Can the Health Belief Model and moral responsibility explain influenza vaccination uptake among nurses?

A planned behavior theory-based explanatory model of protective behavior against COVID-19, with an age perspective

In this study, an explanatory model of protective behaviors against COVID-19 transmission based on the theory of planned behavior is tested using a sample of 904 individuals by adding two relevant variables in the COVID-19 context: skepticism and responsibility toward COVID-19 transmission. Responsibility and the intention to behave in a protective way act as mediators in predicting protective behaviors. The model is invariant between younger and older people, although some path differences were found: the perception that individuals have about the extent to which their reference group adopts protective behaviors directly influences individual protective behavior for younger but not older people, for whom subjective social norms were only indirect predictors of such behavior. Additionally, the rates in all the variables showed that the group under 35 took more risks in the context of protective behaviors against COVID-19: they exhibited more skepticism, lower behavioral control, perceived fewer positive social norms regarding protective behaviors, felt less responsible for spreading the disease, had less intention to behave in a protective way, and finally adopted fewer protective behaviors. Developers of intervention strategies and campaigns should contemplate such variables and focus on differences according to age.

Talking about the Vaccine after the Pandemic: A Cross-Sectional Study among Youth in Turkey and Ethical Issues

Examining the factors that affect the vaccination rate among young people in an ethical frame can support vaccination promotion. Therefore, this study will elaborate, through an ethical lens, on young people's hesitation about and decisions regarding getting vaccinated. The cross-sectional study was conducted with 2428 people aged 15-30 in Turkey in June 2022. The questionnaire included the following subtitles: psycho-social situation, health services and health policies, COVID-19 vaccine, and predictions about life and health after the pandemic. The average age was 22.9 years. In the study sample, 80% were vaccinated, while 20% were not. Vaccinated participants acted more cautiously to protect their health. Receiving accurate and sufficient information on proposed vaccines affects vaccination status. The primary reason for getting vaccinated was "to protect their health, families, and relatives", and the primary reason for not getting vaccinated was "not trusting the vaccine content or the country where the vaccine was produced". Specifically, those vaccinated felt more relaxed physically, psychologically, and socially. In addition, the expectations for the future of those vaccinated were significantly higher. Accurate and adequate information is essential for reducing vaccine hesitancy. In addition, promoting prosocial behaviors in young people and highlighting related values will support vaccination.

Influenza and Universal Vaccine Research in China

Influenza viruses usually cause seasonal influenza epidemics and influenza pandemics, resulting in acute respiratory illness and, in severe cases, multiple organ complications and even death, posing a serious global and human health burden. Compared with other countries, China has a large population base and a large number of influenza cases and deaths. Currently, influenza vaccination remains the most cost-effective and efficient way to prevent and control influenza, which can significantly reduce the risk of influenza virus infection and serious complications. The antigenicity of the influenza vaccine exhibits good protective efficacy when matched to the seasonal epidemic strain. However, when influenza viruses undergo rapid and sustained antigenic drift resulting in a mismatch between the vaccine strain and the epidemic strain, the protective effect is greatly reduced. As a result, the flu vaccine must be reformulated and readministered annually, causing a significant drain on human and financial resources. Therefore, the development of a universal influenza vaccine is necessary for the complete fight against the influenza virus. By statistically analyzing cases related to influenza virus infection and death in China in recent years, this paper describes the existing marketed vaccines, vaccine distribution and vaccination in China and summarizes the candidate immunogens designed based on the structure of influenza virus, hoping to provide ideas for the design and development of new influenza vaccines in the future.

Variations in COVID-19 Vaccine Attitudes and Acceptance among Refugees and Lebanese Nationals Pre- and Post-Vaccine Rollout in Lebanon

Vaccine hesitancy among displaced populations is associated with inequitable access to services and mistrust of authorities, among other factors. This study evaluated variations in attitudes toward COVID-19 vaccines and factors associated with vaccine acceptance among refugees and Lebanese nationals accessing 60 International Medical Corps-supported health facilities through two cross-sectional surveys pre- (n = 3927; Survey 1) and post- (n = 4174; Survey 2) vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health beliefs model. Refugees comprised 52.9% (Survey 1) and 54.2% (Survey 2) of respondents. Vaccine acceptance was low among both groups in Survey 1 (25.9% refugees vs. 23.1% Lebanese nationals), but higher in Survey 2 in Lebanese (57.6%) versus refugees (32.9%). Participants reported greater perceived benefits of vaccination, higher perceived COVID-19 susceptibility, and lower perceived vaccination barriers in Survey 2 versus Survey 1. Post-vaccine rollout, refugees had lower odds of vaccine acceptance compared to Lebanese (OR 0.50, 95%CI 0.41–0.60), while older age (OR 1.37, 95%CI 1.06–1.78, ≥51 years vs. 18–30 years) was associated with greater vaccine acceptance. Health beliefs model variables were associated with vaccine acceptance in both surveys. Tailored strategies to respond dynamically to changes in vaccine attitudes among vulnerable groups in Lebanon are essential for equitable vaccine uptake.

The effect of moral appeals on influenza vaccination uptake and support for a vaccination mandate among health care workers

OBJECTIVE

Influenza vaccination uptake among health care workers (HCWs) protects patients and staff. Still, many health institutions' coverage rates are unsatisfactory. We aimed to test the effect of communicating moral appeals in increasing vaccination uptake in a real life setting.

METHOD

In three field experiments among HCWs, a moral appeal highlighting morally relevant consequences of influenza vaccination was manipulated. The outcome variables were vaccination intention right after exposure to the moral appeal (Study 1; N = 569 US and UK HCWs from various institutions) and vaccination uptake in subsequent weeks for those respondents who consented in sharing this data during the survey (Studies 2 and 3, respectively N = 121 and N = 770 Dutch hospital employees).

RESULTS

Studies 1 and 3 showed that moral appeal enhanced vaccination intention and uptake (vaccination uptake increased by 11%), due to increased awareness that vaccination is a moral decision. In Study 2, moral appeal had no effect, probably because people with more outspoken vaccination attitudes had responded to the call to fill in the survey. Moreover, moral appeal increased support for an influenza vaccination mandate. Furthermore, the results suggest that moral appeal was especially effective among HCWs with no history of influenza vaccination.

CONCLUSION

These results indicate that moral appeal can be a useful tool for increasing both vaccination uptake and mandate support within health care institutions.

Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: A qualitative study

Although COVID-19 vaccines are available, evidence suggests that several factors hinder or facilitate their use. Several studies have found gender differences in COVID-19 vaccine uptake, with women less likely to vaccinate than men in many countries, including Ghana. These studies, however, have primarily been quantitative. This study used a qualitative approach to examine the facilitators and barriers to vaccine uptake among women in Ghana. Using a cross-sectional descriptive qualitative research design, 30 women in the Greater Accra and Ashanti regions of Ghana were conveniently sampled and interviewed using a semi-structured interview guide. Fifteen (15) interviews were conducted in each region. The data were transcribed verbatim and analysed thematically using QSR NVivo version 10 software. Among the key factors that facilitate COVID-19 vaccination are the desire to protect oneself and family against COVID-19, education about COVID-19 vaccines, seeing others receive the COVID-19 vaccine, and vaccine being cost-free. On the other hand, long queues at the vaccination centres, fear of side effects, misconceptions about the vaccines, and shortage of vaccines were the main barriers against COVID-19 vaccination. The study results show that individual, institutional, and vaccine-related factors facilitate or hinder COVID-19 vaccination among women. Addressing these factors need continuous comprehensive health education, and ensuring vaccine availability at vaccination sites will improve women’s uptake of the COVID-19 vaccines.

The level and determinants of COVID-19 vaccine acceptance in Ghana

Objective

As part of the efforts to curb the COVID-19 pandemic, the government of Ghana has received several shipments of approved vaccines, and administration has begun in the country. Studies examining the determinants of COVID-19 vaccine acceptance in Ghana were mostly conducted before the vaccination exercise. Vaccine acceptance decisions however vary with time and hence, peoples’ decisions may have changed once vaccines became accessible. This study examines the level and determinants of COVID-19 vaccine acceptance among adult Ghanaians during the vaccination exercise.

Methods

The study was a cross-sectional online survey involving Ghanaian adults (18 years and above) eligible to take the COVID-19 vaccine. The study was conducted from 18th May 2021 to 14th July 2021 and the questionnaire was answered by 362 respondents. Snowball sampling technique was utilized to obtain the respondents. Probit regression analysis was used to identify factors influencing COVID-19 vaccine acceptance.

Key findings

Only 62.7% of the respondents indicated that they will accept the COVID-19 vaccine if provided. The regression results revealed that the decision to accept the COVID-19 vaccine was influenced by occupation, perceived susceptibility, perceived benefits and attitudes towards the vaccines.

Conclusion

The findings suggest that government must implement strategies to enhance positive attitudes toward vaccines, increase the risk perception of contracting the virus and also educate the populace about the benefits of the vaccine.

Statewide evaluation of COVID-19 vaccine hesitancy in Rhode Island

BACKGROUND

Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation.

METHODS

Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model.

RESULTS

A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26-0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41-0.50) decrease in vaccine hesitancy.

CONCLUSIONS

COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy.

Health concerns among waste collectors during pandemic crisis

The COVID-19 pandemic has negatively affected the economic, social, and psychological aspects globally. COVID-19 can possibly spread through municipal solid waste (MSW) if it is collected, bagged, transported, and disposed inappropriately. Such situation has posed significant challenges to MSW management (MSWM), which has led waste personnel under massive pressure. This study aims to examine the health-protective behavior of sanitation workers/MSW collectors (MSWCs) during the COVID-19 crisis. Quantitative data were collected by using a self-administered survey from 418 MSWCs working in Mainland China. The study extended the traditional health-belief model and proposed education and training as a facet of the behavioral model. Result showed that education and training were a significant predictor of health-protective behavior. Moreover, the moderating incremental influence of regulative assistance significantly affected the behavioral mapping of MSWCs. This study contributes to the literature by mapping the concerns, risks, and challenges experienced by MSWCs in times of a health crisis. Policymakers should specially consider the safety and hygiene concerns of frontline workforce in the whole chain of waste management (including the outsourced operations of MSWM). Lastly, the adoption of smart communication with the frontline workforce (i.e., MSWCs) is in dire need to maintain trust and avoid rumors and misconceptions during the time of a pandemic situation.

Dualistic Determinants of COVID-19 Vaccination Intention among University Students in China: From Perceived Personal Benefits to External Reasons of Perceived Social Benefits, Collectivism, and National Pride

Vaccination is one of the most effective ways of controlling the COVID-19 pandemic. However, vaccine hesitancy is prevalent, and relatively few studies have explored how variables related to personal and external motives have affected the intention to vaccinate. The present study investigated the association between perceived personal benefits, variables reflecting external motives (i.e., perceived social benefits, collectivism, and national pride) and intention to receive COVID-19 vaccination among university students in China. The interaction between perceived personal benefits and the three factors reflecting external motives on intention to receive COVID-19 vaccination was also examined. A total of 6922 university students from five provinces of China completed a cross-sectional survey. Results showed that adjusting for significant background variables, perceived personal benefits, perceived social benefits, collectivism, and national pride were all significant factors of intention to receive COVID-19 vaccination. Results from interaction analyses also showed that the association between perceived personal benefits and COVID-19 vaccination intention was stronger among those with lower levels of national pride. Findings highlighted the important role of self-directed interest and external motives in promoting uptake of COVID-19 vaccination.

Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review

AIMS AND OBJECTIVES

To explore the determinants of and behaviour change models for seasonal influenza vaccination compliance among healthcare personnel.

BACKGROUND

COVID-19 vaccine hesitancy among healthcare personnel may be better understood by exploring determinants of seasonal influenza vaccine hesitancy.

DESIGN

Integrative literature review.

METHODS

A systematic search was conducted in accordance with PRISMA guidelines. Six thousand and forty-eight articles were screened. Seventy-eight met inclusion criteria. Due to the heterogeneity of included articles, a narrative synthesis was conducted utilising a conceptual matrix to identify thematic categories.

RESULTS

Six thematic categories were identified as influencing HCP SIV compliance: 'perceived vulnerability', 'trust', 'past behaviour', 'professional duty', 'access and convenience' and 'knowledge and experience'. The Health Belief Model (HBM) was the most commonly utilised health behaviour change model within the seasonal influenza vaccination context. Few studies have examined seasonal influenza vaccine acceptance and uptake within the Australian HCP context, particularly involving community care and aged care.

CONCLUSIONS

Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake. In particular, an emerging focus on 'trust' or the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic. Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behaviour change model.

RELEVANCE TO CLINICAL PRACTICE

Healthcare personnel (HCP) face high levels of occupational exposure to seasonal influenza every year. An emerging focus on 'trust' and the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic.

Factors influencing COVID-19 vaccination intention among overseas and domestic Chinese university students: a cross-sectional survey

To vaccinate the Chinese on a nationwide scale timely and effectively, it is necessary to assess the vaccination uptake intention of the public. University students are opinion leaders, who have an important impact on the vaccination uptake intention of others around them. As a group with strong population mobility, overseas university students have an extra influence on the spread of COVID-19 and the prevention and control of the pandemic. Thus, it is necessary to investigate the vaccination uptake intention of overseas and domestic university students to promote vaccination and control the pandemic globally. However, little is known about the COVID-19 vaccination uptake intention among overseas and domestic university students. This study aimed to explore the difference between overseas and domestic Chinese university students' COVID-19 vaccination uptake intentions and influencing factors using the Health Belief Model. A cross-sectional survey using an online questionnaire was conducted among 370 overseas university students and 463 domestic university students between January and February 2021. More than half of the respondents (536, 64.3%) reported vaccination uptake intentions, with overseas and domestic university students reporting similar vaccination uptake intentions (64.1% vs 64.6%, p > .05). Perceived benefits, perceived barriers, and cues to action were important factors that influenced the vaccination intention among overseas and domestic university students. It is worth trying to communicate the benefits of the vaccine, enhance the role of cues to action, and eliminate the potential barriers among overseas and domestic university students through creative propagation to further promote the COVID-19 vaccination.

Factors related to preventive COVID-19 behaviors using health belief model among general population: a cross-sectional study in Iran

BACKGROUND

Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM).

METHODS

The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22.

RESULTS

The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (β = 0.11), perceived benefits (β = 0.10), perceived barriers (β = - 0.18), external cues to action (β = 0.25), and internal cues to action (β = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05).

CONCLUSION

Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men.

Should nurses take a COVID-19 vaccine?

The issue as to whether health care professionals have a moral obligation to take a vaccine for a communicable disease is not new. Nonetheless, this issue takes on a fresh urgency within nursing practice in the context of the present COVID-19 pandemic, i.e., is there an ethical requirement for nurses to take a COVID-19 vaccine? This paper approaches the issue by using a hypothetical example of Nurse X who has inadvertently infected Patient Y. French's (1984a) Principle of Responsive Adjustment is adapted to claim that there would be a moral expectation that Nurse X takes a COVID-19 vaccine (unless there are justifiable reasons not to). The proposition is also made that, should Nurse X not take a COVID-19 vaccine, they could be morally associated with originally infecting Patient Y.

Predictors of COVID-19 vaccine intentions in the United States: the role of psychosocial health constructs and demographic factors

Background

On December 21, 2020, a study was conducted to investigate a range of psychosocial health constructs and demographic variables potentially associated with intentions toward accepting or forgoing the coronavirus (COVID-19) vaccine.

Purpose

The goal of the study was to identify predictors of forgoing COVID-19 vaccination at the time of the initial rollout.

Methods

A cross-sectional, representative online survey of 350 U.S. residents was conducted using the online crowdsourcing site Prolific to assess vaccine intentions, health attitudes, and demographic information. Variables examined included demographic factors and health constructs corresponding to each of the elements of the health belief model (perceived severity, susceptibility, benefits, barriers, and cues to action), the theory of planned behavior (attitudes, subjective norms, and perceived behavioral control), attitudes toward vaccines in general, and trust in the COVID-19 vaccine approval process.

Results

After using hierarchical linear regression to control for demographics, the health constructs uniquely associated with the likelihood to forgo vaccination were perceived barriers, general attitudes toward the COVID-19 vaccine, subjective norms, and trust in the vaccine approval process. Significant demographic predictors of vaccine reluctance included being female, politically conservative, and more religious.

Conclusions

The current research identified three demographic factors and four health constructs uniquely associated with vaccine acceptance. These findings reveal that the constructs contained within the health belief model and theory of planned behavior can be used to predict COVID-19 vaccination intentions, and can be supplemented with an assessment of general vaccine attitudes and attitudes toward the vaccine approval process.

COVID-19 vaccination intention and influencing factors among different occupational risk groups: a cross-sectional study

As an effective measure to manage the Coronavirus disease 2019 (COVID-19) pandemic, the acceptance of the COVID-19 vaccine and understanding the influencing factors of vaccination intention is particularly important. This study aimed to describe the COVID-19 vaccination intention among three different occupational risk groups and identify influencing factors of vaccination intention since a COVID-19 vaccine is available in China. A cross-sectional questionnaire survey was conducted from January 10 to February 5, 2021 in Hangzhou city of Zhejiang Province, an eastern coastal province in China. The intention to accept COVID-19 vaccination and health beliefs based on the Health Belief Model were collected. Of the participants, college students reported the lowest COVID-19 vaccination intention (64.6%), followed by public transportation workers (72.4%) and health care workers (79.9%). Perceived barriers were identified as negative factors of vaccination intention among all three occupational groups. For college students and public transportation workers, perceived benefits and cues to action were identified as protective factors, and cues to action had a positive effect on vaccination intention of health care workers. Tailored interventions are encouraged to reduce barriers of vaccination, improve health beliefs and promote COVID-19 vaccination intentions.

Understanding the Health Behavior Decision-Making Process with Situational Theory of Problem Solving in Online Health Communities: The Effects of Health Beliefs, Message Credibility, and Communication Behaviors on Health Behavioral Intention

Online health communities (OHCs) offer users the opportunity to share and seek health information through these platforms, which in turn influence users' health decisions. Understanding what factors influence people's health decision-making process is essential for not only the design of the OHC, but also for commercial health business who are promoting their products to patients. Previous studies explored the health decision-making process from many factors, but lacked a comprehensive model with a theoretical model. The aim of this paper is to propose a research model from the situational theory of problem solving in relation to forecasting health behaviors in OHCs. An online questionnaire was developed to collect data from 321 members of online health communities (HPV Tieba and HPV vaccina Tieba) who have not received an HPV vaccination. The partial least squares structural equation modeling (PLS-SEM) method was employed for the data analysis. Findings showed that information selection and acquisition is able to forecast HPV vaccination intentions, perceived seriousness and perceived susceptibility can directly impact HPV vaccination intention and have an indirect impact by information selection and acquisition, and perceived message credibility indirectly affected HPV vaccination intention via information selection. The current paper supports health motivations analysis in OHCs, with potential to assist users' health-related decision-making.

Intention to Receive the COVID-19 Vaccination in China: Application of the Diffusion of Innovations Theory and the Moderating Role of Openness to Experience

COVID-19 has caused a devastating impact on public health and made the development of the COVID-19 vaccination a top priority. Herd immunity through vaccination requires a sufficient number of the population to be vaccinated. Research on factors that promote intention to receive the COVID-19 vaccination is warranted. Based on Diffusion of Innovations Theory, this study examines the association between the perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, openness to experience and descriptive norm with the intention to receive the COVID-19 vaccination, and the moderating role of openness to experience among 6922 university students in mainland China. The intention to receive the free and self-paid COVID-19 vaccination is 78.9% and 60.2%, respectively. Results from path analyses show that perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, and openness to experience and descriptive norm are all positively associated with the intention to receive COVID-19 free and self-paid vaccination. The association between the perceived efficacy of the COVID-19 vaccination and descriptive norm with the intention to receive the COVID-19 vaccination is stronger among those with a lower level of openness to experience. Our findings support the usefulness of Diffusion of Innovations Theory and the moderating role of openness of experience in explaining intention to receive the COVID-19 vaccination.

Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a new viral disease that has caused a pandemic in the world. Due to the lack of vaccines and definitive treatment, preventive behaviors are the only way to overcome the disease. Therefore, the present study aimed to determine the preventive behaviors from the disease based on constructs of the health belief model.

METHODS

In the present cross-sectional study during March 11-16, 2020, 750 individuals in Golestan Province of Iran were included in the study using the convenience sampling and they completed the questionnaires through cyberspace. Factor scores were calculated using the confirmatory factor analysis. The effects of different factors were separately investigated using the univariate analyses, including students sample t-test, ANOVA, and simple linear regression. Finally, the effective factors were examined by the multiple regression analysis at a significant level of 0.05 and through Mplus 7 and SPSS 16.

RESULTS

The participants' mean age was 33.9 ± 9.45 years; and 57.1% of them had associate and bachelor's degrees. Multiple regression indicated that the mean score of preventive behavior from COVID-19 was higher in females than males, and greater in urban dwellers than rural dwellers. Furthermore, one unit increase in the standard deviation of factor scores of self-efficacy and perceived benefits increased the scores of preventive behavior from COVID-19 by 0.22 and 0.17 units respectively. On the contrary, one unit increase in the standard deviation of factor score of perceived barriers and fatalistic beliefs decreased the scores of the preventive behavior from COVID-19 by 0.36 and 0.19 units respectively.

CONCLUSIONS

Results of the present study indicated that female gender, perceived barriers, perceived self-efficacy, fatalistic beliefs, perceived interests, and living in city had the greatest preventive behaviors from COVID-19 respectively. Preventive interventions were necessary among males and villagers.

How to Improve Compliance with Protective Health Measures during the COVID-19 Outbreak: Testing a Moderated Mediation Model and Machine Learning Algorithms

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18-22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82-0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Seasonal influenza self-vaccination behaviours and attitudes among nurses in Southeastern France

BACKGROUND

Despite seasonal influenza vaccination (SIV) being recommended to healthcare professionals to protect themselves and their patients, uptake is low, especially among nurses. We sought to study self-vaccination behaviours, attitudes and knowledge about SIV among nurses in Southeastern France.

METHODS

A cross-sectional survey with community and hospital-based hospital nurses was conducted with the same standardised questionnaire. Multi-model averaging approaches studied factors associated with the following dependent variables: self-reported SIV uptake; and considering SIV a professional responsibility.

RESULTS

1539 nurses completed the questionnaire (response rate: 85%). SIV was the most frequently cited vaccine (49%) regarding nurses' unfavourable opinions towards specific vaccines. Thirty-four percent of nurses reported being vaccinated at least once during the 2015-2016 or 2016-2017 seasons. A lack of perceived personal vulnerability to influenza, a fear of adverse effects, and a preference for homeopathy constituted the main deterrents of SIV. Nurses held various misconceptions about the SIV, but 69% considered its benefits to be greater than its risks. The multi-model averaging approach showed that considering SIV as a professional responsibility was the main factor associated with SIV uptake among nurses (Nagelkerke's partial R-squared: 15%). This sense of responsibility was strongly associated with trust in various vaccine information sources.

CONCLUSION

Nurses had low SIV uptake rates and held various concerns and a lack of knowledge surrounding the vaccine. This is concerning considering the impact that these factors can have on nurses and patients' health, especially considering the increased role that nurses could have surrounding SIV in the near future.