Factors Affecting Medical Students' Uptake of the 2009 Pandemic Influenza A (H1N1) Vaccine

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

Evaluation of knowledge and barriers of influenza vaccine uptake among university students in Saudi Arabia; a cross-sectional analysis

Background

Influenza vaccine hesitancy is a significant threat to global maneuvers for reducing the burden of seasonal and pandemic influenza. This study estimated the vaccine uptake, barriers, and willingness for influenza vaccines among university students in Saudi Arabia.

Methods

A cross-sectional survey was conducted among health science (HS) and non-health science (NHS) university students. A 31-item questionnaire was used to ascertain the vaccination rate, barriers, and willingness for the flu vaccine.

Results

This study included 790 students (mean age: 21.40 ± 1.94 years), 246 (31.1%) from HS and 544 (68.9%) from NHS disciplines. About 70% did not take flu shots before the arrival of the winter. The mean knowledge score was 7.81 ± 1.96, where 20.4%, 67.6%, and 12% of respondents had good, moderate, and poor knowledge regarding flu vaccines. The relative importance index (RII) analysis showed a lack of recommendation from physicians (51.5%, RI ranked: 1) was a top-ranked barrier to vaccine uptake, followed by negative perceptions and accessibility issues. Only 36.6% of the participants were willing to get vaccinated every year, 70% were willing to receive a vaccine on their doctor's recommendations, and 46% agreed to vaccinate if vaccines were freely available in the university. The knowledge, barriers, and willingness widely varied across students from two disciplines.

Conclusions

Our analysis underscored low flu vaccine uptake among university students. In addition, the study participants' knowledge was unsatisfactory, and they were less inclined to receive the flu vaccine in the future. Lack of recommendation from the physicians, negative perceptions towards the flu vaccine, and difficult accessibility were found as significant barriers to the vaccine uptake. A multidimensional approach at educational institutes to cover the knowledge gap and address the barriers curtailing the vaccination rate among students is recommended.

Determinants of Willingness for COVID-19 Vaccine: Implications for Enhancing the Proportion of Vaccination Among Indians

Objective

To assess willingness for the coronavirus disease 2019 (COVID-19) vaccine and identify the factors attributing to the willingness.

Design

A cross-sectional study was conducted, adopting an exponential, non-discriminative snowball sampling technique. The questionnaire collected the socio-demographic profile, history of COVID-19 infection, presence of co-morbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease (COPD), asthma, cancer), willingness, and preference of vaccine among participants. An online platform (Google Forms) was used to collect data from all over India. A total of 2032 Indian adults aged above 18 years were included in the study.

Results

Around 1598 (78.6%) expressed willingness to receive the COVID vaccine, and among the healthcare providers (HCPs), 579 (80.3%) were willing for COVID vaccination. Factors like the belief that the vaccine is necessary (aOR=1.68, 95% CI =1.34 to 2.11), respondents having no history of COVID infection (aOR=0.71, 95% CI: 0.52 to 0.97), having trust in the government (aOR=6.09, CI: 4.59 to 7.98), people who felt the cost of the vaccine didn’t matter (aOR=4.92, CI: 3.80 to 6.37), and respondents with no perceived risk of COVID infection (aOR=0.63; CI: 0.47 to 0.83) were more associated with willingness for COVID vaccination.

Conclusions

An effective vaccine should be well-received by the public. The responsibility lies with the government, health authorities, and manufacturers to take appropriate steps to dispel rumors in order to ensure people’s understanding and acceptance.

Understanding influenza vaccine perspectives and hesitancy in university students to promote increased vaccine uptake

Introduction

Influenza vaccine hesitancy is a global barrier to controlling seasonal influenza. Influenza vaccination rates in university students lag behind current goals and pose a significant threat to the health of students on campuses. A broader understanding of the knowledge, attitudes and beliefs of university students are needed to develop targeted interventions to increase vaccination.

Methods

An anonymous cross-sectional survey was developed and distributed via REDCap to graduate and undergraduate students via individual college listservs at a large public university. Survey questions included demographic information and questions about vaccination history, preference for vaccine type (inactivated vaccine (IIV) or live attenuated vaccine (LAIV), knowledge of influenza vaccines, reasons for accepting or refusing vaccine and preference for receiving vaccine information and education.

Results

Students in 14 colleges received the survey and 1039 respondents were included in analysis. Sixty two percent reported having been vaccinated for influenza and of those vaccinated most were in health-related fields that require vaccination. Graduate and vaccinated students were more knowledgeable about influenza; undergraduates had lower vaccination rates. Students preferred IIV over LAIV and were more knowledgeable about IIV. Those with history of vaccination during childhood had higher rates of vaccination. Twenty six percent overall and 41.6% of the unvaccinated still believed you could get the flu from the flu vaccine. Fear of needles and inconvenience were cited as major reasons for not getting vaccinated. Incentives were cited as important motivators by only 20%. Students preferred to receive vaccine information from medical providers followed by online information and campus events.

Conclusions

A multipronged approach to increasing influenza vaccination of university students will be needed. Myths about influenza vaccine persist even in a relatively educated population. Programs will need to target undergraduate and students in non health-related fields, offer vaccine choices - IIV and LAIV and promote vaccination through medical providers and online information.

Attitudes and barriers associated with seasonal influenza vaccination uptake among public health students; a cross-sectional study

Background

Although research has explored influenza vaccination uptake among medical and college students, there is a dearth of research in understanding influenza vaccination uptake and attitudes toward the vaccine among future public health practitioners. Undergraduate public health students represent future public health practitioners who may be a significant educational resource for health information, including the importance of vaccinations.

Methods

This cross-sectional study utilized survey data from 158 undergraduate public health students attending a large public university in Southern California. The survey assessed public health students’ attitudes and beliefs towards the seasonal influenza vaccine and seasonal vaccination rates among this population.

Results

Over 88% of respondents reported having been encouraged to receive the seasonal influenza vaccine, while only 43.0% reported receipt. Of the students who reported not receiving the vaccine, 49.4% believed it may give them the flu, 30.4% believed there may be dangerous side effects, and 28.9% believed they were not at risk for contracting the flu. Access to health care practitioners (OR: 3.947, 95% CI [1.308–11.906]) and social encouragement (OR: 3.139, 95% CI [1.447–6.811]) were significantly associated with receipt of the seasonal influenza vaccine.

Conclusion

As public health program curriculum includes information about seasonal influenza vaccination and 68% of the sample were seniors soon to be exiting the program with an undergraduate degree in public health education, this low seasonal influenza vaccination rate is disturbing. This study may add to the body of data demonstrating how knowledge of the vaccine does not always guarantee vaccine uptake. Results of the current study suggest that it may be beneficial to provide additional information targeted to public health students, aimed at mediating safety concerns and increasing social pressure to assist in improving vaccine acceptance and rates in this population. Maximizing seasonal influenza vaccination uptake by addressing attitudes, barriers and misperceptions may not only improve vaccination rates among public health students, but also in communities served by these future public health practitioners.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Barriers Associated with Seasonal Influenza Vaccination among College Students

Influenza can spread rapidly on college campuses because of high-density living conditions and frequent social interactions. However, seasonal influenza vaccination rates on college campuses are low. The purpose of this study is to identify barriers associated with receipt of the seasonal influenza vaccination. Questionnaires were completed by a convenience sample of 383 undergraduate students in January 2014. Data were analyzed to identify barriers associated with receiving the seasonal influenza vaccine. Only 20.6% of students reported receiving the vaccine within the last 6 months. Among students who did not receive the vaccine, 47.8% believed they would get influenza from the vaccine, 41.6% believed the vaccination may have dangerous side effects, and 39.6% believed they were not at risk for contracting influenza. The majority of nonvaccinated students did not believe cost of the vaccine or access to the vaccine were barriers. Many college students are not receiving the seasonal influenza vaccine, representing an important area for improvement. Understanding potential barriers associated with receipt of this vaccine is important for identifying and creating effective public health education programs and campaigns. There is a need for enhanced vaccination education efforts among college students, particularly with respect to the safety and importance of this vaccine.

Healthy bodies, toxic medicines: college students and the rhetorics of flu vaccination

This article examines flu vaccination beliefs and practices produced during a survey of undergraduate students in Spring 2012 (IRB#10-732). This research uses the methods of rhetorical analysis - or the study of persuasive features and arguments used in language - to examine statements respondents made regarding flu and flu vaccine. In these responses, students generated unique categories of arguments about the perceived dangers of flu vaccination, including the assertion that vaccines cause disease (including illnesses and conditions other than flu), that vaccines are toxic medicines, and that vaccines carry unknown, population-wide risks that are inadequately acknowledged. This study provides insight into vaccination beliefs and rationales among a population at risk of flu (college students) and suggests that further study of this population may yield important keys to addressing flu vaccine concerns as expressed by college students. Rhetorical analysis also offers a useful set of methods to understanding vaccination beliefs and practices, adding to existing methods of study and analysis of vaccination practices and beliefs in medicine and public health.

Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention

INTRODUCTION

Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet uptake of vaccination remains low. If vaccination education is integrated into the early medical school curriculum, will student attitudes toward the vaccine change? The objectives of the study were to: (1) Determine influenza vaccination rates among entering medical students; (2) Assess the attitudes toward influenza vaccination; (3) Evaluate the effects of a multifaceted educational intervention on attitudes to vaccination.

METHODS

Entering medical students were surveyed before and after an intervention at the beginning of the influenza season. This intervention provided by an inter-professional team, included education about influenza, importance of vaccination for HCWs, followed by vaccination administration practice, and ended with students vaccinating consenting classmates.

RESULTS

The pre-intervention surveys and intervention were completed by 124 of 125 (99%) students. Pre-intervention survey revealed 60 (48%) of students had been previously vaccinated. Of the vaccinated students 91% had been recommended vaccination by their healthcare provider compared to 43% of non-vaccinated students. More positive attitudes were noted in the vaccinated students compared to non-vaccinated students: importance of vaccination (p<0.01); HCWs should be vaccinated (p<0.01); recommendation of vaccine to family and friends (p<0.01). 97 (78%) students completed post-intervention surveys. Significant improvement in these attitudes was noted post-intervention compared to pre-intervention: importance of vaccination 93% versus 71% (p<0.01); HCWs should be vaccinated 95% versus 83% (p<0.01); recommendation to family and friends 93% versus 73% (p<0.01); comfort with vaccine counseling 92% versus 41%; comfort with vaccine administration 84% versus 22% (p<0.01).

CONCLUSION

Educating medical students and promoting the importance of vaccination early in a medical student's career using such an intervention is relatively simple and easily integrated into the curriculum. This intervention was successful in vaccinating all students, and demonstrated a marked positive shift in attitudes toward influenza vaccination.