International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries

[Potential and limitations of school vaccination programs to increase HPV vaccination rates in Germany]

Even more than 15 years after the first vaccination recommendation by the Standing Committee on Vaccination (STIKO) against human papillomaviruses (HPV), vaccination coverage in Germany remains low. As a possible measure to increase HPV vaccination coverage in Germany, the widespread introduction of HPV school vaccination programs, as they exist in other European countries, is often called for. However, any implementation of a widespread health intervention should be preceded by an evidence assessment that also takes national circumstances into account. This article provides an overview of the evidence available to date on the effect of school vaccination programs in Germany and discusses the results. Corresponding evidence is so far limited and comes from three local (pilot) programs. These show that about one-third of those not vaccinated took up the school vaccination offer, while two-thirds did not. No program in Germany has yet collected data on the reasons for not accepting the vaccination offer or whether any hesitancy that may exist relates to the place of vaccination (school) or the vaccination itself. Furthermore, there is a lack of cost-benefit analyses of school vaccination programs. This would be important for their evaluation due to the structures that would have to be newly established in Germany for this purpose. Based on the evidence available to date, it seems rather unlikely that the introduction of a comprehensive school vaccination program could significantly increase HPV vaccination rates in Germany. However, in addition to other measures, school vaccination programs could possibly be part of a structured vaccination system for specific target groups or in certain defined regions. In contrast to the existing vaccination system in Germany, such a structured vaccination system could ensure that all members of the target group are actively offered HPV vaccination.

A randomized controlled trial of empathetic refutational learning with health care professionals

BACKGROUND

Health care professionals are in a key position to promote vaccinations. However, consulting vaccine-hesitant patients can be difficult, especially when patients bring up anti-vaccination arguments. Whereas prior research has identified essential skills for refuting anti-vaccination arguments, little is known about how to acquire these skills. Our aim was to determine if empathetic refutational interview text scenarios help health care professionals build confidence and abilities in countering anti-vaccination arguments.

METHODS

We conducted an online randomized controlled experiment with UK and Finnish health care professionals in which we randomly assigned them to an empathetic refutational interview group (n = 167) or a control group (n = 180). Participants in the empathetic refutational interview group were presented with examples of the empathetic refutational interview approach, which encompasses the identification of attitude roots, affirmations, corrections of misconceptions, and provision of facts. Control group participants received a standard facts-based approach. We examined posttest use of empathetic refutational interview techniques and pre- and posttest perceived difficulty of refuting anti-vaccination arguments.

RESULTS

Participants in the empathetic refutational interview group used more empathetic affirmations than control group participants. The empathetic refutational interview group and the control group did not differ significantly in how often they explicitly tried to identify attitude roots, correct misconceptions, and provide vaccination facts, nor in how difficult they found anti-vaccination arguments to be to refute.

CONCLUSIONS

Brief empathetic refutational interview text scenarios can increase health care professionals' use of affirmations when discussing vaccines with patients. Additional materials are needed to efficiently teach refutations of attitude roots.

Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

BACKGROUND

Before, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating.

OBJECTIVES

To study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy.

DESIGN

A cross-sectional survey.

SETTINGS

Salaried, community (self-employed) and mixed nurses in France.

PARTICIPANTS

18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323).

METHODS

In February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors), a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults).

RESULTS

Among the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10-3) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10-3) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses.

CONCLUSIONS

Satisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.

A systematic review of measures of healthcare workers' vaccine confidence

Healthcare workers (HCW) perceptions toward vaccines influence patient and community vaccine decision making. In an era of rising vaccine hesitancy, understanding HCW vaccine confidence is critical. This systematic review aims to review instruments that have been validated to measure HCW vaccine confidence. We conducted a search in five databases in June 2023. Data was descriptively synthesized. Twelve articles describing 10 different tools were included. Most tools included dimensions or items on vaccine knowledge (n = 9), safety (n = 8), vaccine usefulness (n = 8), recommendation behavior (n = 8), and self-vaccination practice (n = 7). All, except one study, were conducted in high-income countries. There was variability in the quality of the validation process. There is limited existing literature on development and validation of tools for HCW vaccine confidence. Based on the tools currently available, the Pro-VC-Be tool is the most well validated. Further research needs to include low- and middle-income contexts.

Context matters: How to research vaccine attitudes and uptake after the COVID-19 crisis

The pandemic dramatically accelerated research on vaccine attitudes and uptake, a field which mobilizes researchers from the social sciences and humanities as well as biomedical and public health disciplines. The field has the potential to contribute much more, but the growth in research and the deeper connections between disciplines brings challenges as well as opportunities. This perspective article assesses the recent development of the field, exploring progress whilst emphasizing that not enough attention has been paid to national and local contexts. This lack of contextual attention limits the progress of research and hinders our capacity to learn from the COVID-19 crisis. We suggest three concrete responses: building and recognizing new publishing formats for reporting and synthesizing studies at a country level; establishing country-level interdisciplinary networks to connect research and praxis; and strengthening international comparative survey work by enhancing the focus on local contextual factors.

Healthcare professionals' perceptions of challenges in vaccine communication and training needs: a qualitative study

BACKGROUND

Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs' perspectives on challenges in vaccine communication and unmet training needs in this domain.

METHODS

Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs' approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs' training needs around vaccine communication.

RESULTS

HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients' misconceptions or misinformation about vaccines.

CONCLUSIONS

HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Difficulties faced by physicians from four European countries in rebutting antivaccination arguments: a cross-sectional study

Introduction

Physicians play a critical role in encouraging their patients to get vaccinated, in part by responding to patients' concerns about vaccines. It is, therefore, important to understand what difficulties physicians have in dealing with different concerns they may encounter. The aim of this article was to determine physicians' perceptions of difficulties in rebutting different antivaccination arguments from patients using data collected as part of a cross-sectional, cross-national questionnaire on physicians' vaccine attitudes and behaviours.

Methods

Physicians in 4 European countries (Finland, Germany, France and Portugal, total n=2718) rated 33 different arguments, chosen to represent 11 different psychological motivations underlying vaccine hesitancy, in terms of their perceptions of how difficult each argument would be to rebut.

Results

Across all countries, physicians perceived arguments based on religious concerns and 'reactance' (ie, resistance to perceived curbs of freedom) to be the most difficult to rebut, whereas arguments based on patients' distorted perception of the risks of disease and vaccines were perceived to be the easiest. There were also between-country differences in the level of perceived difficulty of argument rebuttal. Physicians' perceived difficulty with rebutting arguments was significantly negatively correlated with their vaccine recommendation behaviours and their preparedness for vaccination discussions.

Conclusions

Physicians may feel better equipped to counter arguments that can be rebutted with facts and evidence but may struggle to respond when arguments are motivated by psychological dispositions or values.

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries

Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.