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Yang M, Ma W, Jiang J, Lu Z, Wang X, Shen Y, Zou H, Meng X. COVID-19 vaccination and concerns regarding vaccine hesitancy after the termination of the zero-COVID policy in China: A nationwide cross-sectional study. Hum Vaccin Immunother 2024; 20:2388938. [PMID: 39140437 PMCID: PMC11326449 DOI: 10.1080/21645515.2024.2388938] [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: 03/18/2024] [Revised: 07/18/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
COVID-19 vaccine hesitancy remains prevalent globally. However, national data on this issue in the general population after the termination of the zero-COVID policy in China are limited. In March 2023, we conducted a nationwide cross-sectional survey among Chinese adults using a self-administered questionnaire. Descriptive statistics and multivariate logistic regressions were employed. Among 4,966 participants, 43.8% reported COVID-19 vaccine hesitancy following the end of the zero-COVID policy in China. Higher rates of vaccine hesitancy were associated with being married (married: OR 1.36, 95%CI 1.17-1.57; other marital status: OR 1.86, 95%CI 1.36-2.55), working in healthcare (OR 1.64, 95%CI 1.38-1.96), having both minors and older adults in the household (OR 1.45, 95%CI 1.20-1.75), having no minors and older adults in the household (OR 1.44, 95%CI 1.17-1.77), having chronic diseases (OR 1.42, 95%CI 1.23-1.64), experiencing adverse events post-vaccination (OR 1.39, 95%CI 1.19-1.61), and uncertainty about previous COVID-19 infection (OR 1.45, 95%CI 1.13-1.86). Conversely, participants who had received the influenza vaccine in the past three years (OR 0.62, 95%CI 0.54-0.72), had previously taken the COVID-19 vaccine (OR 0.44, 95%CI 0.32-0.59), and had higher confidence in vaccines (OR 0.63, 95%CI 0.60-0.67) were less likely to exhibit hesitancy. Our findings indicate a significant level of vaccine hesitancy, underscoring the urgent need for tailored public health strategies to address vaccine hesitancy and improve uptake post-zero-COVID policy in China. A comprehensive understanding of public concerns and related factors is essential for developing effective vaccine communication strategies.
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Affiliation(s)
- Min Yang
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
| | - Wenjuan Ma
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
| | - Jingfeng Jiang
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xuwen Wang
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
| | - Yuan Shen
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi, China
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Jiang F, Ye X, Wang Y, Tang N, Feng J, Gao Y, Bao M. Factors associated with pregnant women's willingness to receive maternal pertussis vaccination in Guizhou Province, China: An exploratory cross-sectional study. Hum Vaccin Immunother 2024; 20:2331870. [PMID: 38575528 PMCID: PMC10996833 DOI: 10.1080/21645515.2024.2331870] [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: 08/27/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
The rise in pertussis incidence among infants in Guizhou, China underscores the need for maternal acellular pertussis vaccine (aP) immunization, a key strategy in protecting infants from severe health consequences. However, the willingness of pregnant women in Guizhou to receive this vaccine is not well-understood. This study aimed to explore pregnant women's intentions toward maternal pertussis vaccination in Guizhou and identify the associated factors. A questionnaire based on the health belief model, was administered in an exploratory cross-sectional study from January to February 2022. Data from 564 participants were collected and analyzed. The chi-square test, Mann-Whitney U test, and Poisson regression were used to identify potential factors associated with vaccination intentions. Participants' median age was 27 y (interquartile range (IQR): 24-31), and the median number of children per participant was one. The study found that only 36.0% of the participants intended to receive the aP vaccine while 64.0% were uncertain or negative in this regard. Significant factors associated with intentions to vaccinate included perceived barriers and cues for action and perceived benefits. The major barriers for low vaccination intentions were safety concerns for both the fetus and the mother, and family members' negative attitudes. Free vaccines, perceiving preventive benefits, observing other pregnant women getting vaccinated, and healthcare provider recommendations may facilitate vaccination intentions. Multiple immune strategies should be developed or optimized to cope with the resurgence of pertussis.
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Affiliation(s)
- Feng Jiang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Xingui Ye
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Ning Tang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Jun Feng
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Yuanxue Gao
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Meiling Bao
- School of Public Health, Guizhou Medical University, Guiyang, China
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Krithika V, Sunder MV. From Hesitancy to Acceptance: An Interpretative Approach to Unravel the Vaccination Motivation Among the Rural Population. HEALTH COMMUNICATION 2024:1-13. [PMID: 39101223 DOI: 10.1080/10410236.2024.2384811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Our study focuses on vaccination decisions within a collectivistic framework, prioritizing social and behavioral factors over individualistic views amidst COVID-19. Integrating behavioral biases and social ties, we inform targeted public health communication strategies. Examining vaccine uptake in rural India, we use Interpretative Phenomenological Analysis (IPA) to interpret deviations, capturing personal experiences and biases. Through the COM-B model and 25 interviews, we uncover motivations influenced by individual, family, and community factors. Synthesizing findings, we propose tailored public health communication grounded in behavioral psychology. Rather than disregarding biases, we explore their implications for effective interventions. This research advances health communication, particularly benefiting lower-middle-income countries with non-pharmacological approaches.
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Affiliation(s)
- V Krithika
- Faculty of Management Sciences, Sri Ramachandra Institute of Higher Education and Research
| | - M Vijaya Sunder
- Academic Director, Centre for Business Innovation, Indian School of Business Administration
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Sum Z, Sofija E, Sebar B. Exploring COVID-19 vaccine hesitancy among young adults in Australia. A qualitative study. Vaccine X 2024; 19:100515. [PMID: 39040885 PMCID: PMC11260859 DOI: 10.1016/j.jvacx.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background COVID-19 vaccine hesitancy among young adults in Australia is still poorly understood. Young adults aged 25-34 years have been identified as a population subgroup where COVID-19 vaccine-hesitant views are highly prevalent. Objective Exploring the attitudes, thoughts, feelings and social environments affecting the decision to have or not have the vaccine can provide vital transferrable lessons in future health campaigns. Methods A qualitative phenomenological study was conducted using semi-structured phone interviews between June 2021 and July 2021. Interview questions were adopted from the World Health Organization's guidance document 'Data for Action: Achieving High Uptake of COVID-19 Vaccines'. Participants aged 25-34 years (n = 26) were recruited via purposive and snowball sampling methods. Data were analysed thematically. Results Overall, participants presented themselves as highly vaccine literate, understanding their social contract with society. Many participants also did not display traditional vaccine-hesitant views. Six themes specifically regarding COVID-19 vaccine hesitancy were identified, namely (1) decision-making complexities, (2) perceived risk of COVID-19 infection, (3) media's misrepresentation of COVID-19, (4) vaccine-related issues, (5) inconsistent government messaging and program execution, and (6) social benefits assessment. In addition, motivators to COVID-19 vaccine uptake were classified into three categories: (1) tangible benefits, (2) protecting others, and (3) mandates and incentives. Findings suggest the motivators for COVID-19 vaccine uptake in young adults depend on individual benefits, highlighting the importance of recognising and addressing personal concerns. Conclusion There is a need to re-examine and redefine the meaning of vaccine hesitancy in young Australian adults. We offer an understanding of prospective challenges with vaccine hesitancy and potential solutions to address them. These include carefully tailored approaches regarding ongoing vaccine safety concerns and the expected personal benefits following vaccination. Combining these factors can aid in developing new methods of public engagement in the next public health crisis.
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Affiliation(s)
- Zachary Sum
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
| | - Bernadette Sebar
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, 1 Parklands Dr, Southport, QLD 4222, Australia
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Dong W, Miao Y, Shen Z, Zhang W, Bai J, Zhu D, Ren R, Zhang J, Wu J, Tarimo CS, Ojangba T, Li Y. Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study. JMIR Public Health Surveill 2024; 10:e50595. [PMID: 39028548 PMCID: PMC11297372 DOI: 10.2196/50595] [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: 07/06/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future. OBJECTIVE This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China. METHODS This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM). RESULTS A total of 5780 participants were included, with 53.04% (3066/5780) being female. The vaccination rate was 12.18% (704/5780; 95% CI 11.34-13.02) in the total sample, 13.76% (341/2478; 95% CI 12.40-15.12) among the rural participants, and 10.99% (363/3302; 95% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all P<.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all P<.05). PSM analysis uncovered a 3.42% difference in vaccination rates between urban and rural participants. CONCLUSIONS The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated.
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Affiliation(s)
- Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Clifford Silver Tarimo
- Department of Science and Laboratory Technology, Dar Es Salaam Institute of Technology, Dar es Salaam, United Republic of Tanzania
| | - Theodora Ojangba
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
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Kafadar AH, Sabatini S, Jones KA, Dening T. Categorising interventions to enhance vaccine uptake or reduce vaccine hesitancy in the United Kingdom: A systematic review and meta-analysis. Vaccine 2024:S0264-410X(24)00733-3. [PMID: 38960789 DOI: 10.1016/j.vaccine.2024.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Vaccination is one of the most important public health interventions to combat infectious disease. However, vaccine hesitancy prevents us reaching the global target of vaccine uptake (e.g., 75 % of influenza vaccination in at-risk groups). This review summarises all interventions designed to reduce vaccine hesitancy and increase vaccine uptake for all types of vaccines offered to adults (≥18 years) since 2000, in the United Kingdom (UK). METHODS PubMed, Cochrane Reviews, CINAHL EBSCO, and Scopus were searched (September 19, 2023). The PRISMA Checklist 2020 was used for quality checking. Data from randomised-controlled trials (RCTs) were analysed with a meta-analysis and narrative analysis. In all included studies, a narrative synthesis was undertaken to summarise, evaluate and characterisethe reported behaviour change interventions into four categories: organisational-level, public demand, provider-level, and multidimensional interventions. Findings are evaluated based on the MINDSPACE framework to understand the possible psychological mechanisms underpinning the interventions. FINDINGS A total of 9,842 articles were identified, 50 met the inclusion criteria. Interventions aimed to boost vaccine uptake or reduce hesitancy of influenza (50 %), COVID-19 (32 %), hepatitis B (6 %), and other vaccines. A meta-analysis was conducted for nine RCTs evaluating various interventions impact on vaccine uptake. The pooled effect was statistically significant (OR with 95 % CI = 1.23 [1.07 to 1.41]). Providing certain and understandableinformation and using a reminder system with personal messages or letters were the most frequently documented and effective interventions to enhance public demand (enhance information salience). Organisational level interventions intended to make vaccinations more accessible (e.g., providing vaccination at alternative places or times). Provider-oriented interventions encouraged healthcare workers to focus on reducing vaccine hesitancy or enhancing vaccine uptake. INTERPRETATION Among the main MINDSPACE techniques, enhancing the salience of vaccine information and priming vaccination by improving access were identified as the most applied and effective interventions in the UK.
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Affiliation(s)
- Aysegul Humeyra Kafadar
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom.
| | - Serena Sabatini
- Academic and Research Departments, School of Psychology, University of Surrey, United Kingdom
| | - Katy A Jones
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Tom Dening
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
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Shen Z, Li Q, Wu J, Zhu D, Bai J, Ren R, Zhang J, Li Y, Wang M, Gu J, Li Y, Dong W, Wang H, Sun T, Yang F, Zhou X, Yang J, Tarimo CS, Ma M, Feng Y, Miao Y. Dynamic evolution of COVID-19 vaccine hesitancy over 2021-2023 among Chinese population: Repeated nationwide cross-sectional study. J Med Virol 2024; 96:e29800. [PMID: 39014958 DOI: 10.1002/jmv.29800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
Globally, the rollout of COVID-19 vaccine had been faced with a significant barrier in the form of vaccine hesitancy. This study adopts a multi-stage perspective to explore the prevalence and determinants of COVID-19 vaccine hesitancy, focusing on their dynamic evolutionary features. Guided by the integrated framework of the 3Cs model (complacency, confidence, and convenience) and the EAH model (environmental, agent, and host), this study conducted three repeated national cross-sectional surveys. These surveys carried out from July 2021 to February 2023 across mainland China, targeted individuals aged 18 and older. They were strategically timed to coincide with three critical vaccination phases: universal coverage (stage 1), partial coverage (stage 2), and key population coverage (stage 3). From 2021 to 2023, the surveys examined sample sizes of 29 925, 6659, and 5407, respectively. The COVID-19 vaccine hesitation rates increased from 8.39% in 2021 to 29.72% in 2023. Urban residency, chronic condition, and low trust in vaccine developer contributed to significant COVID-19 vaccine hesitancy across the pandemic. Negative correlations between the intensity of vaccination policies and vaccine hesitancy, and positive correlations between vaccine hesitancy and long COVID, were confirmed. This study provides insights for designing future effective vaccination programs for emerging vaccine-preventable infectious X diseases.
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Affiliation(s)
- Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Quanman Li
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Meiyun Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Jianqin Gu
- School of Medicine, Southern University of Science and Technology, Guangdong, China
| | - Yinfei Li
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Wenyong Dong
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Haipeng Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Fan Yang
- School of Public Health, Fudan University, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xue Zhou
- College of Health Management, Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Jian Yang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Clifford Silver Tarimo
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Mingze Ma
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Yifei Feng
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Province Engineering Research Center of Health Economy & Health Technology Assessment, Zhengzhou, China
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Xia S, Nan X. Motivating COVID-19 Vaccination through Persuasive Communication: A Systematic Review of Randomized Controlled Trials. HEALTH COMMUNICATION 2024; 39:1455-1478. [PMID: 37254940 DOI: 10.1080/10410236.2023.2218145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vaccination is a vital defense against COVID-19 infections and outbreaks, yet vaccine hesitancy poses a significant threat to pandemic response and recovery. We conducted a systematic review of published randomized controlled trials (N = 47) assessing the persuasive effects of COVID-19 communication on COVID-19 vaccine acceptance. Individual vs. collective appeals and gain vs. loss frames are among the most frequently assessed message features, but they generally do not make a difference in persuasion. Normative messages that highlight higher (vs. lower) prevalence of vaccine acceptance are more persuasive. Message sources overall have limited impact on COVID-19 vaccine acceptance, but sources that have a shared identity with the message receivers tend to be persuasive. More engaging message channels such as interactive chatbots and videos are promising communication tools but are generally under-utilized and under-studied. Compared to no communication or irrelevant communication, COVID-19 vaccine messages generally have a small advantage in increasing COVID-19 vaccine acceptance. Messages that include 1) vaccine safety and/or efficacy information; 2) collective appeals combined with embarrassment appeals; and 3) political leaders' vaccine endorsement are among the most effective messaging strategies. There is no evidence of any backfire effects of COVID-19 vaccine messages. We discuss the implications of our findings for persuasive message design in pandemic vaccine communication.
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Affiliation(s)
- Shilin Xia
- Department of Communication, University of Maryland
| | - Xiaoli Nan
- Department of Communication, University of Maryland
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Lazić A, Žeželj I. Negativity in online news coverage of vaccination rates in Serbia: a content analysis. Psychol Health 2024; 39:895-913. [PMID: 36097724 DOI: 10.1080/08870446.2022.2121962] [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: 12/28/2021] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This content analysis study explored how online news media communicates and frames vaccination rates and herd immunity (the effect where enough people are immune, the virus is contained). METHODS We analyzed 160 vaccination-related news stories by nine highest-trafficked news websites in Serbia, published July-December 2017, around the start of the measles outbreak. We coded both the news story as a whole and every vaccination-rate mention (N = 339). RESULTS News stories framed current vaccination rates and changes in them in a predominantly negative way (175/241 and 67/98 mentions, respectively) (e.g., "only 50% vaccinated", "fewer parents vaccinating their children"), especially when referring to the measles vaccine (202/262 mentions). A total of 23/86 of news stories mentioning vaccination rates did not provide any numerical values. Reference groups for vaccination rates were rarely specified. Out of the 32 news stories mentioning herd immunity, 11 explained the effect. CONCLUSIONS Even routine communication of vaccination rates can be biased through negative frames and imprecise descriptions. Lamenting low immunization rates could activate a negative descriptive social norm ("many people are not getting vaccinated"), which may be especially ill-advised in the absence of an explanation of the social benefit of achieving herd immunity through vaccination.
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Affiliation(s)
- Aleksandra Lazić
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Iris Žeželj
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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Lei Z, Liu D, Li M, Xian D, Fan S. Vaccination intentions of hypertensive Chinese individuals during the COVID-19 epidemic: a structural equation modeling study. BMC Infect Dis 2024; 24:642. [PMID: 38926657 PMCID: PMC11201319 DOI: 10.1186/s12879-024-09480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Given the high prevalence of hypertension among Chinese adults, this population is at a significantly increased risk of severe COVID-19 complications. The purpose of this study is to assess the willingness of Chinese hypertensive adults to receive the COVID-19 vaccine and to identify the diverse factors that shape their vaccination decisions. METHODS Sampling was conducted utilizing multistage stratified random sampling, and ultimately, a total of 886 adult hypertensive patients from Luzhou City in Southwest China were included in this study. The questionnaire design was based on the Theory of Planned Behaviour and was used to investigate their willingness to be vaccinated with COVID-19. Structural equation modeling was employed for data analysis. RESULTS The results showed that 75.6% of hypertensive individuals were willing to receive COVID-19 vaccination. The structural equation modeling revealed that Subjective Norms (path coefficient = 0.361, CR = 8.049, P < 0.001) and Attitudes (path coefficient = 0.253, CR = 4.447, P < 0.001) had positive effects on vaccination willingness, while Perceived Behavioral Control (path coefficient=-0.004, CR=-0.127, P = 0.899) had no significant impact on Behavioral Attitudes. Mediation analysis indicated that Knowledge (indirect path coefficient = 0.032, LLCI = 0.014, ULCI = 0.058), Risk Perception (indirect path coefficient = 0.077, LLCI = 0.038, ULCI = 0.124), and Subjective Norms (indirect path coefficient = 0.044, LLCI = 0.019, ULCI = 0.087) significantly influenced vaccination willingness through Attitudes as a mediating factor. CONCLUSION The willingness of hypertensive individuals to receive the COVID-19 vaccination is not satisfactory. The Theory of Planned Behavior provides valuable insights into understanding their vaccination intentions. Efforts should be concentrated on enhancing the subjective norms, attitudes, and knowledge about vaccination of hypertensive patients.
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Affiliation(s)
- Zhi Lei
- Department of Chronic Disease Control and Prevention, Luzhou Center for Disease Control and Prevention, Luzhou, China
- Administrative Office, Luzhou People's Hospital, Luzhou, China
| | - Dongyang Liu
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Minghui Li
- Department of Human Resource, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Deqiang Xian
- Administrative Office, Luzhou People's Hospital, Luzhou, China.
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China.
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11
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Bian J, Zhang W, Guo Z, Li X, Fu L, Lu Z, Fitzpatrick T, Sun Y, Gao Y, Chen Y, Liu Q, He L, Sun C, Zou H. Influence of grandchildren on COVID-19 vaccination uptake among older adults in China: a parallel-group, cluster-randomized controlled trial. NATURE AGING 2024; 4:638-646. [PMID: 38724731 DOI: 10.1038/s43587-024-00625-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 04/04/2024] [Indexed: 05/23/2024]
Abstract
The uptake of COVID-19 booster vaccination among older adults in China is suboptimal. Here, we report the results of a parallel-group cluster-randomized controlled trial evaluating the efficacy of promoting COVID-19 booster vaccination among grandparents (≥60 years) through a health education intervention delivered to their grandchildren (aged ≥16 years) in a Chinese cohort (Chinese Clinical Trial Registry: ChiCTR2200063240 ). The primary outcome was the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents' attitude and intention to get a COVID-19 booster dose. A total of 202 college students were randomized 1:1 to either the intervention arm of web-based health education and 14 daily reminders (n = 188 grandparents) or control arm (n = 187 grandparents) and reported their grandparents' COVID-19 booster vaccination status at baseline and 21 days. Grandparents in the intervention arm were more likely to receive COVID-19 booster vaccination compared to control cohort (intervention, 30.6%; control, 16.9%; risk ratio = 2.00 (95% CI, 1.09 to 3.66)). Grandparents in the intervention arm also had greater attitude change (β = 0.28 (95% CI, 0.04 to 0.52)) and intention change (β = 0.32 (95% CI, 0.12 to 0.52)) to receive a COVID-19 booster dose. Our results show that an educational intervention targeting college students increased COVID-19 booster vaccination uptake among grandparents in China.
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Affiliation(s)
- Junye Bian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhihui Guo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | | | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yuanyi Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Qi Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China.
| | - Caijun Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China.
- Shenzhen Campus of Sun Yat-sen University, Shenzhen, China.
- School of Public Health, Southwest Medical University, Luzhou, China.
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
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12
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Reddinger JL, Charness G, Levine D. Vaccination as personal public good provision. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2022.04.21.22274110. [PMID: 35923323 PMCID: PMC9347278 DOI: 10.1101/2022.04.21.22274110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vaccination against infectious diseases has both private and public benefits. We study whether social preferences-concerns for the well-being of other people-are associated with one's decision regarding vaccination. We measure these social preferences for 549 online subjects with a public-good game and an altruism game. To the extent that one gets vaccinated out of concern for the health of others, contribution in the public-good game is analogous to an individual's decision to obtain vaccination, while our altruism game provides a different measure of altruism, equity, and efficiency concerns. We proxy vaccine demand with how quickly a representative individual voluntarily took the initial vaccination for COVID-19 (after the vaccine was widely available). We collect COVID-19 vaccination history separately from the games to avoid experimenter-demand effects. We find a strong result: Contribution in the public-good game is associated with greater demand to voluntarily receive a first dose, and thus also to vaccinate earlier. Compared to a subject who contributes nothing, one who contributes the maximum ($4) is 58% more likely to obtain a first dose voluntarily in the four-month period that we study (April through August 2021). In short, people who are more pro-social are more likely to take a voluntary COVID-19 vaccination. Behavior in our altruism game does not predict vaccination. We recommend further research on the use of pro-social preferences to help motivate individuals to vaccinate for other transmissible diseases, such as the flu and HPV.
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Razai MS, Mansour R, Ravindran P, Freeman S, Mason-Apps C, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review. PLoS One 2024; 19:e0298407. [PMID: 38640190 PMCID: PMC11029626 DOI: 10.1371/journal.pone.0298407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/25/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and the USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis/whooping cough and COVID-19 during pregnancy and identify possible strategies to increase vaccination rates. METHODS We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research. RESULTS Out of 2681 articles screened, 28 studies (n = 1573 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety and efficacy, lack of knowledge about vaccines' benefits and necessity, fear of adverse effects on the foetus or mother and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear communication on the benefits and safety of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, and clear and consistent communication about vaccines addressing pregnant women's concerns. CONCLUSION This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Recommendation from a healthcare provider can play a significant role in promoting vaccine uptake, as can clear risk/benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.
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Affiliation(s)
- Mohammad S. Razai
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Rania Mansour
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | | | - Samuel Freeman
- University Hospitals Sussex NHS Foundation Trust, Sussex, United Kingdom
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joan Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Sally Hargreaves
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- The Migrant Health Research Group, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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Luisi M, Geana MV, Pei J. Pandemic antecedents - Exploring predictivity and relationships between COVID-19 vaccine uptake and influenza, shingles, and HPV vaccination. Vaccine 2024; 42:2455-2462. [PMID: 38461049 DOI: 10.1016/j.vaccine.2024.03.003] [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: 01/27/2023] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND A wealth of extant research focuses on identifying barriers to, and predictors of, COVID-19 vaccination. In addition to treating COVID-19 vaccination and related experiences as antecedents, this study analyzes the relationships between COVID-19 vaccination experiences and intent to receive the flu, shingles, and HPV vaccines. METHOD Analyses were performed on the responses from U.S. survey panel of 1,024 participants (n = 1,024), 530 (51.8 %) who received at least a dose of the COVID-19 vaccine and 494 (48.2 %) who had not. Descriptive and inferential statistics identify participant demographic characteristics, prior vaccination behavior, vaccination intentions, risk behavior assessment, vaccination attitudes and beliefs, and the predictivity of COVID-19 vaccination, when treated as an antecedent. RESULTS Receiving a first dose of the COVID-19 vaccine interacted with receiving a past influenza vaccine, predicting the future intention to receive a COVID-19 vaccine or booster. Vaccine hesitancy in parents is significantly related to vaccination behaviors for themselves and their children. Analyses also showed differences between the vaccinated group (VG) and the unvaccinated group (UVG) on hesitancy, beliefs, and attitudes toward the COVID-19 vaccine. CONCLUSION Experience with COVID-19 vaccination and the relationship of those experiences with other vaccinations provide useful insight on leveraging vaccine uptake. Healthcare professionals should improve the COVID-19 vaccination experience and use vaccination appointments to promote other vaccinations. Research should continue to compare vaccination experiences and how they may persuade or dissuade vaccination intent for other vaccinations.
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Affiliation(s)
- Monique Luisi
- School of Journalism, University of Missouri, 178 Gannett Hall, Columbia, MO 65211, USA.
| | - Mugur V Geana
- Center for Excellence in Health Communication to Underserved Populations, School of Journalism and Mass Communications, University of Kansas, 1000 Sunnyside Ave., Suite 2001, Lawrence, KS 66045, USA.
| | - Jun Pei
- Center for Excellence in Health Communication to Underserved Populations, School of Journalism and Mass Communications, University of Kansas, 1000 Sunnyside Ave., Suite 2001, Lawrence, KS 66045, USA.
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Szászi ÁJ, Bíró-Nagy A. Controversies of COVID-19 vaccine promotion: lessons of three randomised survey experiments from Hungary. Public Health 2024; 229:192-200. [PMID: 38457939 DOI: 10.1016/j.puhe.2024.01.030] [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: 07/11/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This study aimed to investigate vaccine promotion messages, examine the heterogeneous effects of these messages and provide experimental evidence to help evaluate the efficiency of COVID-19 vaccine promotion campaigns in Hungary. STUDY DESIGN This study presents the results of three randomised survey experiments that were embedded in cross-sectional, representative, public opinion studies of Hungarian adults based on in-person interviews. Simple randomisation and blinding were applied to assign participants into the control group (no message) or treatment groups (vaccine promotion messages). METHODS The first experiment (March 2021) aimed to test vaccination promotion messages from politicians (N = 331) and medical experts (N = 342) by comparing experimental groups' trust in vaccines and conspiratorial beliefs with the control group (N = 327). The second experiment (September 2022) tested the impact of two communication strategies ([1] highlighting the safety and effectiveness of vaccines, N = 104; and [2] highlighting the wide variety of vaccines available, N = 110) on increasing vaccine uptake among those who were still unvaccinated (control group, N = 89). The third experiment (September 2022) tested one message aiming to increase COVID-19 booster uptake among those who received only the first round of vaccination (N = 172; control group, N = 169). The outcome variable in the second and third experiments was intent to get vaccinated. Robust regressions, logit models, Mann-Whitney U-tests and model-based recursive partitioning were run. The inference criteria (p < 0.05) was set in pre-registration of the experiments. RESULTS All treatment effects were insignificant, but exploratory research found significant conditional treatment effects. Exposure to vaccine promotion by medical professionals was associated with a higher level of trust in Russian and Chinese COVID-19 vaccines in older age cohorts (weighted robust regressions, 50-59 years old, Russian vaccine: +0.769, interaction term [i.t.] p = 0.010; Chinese vaccine: +0.326, i.t. p = 0.044; and ≥60 years old, Russian vaccine +0.183, i.t. p = 0.040; Chinese vaccine +0.559, i.t. p = 0.010) and with a lower level of trust in these vaccines among younger adults (<30 years old, Russian vaccine: -1.236, i.t. p = 0.023; Chinese vaccine: -1.281, i.t. p = 0.022). Receiving a vaccine promotion message from politicians led to a higher level of trust in Chinese vaccines among the oldest respondents (≥60 years: +0.634, i.t. p = 0.035). CONCLUSIONS Short-term persuasion attempts that aimed to convince respondents about COVID-19 vaccination were ineffective. Booster hesitancy, similar to primary vaccine hesitancy, was resistant to vaccine promotion messages. Significant conditional effects suggest that COVID-19 vaccine promotion by medical experts and politicians may have had adverse effects for some demographic groups in Hungary.
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Affiliation(s)
- Á J Szászi
- HUN-REN Centre for Social Sciences, Institute for Political Science, Budapest, 1097, Tóth Kálmán u. 4., Hungary.
| | - A Bíró-Nagy
- HUN-REN Centre for Social Sciences, Institute for Political Science, Budapest, 1097, Tóth Kálmán u. 4., Hungary.
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16
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Byerley CO, Horne D, Gong M, Musgrave S, Valaas LA, Rickard B, Yoon H, Park MS, Mirin A, Joshua S, Lavender H, You S. An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection. Sci Rep 2024; 14:7419. [PMID: 38548828 PMCID: PMC10978892 DOI: 10.1038/s41598-024-57841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/22/2024] [Indexed: 04/01/2024] Open
Abstract
We designed the Relative Risk Tool (RRT) to help people assess the relative risks associated with COVID-19 vaccination and infection. In May 2022 (N = 400) and November 2022 (N = 615), U.S. residents participated in a survey that included questions about the risks of vaccination and infection. In both cohorts, we found an association between relative risk perception and vaccine hesitancy. Participants in the May cohort were randomly assigned an intervention: to see information from the RRT or the Centers for Disease Control and Prevention (CDC). After the intervention, participants answered the same questions about risk perception and vaccination intent again. The RRT was more effective than the CDC at changing risk perception and increasing vaccination intent. In November, the survey structure was the same, but the RRT was the only intervention included, and we confirmed that the RRT was effective at changing opinions in this new sample. Importantly, the RRT provided accurate information about the risks of serious adverse outcomes to vaccination and still increased vaccination intent. Our work suggests that the RRT helps people assess relative risk, which can in turn help empower them to make informed decisions and ultimately reduce vaccine hesitancy.
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Affiliation(s)
- Cameron O'Neill Byerley
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA.
| | - Dru Horne
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Mina Gong
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Stacy Musgrave
- Department of Mathematics and Statistics, Cal Poly Pomona, Pomona, 91768, USA
| | - Laura A Valaas
- Department of Dermatology, University of Washington, Seattle, 98195, USA
| | - Brian Rickard
- Department of Mathematical Sciences, University of Arkansas, Fayetteville, 72701, USA
| | - Hyunkyoung Yoon
- Department of Mathematics and Statistics, Cal Poly Pomona, Pomona, 91768, USA
| | - Min Sook Park
- Department of Information Studies, University of Wisconsin-Milwaukee, Milwaukee, 53201, USA
| | - Alison Mirin
- Department of Mathematics, University of Arizona, Tucson, 85721, USA
| | | | - Heather Lavender
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Sukjin You
- Department of Information Studies, University of Wisconsin-Milwaukee, Milwaukee, 53201, USA
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Thorpe A, Fagerlin A, Drews FA, Shoemaker H, Brecha FS, Scherer LD. Predictors of COVID-19 vaccine uptake: an online three-wave survey study of US adults. BMC Infect Dis 2024; 24:304. [PMID: 38475702 DOI: 10.1186/s12879-024-09148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To effectively promote vaccine uptake, it is important to understand which people are most and least inclined to be vaccinated and why. In this study, we examined predictors of COVID-19 vaccine uptake and reasons for non-vaccination. METHODS We conducted an online English-language survey study in December-2020, January-2021, and March-2021. A total of 930 US respondents completed all surveys. Multiple logistic regression models were run to test whether the early vaccine eligibility, demographic factors, and psychological factors predict getting at least one dose of a COVID-19 vaccination in January-2021 and in March-2021. RESULTS The proportion of respondents who received ≥ 1-dose of a COVID-19 vaccine increased from 18% (January) to 67% (March). Older age predicted vaccine uptake in January (OR = 2.02[95%CI = 1.14-3.78], p < .001) and March (10.92[6.76-18.05], p < .001). In January, additional predictors were higher numeracy (1.48[1.20-1.86], p < .001), COVID-19 risk perceptions (1.35[1.03-1.78], p = .029), and believing it is important adults get the COVID-19 vaccine (1.66[1.05-2.66], p = .033). In March, additional predictors of uptake were believing it is important adults get the COVID-19 vaccine (1.63[1.15-2.34], p = .006), prior COVID-19 vaccine intentions (1.37[1.10-1.72], p = .006), and belief in science (0.84[0.72-0.99], p = .041). Concerns about side effects and the development process were the most common reasons for non-vaccination. Unvaccinated respondents with no interest in getting a COVID-19 vaccine were younger (0.27[0.09-0.77], p = .016), held negative views about COVID-19 vaccines for adults (0.15[0.08-0.26], p < .001), had lower trust in healthcare (0.59[0.36-0.95], p = .032), and preferred to watch and wait in clinically ambiguous medical situations (0.66[0.48-0.89], p = .007). CONCLUSIONS Evidence that attitudes and intentions towards COVID-19 vaccines were important predictors of uptake provides validation for studies using these measures and reinforces the need to develop strategies for addressing safety and development concerns which remain at the forefront of vaccine hesitancy.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.
- Department of Applied Health Research, University College London, London, UK.
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
- University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Holly Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Federica S Brecha
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Laura D Scherer
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, USA
- Denver VA Center of Innovation, Denver, CO, USA
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Krausewitz P, Schmeller H, Spitzer C, Ellinger J, Ritter M, Petrowski K, Conrad R. Emotion-centered versus fact-centered medical information to alleviate pain and anxiety in prostate biopsy: A randomized trial. Prostate 2024; 84:389-394. [PMID: 38116739 DOI: 10.1002/pros.24659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND To test the efficacy of emotion-centered (EC) versus fact-centered (FC) written medical information for prostate biopsy to alleviate pain and anxiety in a randomized controlled trial. METHODS In a single-center, single-blinded study participants were randomized to receive FC or EC (DRKS00022361; 2020). In the EC, the focus was on possible stress reactions and stress-reducing strategies. Participants were asked to complete questionnaires on the day of MRI acquisition (T0) directly before (T1) and after the procedure (T2). The primary outcome measure was the assessment of worst pain in the last 2 h measured by the adapted brief pain inventory. Secondary outcome measures included state anxiety measured by the state-trait anxiety inventory and the subjective evaluation of the impact of the written medical information at T2. For statistical analysis, mixed models were calculated. RESULTS Of 137 eligible patients, 108 (79%) could be recruited and were randomized. There was a significant effect for time for the outcome variables pain and anxiety. Regarding the comparison for the primary outcome variable worst pain there was a significantly lower increase from T1 to T2 after FC compared to EC (p < 0.004). The course of anxiety displayed no overall group differences. The FC was evaluated as significantly more helpful regarding stress, pain, and anxiety with moderate effect sizes. CONCLUSIONS FC was favorable with regard to worst experienced pain, assuming that the brief introduction of emotional issues such as stress and coping in written information might be counterproductive particularly in men not used to these subjects.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Helene Schmeller
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
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Li S, Hao J, Su Y, Zhan H, Zhou N, Qiu Y, Lu Y, Sun K, Tian Y. COVID-19 vaccine hesitancy and influencing factors among Chinese hospital staff: a cross-sectional study. Sci Rep 2024; 14:4369. [PMID: 38388666 PMCID: PMC10883913 DOI: 10.1038/s41598-024-55001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
We aimed to investigate the willingness of hospital staff to receive the COVID-19 vaccine and explore the associated factors and reasons of vaccine hesitancy among Chinese hospital staff, which were not yet known. A cross-sectional questionnaire survey was conducted online on the vaccine hesitancy of staff in a grade A tertiary general hospital in Beijing from February 22 to 23, 2023. Univariate and multivariate logistic regression were used to assess associations between potential influencing factors and vaccine hesitancy. A total of 3269 valid respondents were included, and the rate of COVID-19 vaccine hesitancy was 32.67%. Multivariate logistic regression showed that women [1.50 (1.22-1.83)], having high-school education level [1.69 (1.04-2.76)], college degree [2.24 (1.35-3.72)] or graduate degree [2.31 (1.33-4.03)], and having underlying disease [1.41 (1.12-1.77)] were associated with a higher rate of COVID-19 vaccine hesitancy. The main reasons for vaccine hesitancy included doubts for the safety and effectiveness of COVID-19 vaccine and worries in adverse reactions. Hospital staff's willingness to vaccinate COVID-19 vaccine is generally high in the study. Hospitals should spread the knowledge of COVID-19 vaccine through multiple channels to improve the cognition of hospital staff and encourage vaccination based on associated factors.
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Affiliation(s)
- Shangyao Li
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Jinjuan Hao
- Hospital Administration Office, Beijing Hospital, National Center of Gerontology, Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, 1 Dahua Road, Dongdan, Beijing, 100730, China
| | - Yu Su
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Haoran Zhan
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Nuo Zhou
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Yitong Qiu
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Yitong Lu
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China
| | - Ke Sun
- Hospital Administration Office, Beijing Hospital, National Center of Gerontology, Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, 1 Dahua Road, Dongdan, Beijing, 100730, China.
| | - Yu Tian
- School of Public Health, Capital Medical University, 10 You'anmen Outer West 1st Street, Beijing, 100069, China.
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20
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Felgendreff L, Siegers R, Otten L, Betsch C. Infographics on risks associated with COVID-19 and the willingness to get the AstraZeneca vaccine: two randomized online experiments. BMC Public Health 2024; 24:529. [PMID: 38378506 PMCID: PMC10880230 DOI: 10.1186/s12889-024-18057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Germans hesitated to get vaccinated with AstraZeneca in the COVID-19 pandemic after reports of blood clots. METHODS In two preregistered online experiments with stratified randomization (Study 1 N = 824, Study 2: N = 1,056), we tested whether providing evidence-based benefit-risk information reduces the perceived risk of the AstraZeneca vaccine and the perceived probability of blood clots due to the AstraZeneca vaccine and increases the vaccination intention. In Study 1, participants saw no infographic (control) or one of two infographics (low vs. high exposure risk varied by the underlying incidence rates). Study 2 additionally varied the infographic design displaying the risk information (presented as table, circle icons, or manikin-like icons). RESULTS The infographic decreased the risk perception of the vaccine compared to no infographic (Study 1: Cohens d = 0.31, 95% CI [0.14, 0.48]; Study 2: Cohens d = 0.34, 95% CI [0.06, 0.62]), but it did not influence the perceived probability of blood clots due to the AstraZeneca vaccine (Study 2: Cohens d = 0.05, 95% CI [-0.23, 0.33]). Also, the infographic design did not affect the perceived probability of blood clots (Study 2). The vaccination intention was not affected by viewing the infographic (Study 1: Cohens d = 0.04, 95% CI [-0.13, 0.21]; Study 2: Cohens d = 0.04, 95% CI [-0.24, 0.32]) nor the presented infection rate (Study 1: Cohens d = 0.07, 95% CI [-0.09, 0.24], Study 2: Cohens d = 0.01, 95% CI [-0.12, 0.15]) but by risk perceptions, sociodemographic characteristics, confidence in the AstraZeneca vaccine, and preference for alternative vaccines. CONCLUSIONS The evidence-based benefit-risk information helped putting the risk of vaccinations into perspective. Nevertheless, objective risk information alone did not affect vaccination intention that was low due to the preexisting lacking vaccine confidence.
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Affiliation(s)
- Lisa Felgendreff
- Institute for Planetary Health Behaviour, University of Erfurt, Nordhäuser Str. 63, Erfurt, 99089, Germany.
- Health Communication, BNITM Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Regina Siegers
- Data Literacy Project, Leibniz Institute for Educational Trajectories, Bamberg, Germany
| | - Leonie Otten
- Institute for Planetary Health Behaviour, University of Erfurt, Nordhäuser Str. 63, Erfurt, 99089, Germany
- Health Communication, BNITM Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Cornelia Betsch
- Institute for Planetary Health Behaviour, University of Erfurt, Nordhäuser Str. 63, Erfurt, 99089, Germany
- Health Communication, BNITM Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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21
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Robertson DA, Timmons S, Lunn PD. Behavioural evidence on COVID-19 vaccine uptake. Public Health 2024; 227:49-53. [PMID: 38104419 DOI: 10.1016/j.puhe.2023.10.046] [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: 06/15/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The World Health Organization has declared that COVID-19 is no longer a public health emergency of international concern. Nevertheless, it remains a public health issue, and seasonal vaccinations, at the same time of year as influenza vaccinations, will be necessary. When the first vaccines were administered in 2020, decision-makers had to make assumptions about the best methods to communicate and administer vaccines to increase uptake. Now, a body of evidence can inform these decisions. STUDY DESIGN A narrative review written by three behavioural scientists who design research for policy. METHODS We searched the PubMed database for: (i) reviews of interventions to increase uptake of COVID-19 or influenza vaccines and (ii) empirical studies on uptake of COVID-19 and influenza vaccines. In addition, registered trials gathered by a Cochrane scoping review of interventions to increase uptake of COVID-19 vaccines were searched for updated results. RESULTS Results centre around two aspects of a vaccination campaign of interest to policymakers: communication and administration. Results suggest that communications highlighting the personal benefits of vaccination are likely to be more effective than those highlighting collective benefits. The efficacy of vaccination may be underestimated and stressing efficacy as a strong personal benefit may increase uptake. Keeping vaccines free, sending personalised messages, reminders and prebooked appointment times may also increase uptake. CONCLUSIONS There is now a body of evidence from behavioural science that suggests how vaccination campaigns for COVID-19 can be structured to increase uptake. These recommendations may be useful to policymakers considering seasonal vaccination campaigns and to researchers generating hypotheses for country-specific trials.
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Affiliation(s)
- D A Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - S Timmons
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - P D Lunn
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; Department of Economics, Trinity College Dublin, Dublin, Ireland
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22
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Zhao M, Lee K, Huang Y. Development and psychometric testing of the Coronavirus Awareness and Preparedness Scale: A cross-sectional study. Health Sci Rep 2024; 7:e1857. [PMID: 38410494 PMCID: PMC10895196 DOI: 10.1002/hsr2.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/06/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims A comprehensive standardized evaluation tool was needed to assess community awareness and preparedness when the pandemic hit the United States. This study aimed to develop and validate a new Coronavirus Awareness and Preparedness Scale (CAPS) through psychometric testing. Methods This study unfolded in two phases. Phase 1 (conducted in March and April 2020) focused on the development of the scale. Phase 2 (conducted in June and July 2020) measured the reliability and validity of the scale. Psychometric testing, including exploratory factor analysis and reliability testing, was performed with a convenience sample of 1237 faculty, staff, and students at a southern university in the United States. Results The final CAPS model consists of four factors with 26 items: threat (seven items), confidence (11 items), individual precautions (three items), and public precautions (five items). The scale demonstrated satisfactory internal consistency (Cronbach's α = 0.75). Strong and statistically significant item correlations were observed within the subscales through item analysis. Conclusion The CAPS is a reliable and valid comprehensive evaluation instrument designed to gauge community awareness and preparedness during the early stages of the COVID-19 pandemic. Its adaptability makes it suitable for measuring readiness and preparedness concerning any novel airborne disease or future airborne pandemic within a community.
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Affiliation(s)
- Meng Zhao
- School of NursingNorth Carolina Agricultural and Technical State UniversityGreensboroNorth CarolinaUSA
| | - Kyoung Lee
- Nancy Atmospera‐Walch School of NursingUniversity of Hawai'i at MānoaHonoluluHawaiiUSA
| | - Yuxia Huang
- Department of Computer ScienceTexas A&M UniversityCorpus ChristiTexasUSA
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23
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Flusberg SJ, Mackey A, Semino E. Seatbelts and raincoats, or banks and castles: Investigating the impact of vaccine metaphors. PLoS One 2024; 19:e0294739. [PMID: 38170715 PMCID: PMC10763949 DOI: 10.1371/journal.pone.0294739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024] Open
Abstract
While metaphors are frequently used to address misconceptions and hesitancy about vaccines, it is unclear how effective they are in health messaging. Using a between-subject, pretest/posttest design, we investigated the impact of explanatory metaphors on people's attitudes toward vaccines. We recruited participants online in the US (N = 301) and asked them to provide feedback on a (fictional) health messaging campaign, which we organized around responses to five common questions about vaccines. All participants completed a 24-item measure of their attitudes towards vaccines before and after evaluating the responses to the five questions. We created three possible response passages for each vaccine question: two included extended explanatory metaphors, and one contained a literal response (i.e., no explanatory metaphors). Participants were randomly assigned to receive either all metaphors or all 'literal' responses. They rated each response on several dimensions and then described how they would answer the target question about vaccines if it were posed by a friend. Results showed participants in both conditions rated most messages as being similarly understandable, informative, and persuasive, with a few notable exceptions. Participants in both conditions also exhibited a similar small-but significant-increase in favorable attitudes towards vaccines from pre- to posttest. Notably, participants in the metaphor condition provided longer free-response answers to the question posed by a hypothetical friend, with different metaphors being reused to different extents and in different ways in their responses. Taken together, our findings suggest that: (a) Brief health messaging passages may have the potential to improve attitudes towards vaccines, (b) Metaphors neither enhance nor reduce this attitude effect, (c) Metaphors may be more helpful than literal language in facilitating further social communication about vaccines.
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Affiliation(s)
- Stephen J. Flusberg
- Department of Cognitive Science, Vassar College, Poughkeepsie, New York, United States of America
| | - Alison Mackey
- Department of Linguistics, Georgetown University, Washington, DC, United States of America
| | - Elena Semino
- Department of Linguistics and English Language, Lancaster University, Lancaster, United Kingdom
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24
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Weinstein N, Schwarz K, Chan I, Kobau R, Alexander R, Kollar L, Rodriguez L, Mansergh G, Repetski T, Gandhi P, Pechta L. COVID-19 Vaccine Hesitancy Among US Adults: Safety and Effectiveness Perceptions and Messaging to Increase Vaccine Confidence and Intent to Vaccinate. Public Health Rep 2024; 139:102-111. [PMID: 37924246 PMCID: PMC10905758 DOI: 10.1177/00333549231204419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE Public health agencies have a critical role in providing effective messaging about mitigation strategies during a public health emergency. The objectives of this study were (1) to understand perceptions of COVID-19 vaccines, including concerns about side effects, safety, and effectiveness and how these perceptions influence vaccine decision-making among US adults and (2) to learn what messages might motivate vaccine uptake. METHODS In April and May 2021, we conducted 14 online focus groups with non-Hispanic English-speaking and English- and Spanish-speaking Hispanic adults (N = 99) not vaccinated against COVID-19. We oversampled adults aged 18-39 years and rural residents and systematically assessed 10 test messages. Researchers used a standardized guide and an a priori codebook for focus group discussions, coding transcripts, and thematic analysis. RESULTS Vaccine hesitancy factors included fear of the unknown; long-term side effects, including infertility; and beliefs that the vaccines were developed too quickly and were not sufficiently effective. Motivating factors for receiving vaccination included the ability to safely socialize and travel. Health care providers were considered important trusted messengers. Participants were critical of most messages tested. Messages that came across as "honest" about what is not yet known about COVID-19 vaccines were perceived more positively than other messages tested. Messages were seen as ineffective if perceived as vague or lacking in data and specificity. CONCLUSIONS Messages that were simple and transparent about what is unknown about vaccines relative to emerging science were viewed most favorably. Health care providers, friends, and family were considered influential in vaccination decision-making. Findings underscore the benefits of research-informed strategies for developing and disseminating effective messages addressing critical issues in a public health emergency.
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Affiliation(s)
| | - Kelsey Schwarz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Rosemarie Kobau
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Laura Kollar
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gordon Mansergh
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Laura Pechta
- Division of Communications Science and Services, Office of Communication, Centers for Disease Control and Prevention, Atlanta, GA, USA
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25
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Arsenault C, Lewis TP, Kapoor NR, Okiro EA, Leslie HH, Armeni P, Jarhyan P, Doubova SV, Wright KD, Aryal A, Kounnavong S, Mohan S, Odipo E, Lee HY, Shin J, Ayele W, Medina-Ranilla J, Espinoza-Pajuelo L, Derseh Mebratie A, García Elorrio E, Mazzoni A, Oh J, SteelFisher GK, Tarricone R, Kruk ME. Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries. Lancet Glob Health 2024; 12:e156-e165. [PMID: 38096888 PMCID: PMC10716622 DOI: 10.1016/s2214-109x(23)00490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023]
Abstract
The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington DC, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Emelda A Okiro
- Population & Health Impact Surveillance Group, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Hannah H Leslie
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Patrizio Armeni
- CERGAS SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Katherine D Wright
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Amit Aryal
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | | | - Sailesh Mohan
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Emily Odipo
- Population & Health Impact Surveillance Group, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea
| | - Jeonghyun Shin
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jesús Medina-Ranilla
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura Espinoza-Pajuelo
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- CERGAS SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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26
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Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, Kooner P, Berendes S, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis. J Travel Med 2023; 30:taad138. [PMID: 37934788 PMCID: PMC10755181 DOI: 10.1093/jtm/taad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations. CONCLUSIONS Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.
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Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George’s University of London, London, UK
| | - Rania Mansour
- Population Health Research Institute, St George’s University of London, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George’s University of London, London, UK
| | - Samuel Freeman
- Primary Care Unit, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s University of London, London, UK
| | - Pahalavi Ravindran
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | | | - Sima Berendes
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan Morris
- Population Health Research Institute, St George’s University of London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sally Hargreaves
- Population Health Research Institute, St George’s University of London, London, UK
- The Migrant Health Research Unit, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
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27
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MacEwan SR, Kenah E, Dixon GN, Stevens J, Eiterman LP, Powell JR, Gage CB, Rush LJ, Panchal AR, McAlearney AS. Identifying beliefs driving COVID-19 vaccination: Lessons for effective messaging. Hum Vaccin Immunother 2023; 19:2266929. [PMID: 37947193 PMCID: PMC10653659 DOI: 10.1080/21645515.2023.2266929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023] Open
Abstract
Increasing vaccination acceptance has been essential during the COVID-19 pandemic and in preparation for future public health emergencies. This study aimed to identify messaging strategies to encourage vaccine uptake by measuring the drivers of COVID-19 vaccination among the general public. A survey to assess COVID-19 vaccination acceptance and hesitancy was advertised on Facebook in February-April 2022. The survey included items asking about COVID-19 vaccination status and participant demographics, and three scales assessing medical mistrust, perceived COVID-19 risk, and COVID-19 vaccine confidence (adapted from the Oxford COVID-19 vaccine confidence and complacency scale). The main outcome was vaccination, predicted by patient demographics and survey scale scores. Of 1,915 survey responses, 1,450 (75.7%) were included, with 1,048 (72.3%) respondents reporting they had been vaccinated. In a multivariable regression model, the COVID-19 vaccine confidence scale was the strongest predictor of vaccination, along with education level and perceived COVID-19 risk. Among the items on this scale, not all were equally important in predicting COVID-19 vaccination. The items that best predicted vaccination, at a given score on the COVID-19 vaccine confidence scale, included confidence that vaccine side effects are minimal, that the vaccine will work, that the vaccine will help the community, and that the vaccine provides freedom to move on with life. This study improved our understanding of perceptions most strongly associated with vaccine acceptance, allowing us to consider how to develop messages that may be particularly effective in encouraging vaccination among the general public for both the COVID-19 pandemic and future public health emergencies.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Eben Kenah
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Graham N. Dixon
- School of Communication, College of Arts and Sciences, The Ohio State University, Columbus, OH, USA
| | - Jack Stevens
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Leanna Perez Eiterman
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jonathan R. Powell
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Christopher B. Gage
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashish R. Panchal
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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28
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Okuhara T, Shirabe R, Kagawa Y, Okada H, Kiuchi T. Encouraging COVID-19 vaccination by focusing on anticipated affect: A scoping review. Heliyon 2023; 9:e22655. [PMID: 38076197 PMCID: PMC10709050 DOI: 10.1016/j.heliyon.2023.e22655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE This study reviewed studies of the anticipated affect related with COVID-19 vaccination to understand gaps in currently available studies and practice implications. METHODS We systematically searched MEDLINE, CINAHL, and other multiple databases for English language articles of studies that investigated COVID-19 vaccination related anticipated affects. RESULTS We identified seventeen studies. Thirteen studies focused anticipated regret from inaction (i.e., not vaccinated). Other studies focused anticipated regret from action (i.e., vaccinated), guilt from inaction, pride from action, and positive feelings from action. Eleven studies showed that anticipated regret from inaction was significantly associated with COVID-19 vaccination behavior or intention. Three of the 11 studies showed that anticipated regret from inaction was more strongly associated with vaccination behavior or intention than cognitive belief. CONCLUSION Most studies showed that positive associations between anticipated regret and COVID-19 vaccination outcomes. The use of messages that target cognitive beliefs as well as those that appeal to anticipated affect may be effective to promote COVID-19 vaccination. However, most studies employed a cross-sectional design and examined negative affect. Future studies should adopt an experimental design as well as examine positive affect.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ritsuko Shirabe
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumi Kagawa
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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29
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Candio P, Violato M, Clarke PM, Duch R, Roope LS. Prevalence, predictors and reasons for COVID-19 vaccine hesitancy: Results of a global online survey. Health Policy 2023; 137:104895. [PMID: 37666080 DOI: 10.1016/j.healthpol.2023.104895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
Vaccine hesitancy has the potential to cripple efforts to end the COVID-19 pandemic. Policy makers need to be informed about the scale, nature and drivers of this problem, both domestically and globally, so that effective interventions can be designed. To this end, we conducted a statistical analysis of data from the CANDOUR survey (n = 15,536), which was carried out in 13 countries representing approximately half of the global population. Both pooled and country-level ordered regression models were estimated to identify predictors of vaccine hesitancy and reasons for not getting vaccinated. We found high levels of hesitancy, particularly in high-income countries. Factors driving moderate hesitancy differed from those driving extreme hesitancy. A lack of trust in health care providers was consistently the underlying driver of more extreme hesitancy. Predictors of moderate hesitancy varied across countries, though being younger and female was typically associated with greater hesitancy. While political ideology played a role in vaccine hesitancy in some countries, this effect was often moderated by income level, particularly in the US. Overall, the results suggest that different interventions such as mass-media campaigns and monetary incentives may be needed to target the moderately versus extremely hesitant. The lack of trust in health care professionals that drives extreme hesitancy may reflect deep societal mistrust in science and institutions and be challenging to overcome.
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Affiliation(s)
- Paolo Candio
- Department of Economics and Management, University of Trento, Trento, Italy; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom; Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Raymond Duch
- Nuffield College, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland, UK
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
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Zhang X, Tulloch JSP, Knott S, Allison R, Parvulescu P, Buchan IE, Garcia-Finana M, Piroddi R, Green MA, Baird S, Barr B. Evaluating the impact of using mobile vaccination units to increase COVID-19 vaccination uptake in Cheshire and Merseyside, UK: a synthetic control analysis. BMJ Open 2023; 13:e071852. [PMID: 37802621 PMCID: PMC10565187 DOI: 10.1136/bmjopen-2023-071852] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To evaluate the impact of mobile vaccination units on COVID-19 vaccine uptake of the first dose, the percentage of vaccinated people among the total eligible population. We further investigate whether such an effect differed by deprivation, ethnicity and age. DESIGN Synthetic control analysis. SETTING The population registered with general practices (GPs) in nine local authority areas in Cheshire and Merseyside in Northwest England, UK. INTERVENTION Mobile vaccination units that visited 37 sites on 54 occasions between 12 April 2021 and 28 June 2021. We defined intervention neighbourhoods as having their population weighted centroid located within 1 km of mobile vaccination sites (338 006 individuals). A weighted combination of neighbourhoods that had not received the intervention (1 495 582 individuals) was used to construct a synthetic control group. OUTCOME The weekly number of first-dose vaccines received among people aged 18 years and over as a proportion of the population. RESULTS The introduction of a mobile vaccination unit into a neighbourhood increased the number of first vaccinations conducted in the neighbourhood by 25% (95% CI 21% to 28%) within 3 weeks after the first visit to a neighbourhood, compared with the synthetic control group. Interaction analyses showed smaller or no effect among older age groups, Asian and black ethnic groups, and the most socioeconomically deprived populations. CONCLUSIONS Mobile vaccination units are effective interventions for increasing vaccination uptake, at least in the short term. While mobile units can be geographically targeted to reduce inequalities, we found evidence that they may increase inequalities in vaccine uptake within targeted areas, as the intervention was less effective among groups that tended to have lower vaccination uptake. Mobile vaccination units should be used in combination with activities to maximise outreach with black and Asian communities and socioeconomically disadvantaged groups.
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Affiliation(s)
- Xingna Zhang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Shane Knott
- Public Health, Liverpool City Council, Liverpool, UK
| | | | | | - Iain E Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Roberta Piroddi
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Mark A Green
- Geography & Planning, University of Liverpool, Liverpool, UK
| | | | - Ben Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Yao Y, Wu YS, Weng X, Viswanath K, Lee EWJ, Wang MP. Socio-economic disparities in exposure to and endorsement of COVID-19 vaccine misinformation and the associations with vaccine hesitancy and vaccination. Public Health 2023; 223:217-222. [PMID: 37677851 DOI: 10.1016/j.puhe.2023.08.005] [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: 06/05/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES We examined disparities in vaccine misinformation exposure and endorsement and the associations with vaccine hesitancy and vaccination uptake. STUDY DESIGN Population-based survey. METHODS A population-based survey was conducted on 5,002 Hong Kong adults oversampling low socio-economic status (SES, n = 2,200). Information on exposure (13 misinformation statements, total 0-13, median = 2), endorsement (13 statements, score 0-10, high scores indicate higher levels of endorsement, median = 5.75) of misinformation, vaccine hesitancy (14 items, score 1-5), and vaccination (two doses) were collected. Multivariable regression (adjusted β [aβ]) and Poisson regression (adjusted risk ratio [aRR]) adjusting for demographic characteristics were used to examine the associations of exposure to and endorsement of misinformation with vaccine hesitancy and vaccination. RESULTS A total of 71.8% of respondents had at least exposure to one vaccine misinformation, and 35.7% had a high level of endorsement (median or above). Respondents with lower SES had a lower exposure (≤2 statements, 57.1% vs 50.1%, P < 0.001) but a higher level of endorsement (36.6% vs 34.9%, P = 0.01) of misinformation. Overall, 72.9% had been vaccinated for two or more doses, with a lower proportion in respondents with lower SES (83.6% vs 61.1%; P < 0.001). Compared with no exposure to misinformation, high levels of exposure and endorsement were associated with vaccine hesitancy (aβ = 0.44, 95% confidence interval 0.40-0.48; aβ = 0.50, 0.47-0.54, respectively) and lower vaccination rates (aRR = 0.98, 0.97-0.99; aRR = 0.92, 0.88-0.96, respectively). Vaccine hesitancy mediated the associations of exposure (fully, 100%) and endorsement (partially, 73%) with vaccination uptake. CONCLUSION Endorsement of vaccine misinformation in respondents with lower SES was associated with low vaccination uptake.
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Affiliation(s)
- Y Yao
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Y S Wu
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - X Weng
- Institute of Advanced Studies in Humanities and Social Science, Beijing Normal University (Zhuhai Campus), Zhuhai, China
| | - K Viswanath
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - E W J Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China.
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Goto R, Kawachi I, Kondo N, Inoue K. Contribution of vaccinations to reducing socioeconomic disparities in COVID-19 deaths across U.S. counties. Ann Epidemiol 2023; 86:65-71.e3. [PMID: 37454832 DOI: 10.1016/j.annepidem.2023.07.003] [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: 02/21/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Although increasing vaccine uptake is a key strategy to minimize Coronavirus Disease 2019 (COVID-19) deaths, evidence of the role of vaccination rates in attenuating the socioeconomic disparity in COVID-19 deaths is limited. We thus aimed to quantify the extent to which vaccination rates contribute to the association between U.S. county-level poverty rates and COVID-19 mortality rates. METHODS This nationwide study analyzed data on 3142 U.S. counties. We conducted mediation analyses to calculate the proportions eliminated (PE) of the association between poverty rate and COVID-19 deaths per 100,000 population by setting the COVID-19 vaccination rate (the proportion of fully vaccinated individuals as of December 31, 2021) to different observed values. RESULTS Adjusted for county-level characteristics, we estimate an additional 25.3 COVID-19 deaths per 100,000 population for each 10% increase in a county's poverty rate. When we set the vaccination rate at its maximum, 90th percentile, and 75th percentile of the observed values, the PE was estimated to be 81% (P < .001), 37% (P < .001), and 21% (P < .001), respectively. CONCLUSIONS Higher county-level poverty rates and lower vaccination rates were associated with greater COVID-19 mortality rates in the United States. Aggressive interventions to increase vaccine uptake could substantially reduce the social disparity in COVID-19 mortality.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Fukai T, Kawata K, Nakabayashi M. Updated beliefs and shaken confidence: evidence from vaccine hesitancy caused by experiencing "COVID arm". BMC Infect Dis 2023; 23:612. [PMID: 37723413 PMCID: PMC10507958 DOI: 10.1186/s12879-023-08558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Public health depends largely on people's knowledge, beliefs, or behaviors regarding their health and medical treatments. Although works based on the health belief model have shown that public beliefs about medical treatments affect willingness to take the treatments, little is known about the effects of changes in beliefs on attitudes toward treatment. How one's past experiences relate to one's beliefs about a given medical treatment is worth considering. METHODS We implemented an online panel survey in February 2021 and March 2022 in Japan before and after COVID-19 vaccines were administered to the public within the country. We exploited delayed localized hypersensitivity reactions to COVID-19 vaccines, namely, "COVID arm", as an exogenous shock to investigate the relationship between past negative experiences and current beliefs about medical treatments or science. "COVID arm" was an unexpected side effect and thus likely caused updated beliefs about the vaccine. Out of the nonprobability sample of 15,000 respondents in the first wave in February 2021, 9,668 respondents also responded to the second wave conducted in March 2022. Outcome variables were whether experiencing "COVID arm" affected the respondents' 1) confidence in vaccine safety, 2) willingness to take the next dose of COVID-19 vaccines, 3) acknowledgment of the importance of vaccination, and 4) confidence in science. We measured the impact of experience with "COVID arm" on changes in the probability that survey respondents would respond affirmatively to questions posed about the issues listed above. RESULTS Experiencing "COVID arm" significantly lowered confidence in the safety of vaccination by 4.3 percentage points, which was approximately 6% of the sample mean for the first wave, and lowered the probability of taking a second dose of the COVID-19 vaccine by 1.5 percentage points. These adverse impacts were observed after conditioning background characteristics and prior confidence in vaccination. Experiencing "COVID arm" affected neither the acknowledged importance of vaccination nor confidence in science in a statistically significant way. CONCLUSIONS An unexpected and uncomfortable shock regarding beliefs about a treatment decreases willingness to take the treatment. An appropriate public health policy should account for this effect. TRIAL REGISTRATION The survey was preregistered with the American Economic Association's RCT Registry (Fukai et al., 2022).
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Affiliation(s)
- Taiyo Fukai
- Faculty of Humanities and Social Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keisuke Kawata
- Institute of Social Science, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Masaki Nakabayashi
- Institute of Social Science, The University of Tokyo, Bunkyo, Tokyo, Japan.
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Alhajji M, Alzeer AH, Al-Jafar R, Alshehri R, Alyahya S, Alsuhaibani S, Alkhudair S, Aldhahiri R, Alhomaid A, Alali D, Alothman A, Alkhulaifi E, Alnashar M, Alalmaee A, Aljenaidel I, Alsaawi F. A national nudge study of differently framed messages to increase COVID-19 vaccine uptake in Saudi Arabia: A randomized controlled trial. Saudi Pharm J 2023; 31:101748. [PMID: 37662677 PMCID: PMC10472300 DOI: 10.1016/j.jsps.2023.101748] [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: 12/05/2022] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals. Methods This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn't take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups. Results Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p = 0.001; 19.1%, p = 0.011; 19.0%, p = 0.013; 18.4%, p = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group (p < 0.001). The percentages of booked appointments made by Young adults (18-35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p = 0.016) and ego groups (21.0%, p = 0.010). At the same time, sex didn't affect the percentages of booked appointments in any group. Conclusion Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations.
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Affiliation(s)
| | - Abdullah H. Alzeer
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rami Al-Jafar
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- School of Public Health, Imperial College London, London, UK
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alyahya
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Sara Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sarah Alkhudair
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Raghad Aldhahiri
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Ahmed Alhomaid
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Dalal Alali
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Fahad Alsaawi
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [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: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Kurt O, Küçükkelepçe O, Öz E, Doğan Tiryaki H, Parlak ME. Childhood Vaccine Attitude and Refusal among Turkish Parents. Vaccines (Basel) 2023; 11:1285. [PMID: 37631853 PMCID: PMC10457800 DOI: 10.3390/vaccines11081285] [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: 06/09/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
We aimed to understand and resolve anti-vaccine attitudes by examining the factors associated with vaccine attitudes and exploring potential strategies to improve childhood vaccination rates. Between 2014 and 2021, a total of 628 families refused vaccination in Adiyaman. A total of 300 families accepted visits and were visited. During the visits, the families were administered a questionnaire to determine the reasons for vaccine rejection and their opinions on the matter. While providing general information about the vaccine, parents were encouraged to reconsider their decision, and at the end, parents completed the questionnaire. The questionnaire included sociodemographic questions, reasons for vaccine refusal, and a vaccine attitude scale. Among the participants in the study, 9.3% were convinced about the vaccine. The mean vaccine attitude scale score was calculated as 23.6 ± 2.5 (min = 15-max = 29). Significantly higher rates of persuasion were observed among fathers (17.3%) compared to mothers (7.7%) (p = 0.038). Participants who had received some vaccinations had a higher rate of persuasion (11.6%) compared to those who had not received any vaccinations (2.6%) (p = 0.02). Childhood vaccine refusal is a complex issue that has been the subject of numerous studies. Studies on this subject will increase awareness of vaccines.
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Affiliation(s)
- Osman Kurt
- Adiyaman Provincial Health Directorate, 02100 Adıyaman, Turkey; (O.K.); (E.Ö.)
| | - Osman Küçükkelepçe
- Adiyaman Provincial Health Directorate, 02100 Adıyaman, Turkey; (O.K.); (E.Ö.)
| | - Erdoğan Öz
- Adiyaman Provincial Health Directorate, 02100 Adıyaman, Turkey; (O.K.); (E.Ö.)
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Chater AM, Brook-Rowland P, Tolani F, Christopher E, Hart J, Byrne-Davis LMT, Moffat A, Shorter GW, Epton T, Kamal A, O’Connor DB, Whittaker E, Lewis LJM, McBride E, Swanson V, Arden MA. Understanding a constellation of eight COVID-19 disease prevention behaviours using the COM-B model and the theoretical domains framework: a qualitative study using the behaviour change wheel. Front Public Health 2023; 11:1130875. [PMID: 37475767 PMCID: PMC10355219 DOI: 10.3389/fpubh.2023.1130875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
Background The use of behavioural science and behaviour change within local authorities and public health has supported healthful change; as evidenced by its importance and contribution to reducing harm during the COVID-19 pandemic. It can provide valuable information to enable the creation of evidence-based intervention strategies, co-created with the people they are aimed at, in an effective and efficient manner. Aim This study aimed to use the COM-B model to understand the Capability, Opportunity and Motivation of performing a constellation of eight COVID-19 disease prevention behaviours related to the slogans of 'Hands, Face, Space, Fresh Air'; 'Find, Isolate, Test, (FIT), and Vaccinate' in those employed in workplaces identified as high risk for transmission of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to support intervention development. Methods This qualitative study recruited twenty-three participants (16 female, 7 male), who were interviewed from three environments (schools, care homes, warehouses) across three local authorities. Semi-structured interviews were analysed using thematic analysis. Findings Ten core themes were identified inductively; (1) knowledge and skills, (2) regulating the behaviour, (3) willingness to act, (4) necessity and concerns, (5) emotional impact, (6) conducive environment, (7) societal influence, (8) no longer united against COVID-19, (9) credible leadership, and (10) inconsistent adherence to COVID-19 prevention behaviours. Themes were then deductively mapped to the COM-B model of behaviour change and the theoretical domains framework and a logic model using the behaviour change wheel (BCW) was produced to inform intervention design. Conclusion This study offers a novel approach to analysis that has included eight behaviours within a single thematic analysis and COM-B diagnosis. This will enable local authorities to direct limited resources to overarching priorities. Of key importance, was the need for supportive and credible leadership, alongside developing interventions collaboratively with the target audience. COVID-19 has had an emotional toll on those interviewed, however, promoting the value of disease prevention behaviours, over and above their costs, can facilitate behaviour. Developing knowledge and skills, through education, training, marketing and modelling can further facilitate behaviour. This supports guidance produced by the British Psychological Society COVID-19 behavioural science and disease prevention taskforce.
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Affiliation(s)
- Angel M. Chater
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, United Kingdom
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Phoebe Brook-Rowland
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, United Kingdom
| | - Foyeke Tolani
- Bedford Borough, Central Bedfordshire and Milton Keynes Councils’ Shared Public Health Services, Bedford, United Kingdom
| | - Emily Christopher
- Bedford Borough, Central Bedfordshire and Milton Keynes Councils’ Shared Public Health Services, Bedford, United Kingdom
| | - Jo Hart
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Abby Moffat
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, United Kingdom
| | - Gillian W. Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Tracy Epton
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Atiya Kamal
- School of Social Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Daryl B. O’Connor
- Laboratory for Stress and Health Research, University of Leeds, Leeds, United Kingdom
| | - Eleanor Whittaker
- North Yorkshire County Council, Northallerton, North Yorkshire, United Kingdom
| | - Lesley J. M. Lewis
- Behavioural Science Unit, Public Health, Somerset County Council, Taunton, United Kingdom
| | - Emily McBride
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Vivien Swanson
- Psychology Division, University of Stirling, Stirling, United Kingdom
| | - Madelynne A. Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom
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McGuinness SL, Eades O, Seale H, Cheng AC, Leder K. Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine. J Travel Med 2023; 30:taad056. [PMID: 37074157 PMCID: PMC10289516 DOI: 10.1093/jtm/taad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many travellers do not receive vaccines pre-travel. Tools such as vaccine decision aids could support informed vaccine decision-making. We aimed to characterise Australians' pre-travel vaccine attitudes, behaviours and information needs and examine the role for decision aids in travel medicine. METHODS Online cross-sectional survey of Australian adults in December 2022. We included questions on demographics, pre-travel health-seeking behaviour, and information needs. We measured vaccine confidence (Vaccine Confidence Index Index) and used hypothetical disease scenarios to evaluate behavioural and social drivers of vaccination. We used multivariable logistic regression models to identify predictors of vaccine uptake and thematically analysed free-text responses. RESULTS We received complete survey responses from 1223/1326 Australians (92% response rate). Amongst those reporting previous overseas travel, 67% (778/1161) reported past pre-travel health encounter(s) and 64% (743/1161) reported past pre-travel vaccination. Half (50%) strongly agreed that vaccines were important for their health; fewer strongly agreed that vaccines were safe (37%) and effective (38%). In multivariable analyses, past pre-travel vaccine uptake was associated with increasing age (OR = 1.17 [95% CI 1.08-1.27] p < 0.001 per ten-year increase) and travel to higher-risk destinations (OR = 2.92 [2.17-3.93] p < 0.001); travellers visiting friends and relatives (VFRs) were less likely to have received pre-travel vaccines (OR = 0.74 [0.56-0.97] p = 0.028). Predictors for wanting vaccination against hypothetical diseases included past pre-travel vaccination (Disease X: OR 2.60 [1.91-3.56] p < 0.001) and confidence in vaccine safety (Disease X: OR 7.18 [5.07-10.18], p < 0.001); past VFR travel was predictive of not wanting vaccination (Disease X: OR 0.72 [0.52-1.00], p = 0.049). Most (63%) were interested in using a vaccine decision aid, generally together with a trusted health professional. CONCLUSIONS Health professionals play an important role in supporting pre-travel vaccine decision-making. However, our findings indicate that reliable, accurate and engaging digital resources, such as decision aids, could support travellers to make informed pre-travel vaccine decisions.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Monash Infectious Diseases Service, Monash Health and School of Clinical Sciences, Monash University, Melbourne 3168, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne 3000, Australia
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Steffens MS, Bullivant B, Kaufman J, King C, Danchin M, Hoq M, Marques MD. Testing persuasive messages about booster doses of COVID-19 vaccines on intention to vaccinate in Australian adults: A randomised controlled trial. PLoS One 2023; 18:e0286799. [PMID: 37267399 DOI: 10.1371/journal.pone.0286799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Achieving high COVID-19 vaccine booster coverage is an ongoing global challenge. Health authorities need evidence about effective communication interventions to improve acceptance and uptake. This study aimed to test effects of persuasive messages about COVID-19 vaccine booster doses on intention to vaccinate amongst eligible adults in Australia. METHODS In this online randomised controlled trial, adult participants received one of four intervention messages or a control message. The control message provided information about booster dose eligibility. Intervention messages added to the control message, each using a different persuasive strategy, including: emphasising personal health benefits of booster doses, community health benefits, non-health benefits, and personal agency in choosing vaccination. After the intervention, participants answered items about COVID-19 booster vaccine intention and beliefs. Intervention groups were compared to the control using tests of two proportions; differences of ≥5 percentage points were deemed clinically significant. A sub-group analysis was conducted among hesitant participants. RESULTS Of the 487 consenting and randomised participants, 442 (90.8%) completed the experiment and were included in the analysis. Participants viewing messages emphasising non-health benefits had the highest intention compared to those who viewed the control message (percentage point diff: 9.0, 95% CI -0.8, 18.8, p = 0.071). Intention was even higher among hesitant individuals in this intervention group compared to the control group (percentage point diff: 15.6, 95% CI -6.0, 37.3, p = 0.150). Conversely, intention was lower among hesitant individuals who viewed messages emphasising personal agency compared to the control group (percentage point diff: -10.8, 95% CI -33.0, 11.4, p = 0.330), although evidence in support of these findings is weak. CONCLUSION Health authorities should highlight non-health benefits to encourage COVID-19 vaccine booster uptake but use messages emphasising personal agency with caution. These findings can inform communication message development and strategies to improve COVID-19 vaccine booster uptake. Clinical trial registration: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001404718); trial webpage: https://www.anzctr.org.au/ACTRN12622001404718.aspx.
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Affiliation(s)
- Maryke S Steffens
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Bullivant
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jessica Kaufman
- Vaccine Uptake Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Margie Danchin
- Vaccine Uptake Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Monsurul Hoq
- Vaccine Uptake Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Australia
- The National Child Health Poll, The Royal Children's Hospital, Parkville, Australia
| | - Mathew D Marques
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Xie L, Wang D, Ma F. Analysis of individual characteristics influencing user polarization in COVID-19 vaccine hesitancy. COMPUTERS IN HUMAN BEHAVIOR 2023; 143:107649. [PMID: 36683861 PMCID: PMC9844095 DOI: 10.1016/j.chb.2022.107649] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
During the COVID-19 pandemic, vaccine hesitancy proved to be a major obstacle in efforts to control and mitigate the negative consequences of COVID-19. This study centered on the degree of polarization on social media about vaccine use and contributing factors to vaccine hesitancy among social media users. Examining the discussion about COVID-19 vaccine on the Weibo platform, a relatively comprehensive system of user features was constructed based on psychological theories and models such as the curiosity-drive theory and the big five model of personality. Then machine learning methods were used to explore the paramount impacting factors that led users into polarization. Findings revealed that factors reflecting the activity and effectiveness of social media use promoted user polarization. In contrast, features reflecting users' information processing ability and personal qualities had a negative impact on polarization. This study hopes to help healthcare organizations and governments understand and curb social media polarization around vaccine development in the face of future surges of pandemics.
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Affiliation(s)
- Lei Xie
- School of Information Management, Wuhan University, Wuhan, 430072, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China
| | - Dandan Wang
- School of Information Management, Wuhan University, Wuhan, 430072, China,School of Data Science, City University of Hong Kong, Hong Kong, 999077, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China
| | - Feicheng Ma
- School of Information Management, Wuhan University, Wuhan, 430072, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China,Corresponding author. School of Information Management, Wuhan University, Wuhan, China
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Bullivant B, Bolsewicz KT, King C, Steffens MS. COVID-19 vaccination acceptance among older adults: A qualitative study in New South Wales, Australia. PUBLIC HEALTH IN PRACTICE 2023; 5:100349. [PMCID: PMC9737511 DOI: 10.1016/j.puhip.2022.100349] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives The COVID-19 pandemic has had a severe impact on people across the world, particularly older adults who have a higher risk of death and health complications. We aimed to explore older adults’ intention towards COVID-19 vaccination and factors that influenced their motivation to get vaccinated. Study design A qualitative study was conducted in New South Wales, Australia (April 2021), involving interviews with older adults (aged 70 years and older). Methods In-depth interviews were carried out with 14 older adults on their perceptions around COVID-19 vaccination. The COVID-19 vaccination program had just commenced at the time of data collection. We thematically analysed interviews and organised the themes within the Behavioural and Social Drivers of Vaccination (BeSD) Framework. Results We found that most participants were accepting of COVID-19 vaccination. Participants’ motivation to get vaccinated was influenced by the way they thought and felt about COVID-19 disease and vaccination (including perceptions of vaccine safety, effectiveness, benefits, COVID-19 disease risk, and vaccine brand preferences) and social influences (including healthcare provider recommendation, and influential others). The uptake of COVID-19 vaccination was also mediated by practical issues such as access and affordability. Conclusions Efforts to increase COVID-19 vaccination acceptance in this population should focus on highlighting the benefits of vaccination. Support should be given to immunisation providers to enhance efforts to discuss and recommend vaccination to this high-risk group.
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Affiliation(s)
- Bianca Bullivant
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St., Westmead, NSW, 2145, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Corresponding author. National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St., Westmead, NSW, 2145, Australia
| | - Katarzyna T. Bolsewicz
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St., Westmead, NSW, 2145, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Hunter New England Local Health District, Health Protection, Wallsend Hospital Campus, Wallsend, NSW, 2287, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St., Westmead, NSW, 2145, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maryke S. Steffens
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children's Hospitals Network, Cnr Hawkesbury Rd & Hainsworth St., Westmead, NSW, 2145, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Sharma E, Mondal S, Das S, Vrana VG. Scale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological Factors. Vaccines (Basel) 2023; 11:1052. [PMID: 37376441 DOI: 10.3390/vaccines11061052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Vaccination is the most cost-effective way to maintain population health. However, it can only be effective if widespread acceptance is held. The efficacy of COVID-19 vaccines depends on their favor. When countries start to vaccinate their citizens, there is a certain level of skepticism about the effectiveness of the vaccines. The hesitancy study on vaccines has gained momentum following the pandemic. However, few studies have examined the link between the psychological and sociodemographic factors influencing the fit. This paper proposes integrating the concepts of the information systems success and stimulus-organism-response into a cognitive fit theory framework to explore the integration of psychological and sociodemographic factors in the receivers' reactions (n = 1510). This study analyses the factors that influence the hesitancy of vaccines and the public's refusal in Asia and Europe. Receivers' reactions were assessed to various stimuli and we explored the link between psychological and sociodemographic elements and the concept of fit. Two surveys were conducted following the scale development of Mackenzie. The first was to develop the fit scale, while the second was to validate the fit scale. The results of the second survey were analyzed using structural equation modelling. The results indicate that the scale's fit development is valid and reliable. The quality of the vaccine information, the psychological characteristics of the vaccine system, and vaccine receivers' satisfaction are also beneficial factors for emotional and cognitive fit. Maintaining the vaccines' quality and efficiency can help improve the fit between sociodemographic and psychological characteristics. It can also enhance receivers' satisfaction and encourage continued vaccine administration. This study is regarded as one of the first to examine and develop an emotional and cognitive fit scale for practitioners and researchers.
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Affiliation(s)
- Eliza Sharma
- Symbiosis Institute of Business Management Bengaluru, Symbiosis International (Deemed University), Karnataka 560100, India
| | - Subhra Mondal
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Subhankar Das
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Vasiliki G Vrana
- Department of Business Administration, School of Economics and Administration, The Campus of Serres, International Hellenic University, 62124 Serres, Greece
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Ryan GW, Goulding M, Borg A, Minkah P, Beeler A, Rosal MC, Lemon SC. Development and Beta-Testing of the CONFIDENCE Intervention to Increase Pediatric COVID-19 Vaccination. J Pediatr Health Care 2023; 37:244-252. [PMID: 36470798 PMCID: PMC9671697 DOI: 10.1016/j.pedhc.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Innovative strategies are needed to improve pediatric COVID-19 vaccination rates. We describe the process for developing a clinic-based intervention, CONFIDENCE, to improve pediatric COVID-19 vaccine uptake and present results of our beta-test for feasibility and acceptability. METHOD CONFIDENCE included communication training with providers, a poster campaign, and parent-facing educational materials. We assessed feasibility and acceptability through interviews and measured preliminary vaccine intention outcomes with a pre-post parent survey. Interviews were analyzed using rapid qualitative methods. We generated descriptive statistics for variables on the parent survey and used Fisher's exact test to assess pre-post differences. RESULTS Participating providers (n = 4) reported high levels of feasibility and acceptability. We observed positive trends in parents' (n = 69) reports of discussing vaccination with their provider and the parental decision to accept COVID-19 vaccination. DISCUSSION Our next steps will be to use more rigorous methods to establish the efficacy and effectiveness of the CONFIDENCE intervention.
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Thaker J, Richardson LM, Holmes DC. Audience segmentation analysis of public intentions to get a COVID-19 vaccine in Australia. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:470-488. [PMID: 36546333 PMCID: PMC9790861 DOI: 10.1177/09636625221138494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
While previous studies provide broad categories of the public who intend to get a COVID-19 vaccine, few systematically segment and help understand and engage with distinct publics to improve COVID-19 vaccine uptake. Using data from a national sample of the Australian public (N = 1054) and using measures primarily based on the Theory of Planned Behaviour, a latent class analysis of 16 items was undertaken to identify COVID-19 audience segments for potential future message targeting. We found five different segments of COVID-19 vaccine intentions: vaccine enthusiasts (28%), supporters (26%), socials (20%), hesitant (15%) and sceptics (10%). These five audience segments also differ on demographic variables and their level of trust in mainstream media, scientists and health experts, social media and family and friends. Understanding the COVID-19 vaccine attitudinal and information-seeking characteristics of these sub-publics will help inform appropriate messaging campaigns.
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Affiliation(s)
- Jagadish Thaker
- Jagadish Thaker, University of Auckland, 502 Room, Bldg 207, Symonds Street, Auckland 1010, New Zealand.
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Zhang M, Wang Y, Zhang T, Zhou J, Deng Y, Wang L, Du Y. Status of and perspectives on COVID-19 vaccination after lifting of the dynamic zero-COVID policy in China. Glob Health Med 2023; 5:112-117. [PMID: 37128227 PMCID: PMC10130544 DOI: 10.35772/ghm.2022.01063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 05/03/2023]
Abstract
On December 7, 2022, China's National Health Commission issued the Ten New Covid Rules lifting the dynamic zero-COVID policy. In the interim, vaccination campaigns continue to be promoted. We assessed the potential impacts on the status, perceptions, and attitudes toward COVID-19 vaccines via an online self-administered questionnaire. Among 1,170 participants, 1,142 (97.6%) participants were vaccinated against COVID-19, and 51.8% (591/1,142) have already received the booster. More than half of the participants who were vaccinated were ages 31 to 50 (51.8%). Participants believed the following strategies could improve the vaccination rate: timely feedback of the vaccination data (such as safety, efficacy, and other issues of public concern) from authoritative media (95.6%), increasing the number of vaccination sites and availability of vaccines and using more convenient methods of making appointment (95.2%), recommendations from friends and relatives (94.8%), and presenting the qualifications of the staff performing vaccination (89.1%). More measures, including targeted measures for different age groups and timely feedback on the vaccination data including safety and efficacy from authoritative media, are likely to help improve vaccination rates.
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Affiliation(s)
- Mo Zhang
- Clinical Research Unit, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yan Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Tao Zhang
- Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
| | - Yang Deng
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Address correspondence to:Yan Du, Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai 200090, China. E-mail:
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Address correspondence to:Yan Du, Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai 200090, China. E-mail:
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Dupuy-Zini A, Audeh B, Gérardin C, Duclos C, Gagneux-Brunon A, Bousquet C. Users' Reactions to Announced Vaccines Against COVID-19 Before Marketing in France: Analysis of Twitter Posts. J Med Internet Res 2023; 25:e37237. [PMID: 36596215 PMCID: PMC10132828 DOI: 10.2196/37237] [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: 02/11/2022] [Revised: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Within a few months, the COVID-19 pandemic had spread to many countries and had been a real challenge for health systems all around the world. This unprecedented crisis has led to a surge of online discussions about potential cures for the disease. Among them, vaccines have been at the heart of the debates and have faced lack of confidence before marketing in France. OBJECTIVE This study aims to identify and investigate the opinions of French Twitter users on the announced vaccines against COVID-19 through sentiment analysis. METHODS This study was conducted in 2 phases. First, we filtered a collection of tweets related to COVID-19 available on Twitter from February 2020 to August 2020 with a set of keywords associated with vaccine mistrust using word embeddings. Second, we performed sentiment analysis using deep learning to identify the characteristics of vaccine mistrust. The model was trained on a hand-labeled subset of 4548 tweets. RESULTS A set of 69 relevant keywords were identified as the semantic concept of the word "vaccin" (vaccine in French) and focused mainly on conspiracies, pharmaceutical companies, and alternative treatments. Those keywords enabled us to extract nearly 350,000 tweets in French. The sentiment analysis model achieved 0.75 accuracy. The model then predicted 16% of positive tweets, 41% of negative tweets, and 43% of neutral tweets. This allowed us to explore the semantic concepts of positive and negative tweets and to plot the trends of each sentiment. The main negative rhetoric identified from users' tweets was that vaccines are perceived as having a political purpose and that COVID-19 is a commercial argument for the pharmaceutical companies. CONCLUSIONS Twitter might be a useful tool to investigate the arguments for vaccine mistrust because it unveils political criticism contrasting with the usual concerns on adverse drug reactions. As the opposition rhetoric is more consistent and more widely spread than the positive rhetoric, we believe that this research provides effective tools to help health authorities better characterize the risk of vaccine mistrust.
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Affiliation(s)
- Alexandre Dupuy-Zini
- Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, Sorbonne Université, Université Sorbonne Paris Nord, Institut national de la santé et de la recherche médicale, INSERM, Paris, France
| | - Bissan Audeh
- Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, Sorbonne Université, Université Sorbonne Paris Nord, Institut national de la santé et de la recherche médicale, INSERM, Paris, France
| | - Christel Gérardin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de médecine interne, Sorbonne Université, Paris, France
| | - Catherine Duclos
- Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, Sorbonne Université, Université Sorbonne Paris Nord, Institut national de la santé et de la recherche médicale, INSERM, Paris, France
| | - Amandine Gagneux-Brunon
- Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, Centre International de Recherche en Infectiologie, University of Lyon, Saint Etienne, France
- Vaccinologie, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne, France
| | - Cedric Bousquet
- Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, Sorbonne Université, Université Sorbonne Paris Nord, Institut national de la santé et de la recherche médicale, INSERM, Paris, France
- Service de santé publique et information médicale, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
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Schackmann L, Hek K, Vervloet M, Koster ES, van Dijk L. Provision of and trust in COVID-19 vaccines information: Perspectives of people who have had COVID-19. Health Expect 2023; 26:806-817. [PMID: 36734131 PMCID: PMC10010094 DOI: 10.1111/hex.13706] [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: 07/20/2022] [Revised: 12/13/2022] [Accepted: 01/02/2023] [Indexed: 02/04/2023] Open
Abstract
AIM The aim of this study was to understand the provision and need, quality of and trust in COVID-19 vaccines information from the perspectives of people who have had COVID-19 infection. METHOD People who have had a COVID-19 infection were approached via their general practice and invited to participate in the Nivel Corona Cohort. They completed questionnaires at baseline (Q1), and at three months (Q2). Outcome measures were based on health information-seeking behaviour, as used in the Comprehensive Model of Information Seeking. Antecedents (i.e., gender, age, education level, health literacy) were used from Q1, and one's beliefs and experiences (i.e., trust in the information and healthcare system, how applicable the information is), information carrier factors (i.e., information quality perceptions and via which sources), health-information seeking actions (i.e., decision to vaccinate and information sufficiency) and vaccination status from Q2. Data were analysed using descriptive analyses, analysis of variance tests (F-tests) and χ2 tests with the statistical software STATA. RESULTS Of the respondents (N = 314), 96% were vaccinated at least once, mostly after having had the virus. Most retrieved information about COVID-19 vaccines on the website of the National Institute for Public Health and the Environment (79%), broader via the internet (56%), or from family and friends (35%). Almost all had trust in the information (89%) and healthcare system (94%). Most found the information applicable to their situation (67%). Moreover, most perceived the information as correct (71%) and did not perceive the information to be misleading (85%), while fewer people found the information reliable (59%) and clear (58%). Overall, the majority indicated that the information met their expectations to make a well-informed decision to vaccinate (89%). CONCLUSION Different characteristics of people who had COVID-19 and sought information were identified, which is important to offer tailored information. People who had COVID-19 in this study, mainly middle-aged, vaccinated and highly educated, were generally positive about the vaccines information, but overall the reliability and clarity could be improved. This is important for a high vaccination uptake, booster programs and coming pandemics. PATIENT OR PUBLIC CONTRIBUTION The questionnaire was reviewed by patients who had COVID-19, one of whom is a health services researcher.
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Affiliation(s)
- Laura Schackmann
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ellen S Koster
- Department of Pharmacoepidemiology & Clinical Pharmacology (UPPER), Utrecht University, Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Huff KA, Braun A, Salvaggio MR, McGough P, Frank-Pearce SG, Kendzor DE, Bui TC. Promoting HPV Vaccination in People with HIV: Factors to Consider. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5345. [PMID: 37047959 PMCID: PMC10094493 DOI: 10.3390/ijerph20075345] [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] [Received: 02/03/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
People with HIV (PWH) and their sexual partners have increased risk of human papillomavirus (HPV) infection. Despite recommended HPV vaccination for PWH aged 18-26 years, vaccination rates among PWH remain low. This qualitative study used the Information-Motivation-Behavioral Skills (IMBS) model to identify factors influencing the decisions of PWH around promoting HPV vaccination to their sexual partners. Fourteen PWH with diverse sociodemographic characteristics participated in four focus-group discussions. Data were analyzed using thematic content analysis; codes and themes included IMBS constructs. For the information construct, the need for improved HPV education emerged as the driving factor for HPV vaccine uptake and discussing HPV vaccines with partners. Focal reasons for being unvaccinated included low knowledge of HPV risk, asymptomatic cancer-causing HPV, HPV vaccines, and vaccine eligibility. Salient factors in the motivation construct included the preventive benefits of HPV vaccination to both self and sexual partners. Salient factors in the behavioral skills construct included: accessing vaccine, low self-confidence and skills for promoting vaccination, relationships with sexual partners, partners' vaccine hesitancy, and stigma. Race/ethnicity impacted HPV vaccination promotion; important determinants included perceptions of HPV-related diseases as "White people's diseases" among Black people, and discrimination against those with HPV-related diseases among the Hispanic population.
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Affiliation(s)
- Kinsey A. Huff
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Michelle R. Salvaggio
- Infectious Diseases Section, Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Patrick McGough
- Oklahoma City-County Health Department, Oklahoma City, OK 73111, USA;
| | - Summer G. Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Darla E. Kendzor
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Thanh Cong Bui
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
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The Impact of Educational Intervention on Willingness to Enroll in a Clinical Trial of a Gonorrhea Vaccine. Vaccines (Basel) 2023; 11:vaccines11030648. [PMID: 36992233 DOI: 10.3390/vaccines11030648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Globally, >80 million new gonorrhea infections occur annually. Here, we assessed barriers to and influences on participation in a gonorrhea clinical trial and the impact of educational intervention. The survey was fielded in the US in March 2022. Higher enrollment of Black/African Americans and younger individuals than represented in the US demographic distribution reflected the higher incidence of gonorrhea in these groups. Behavioral characteristics and baseline attitudes toward vaccination were collected. Participants were probed on their knowledge of and likelihood to enroll in general and gonorrhea vaccine trials. Participants hesitant to enroll in a gonorrhea vaccine trial were given nine bullets of basic facts about the disease and asked again to rank their likelihood to enroll. Overall, 450 individuals completed the survey. Fewer participants were willing (quite/very likely) to join a gonorrhea versus a general vaccine trial (38.2% [172/450] vs. 57.8% [260/450]). The likelihood to enroll in any vaccine trial or a gonorrhea vaccine trial was greater with higher self-declared knowledge (Spearman’s ρ = 0.277 [p < 0.001] and 0.316 [p < 0.001], respectively) and baseline openness towards vaccination (p < 0.001 for both). Self-declared awareness of gonorrhea was associated with age (p = 0.001), education (p = 0.031), and ethnicity/race (p = 0.002), with older, more educated, and Black/African Americans having higher awareness. Males (p = 0.001) and those with more sexual partners (p < 0.001) were more likely to enroll in a gonorrhea vaccine trial. Educational intervention had a significant (p < 0.001) impact on hesitancy. Improvement in willingness to enroll in a gonorrhea vaccine trial was greatest in those initially marginally hesitant and lowest in those initially strongly hesitant. Basic educational intervention has the potential to improve recruitment into gonorrhea vaccine trials.
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Zhu P, Tatar O, Haward B, Steck V, Griffin-Mathieu G, Perez S, Dubé È, Zimet G, Rosberger Z. Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework. Vaccines (Basel) 2023; 11:vaccines11030628. [PMID: 36992212 DOI: 10.3390/vaccines11030628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional “booster” doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18–39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults’ perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Veronica Steck
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Samara Perez
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Psychosocial Oncology Program, Cedars Cancer Center, McGill University Health Center, Montreal, QC H3A 3J1, Canada
| | - Ève Dubé
- Department of Anthropology, Laval University, Quebec, QC G1V 0A6, Canada
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
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