivation); convenience of vaccination and access to accurate information (physical opportunity); and a supporting social environment around them favouring vaccination (social opportunity). Barriers included fears about side-effects (automatic motivation); a lack of trust due to the quick release of the vaccine (reflective motivation); and feeling pressurised to accept vaccination if mandatory (automatic motivation).

CONCLUSIONS

We identified influences on COVID-19 vaccine uptake by care home staff that can inform the implementation of future vaccination programmes. Strategies likely to support uptake include information campaigns and facilitating communication between staff and managers to openly discuss concerns regarding possible vaccination side effects. Freedom of choice played an important role in the decision to be vaccinated suggesting that the decision to mandate vaccination may have unintended behavioural consequences.

Strategies to Increase Willingness to Receive a COVID-19 Vaccine among Nursing Home Staff

BACKGROUND

Nursing home (NH) staff and residents have been prioritized to receive COVID-19 vaccinations. However, NH staff have been hesitant. This study explored what strategies were used to overcome this hesitancy and which of these were found to be important by NH staff to increase their willingness to take a COVID-19 vaccine.

METHODS

This study employed a sequential exploratory qualitative design. The COVID-19 MINUTES study aimed to describe the challenges presented by, responses to, and impact of the COVID-19 pandemic in NHs. The minutes of COVID-19 outbreak teams (COTs) in Dutch long-term care organizations (n = 41) were collected and coded using content analysis. Textual units from December 2020 to April 2021 that regarded strategies to increase staff's vaccination willingness (n = 67) were selected. Subsequently, to validate these data, two panels of NH healthcare workers (HCWs) and policy workers (PWs) (n = 8) selected, discussed, and ranked the strategies that they found to be important using a modified nominal group technique.

RESULTS

The strategies described in the minutes included financial reimbursements, personal contact, story sharing, logistics support, role models, visual information, and written information. Except for financial reimbursement, all these strategies were considered important or very important by the panel participants. Some organizations combined multiple strategies.

CONCLUSION

The strategies that were found important in combination may be used more broadly and should be developed further with the involvement of HCWs.

Examining Vaccine Sentiment on Twitter and Local Vaccine Deployment during the COVID-19 Pandemic

Understanding local public attitudes toward receiving vaccines is vital to successful vaccine campaigns. Social media platforms may help uncover vaccine sentiments during infectious disease outbreaks at the local level, and whether offline local events support vaccine-promotion efforts. Communication Infrastructure Theory (CIT) served as a guiding framework for this case study of the San Diego region examining local public sentiment toward vaccines expressed on Twitter during the COVID-19 pandemic. We performed a sentiment analysis (including positivity and subjectivity) of 187,349 tweets gathered from May 2020 to March 2021, and examined how sentiment corresponded with local vaccine deployment. The months of November and December (52.9%) 2020 saw a majority of tweets expressing positive sentiment and coincided with announcements of offline local events signaling San Diego's imminent deployment of COVID-19 vaccines. Across all months, tweets remained mostly objective (never falling below 63%). In terms of CIT, considering multiple levels of the Story Telling Network in online spaces, and examining sentiment about vaccines on Twitter may help scholars to explore the Communication Action Context, as well as cultivate positive community attitudes to improve the Field of Health Action regarding vaccines. Real-time analysis of local tweets during development and deployment of new vaccines may help monitor local public responses and guide promotion of immunizations in communities.

Reducing COVID vaccine hesitancy by inducing a comparative mindset

OBJECTIVE

To investigate if a behavioral nudge comprising a vaccination opportunity that employs a comparative probe first (i.e., which vaccine to take) versus the more commonly-used deliberative probe (i.e., willingness to take a vaccine), reduces vaccine hesitancy, while controlling for political partisanship.

METHODS

In a randomized study, conducted on Amazon Mechanical Turk and Prolific, we varied the manner in which the vaccination offer is posed. In one group, participants were asked to compare which vaccine they would like to take (i.e., the comparative probe), while, in another group, participants were asked to deliberate whether they would like to take the vaccine (i.e., the deliberative probe). Participants' political preferences were also measured. The primary outcome variable was vaccine hesitancy.

RESULTS

A LOGIT regression (N = 1736), was conducted to test the research questions. Overall, the comparative probe yielded a 6% reduction in vaccine hesitancy relative to the typical deliberative probe. Additionally, while vaccine hesitancy varies due to individual political views, the comparative probe is effective at reducing vaccine hesitancy even among the most vaccine hesitant population (i.e., Pro-Trump Republicans) by almost 10% on average.

CONCLUSIONS

Subtly changing the manner in which the vaccination offer is framed, by asking people to compare which vaccine to take, and not deliberate about whether they would like to take a vaccine, can reduce vaccine hesitancy, without being psychologically taxing or curtailing individuals' freedom to choose. The nudge is especially effective among highly vaccine hesitant populations such as Pro-Trump Republicans. Our results suggest a costless communication protocol in face-to-face interactions on doorsteps, in clinics, in Pro-Trump regions and in the mass media, that might protect 5 million Americans from COVID-19.

A comparison of seasonal influenza and novel Covid-19 vaccine intentions: A cross-sectional survey of vaccine hesitant adults in England during the 2020 pandemic

We compared intention to receive the seasonal influenza vaccine with a prospective coronavirus (COVID-19) vaccine among undecided or COVID-19 vaccine hesitant individuals to better understand the underlying differences and similarities in factors associated with vaccine intention. We delivered a cross-sectional online survey in October-November 2020. We included psychological constructs and sociodemographic variables informed by theory. We conducted pairwise comparisons and multiple linear regression models to explore associations between vaccine intention and psychological constructs. We recruited 1,660 participants, where 47.6% responded that they would likely receive the influenza vaccine, 31.0% that they would probably not accept the vaccination and 21.4% were unsure. In relation to the prospective COVID-19 vaccine, 39.0% responded that they would likely receive the vaccination, 23.7% that they would probably not accept the vaccination and 37.3% were unsure. Unique factors positively associated with COVID-19 vaccine intention were: perceived knowledge sufficiency about vaccine safety, beliefs about vaccine safety, and living in an area of low deprivation. The only unique factor positively associated with influenza intention was past influenza behavior. The strongest common predictors positively associated with intention were: favorable vaccine attitudes, the anticipated regret they may feel following infection if they were not to receive a vaccine, and the expectation from family or friends to accept the vaccine. Despite overall similarities in those factors associated with vaccination intention, we identified unique influences on intention. This additional insight will help support the planning and tailoring of future immunizations programmes for the respective viruses.

Facilitators and barriers to COVID-19 vaccination among healthcare workers and the general population in Guinea

Introduction

The advent of the effective COVID-19 vaccine was the most eagerly expected worldwide. However, this hope quickly became hesitation and denial in many countries, including Guinea. Understanding the reasons for low vaccine coverage is essential to achieving herd immunity leading to disease control. This study aimed to comprehend the facilitators and barriers to the acceptance COVID-19 vaccine in Guinea.

Methods

The survey focused on healthcare workers (HCWs) and the general population (GP) in 4 natural regions in Guinea from 23 March 2021 to 25 August 2021. We used the Fishbein integration model to study the behaviours of HWCs and GP regarding vaccination. A mixed cross-sectional study collected knowledge, attitudes, norms, and perceptions. Regression and thematic content analysis identified the main facilitators and barriers to vaccination.

Results

We surveyed 3547 HCWs and 3663 GP. The proportion of people vaccinated was 65% among HCWs and 31% among the GP. For HCWs: the main factors associated with vaccination against COVID-19 were as follows: absence of pregnancy AOR = 4.65 [3.23–6.78], being supportive of vaccination AOR = 1.94 [1.66–2.27] and being an adult AOR = 1.64 [1.26–2.16]. Regarding the GP, the following factors increased the odds of vaccination: absence of pregnancy AOR = 1.93 [CI 1.01–3.91], being favourable for vaccination AOR = 3.48 [CI 2.91–4.17], being an adult AOR = 1.72 [CI 1.38–2.14] and being able to get the vaccine AOR = 4.67 [CI 3.76–5.84]. Semi-interviews revealed fear, lack of trust, and hesitant perception of the government as potential barriers to vaccination.

Conclusion

This study suggests that beliefs and negative perceptions are potential barriers to vaccination against COVID-19 among HCWs and the GP. Policies should emphasise practical strategies to mitigate these barriers among young people and pregnant women. Lastly, there is a need to improve access to vaccines in the GP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07742-3.

The Effects of Drowsiness Detection Technology and Education on Nurses' Beliefs and Attitudes Towards Drowsy Driving

Background: Drowsy driving is prevalent among night-shift nurses, yet there is a gap in understanding nurses' beliefs and attitudes that may affect their intention to avoid drowsy driving.Objectives: The objectives of the study were twofold: 1) investigate how behavioral constructs such as beliefs and attitudes may affect nurses' intention to avoid drowsy driving; and 2) assess changes in such beliefs and attitudes during a study that evaluated the effectiveness of educational and technological interventions.Methods: Three-hundred night-shift nurses were recruited from a large hospital in Texas to participate in a randomized control trial. Participants were randomly assigned to three groups: 1) control; 2) educational intervention; and 3) combined educational and technological intervention. The study utilized an integrated model drawing from the constructs of the Theory of Planned Behavior and the Health Belief Model to elicit attitudes, beliefs, and intentions to use in-vehicle drowsiness detection technologies. Each group was surveyed pre- intervention and at post-intervention around 3 months later to assess changes in beliefs and attitudes. Structural equation models and path analysis were used to analyze changes in beliefs.Results: Seventy-nine participants completed the pre-intervention questionnaire, and 44 nurses completed the pre- and post-intervention surveys. Intention was predicted primarily by attitude and perceived health threat. Perceived health threat also mediated the relationship between behavioral intention and the influence of subjective norms as well as perceived behavioral control. Participants who received education about drowsy driving had positive changes in beliefs.Conclusions: Nurses' perceived health threat from driving drowsy and their attitude towards our intervention were important motivators to avoid drowsy driving. Interventions aiming at raising awareness of the risks associated with drowsy driving may be effective at motivating nurses to avoid drowsy driving.

Factors associated with behavioral intention of free and self-paid severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccination based on the social cognitive theory among nurses and doctors in China

OBJECTIVE

To examine the associations between factors based on the social cognitive theory (SCT) and behavioral intention among doctors and nurses in China toward free and self-paid (600 RMB or US$91) severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccination given 80% effectiveness and rare mild side effects.

DESIGN

Cross-sectional study.

SETTING

Public hospitals.

PARTICIPANTS

The study included 362 doctors and 1,702 nurses in major departments of 5 hospitals of 3 Chinese provinces.

METHODS

An anonymous online survey was conducted from October to November 2020, facilitated by hospital administrators through online WeChat/QQ working groups. Data on outcome expectations, self-efficacy, norms, and COVID-19-related work experiences were collected. Multivariate logistic regression models were used for data analyses.

RESULTS

The logistic regression analysis showed that physical (eg, protective effect of vaccination) and self-evaluative outcome expectations (eg, anticipated regret), self-efficacy, norms (eg, descriptive norm, subjective norm, professional norm, and moral norm), and job satisfaction were significantly and positively associated with the free and self-paid SARS-CoV-2 vaccination intention outcomes among doctors and nurses, adjusted for background variables. Doctors who had engaged in COVID-19-related work reported higher self-paid vaccination intention.

CONCLUSIONS

Health promotion is needed to improve the uptake of SARS-CoV-2 vaccination among healthcare workers. Such interventions may consider modifying the identified factors of vaccination intention, including strengthening perceived efficacy, positive feelings about vaccination, the need to avoid future regret, self-efficacy, and social norms. Future studies should examine the actual behavior patterns of SARS-CoV-2 vaccination, and the efficacy of promotion intervention should be tested in randomized controlled studies.

COVID-19 Vaccination Behavior Among Frontline Healthcare Workers in Pakistan: The Theory of Planned Behavior, Perceived Susceptibility, and Anticipated Regret

Healthcare workers in Pakistan are still fighting at the frontline to control the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and have been identified as the earliest beneficiaries for COVID-19 vaccination by the health authorities of the country. Besides, the high vaccination rates of frontline healthcare workers (FHWs) are essential to overcome the ongoing pandemic and reduce the vaccines hesitancy among the general population. The current research employed the theory of planned behavior (TPB) to investigate the COVID-19 vaccination behavior among FHWs in Pakistan as well as the predictors of such behavior. Following the epidemic control and prevention policies, a sample of 680 FHWs were accessed to fill in the questionnaire evaluating the components of the TPB. Moreover, the potential role of anticipated regret (AR) and perceived susceptibility (PS) on COVID-19 vaccination behavior was also assessed. The partial least square structural equation modeling (PLS-SEM) results revealed that the TPB components, as well as the AR, have positive associations with the COVID-19 vaccination behavior. The results further confirmed that PS positively affects the anticipated regret, attitude (ATT), and subjective norm (SN) to vaccinate against SARS-CoV-2. The perceived susceptibility also has a positive association with COVID-19 vaccination behavior through the mediation of anticipated regret, ATT, and SN. Our findings highlighted the importance of COVID-19 vaccination among healthcare workers, which can be applied to reduce vaccine hesitancy among the general public.

‘Exploring the Influence of Social Media Influencers on Intention to Attend Cervical Screening in the UK: Utilising the Theory of Planned Behaviour’

Objectives

Cervical cancer is 99.8% preventable when detected early; however, uptake of screening in the United Kingdom is at a 20-year low. Recently, a number of social media influencers have video logged about their experiences of cervical screening through narrative communication with their audience. Here we aimed to explore if accessing cervical screening information from a social media influencer can impact the theory of planned behaviour variables and predict intention to attend cervical screening appointments.

Design

Utilising a cross-sectional design a volunteer sample of 102 UK women (mean age = 28; SD = 3.10; range = 25–35) took part in an online questionnaire study.

Results

Hierarchical regression modelling revealed attitude as a significant predictor of intention to attend a cervical screening appointment and that social media influencers affect attitudes of their audience, indirectly influencing intention to attend.

Conclusion

Health messages communicated by social media influencers are effective in promoting positive attitudes but not directly influence intention to attend towards cervical screening. Further research should explore influencer impact on attitudes towards this health behaviour with the ultimate aim of increasing attendance and consequently saving lives.

Predicting COVID-19 booster vaccine intentions

Achieving broad immunity through vaccination is a cornerstone strategy for long‐term management of COVID‐19 infections, particularly the prevention of serious cases and hospitalizations. Evidence that vaccine‐induced immunity wanes over time points to the need for COVID‐19 booster vaccines, and maximum compliance is required to maintain population‐level immunity. Little is known of the correlates of intentions to receive booster vaccines among previously vaccinated individuals. The present study applied an integrated model to examine effects of beliefs from multiple social cognition theories alongside sets of generalized, stable beliefs on individuals' booster vaccine intentions. US residents (N = 479) recruited from an online survey panel completed measures of social cognition constructs (attitude, subjective norms, perceived behavioral control, and risk perceptions), generalized beliefs (vaccine hesitancy, political orientation, and free will beliefs), and COVID‐19 vaccine intentions. Social cognition constructs were related to booster vaccine intentions, with attitude and subjective norms exhibiting the largest effects. Effects of vaccine hesitancy, political orientation, and free will beliefs on intentions were mediated by the social cognition constructs, and only vaccine hesitancy had a small residual effect on intentions. Findings provide preliminary evidence that contributes to an evidence base of potential targets for intervention messages aimed at promoting booster vaccine intentions.

Preliminary evidence that brief exposure to vaccination-related internet memes may influence intentions to vaccinate against COVID-19

Despite global efforts to rapidly distribute COVID-19 vaccines, early estimates suggested that 29–35% of the population were hesitant/unwilling to receive them. Countering such vaccine hesitancy is thus an important priority. Across two sets of online studies (total n = 1584) conducted in the UK before (August–October 2020) and immediately after the first effective vaccine was publicly announced (November 10–19, 2020), brief exposure (<1 min) to vaccination memes boosted the potentially life-saving intention to vaccinate against COVID-19. These intention-boosting effects, however, weakened once a COVID-19 vaccine became a reality (i.e., after the announcement of a safe/effective vaccine), suggesting meme-based persuasion may be context-dependent. These findings thus represent preliminary evidence that naturally circulating memes may—under certain circumstances—influence public intentions to vaccinate, although more research regarding this context-specificity, as well as the potential psychological mechanisms through which memes act, is needed.

Factors associated with vaccine intention in adults living in England who either did not want or had not yet decided to be vaccinated against COVID-19

Early studies showed that 28-36% of UK adults were unsure or unwilling to be vaccinated against COVID-19. We wanted to identify which socio-demographic, socio-economic, personal health and psychological factors were associated with COVID-19 vaccine intentions (CVI) in adults living in England who did not want, yet to consider, or not sure whether to vaccinate. In October/November 2020, prior to vaccine availability, we surveyed adults stratified by gender, region, and deprivation, with additional purposive sampling of those aged 50 and over and those from an ethnic minority. Two hundred and ten did not want; 407 had yet to consider; and 1,043 were not sure whether to be vaccinated. Factors positively associated with CVI were: favorable vaccine views, trust in institutions associated with vaccine approval, vaccine subjective norms, anticipated regret of not having a vaccine, perceived vaccine benefits, perceived safety knowledge sufficiency, and a history of having an influenza vaccine. Factors negatively associated were: anti-lockdown views, and being a health or social care worker. Whilst showing significant relationships with CVI when analyzed in isolation, neighborhood deprivation and ethnicity did show an independent relationship to intention when all study measures were controlled for. Our findings suggest vaccine promotion focusing on the anticipated regret of not having a vaccine, the benefits of a mass COVID-19 immunization program, and the safety of a vaccine whilst ensuring or engendering trust in those bodies that brand a campaign may be most supportive of COVID-19 vaccine uptake.

Exploring the predictors of health-protective behavior during the COVID-19 pandemic: A multi-country comparison

In recent years, examining the determinants of health behaviors on a multi-country level remains limited. Therefore, the purpose of this study is to explore the key factors that may enhance the adoption of health-protective behaviors during the COVID-19 pandemic in Morocco and India. A theoretical framework derived from the health belief model (HBM) was used for this research. Data was collected from a sample of 444 adult individuals split across Morocco (n = 215) and India (n = 229). Data analysis was carried out using two-stage multiple-analytic techniques. First, structural equation modeling (SEM) was employed to test the hypothesized relationships. Second, an artificial neural network (ANN) model was employed to rank the significant independent variables obtained from SEM analysis. The results of SEM showed that perceived benefit is the key predictor of the protective behavior in Morocco, followed by self-efficacy, and then perceived severity. By contrast, ANN analysis showed that perceived severity was the most vital factor for predicting the protective behavior in Morocco, followed by perceived benefits, and then self-efficacy. For the Indian sample, both SEM analysis and the ANN model revealed that the impact of perceived susceptibility on the adoption of the protective measure is stronger than that of cues to action. Theoretical contributions and managerial implications are also discussed toward the end.

Integrating Health Behavior Theories to Predict COVID-19 Vaccine Acceptance: Differences between Medical Students and Nursing Students

BACKGROUND

This study aimed to explore behavioral-related factors predicting the intention of getting a COVID-19 vaccine among medical and nursing students using an integrative model combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB).

METHODS

A cross-sectional online survey was conducted among medical and nursing students aged > 18 years in their clinical years in Israel between 27 August and 28 September 2020. Hierarchical logistic regression was used to predict acceptance of a COVID-19 vaccine.

RESULTS

A total number of 628 participants completed the survey. Medical students expressed higher intentions of getting vaccinated against COVID-19 than nursing students (88.1% vs. 76.2%, p < 0.01). The integrated model based on HBM and TPB was able to explain 66% of the variance (adjusted R2 = 0.66). Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived susceptibility, benefits, barriers, cues to action, attitude, self-efficacy and anticipated regret. Two interaction effects revealed that male nurses had a higher intention of getting vaccinated than did female nurses and that susceptibility is a predictor of the intention of getting vaccinated only among nurses.

CONCLUSIONS

This study demonstrates that both models considered (i.e., HBM and TPB) are important for predicting the intention of getting a COVID-19 vaccine among medical and nursing students, and can help better guide intervention programs, based on components from both models. Our findings also highlight the importance of paying attention to a targeted group of female nurses, who expressed low vaccine acceptance.

Evaluation of Flu Vaccination Coverage among Healthcare Workers during a 3 Years' Study Period and Attitude towards Influenza and Potential COVID-19 Vaccination in the Context of the Pandemic

(1) Background: vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs, ensure patient's safety and to maintain essential health care services during influenza epidemics. With the present study we aimed to evaluate the efficacy of incremental bundles of measures implemented during the last three flu campaigns and to assess the attitudes towards influenza vaccination and a potential vaccine against COVID-19 among HCWs, in a large university hospital in Pisa, Italy. (2) Methods: We described measures implemented during 2018/2019, 2019/2020 and 2020/2021 and assessed their impact on flu vaccine coverage (VC) among employees and residents in Pisa university hospital. We considered sex, profession and ward to investigate differences in uptake. In addition, in 2020 a survey was developed and distributed to all employees to evaluate flu and COVID-19 vaccines attitudes. (3) Results: during the 2018/19 and 2019/20 flu campaigns the overall VC rate among HCWs was, respectively, 10.2% and 11.9%. In 2020/21 the overall VC rate jumped to 39.3% (+ 230.6%). Results from the survey indicated a more positive attitude towards flu vaccine as compared to COVID-19 vaccines among the 10.6% of the staff members who responded to the survey. In addition, 70.97% of HCWs totally agreed that being vaccinated against influenza would be more important than the previous years because of COVID-19 emergency. (4) Conclusions: a significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years. The COVID-19 pandemic positively influenced flu vaccination uptake during the 2020/21 season.

Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these unique classes of motivations to get vaccinated and to adopt preventive behaviors. We recruited 1047 participants by using a Facebook advertisement. Participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19, PMT constructs of threat appraisal (perceived severity and perceived vulnerability), and PMT constructs of coping appraisal (self-efficacy, response efficacy, response cost, knowledge, and previous vaccination for seasonal influenza) were determined. We analyzed participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19 by using latent profile analysis. The present study identified three latent classes, including the participants with high motivation for vaccination and preventive behaviors (the class of Both High), those with low motivation for vaccination and preventive behaviors (the class of Both Low), and those with high motivation for vaccination but low motivation for preventive behaviors (the class of High Vaccination but Low Preventive Behaviors). Compared with the participants in the class of Both High, participants in the class of Both Low had lower levels of perceived vulnerability, perceived severity, self-efficacy to have vaccination, response efficacy of vaccination, knowledge about vaccination, and previous vaccination for seasonal influenza; participants in the class of High Vaccination but Low Preventive Behaviors had lower levels of perceived vulnerability and perceived severity but higher levels of response cost of vaccination. We concluded that varieties of motivations, threat, and coping appraisals should be considered in intervention programs aiming to increase motivation to adopt recommended protective behaviors against COVID-19.

A Norm-Based Conditional Process Model of the Negative Impact of Optimistic Bias on Self-Protection Behaviors During the COVID-19 Pandemic in Three Chinese Cities

Data were collected from 896 participants in three Chinese cities affected by the COVID-19 pandemic to varying degrees through an online survey platform. A conditional process model was then proposed for the impact of optimistic bias on self-protection behaviors during the COVID-19 pandemic from the perspective of social norms. Statistical analysis demonstrates that optimistic bias has a negative impact on self-protection behaviors through message acceptance. Perceived social norms moderate this relationship in the following ways: (1) The higher the perceptions of social norms, the smaller the negative impact of optimistic bias on message acceptance, and the smaller the positive impact of message acceptance on self-protection behaviors. (2) Within a certain range, the higher the perceptions of social norms, the smaller the negative impact, both direct and indirect, of optimistic bias on self-protection behaviors. (3) The direct and indirect effects of optimistic bias on self-protection behaviors become insignificant when perceptions of social norms are very strong. Comparing the data of the three cities shows that higher risk is associated with a stronger role of social norms in moderating the relationship between optimistic bias and self-protection behaviors. The above results suggest that there may be both internal (optimistic bias) and external (social norms) reference points in individual decision-making regarding health behaviors. The theoretical and practical significance of the dual reference points are discussed.

Knowledge and healthcare professionals' perceptions of influenza vaccination in the Qassim region, Saudi Arabia (2019-2020)

Influenza is associated with a substantial economic burden owing to the extensive immediate and circuitous medicinal service costs at the individual and institutional levels. We aimed to evaluate healthcare workers' perceptions of the influenza vaccination in the Qassim region in Saudi Arabia. A cross-sectional study was conducted at selected hospitals from November to March 2020, in which healthcare workers completed a self-administered questionnaire. Of 327 participants, most were equally distributed between the ages 18-30 and 31-45 years (42.8% each), with 57.5% female and 42.5% male. Both Saudi (47.7%) and non-Saudi participants (52.3%) were included. The majority were physicians (29.7%), pharmacists (28.1%), and nurses (27.5%). Overall, 60.9% had good knowledge, 89% had positive perceptions, and 10.7% had negative perceptions. The primary reason for not getting vaccinated was a concern for complications. Moreover, 20.8% had never previously been vaccinated. Knowledge was positively correlated with nationality, educational level, and perception (p = .002, p = .047, and p = .021, respectively). Perceptions were significantly correlated with nationality (p =.009). Furthermore, 24.5% completely disagreed with compulsory vaccination and believe it would not improve coverage. Once fitted using a multinomial regression model, an r-square value of 0.026 indicated that nationality and history of previous vaccination significantly contributed to negative perceptions. We concluded that most healthcare workers had good knowledge and positive perceptions, and more than a third of the participants adhered to seasonal vaccination. Saudi patients and those who had never been vaccinated were more likely to have negative perceptions.

Social norms and vaccine uptake: College students' COVID vaccination intentions, attitudes, and estimated peer norms and comparisons with influenza vaccine

BACKGROUND

Vaccination may be critical to curtailing the spread of the SARS-CoV-2 virus responsible for the COVID-19 pandemic, but herd immunity can only be realized with high vaccination coverage. There is a need to identify empirically supported strategies to increase uptake, especially among young adults as this subpopulation has shown relatively poor adherence to physical distancing guidelines. Social norms - estimates of peers' behavior and attitudes - are robust predictors of health behaviors and norms-based intervention strategies may increase COVID vaccine uptake, once available. This study examined the extent that vaccination intentions and attitudes were associated with estimated social norms as an initial proof-of-concept test.

METHOD

In November of 2020, 647 undergraduate students (46.21% response rate) completed online surveys in which they reported intentions to get COVID and influenza vaccines, perceived importance of these vaccines for young adults, and estimated social norms regarding peers' vaccination behaviors and attitudes.

RESULTS

Students reported significantly greater intentions to get a COVID vaccine (91.64%) than an influenza vaccine (76.04%), and perceived COVID vaccination as significantly more important than influenza vaccination. The sample generally held strong intentions to receive a COVID vaccine and thought that doing so was of high importance, but participants, on average, perceived that other young adults would be less likely to be vaccinated and would not think vaccination was as important. Multiple regression models indicated that estimated social norms were positively associated with participants' own intentions and perceived importance of getting a COVID vaccine.

CONCLUSIONS

These significant associations highlight the potential value in developing and testing norms-based intervention strategies, such as personalized normative feedback, to improve uptake of forthcoming COVID vaccines among young adults.

Preventive Behaviors Towards Covid-19 Pandemic Among Healthcare Providers in Saudi Arabia Using the Protection Motivation Theory

Purpose

The main objectives of the study are firstly to measure the COVID–19 preventive health behaviors related among health care providers (HCPs), then to identify the determinants of such behavior using the protection motivation theory (PMT).

Patients and Methods

An online cross-sectional survey, containing closed-ended questions, was distributed among healthcare professionals including physicians, pharmacists, technicians, and nurses. It consisted of questions assessing socio-demographic and occupational characteristics, in addition to questions from the modified PMT that has been tailored for the COVID-19 pandemic through five sub-constructs: perceived severity and perceived vulnerability, response efficacy, self-efficacy, response costs, and behavioral intention.

Results

A total of 385 HCPs have participated in the study with a mean age of 40.08±8.2 years; the majority was Saudi, married, and having children. There was a significant association between intention to comply with COVID-19 preventive behavior and being females, nurses, having training in Infection prevention and control (IPC) measures, and availability of personal protective equipment (PPE) during work time (p≤0.01). Other demographic variables, working experience, the status of being in the workforce during the pandemic COVID-19 in Saudi Arabia did not have a significant effect on the intention of HCPs to comply with COVID-19 preventive behavior. The vast majority 85.7% of HCPs answered “always” regarding the behavioral intention of HCPs to comply with COVID-19 preventive behavior. There was a significant positive correlation between COVID-19 behavioral intention and other constructs of PMT model, including perceived severity (r=0.272) perceived vulnerability (r= 0.248), self-efficacy (r=0.218), response-efficacy (r=0.167), and response-cost (r=0.13). Gender, availability of PPE, and self-efficacy had a significant prediction of COVID-19 behavioral intentions (P <0.05) with a predicted increase of 0.56, 0.37, and 0.12, respectively, in the mean of the intention score. Self-efficacy was the highest significant predictor of the behavior (p=0.008).

Conclusion

Females’ gender, nurses, having training in IPC measures, and availability of PPE during work time have a significant association with intention to comply with COVID-19 preventive behavior. The present study coping appraisal particularly self-efficacy predicted the COVID-19 pandemic protection motivation and preventive behavior more than threat appraisal. Therefore, future training programs must consider the level of self-efficacy of HCPS, and increase their knowledge regarding the effectiveness of recommendation strategies to perform protective measures against the COVID-19.

Disease Prevention Behavior During the COVID-19 Pandemic and the Role of Self-Esteem: An Extended Parallel Process Model

Objective

The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors.

Methods

This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data.

Results

The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p<0.001), but perceived efficacy did not (β=−0.019, t=−0.619, p>0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p<0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, −0.472; t=26.303, −17.694; p<0.001, p<0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors.

Conclusion

When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).

Perceptions of Seasonal Influenza Vaccine Among U.S. Army Civilians and Dependents in the Kaiserslautern Military Community: A Mixed-Methods Survey

Introduction

Influenza is a globally occurring viral respiratory infection that can lead to hospitalizations and death. An influenza outbreak can interfere with combat readiness in a military setting, as the infection can incapacitate soldiers. Vaccination remains the most effective tool to prevent and mitigate seasonal influenza. Although influenza vaccinations for U.S. Army soldiers can be monitored through military health systems, those systems cannot capture DoD civilians and Army dependents who may not use military health services. This study aims to gauge flu vaccine uptake and perceptions in U.S. Army civilians and dependents.

Materials and Methods

An online survey was e-mailed to civilian and dependent enrollees of Landstuhl Regional Medical Center. The survey contained 24 questions pertaining to demographics, vaccine history, history of the flu, and beliefs toward vaccines. Chi-square tests, t-tests, and logistic regressions were performed to investigate the association between demographic, behavior, and belief factors with vaccine uptake. Free-text answers were coded and categorized by themes.

Results

Over 70% of respondents were vaccinated for the flu. There were differences between vaccinated and unvaccinated respondents regarding their perceptions of barriers to vaccination, benefits of the flu vaccine, severity of flu symptoms, and personal risk of getting ill with the flu. After controlling for confounders, flu vaccination in the previous season and healthcare worker status were associated with increased vaccine uptake, while perceived barriers to influenza vaccination were associated with decreased vaccine uptake.

Conclusions

Flu vaccine uptake may be increased by increasing access to vaccination, promoting vaccination and addressing concerns at the provider level, and engaging positively framed public messaging. Increasing flu vaccine uptake is of particular importance as the flu season approaches during the COVID-19 (Coronavirus disease 2019) pandemic.

Impact of COVID-19 Pandemic on Flu and COVID-19 Vaccination Intentions among University Students

Flu vaccination for the general population, and specifically for vulnerable subgroups, brings the potential to reduce the impact of the COVID-19 pandemic in terms of mobility, mortality, and hospitalizations. In Italy, flu vaccination is recommended to all ≥6 months of age, even if it is only free of charge for specific categories. We investigated the intentions towards flu and COVID-19 vaccinations from a sample of 436 Italian university students. Results of a web-based survey show that 77.52% of them were willing to get the flu vaccine and 94.73% were willing to be vaccinated against COVID-19 when available. We identified positive predictive factors to undertake flu vaccination as being a medical student, having undertaken a previous vaccination against flu, and having a high level of concern and perceived vulnerability to the COVID-19 pandemic. Reinforced public health activities might consider engaging university students a as possible "positive influencer" towards flu and COVID-19 vaccination programs.

Relationship between Citizens' Health Engagement and Intention to Take the COVID-19 Vaccine in Italy: A Mediation Analysis

The actual effectiveness of the still-to-come vaccination against the coronavirus SARS-CoV-2 might be challenged by vaccine hesitancy, a rather common and known phenomenon whose psychological predictors are, nevertheless, still largely debated. Our study aims at understanding how adult citizens' health engagement, perceived COVID-19 susceptibility and severity, and general vaccine-related attitudes affect the willingness to vaccinate against COVID-19. To that end, on a sample of Italian citizens, we implemented a path model to test the impact of health engagement on the willingness to vaccinate against SARS-CoV-2, and whether this relationship is direct or mediated by the general attitude towards vaccines and the risk perception. Moreover, we tested the configural and weak invariance of the model across gender and three age groups. Results show that health engagement is positively related to the intention to vaccinate and that this relationship is partially mediated by the general attitude towards vaccines. The model appears invariant across genders and partially invariant across age groups, showing some differences in the role of perceived susceptibility. These findings vouch for the implementation of educational campaigns aimed at sustaining future vaccination programs that also include health engagement promotion.

The Health Belief Model in predicting healthcare workers' intention for influenza vaccine uptake in Jordan

BACKGROUND

Theories of health behavior change are being inadequately adopted to understand the reasons behind low influenza vaccination rates among healthcare workers (HCWs). The Theory of Planned Behavior (TPB) is being used to predict intention-behavior relationship while the Health Belief Model (HBM) is being employed to predict actual behavior. The purpose of this study was to test a conceptual model based on the HBM's constructs to predict Jordanian HCWs' intentions for influenza vaccine uptake as an alternative to the TPB.

METHOD

A cross-sectional questionnaire-based study was conducted in 2016 in a tertiary teaching hospital in Amman-Jordan including a convenience sample of 477 HCWs with direct patient contact. The study instrument was tested for validity and reliability. A conceptual regression model was proposed incorporating the constructs of the primary HBM with some modifications in the threat construct as well as an additional variable about explicit past vaccination behavior (in the past year and/or any previous history of influenza vaccine uptake).

RESULTS

Almost all the constructs of the HBM demonstrated significant differences between participants intending and those who did not intend to vaccinate against influenza. After adjusting for the confounding variables in the final conceptual regression model, past vaccination behavior (OR= 4.50, 95%Confidence Interval 3.38-6.00, P< 0.0005) and the perceived benefit scale (OR= 1.19, 95% Confidence Interval 1.11-1.28, P< 0.0005) were the only significant predictors of intentions to vaccinate against influenza in the next season.

CONCLUSION

Taking into consideration the altruistic beliefs of HCWs and their explicit past vaccination history augments the utility of the original HBM tool in predicting HCWs' intentions to vaccinate against influenza in a way that is consistent with the predictive ability of the Theory of Planned Behavior.

Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: an application of the Protection Motivation Theory

This study was conducted to predict the preventive behaviours of healthcare workers (HCWs) towards COVID-19 based on the Protection Motivation Theory (PMT). This cross-sectional and analytical study was conducted on 761 HCWs in Hamadan, Iran, using multi-stage random sampling. The preventive behaviours against COVID-19 among HCWs were assessed at a relatively desirable level. Based on the PMT, threat and coping appraisal were predictors of protection motivation to conduct COVID-19 preventive behaviours (P<0.001). The intention was also predictive of COVID-19 preventive behaviours (P<0.001). Consideration of personnel's self-efficacy and their knowledge regarding the effectiveness of protective behaviours in designing staff training programmes are recommended.

What influenza vaccination programmes are preferred by healthcare personnel? A discrete choice experiment

OBJECTIVES

This study examined the relative importance of factors relating to vaccine characteristics, social normative influence and convenience in access to vaccine for determining decision making for seasonal influenza vaccination (SIV) among healthcare personnel (HCP), aiming to optimize existing influenza vaccination programmes for HCP.

METHODS

A discrete choice experiment (DCE) was conducted in HCP working in public hospitals in Hong Kong. The DCE was designed to examine the relative importance of vaccine characteristics (vaccine efficacy and safety), social normative influence reflected by the proportion of HCP colleagues intending to take SIV, and convenience in access to vaccine indicated by vaccination programme duration, vaccination location, vaccination arrangement procedure and service hours in determining influenza vaccination choice among HCP. Mixed logit regression modelling was conducted to examine the preference weight (β) of factors included in the DCE for determining vaccination choice.

RESULTS

Vaccination probability increased with increase in vaccine efficacy (β = 0.02 for per 1% increase), vaccination location changing from "designated staff clinic" to "mobile station" (β = 0.37), vaccination arrangement procedure changing from "by appointment" to "by walk-in" (β = 0.99), but decreased with the increase in probability of mild reactions to vaccination (β = -0.05 for per 1% increase).

CONCLUSION

Vaccine safety was judged to be more important than vaccine efficacy for determining vaccination choice. Arranging vaccination service by walk-in and implementing mobile vaccination station should be considered in future SIV programmes to compensate for the effect of perceived low vaccination efficacy and concerns about vaccine safety to promote SIV uptake among HCP.

Organisational factors affecting performance in delivering influenza vaccination to staff in NHS Acute Hospital Trusts in England: A qualitative study

Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following "best practices". It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.

Key Factors Influencing Italian Mothers’ Intention to Vaccinate Sons against HPV: The Influence of Trust in Health Authorities, Anticipated Regret and Past Behaviour

The Human Papillomavirus (HPV), which is the most common sexually transmitted infection in the world, is associated with different types of cancer, especially cervical cancer. In Italy in 2017 the Italian Ministry of Health introduced a free HPV vaccination programme for 12-years-old boys. In this study we tested an integrated theory of planned behaviour (TPB) model to explain Italian mothers’ intention to vaccinate their sons against HPV. TPB variables plus past behaviour, trust in healthy authorities and anticipated regret were measured by a questionnaire in a sample of 333 Italian mothers of 6–11 years old boys, who were not yet vaccinated against HPV. Results showed that subjective norm was the strongest predictor of mothers’ intention followed by anticipated regret, trust in health authorities, perceived behavioural control and attitude. Mediation analysis found that past behaviour influenced intention via attitude. The discussion considers the relevance of these factors in promoting mothers’ adherence.