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Jiang M, Yan X, Jiang W, Ma H, Zhou S, Ying X. From both sides of the needle: Understanding effective interventions for facilitating non-national immunization program vaccine decision making in China. Hum Vaccin Immunother 2024; 20:2389578. [PMID: 39171499 PMCID: PMC11346547 DOI: 10.1080/21645515.2024.2389578] [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: 06/17/2024] [Revised: 07/17/2024] [Accepted: 08/04/2024] [Indexed: 08/23/2024] Open
Abstract
Vaccination decisions are influenced by various psychological and practical factors. In China, non-National Immunization Program (non-NIP) vaccines, which are voluntary and self-paid, add uncertainty and autonomy to the decision-making process. Effective communication between providers and recipients is crucial but understudied. This study aims to integrate their perspectives, identify strategies for facilitating vaccination decisions, and analyze their mechanisms. From July to December 2023, semi-structured interviews were conducted with 17 caregivers and 12 vaccination providers across five Chinese provinces. Participants shared their experiences and decision-making processes regarding non-NIP vaccines. The Behaviour Change Wheel framework guided the analysis, utilizing iterative coding and directed content analysis. Thirteen Behavior Change Techniques were identified, with feedback, monitoring, and environmental restructuring being the most common. Key intervention functions included Persuasion, Education, and Training. We further mapped how these interventions influence non-NIP vaccine decisions. Capability was enhanced through education and effective communication, providing necessary knowledge and skills. Opportunity was increased via infrastructural improvements and societal support, making vaccines more accessible and endorsed by the community. Motivation was driven by clear communication of vaccination benefits and risks, reinforced by societal norms through public health messaging. By understanding the mechanisms influencing vaccination behaviors and interacting with stakeholders, tailored strategies can be developed. Healthcare providers can enhance service accessibility and offer evidence-based guidance with reminders, monitoring, and incentives to ensure compliance. For recipients, reliable information, sustained engagement, timely communication, and motivational opportunities are essential. A multi-dimensional approach involving multiple stakeholders is crucial for promoting non-NIP vaccine uptake.
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Affiliation(s)
- Mingzhu Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Xuanxuan Yan
- School of Public Health, Fudan University, Shanghai, China
| | - Weixi Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Haifeng Ma
- School of Public Health, Fudan University, Shanghai, China
| | - Sijuan Zhou
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
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Addario A, Pardo M, Gavazzi G, Bongue B, Célarier T, Dorier S, Barth N, Botelho-Nevers E. The desire of autonomy: A lever for vaccination of the elderly? Results of a qualitative study. Hum Vaccin Immunother 2024; 20:2390227. [PMID: 39161121 PMCID: PMC11340770 DOI: 10.1080/21645515.2024.2390227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
The COVID-19 pandemic has highlighted the challenges of vaccination and the infectious risks among the elderlies. However, immunization rates for recommended vaccines in this population are insufficient in France. We aimed in this study to identify the levers and obstacles to vaccination among seniors, and to establish the arguments that could lead to some new vaccination behaviors. A qualitative survey based on 14 semi-structured interviews was conducted with people aged 65 and over, living at home in the Auvergne Rhône-Alpes region (France) from March to May 2022. The interviews were recorded, entirely transcribed, then subjected to a thematic content analysis. The results show that participants are keen to preserve their health by maintaining their physical capacity, taking regular exercise and eating a balanced diet. However, vaccination was not mentioned as a mean of preventing infectious diseases. Infections were not perceived as a cause for concern. Furthermore, the physical and cognitive consequences of infectious diseases, which could result in a loss of autonomy, were not known. These elements could be a good lever to bring hesitant elderly people to reconsider their position toward vaccination. Vaccines were not seen as a strategy to prevent loss of autonomy among elderlies. Since vaccines against influenza, COVID-19, shingles, pneumococcus have proved to be effective in protecting against cardiovascular events, this argument might be the starting point for a prevention campaign for the elderly.
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Affiliation(s)
- Alexandra Addario
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université Claude Bernard, Lyon, France
- CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
- Groupe de Translational Research In Autoimmunity and Inflammation Group (T-RAIG, TIMC IMAG), Université de Grenoble-Alpes, Grenoble, France
- Chaire PREVACCI, PRESAGE Institute, Université Jean Monnet, Saint-Etienne, France
- Chaire Sante des ainés, Ingénierie de la Prévention, PRESAGE Institute, Université Jean Monnet, Saint-Etienne, France
| | | | - Gaëtan Gavazzi
- Groupe de Translational Research In Autoimmunity and Inflammation Group (T-RAIG, TIMC IMAG), Université de Grenoble-Alpes, Grenoble, France
- Geriatric Medicine Department, CHU de Grenoble Alpes, Grenoble, France
| | - Bienvenu Bongue
- Chaire Sante des ainés, Ingénierie de la Prévention, PRESAGE Institute, Université Jean Monnet, Saint-Etienne, France
- CETAF, Saint Etienne, France
| | - Thomas Célarier
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Solène Dorier
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
| | | | - Elisabeth Botelho-Nevers
- Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université Claude Bernard, Lyon, France
- CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
- Chaire PREVACCI, PRESAGE Institute, Université Jean Monnet, Saint-Etienne, France
- Department of Infectious Diseases, CHU de Saint-Etienne, Saint-Etienne, France
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White P, Alberti H, Rowlands G, Tang E, Gagnon D, Dubé È. Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries. Hum Vaccin Immunother 2024; 20:2397875. [PMID: 39323010 PMCID: PMC11441049 DOI: 10.1080/21645515.2024.2397875] [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: 06/13/2024] [Revised: 08/15/2024] [Accepted: 08/24/2024] [Indexed: 09/27/2024] Open
Abstract
Physician recommendations can reduce vaccine hesitancy (VH) and improve uptake yet are often done poorly and can be improved by early-career training. We examined educational interventions for medical students in Western countries to explore what is being taught, identify effective elements, and review the quality of evidence. A mixed methods systematic narrative review, guided by the JBI framework, assessed the study quality using MERSQI and Cote & Turgeon frameworks. Data were extracted to analyze content and framing, with effectiveness graded using value-based judgment. Among the 33 studies with 30 unique interventions, effective studies used multiple methods grounded in educational theory to teach knowledge, skills, and attitudes. Most interventions reinforced a deficit-based approach (assuming VH stems from misinformation) which can be counterproductive. Effective interventions used hands-on, interactive methods emulating real practice, with short- and long-term follow-ups. Evidence-based approaches like motivational interviewing should frame interventions instead of the deficit model.
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Affiliation(s)
- Philip White
- Population Health Sciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Gill Rowlands
- Population Health Sciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Eugene Tang
- Population Health Sciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec, Canada
| | - Ève Dubé
- Department of Anthropology, Laval University, Quebec, Canada
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Marhánková JH, Kotherová Z, Numerato D. Navigating vaccine hesitancy: Strategies and dynamics in healthcare professional-parent communication. Hum Vaccin Immunother 2024; 20:2361943. [PMID: 38855961 PMCID: PMC11168214 DOI: 10.1080/21645515.2024.2361943] [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: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024] Open
Abstract
Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST. More specifically, 60 hours of observations were carried out in three different pediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed. We focused on the specific context of the Czech Republic, which represents a country with a mandatory vaccination system and in which children's immunization is the responsibility of pediatric general practitioners. We demonstrate that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorize and label parents. Furthermore, we outline some of the different strategies HCPs employ while addressing concerns regarding vaccination. We identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents. The first strategy focused on the communication of risks associated with vaccination (and lack thereof). HCPs used a variety of discursive practices to familiarize the unfamiliar risks of vaccine-preventable diseases (by mobilizing representations that are part of collective memory, incorporating personal experiences to materialize the presence of risk and the confidence in the safety of vaccines and by situating risk as embedded in everyday processes and integral to the uncertainty of the global world). The second strategy involved the conscious employment of medical procedures that may contribute to reducing vaccination fears.
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Affiliation(s)
| | - Zuzana Kotherová
- Department of Public and Social Policy, Faculty of Social Sciences, Charles University, Praha, Czech Republic
- Department of Public and Social Policy, Faculty of Social Sciences and Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Dino Numerato
- Department of Sociology, Faculty of Social Sciences, Charles University, Praha, Czech Republic
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa DSJ, Trevena L, Henseler J, Danchin M. Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia. Hum Vaccin Immunother 2024; 20:2359623. [PMID: 38845399 PMCID: PMC11164230 DOI: 10.1080/21645515.2024.2359623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Carissa Bonner
- School of Public Health, University of Sydney, Camperdown, Australia
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
- Health Protection, Hunter New England Population Health, Wallsend, Australia
| | | | - Lyndal Trevena
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Jörg Henseler
- Department of Design, Production & Management, University of Twente, Enschede, Netherlands
- Nova Information Management School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
- Department of General Medicine, Royal Children’s Hospital, Parkville, Australia
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Kaufman J, Overmars I, Fong J, Tudravu J, Devi R, Volavola L, Vodonaivalu L, Jenkins K, Leask J, Seale H, Mohamed Y, Joshi K, Datt H, Sagan S, Dynes M, Hoq M, Danchin M. Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation. BMJ Glob Health 2024; 9:e015433. [PMID: 39251236 DOI: 10.1136/bmjgh-2024-015433] [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: 02/26/2024] [Accepted: 08/22/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji's Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation. METHODS The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months.The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions' knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members' intention to vaccinate. RESULTS We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions' communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement. CONCLUSION Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
| | - Isabella Overmars
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - James Fong
- Republic of Fiji Ministry of Health, Suva, Rewa, Fiji
| | | | - Rachel Devi
- Republic of Fiji Ministry of Health, Suva, Rewa, Fiji
| | | | - Luisa Vodonaivalu
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Kylie Jenkins
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Julie Leask
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yasmin Mohamed
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | | | | | - Michelle Dynes
- UNICEF East Asia and Pacific Regional Office, Bangkok, Thailand
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
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Wang X, Liu M, Li Y, Mei X, Liao S, Liang Q, Liu Y. What determinants of COVID-19 vaccine hesitancy among Chinese nursing students? A cross-sectional study. Front Public Health 2024; 12:1432225. [PMID: 39228852 PMCID: PMC11368718 DOI: 10.3389/fpubh.2024.1432225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/05/2024] [Indexed: 09/05/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) continues to threaten human health, and health professionals, including nursing students, usually work in healthcare frontiers with a high risk of infection. Vaccination is currently one of the most effective preventive measures. This study aimed to explore the determinants of COVID-19 vaccine hesitancy in nursing students. Methods In November 2022, a sample of undergraduate nursing students was recruited from several medical schools in Anhui Province, China, and an online cross-sectional survey was conducted using the questionnaire star platform (Wenjuanxin). A Chi-square test was used to explore vaccine hesitancy among nursing students with different social demographic characteristics and vaccine attitudes. Binary logistic regression analysis was then used to determine the influence factors of vaccine hesitancy among nursing students. Results A total of 1,090 valid samples were collected in this study. Of these, 27.06% (295) of nursing students reported COVID-19 vaccine hesitancy. The results showed "the need to go out of town recently" (OR = 0.670), "very confident that the outbreak could be controlled sustainably" (OR = 0.393), "feeling at risk of infection" (OR = 0.658), "not being worried/being generally worried about the vaccine's safety" (OR = 0.226 and OR = 0.686, respectively), and "not being worried about the vaccine's effectiveness" (OR = 0.411). These five factors are protective factors associated with COVID-19 vaccine hesitancy in nursing students. The factors "considering the country completely safe from an outbreak" (OR = 3.436), "considering themselves safe because others are vaccinated" (OR = 2.239), and "Agreeing that other protective measures can be relaxed after vaccination with the COVID-19 vaccine" (OR = 2.007) are risk factors associated with COVID-19 vaccine hesitancy among nursing students (P < 0.05). Conclusion Overall, relatively few nursing students had COVID-19 vaccine hesitancy. Schools and relevant institutions still need to actively guide them to improve their confidence in the COVID-19 vaccine, strengthen the prevention and control measures of the epidemic, and improve their awareness of the crisis to improve the vaccination rate to reduce the COVID-19 vaccine hesitancy in nursing students.
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Affiliation(s)
- Xin Wang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Ming Liu
- Peking University Health Science Center-Macao Polytechnic University Nursing Academy, Macao Polytechnic University, Macao, Macao SAR, China
| | - Yuanzhen Li
- School of Nursing, Wannan Medical College, Wuhu, China
| | - Xiaoxiao Mei
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Shuting Liao
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Qingqing Liang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Yachen Liu
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
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Prettner R, Te Molder H, Robinson JD. The Delicate Situation of Childhood Vaccination: On the Dispreferredness of Soliciting Parents' Intent to Vaccinate. HEALTH COMMUNICATION 2024:1-19. [PMID: 39155599 DOI: 10.1080/10410236.2024.2387387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
In the Netherlands, parents of newborns typically participate in two-, four-, and eight-week medical consultations to monitor their children's development and discuss vaccinations, which will not be administered before eight weeks. During these visits, healthcare professionals routinely ask parents if they intend to vaccinate their children (i.e. to participate in the National Immunization Program). Using Conversation Analysis, we examine 62 videotaped consultations and present two lines of evidence to argue that the sequence initiated by professionals wherein they solicit parents' intent to vaccinate is dispreferred. First, this action is routinely deferred by preliminary sequences. Second, when professionals eventually initiate this action (i.e. if it is not preempted by parents during pre-sequences), they orient to its dispreferred status, for example by highlighting benefactive details of vaccination. We discuss the possible existence of asymmetrical (initiator-sided) pre-sequences, why soliciting parents' vaccination intent might be dispreferred, and implications for the design of communication interventions.
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Affiliation(s)
- Robert Prettner
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam
| | - Hedwig Te Molder
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam
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Skirrow H, Lewis C, Haque H, Choundary-Salter L, Foley K, Whittaker E, Costelloe C, Bedford H, Saxena S. The impact of the COVID-19 pandemic on UK parents' attitudes towards routine childhood vaccines: A mixed-methods study. PLoS One 2024; 19:e0306484. [PMID: 39137199 PMCID: PMC11321586 DOI: 10.1371/journal.pone.0306484] [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: 12/13/2023] [Accepted: 06/17/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND COVID-19 vaccines were key to controlling the pandemic and vaccination has been discussed extensively by the media and the public since 2020. We aimed to explore parents' attitudes towards routine childhood vaccination since COVID-19 and how the pandemic impacted their experiences of getting their child vaccinated. METHODS We used a mixed-methods approach-involving a questionnaire survey followed by focus groups. We partnered with The Mosaic Community Trust, an ethnic minority women's group based in a deprived area of North-West London, United Kingdom (UK) with historically low childhood vaccine uptake. Descriptive findings from the questionnaires were reported and chi-square analyses performed to examine differences by ethnicity. Thematic analysis of the free-text questionnaire responses and focus groups was undertaken, guided by the COM-B model of Capability, Opportunity, and Motivation. RESULTS Between Jun-Oct 2022, 518 parents completed the questionnaire (25% from ethnic minorities). Between March-May 2023 we held four focus groups with 22 parents (45% from ethnic minorities). Most parents (>90%) thought routine childhood vaccines for children were important. Over a third (38%) of all parents reported having more questions about childhood vaccines since COVID-19, though among parents belonging to an ethnicity group other than white, 59% said they had more questions compared to those of any white ethnicity group (30%, (p = <0.0001)). Difficulties accessing vaccine appointments were commoner reasons for children's vaccinations being delayed than parents increased concerns about vaccines. Since COVID-19 some parents felt vaccinations were even more important, and a very small minority felt the pandemic had made them mistrust vaccinations. CONCLUSION Following COVID-19, we found parents remain confident in childhood vaccines. However, some parents, particularly from ethnic minority groups may have more questions about childhood vaccines than pre-pandemic. Post COVID-19, to address declining vaccine uptake, parents need easy access to healthcare professionals to answer questions about childhood vaccinations.
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Affiliation(s)
- Helen Skirrow
- School of Public Health, Imperial College London, London, United Kingdom
| | - Celine Lewis
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- London North Genomic Laboratory Hub, Great Ormond Street Hospital, London, United Kingdom
| | - Habiba Haque
- The Mosaic Community Trust, London, United Kingdom
| | | | - Kim Foley
- School of Public Health, Imperial College London, London, United Kingdom
| | - Elizabeth Whittaker
- Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ceire Costelloe
- School of Public Health, Imperial College London, London, United Kingdom
- Institute of Cancer Research, London, United Kingdom
| | - Helen Bedford
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, United Kingdom
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Cheung K. Using curiosity to render the invisible, visible. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:251-259. [PMID: 38767830 DOI: 10.1007/s11017-024-09665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
Virtues commonly associated with physicians and other healthcare professionals include empathy, respect, kindness, compassion, trustworthiness, and many more. Building upon the work of Bortolloti, Murphy-Hollies, and others, I suggest that curiosity as a virtue has an integral role to play in healthcare, namely, in helping to make those who are invisible, visible. Practicing the virtue of curiosity enables one to engage with and explore the experiences of patients and contributes toward building a physician-patient relationship of trust. As the perspectives and experiences of patients can be too often dismissed or lost within medical settings, curiosity can allow physicians to deeply know their patients, and thus provide better care. However, caution must be exercised so as to not to venture into inappropriate curiosity, where questions are asked for improper reasons or to help satisfy the personal interest of physicians. Finally, I sketch out two cases-on chronic pain and on vaccine hesitancy-to illustrate where curiosity can play a valuable role.
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Affiliation(s)
- Katherine Cheung
- Department of Bioethics, New York University, New York City, USA.
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Chen AMH, Anthony A, Balogun A, Pereira R, Cole JW. The Impact of Motivational Interviewing and MOTIVE Tool Use by Pharmacists on Vaccine Acceptance. PHARMACY 2024; 12:114. [PMID: 39195843 PMCID: PMC11360627 DOI: 10.3390/pharmacy12040114] [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: 05/31/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.
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Affiliation(s)
- Aleda M. H. Chen
- School of Pharmacy, Cedarville University, 251 N. Main St., Cedarville, OH 45314, USA; (A.A.); (A.B.); (R.P.); (J.W.C.)
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Holford D, Anderson EC, Biswas A, Garrison A, Fisher H, Brosset E, Gould VC, Verger P, Lewandowsky S. Healthcare professionals' perceptions of challenges in vaccine communication and training needs: a qualitative study. BMC PRIMARY CARE 2024; 25:264. [PMID: 39033114 PMCID: PMC11265004 DOI: 10.1186/s12875-024-02509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
- Dawn Holford
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom.
| | - Emma C Anderson
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Aishmita Biswas
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Amanda Garrison
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
| | - Harriet Fisher
- Bristol Medical School, National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE) University of Bristol, Bristol, United Kingdom
| | - Emeline Brosset
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
| | - Virginia C Gould
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Pierre Verger
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRD 190, Inserm 1207, IRBA), Marseille, France
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
- Department of Psychology, University of Potsdam, Potsdam, Germany
- School of Psychological Science, University of Western Australia, Perth, Australia
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13
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Reda S, Weishaar H, Akhter S, Karo B, Martínez J, Singh A, Jackson C. Health service providers' views on barriers and drivers to childhood vaccination of FDMN/Rohingya refugees: a qualitative study in Cox's Bazar, Bangladesh. Front Public Health 2024; 12:1359082. [PMID: 39045160 PMCID: PMC11265221 DOI: 10.3389/fpubh.2024.1359082] [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: 01/04/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
Background Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting. Methods Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles. Findings Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration. Discussion For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.
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Affiliation(s)
- Sarah Reda
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Heide Weishaar
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sadika Akhter
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Basel Karo
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Jorge Martínez
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Aarti Singh
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Cath Jackson
- Valid Research Ltd, Wetherby, Leeds, United Kingdom
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14
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Mansoor MA, Grindem DJ, Kidd N. Exploring Vaccine Hesitancy Among Parents in a Rural Pediatric Clinic System: A Statistical Study. Cureus 2024; 16:e64864. [PMID: 39156453 PMCID: PMC11330338 DOI: 10.7759/cureus.64864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Vaccine hesitancy has been a growing concern in the United States, particularly in rural areas where access to healthcare services may be limited. A rural pediatric clinic system in central Louisiana serves a population with historically low childhood immunization rates. This study explored the prevalence and determinants of vaccine hesitancy among parents of pediatric patients at the organization's clinics. METHODS A qualitative survey was conducted among parents who declined vaccines for their children at the organization's clinics. The survey collected information on parents' attitudes, beliefs, decision-making processes regarding childhood vaccinations, and demographic information about the parents, including income and education levels. Thematic analysis was used to identify key themes and patterns in the survey responses. RESULTS Thirty out of 47 parents (response rate: 64%) completed the survey. Most respondents (n=24, 80%) expressed concerns about vaccine safety and potential side effects. Many parents (n=16, 60%) cited information from social media and alternative health sources as influencing their decision to decline vaccines. Religious and philosophical beliefs were also common reasons for vaccine refusal (n=13, 43%). Another significant theme was the lack of trust in healthcare providers and the pharmaceutical industry (n=17, 53%). No significant differences in responses were observed based on the parent's race or the child's sex. Ninety percent of participants (n=27) reported a household income of under $50,000, and 87% of participants (n=26) had a high school education or less. CONCLUSION Vaccine hesitancy among parents in this rural pediatric population appears to be driven by concerns about vaccine safety, exposure to misinformation, religious and philosophical beliefs, and distrust in the healthcare system. Addressing these factors through targeted education, provider communication, and community engagement may be essential for improving childhood immunization rates in this vulnerable population. The findings highlight the need for culturally sensitive, evidence-based interventions to combat vaccine hesitancy in rural communities.
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Affiliation(s)
- Masab A Mansoor
- Pediatrics, Edward Via College of Osteopathic Medicine, Alexandria, USA
| | | | - Nicholas Kidd
- Family Medicine, University of Virginia, Charlottesville, USA
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15
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Higgins DM, O’Leary ST. A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy. Vaccines (Basel) 2024; 12:694. [PMID: 38932423 PMCID: PMC11209163 DOI: 10.3390/vaccines12060694] [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: 04/19/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.
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Affiliation(s)
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO 80045, USA;
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16
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Lermytte E, Bracke P, Ceuterick M. Healthcare Professionals' Discursive Constructions of Parental Vaccine Hesitancy: A Tale of Multiple Moralities. QUALITATIVE HEALTH RESEARCH 2024:10497323241245646. [PMID: 38881208 DOI: 10.1177/10497323241245646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Healthcare professionals play a crucial role in addressing the concerns of vaccine-hesitant parents since they form a trusted source for vaccine-related information. An increasing body of evidence suggests that healthcare professionals are faced with complexities when navigating the sensitive topic of parental vaccine hesitancy, as they balance their own vaccine- and context-specific concerns with institutional and societal pressures to vaccinate. Furthermore, health choices, such as parental choices for childhood vaccination, are often linked to moralisation. Given the emphasis on effective communication with vaccine-hesitant parents in the patient-centred care literature, it is important to consider healthcare professionals' interpretations of parental vaccine hesitancy. Hence, a deeper understanding of how healthcare professionals make sense of, and moralise, childhood vaccination can help us understand how moralisation might appear in their communication with hesitant parents (in)directly. Drawing on a critical social-psychological framework for discourse analysis, this study analyses 39 semi-structured interviews with healthcare professionals in Flanders, Belgium, and presents the discursive patterns articulated by healthcare professionals on parental vaccine hesitancy. The findings elucidate how healthcare professionals perpetuate, or resist, moral discourse in their accounts of vaccine hesitancy by constructing five different interpretative repertoires, that is, a "good" or "bad" parenting repertoire, a freedom of choice repertoire, an individual risk-benefit repertoire, a public health repertoire, and an accessibility repertoire. Our study highlights the complexities healthcare professionals experience in negotiating vaccine hesitancy, as their understandings of vaccine hesitancy are affected by, and contribute to, existing moral dilemmas and dominant discourses surrounding health and parenting.
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Affiliation(s)
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
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17
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Guo X, Han Q, Wang Y, Zhang R, Huang Y, Guo B. Influenza Vaccine Hesitancy among Cancer Survivors in China: A Multicenter Survey. Vaccines (Basel) 2024; 12:639. [PMID: 38932368 PMCID: PMC11209103 DOI: 10.3390/vaccines12060639] [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: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Cancer survivors are at higher risk of developing severe complications from influenza due to their compromised immune systems. Despite their increased vulnerability to influenza and the availability of vaccines, vaccine hesitancy among cancer survivors remains a significant public health concern in China. METHODS A multicenter, cross-sectional study was conducted among cancer survivors in China from January to December 2023. A total of 500 participants were recruited from the oncology departments of five tertiary hospitals. A structured, self-administered questionnaire was used to collect data on socio-demographic characteristics, cancer-related information, medical history, lifestyle factors, and influenza vaccine hesitancy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with influenza vaccine hesitancy. RESULTS The response rate was 97.0% (485/500). Among all participants, 204 (42.06%) reported vaccine hesitancy. The results of multiple logistic regression showed that the longer the end of anti-cancer treatment, without a history of adverse vaccine reactions, and the level of family support played a protective role in vaccine hesitancy. Current rehabilitation status, frequent colds, not being informed by doctors about vaccination, exercising, lack of community vaccination education programs, and concerns about vaccine safety were risk factors that increase vaccine hesitancy. CONCLUSIONS A high proportion of cancer survivors in our study reported influenza vaccine hesitancy. Addressing concerns about vaccine safety, improving access to vaccination services, and enhancing doctor-patient communication are crucial for increasing influenza vaccine uptake in this vulnerable population.
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Affiliation(s)
- Xin Guo
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Qi Han
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuqin Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Rui Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuenan Huang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Botang Guo
- Department of Medical Psychology, Harbin Medical University, Baojian Road 158, Harbin 150078, China
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen 518001, China
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18
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Pringle W, Greyson D, Graham JE, Dubé È, Mitchell H, Russell ML, MacDonald SE, Bettinger JA. "I try to take all the time needed, even if i do not have it!": Knowledge, attitudes, practices of perinatal care providers in canada about vaccination. Vaccine X 2024; 18:100490. [PMID: 38699156 PMCID: PMC11063514 DOI: 10.1016/j.jvacx.2024.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers' knowledge, attitudes, and practices around vaccination in pregnancy. Methods Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes. Results Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile. Conclusion Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers' knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling.
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Affiliation(s)
- Wendy Pringle
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Janice E. Graham
- Department of Pediatrics, Dalhousie University, 5849 University Ave, C-309, Halifax, Nova Scotia B3H 4H7, Canada
| | - Ève Dubé
- Quebec National Institute of Public Health, 945, av Wolfe, Quebec City, Quebec G1V 5B3, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - Margaret L. Russell
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
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19
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Ashfield S, Donelle L, Tryphonopoulos P, Dubé È, Smith M. Digital health literacy, vaccine information sources, and vaccine acceptance among parents in Ontario: Quantitative findings from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003154. [PMID: 38758822 PMCID: PMC11101077 DOI: 10.1371/journal.pgph.0003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
Parents make important vaccination decisions for their children and many variables affect parents' decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents' digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across the continuum of vaccine hesitant to vaccine accepting is reported. An online survey of parents of young children living in Ontario, Canada was conducted in 2022. Multiple linear regression determined predictors of vaccine acceptance. 219 participants completed the survey and on average reported adequate digital health literacy skill. Healthcare providers were reported as the most commonly used source of vaccine information. Two models were retained that predicted vaccine acceptance, both models predicted about 50% of the variability in vaccine acceptance. Model A identified that trust predicted parent vaccine acceptance and model B identified that digital health literacy, and the vaccine information sources healthcare providers, family and friends, and alternate healthcare providers predicted vaccine acceptance. Family and friends and alternate healthcare providers negatively predicted vaccine acceptance. Most parents in our study had high levels of digital health literacy. Opportunities exist for further research and policy change focused on trust at a systemic public health level. While clinical level implications included the importance of healthcare providers as a vaccine information source and adequate digital health literacy to facilitate parental vaccine decision making. Continued efforts to develop awareness on the importance of digital health literacy among the public and healthcare providers is needed, including further research on the digital health literacy levels of Canadians.
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Affiliation(s)
- Sarah Ashfield
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Canada
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Panagiota Tryphonopoulos
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Ève Dubé
- Department of Anthropology, Faculty of Social Sciences, Université Laval, Quebec, Canada
- Institute National de Santé Publique du Québec, Quebec, Canada
| | - Maxwell Smith
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
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20
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Chinawa AT, Ossai EN, Onukwuli VO, Nduagubam OC, Uwaezuoke NA, Okafor CN, Chinawa JM. Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria. Malar J 2024; 23:117. [PMID: 38664783 PMCID: PMC11044559 DOI: 10.1186/s12936-024-04914-1] [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: 09/12/2023] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria. OBJECTIVES This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis. METHODS This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study. RESULTS A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1-0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1-6-6.8). CONCLUSION Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.
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Affiliation(s)
- Awoere T Chinawa
- Department of Community Medicine, College of Medicine ESUT, Enugu, Nigeria
| | - Edmund N Ossai
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | | | - Obinna C Nduagubam
- Department of Paediatrics, College of Medicine, Enugu State University of Technology, Enugu, Nigeria
| | | | - Chinyere N Okafor
- Department of Community Medicine, College of Medicine UNEC, Enugu, Nigeria.
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21
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Chinawa AT, Ossai EN, Onukwuli VO, Nduagubam OC, Uwaezuoke NA, Okafor CN, Chinawa JM. Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria. Malar J 2024; 23:117. [DOI: https:/doi.org/10.1186/s12936-024-04914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/21/2024] [Indexed: 04/30/2024] Open
Abstract
Abstract
Background
There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.
Objectives
This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.
Methods
This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.
Results
A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1–0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1–6–6.8).
Conclusion
Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.
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22
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Ullah N, Martin S, Poduval S. A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis. JMIR Form Res 2024; 8:e51152. [PMID: 38530334 DOI: 10.2196/51152] [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: 07/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). OBJECTIVE This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. METHODS Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a "snapshot" of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. RESULTS A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. CONCLUSIONS Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities.
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Affiliation(s)
- Nazifa Ullah
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Sam Martin
- Vaccines and Society Unit, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Shoba Poduval
- Institute of Health Informatics, University College London, London, United Kingdom
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23
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Vega RA. Hesitation towards the COVID-19 vaccine in the United States: a digital ethnographic study. Salud Colect 2024; 20:e4541. [PMID: 38733976 DOI: 10.18294/sc.2024.4541] [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: 06/23/2023] [Accepted: 03/13/2024] [Indexed: 05/13/2024] Open
Abstract
Following the authorization the use of COVID-19 vaccines in babies age six months through children four years old in the United States, some individuals (parents, pediatricians, and communicators) framed COVID-19 vaccination as an issue of access, while many others expressed hesitancy and some resisted recommendations from the US Centers for Disease Control and Prevention. In this context, this study aimed to explore: 1) divergent reactions to the authorization of COVID-19 vaccine use in children aged six months to four years; and 2) opposing logics underlying attitudes towards pro-vaccination, anti-vaccination, and vaccine hesitancy regarding COVID-19 vaccines. To achieve this, a digital ethnography was conducted, involving monitoring of 5,700 reactions to a series of eight infographics published on social media by the John Hopkins Bloomberg School of Public Health, and participant observation in an online focus group over a one-year period, from December 2021 to December 2022, consisting of 18 mothers. The findings suggest that healthcare professionals should consider different notions of "risk" when interacting with patients, especially those who are hesitant to vaccinate.
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Affiliation(s)
- Rosalynn Adeline Vega
- Doctora en Antropología Médica. Profesora asociada, University of Texas Rio Grande Valle, Edinburg, EEUU
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24
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McKeever R, Sundstrom B, Rhodes ME, Ritter E, McKeever BW. "A Victim of Our Own Success:" Testing Jenny's First Sleepover's Dark Satire to Improve Attitudes Toward Childhood Vaccination. HEALTH COMMUNICATION 2024:1-9. [PMID: 38514995 DOI: 10.1080/10410236.2024.2330121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The COVID-19 pandemic resulted in substantially lower uptake of childhood vaccinations in the U.S. As vaccination rates struggle to rebound, childhood vaccine hesitancy continues to grow. Addressing vaccine disinformation and increasing catch-up vaccination is an urgent public health priority. The purpose of this study was to evaluate the effectiveness of "Jenny's First Sleepover," a darkly humorous satirical book about childhood vaccinations, to influence attitudes of vaccine hesitant parents. This study implemented a randomized pretest - posttest experimental design using a web-based survey with one intervention and one control. "Jenny's First Sleepover" improved attitudes toward vaccination among vaccine hesitant parents. Negative emotions were an important mediator of attitudes toward vaccinations. Findings identify mechanisms that increase effectiveness of satirical approaches, including the presentation of novel information about serious vaccine-preventable diseases with a dark narrative twist. Health communicators may consider a darkly humorous satirical approach to improve attitudes toward childhood vaccination among vaccine hesitant parents.
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Affiliation(s)
- Robert McKeever
- Department of Advertising and Public Relations, University of Alabama
| | | | | | | | - Brooke W McKeever
- Department of Advertising and Public Relations, University of Alabama
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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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26
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Enyinnaya JC, Anderson AA, Kelp NC, Long M, Duncan CG. The Social Ecology of Health Beliefs and Misinformation Framework: Examining the impact of misinformation on vaccine uptake through individual and sociological factors. Vaccine 2024; 42:455-463. [PMID: 38184392 DOI: 10.1016/j.vaccine.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/04/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND Misinformation presents a critical concern for academic and public health discourse, particularly around vaccine response. Before the COVID-19 pandemic, vaccine hesitancy was responsible for decreased immunization uptake for vaccine-preventable diseases. Misinformation connected to the novel COVID-19 vaccine has further fueled vaccine hesitancy in Colorado and the United States. Our study brings together three different perspectives - physicians, public health professionals, and parents - to understand the impact of misinformation on vaccine uptake in Colorado. Our study proposes a framework for combining the Health Belief Model with the Socio-Ecological model to account for societal factors in healthcare decision making. METHODS Semi-structured interviews and focus groups with public health professionals, physicians, and parents (n = 31) were conducted in late spring and summer 2022. Data were coded inductively using thematic analysis. Identified themes were deductively categorized according to the Socio-Ecological Model and Health Belief Model. RESULTS Using a theoretical framework that combined the Health Belief Model and the Socio-Ecological Model, we identified seven factors that influenced vaccine hesitancy in Colorado. Intrapersonal factors included routine vaccine hesitancy connected to perceptions of severity and susceptibility, efficacy, and benefits and barriers to vaccine uptake; interpersonal factors included social networks; institutional factors included mass mediated platforms, portrayals of uncertainty, distrust in institutional sources of information, and political influences in vaccine decision making; and structural factors included economic barriers behind vaccine hesitancy. CONCLUSIONS Our study provides a unique, triangulated, post-positivist perspective on the role of misinformation in vaccine hesitancy in Colorado. The findings provide evidence that misinformation is an important barrier to vaccination uptake and can permeate multiple socio-ecological determinants/characteristics to influence vaccination behaviors including intrapersonal, interpersonal, institutional, and structural levels. We introduce the Social Ecology of Health Beliefs and Misinformation Framework to account for how misinformation may interrupt vaccine uptake.
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Affiliation(s)
- Joy C Enyinnaya
- Department of Communication, University of the Fraser Valley, Abbotsford Campus, BC Canada
| | - Ashley A Anderson
- Department of Journalism and Media Communication, Colorado State University, United States.
| | - Nicole C Kelp
- Department of Microbiology, Immunology, and Pathology, Colorado State University, United States
| | - Marilee Long
- Department of Journalism and Media Communication, Colorado State University, United States
| | - Colleen G Duncan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, United States
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Ulmido ML, Reñosa MDC, Wachinger J, Endoma V, Landicho-Guevarra J, Landicho J, Bravo TA, Aligato M, McMahon SA. Conflicting and complementary notions of responsibility in caregiver's and health care workers' vaccination narratives in the Philippines. J Glob Health 2024; 14:04016. [PMID: 38206315 PMCID: PMC10783206 DOI: 10.7189/jogh.14.04016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Vaccine hesitancy (VH) continues to pose a public health threat globally. Understanding the attitudes and perceptions about vaccination of key stakeholders in vaccine decision-making (such as health care workers (HCWs) and caregivers) about vaccination can pave the way toward novel approaches to bolster vaccine confidence. In this study, we explored the role of notions of responsibilities among HCWs and caregivers in shaping vaccination interactions and decision-making in the Philippines. Methods We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with 44 vaccine-hesitant caregivers, seven HCWs, and 20 community health workers (barangay health workers) in the Philippines between August 2020 and March 2021. The interviews and focus groups were conducted online, transcribed verbatim, and analysed through the reflexive thematic analysis approach. Results Caregivers highlighted responsibility in terms of being a good caregiver, managing risk to one's own child, and seeking and validating information. Meanwhile, HCWs highlighted responsibility as: being a good HCW, managing risk to children and to the community, and providing and transforming information. Our findings suggest that responsibility manifests differently in HCWs' and caregivers' narratives, and that these notions can be both conflicting and complementary, shaping the interaction between stakeholders and, ultimately, their vaccine decision-making. We also found that fostering a good relationship between HCWs and caregivers through communication techniques such as motivational interviewing could help bridge the gap created by mistrust in vaccinations. HCWs sharing their own experiences as parents who vaccinate their own children also resonate with caregivers. Conclusions Notions of responsibility can underpin collaborative and divisive interactions between HCWs and caregivers. Public health messaging and interventions related to vaccination must consider strategies that align with these notions to address VH.
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Affiliation(s)
- Ma Leslie Ulmido
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Mila Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- International Health Department, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Jordan Z, Rowland E. Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review. Vaccine 2024; 42:75-83. [PMID: 38129287 DOI: 10.1016/j.vaccine.2023.12.045] [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: 08/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness. OBJECTIVE To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns. DESIGN Qualitative systematic review and thematic analysis. METHODS Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes. RESULTS 22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision. CONCLUSIONS Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule. REGISTRATION The review was registered on PROSPERO, registration ID CRD42021236120.
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Affiliation(s)
- Zoe Jordan
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; University Hospitals Bristol and Weston NHS Foundation Trust, UK.
| | - Emma Rowland
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Tron A, Schlegel V, Pinot J, Bruel S, Ecollan M, Bel JL, Rossignol L, Gauchet A, Gagneux-Brunon A, Mueller J, Banaszuk AS, Thilly N, Gilberg S, Partouche H. Barriers and facilitators to the HPV vaccine: a multicenter qualitative study of French general practitioners. Arch Public Health 2024; 82:2. [PMID: 38178269 PMCID: PMC10768163 DOI: 10.1186/s13690-023-01227-8] [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: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In France, human papillomavirus (HPV) vaccination coverage is low, with 30.7% of 17-year-old girls having received a complete HPV vaccination schedule in 2020. AIM To determine the perspective and behaviors of general practitioners (GPs) regarding HPV vaccination with their patients and if a reluctance is observed. DESIGN AND SETTING A qualitative study based on semi-directed individual interviews was conducted between December 2019 and December 2020. A representative sample of GPs with various profiles were included in 4 French regions. METHOD A purposive sampling was used and interviews were continued until data saturation was reached. The analysis was based on the grounded theory. RESULTS Twenty-six GPs aged 29-66 years were interviewed. The measures taken by the French health authorities (lowering the target age, reimbursing the vaccine, extending the target population to boys) were perceived as facilitators. The reported barriers were organizational, due to low attendance of adolescents, and relational, mainly due to parental vaccine hesitancy. Physicians had to deal with fears about the perceived risks and concerns about sexuality conveyed by HPV vaccination and linked to the socio-cultural characteristics of the families. Physicians developed strategies, including scientific knowledge mobilization, empowerment of families by promoting health through prevention, repetition of the vaccination proposals, personal experience and relationship. Different practices were identified according to three GP typologies: effective, convinced but unpersuasive, and reluctant physicians. CONCLUSION Based on these results, specific interventions, including communication techniques, especially for hesitant or unpersuasive physicians, are needed to enable GPs to become more effective.
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Affiliation(s)
- Arthur Tron
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France.
| | - Vincent Schlegel
- Institut de recherche et de documentation en économie de la santé (IRDES), 117 bis rue Manin, Paris, 75019, France
| | - Juliette Pinot
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, P2S UR4129, F-69008, France
- CIC-INSERM 1408, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Marie Ecollan
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Josselin Le Bel
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Louise Rossignol
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Aurélie Gauchet
- Laboratory of Psychology, University Grenoble Alps, Grenoble, France
| | - Amandine Gagneux-Brunon
- CIC-INSERM 1408, Saint-Etienne University Hospital, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France
| | - Judith Mueller
- EHESP French School of Public Health, Institut Pasteur, Paris cedex 15, Paris, France
| | - Anne-Sophie Banaszuk
- Centre régional de Coordination des Dépistages des Cancers-Pays de la Loire, 5 rue des Basses Fouassières, Angers, 49000, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, F-54000, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, F-54000, France
| | - Serge Gilberg
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Henri Partouche
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
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Strasel M, VanLangen KM, Benzer J, Geyer A, Jameson AP, Dumkow LE. HPV vaccination rates in 9- and 10-year-olds following a pharmacist-led intervention. J Am Pharm Assoc (2003) 2024; 64:278-282. [PMID: 37604404 DOI: 10.1016/j.japh.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The American Cancer Society and the American Academy of Pediatrics recommend administering the human papillomavirus (HPV) vaccine to children aged 9 and 10 years to improve on-time vaccination rates as they continue to be below national goal. Pharmacist-led interventions using the electronic health record (EHR) may be an effective way to increase these rates. OBJECTIVE This study aimed to evaluate change in first-dose HPV vaccination rate in 9- and 10-year-olds before and after a multifaceted HPV outreach initiative. METHODS A pre-post, quasi-experimental study involving a pharmacist-led intervention was implemented at 2 primary care offices within a large health care network. Adolescents aged 9 and 10 years during the entire intervention period were included. Between November 1, 2021, and March 31, 2022, an education session was provided by an ambulatory care pharmacist to each primary care team regarding the HPV vaccine and eligibility of 9- and 10-year-olds. On June 1, 2022, a direct message was sent via the EHR to parents or guardians of eligible patients describing eligibility, risks and benefits, and best practice recommendations. The primary end point evaluated change in first-dose HPV vaccination rates in 9- and 10-year-olds measured 6 months after direct messaging. Secondary outcomes evaluated EHR message receipt, adverse events, and program revenue. Nominal outcomes were assessed with McNemar's test or Cochran's Q test using SPSS software; P < 0.05 was considered significant. RESULTS A total of 367 patients aged 9 and 10 years were eligible for HPV vaccination. After the intervention, 45 patients were vaccinated with vaccination rate increasing from 0.5% to 12.8% (P < 0.001). A total of 288 (78.5%) had access to EHR messaging with 203 (55.3%) having confirmed receipt of the message. No adverse reactions were reported within 7 days of vaccination. Most patients (76%) had private insurance, followed by Medicaid (22.6%) and uninsured (1.4%). Approximate revenue of the program was $4129.89. CONCLUSIONS A multifaceted intervention using education and EHR direct messaging significantly increased HPV vaccination rates in 9-and-10-year-olds.
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Déom N, Vanderslott S, Kingori P, Martin S. Online on the frontline: A longitudinal social media analysis of UK healthcare workers' attitudes to COVID-19 vaccines using the 5C framework. Soc Sci Med 2023; 339:116313. [PMID: 37984178 DOI: 10.1016/j.socscimed.2023.116313] [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: 09/30/2022] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
This paper explores vaccine hesitancy among healthcare workers (HCWs) in the UK, where different COVID-19 vaccines were being rolled out through a national vaccination campaign from 2020 to 2022, consisting of a first and second dose programme. Through a mixed-method approach using qualitative discourse analysis and network analysis of Twitter data, we assessed HCW perceptions and views about the administration and delivery of COVID-19 vaccines in the United Kingdom (UK). We were also interested in exploring HCWs' personal experiences and attitudes towards taking COVID-19 vaccines themselves. We drew upon sociology, ethics, communication studies and used research methods concentrating on social media and media analysis. By employing the '5C framework' of 'confidence, complacency, constraints, calculation, and collective responsibility' we evaluated a longitudinal selection of tweets to capture relevant factors driving vaccination views and behaviours among HCWs. We found differing positions expressed about COVID-19 vaccines and policy during the first dose compared with the second, through a drop in confidence compounded by supply and access issues, as well the news of a vaccine mandate for HCWs by the UK government in 2021. HCWs asked calculation questions to the community or brought forward competing pieces of information about vaccine policy and guidelines. Constraint levels in access issues were noted, especially for those with work and caregiving responsibilities, and student nurses found they did not have equal vaccination access. HCWs also displayed collective responsibility on social platforms to both encourage vaccination and express concerns through the organisation of social action against vaccine mandates.
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Affiliation(s)
- Noémie Déom
- Department of Targeted Intervention, University College London, London, UK; Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK
| | - Samantha Vanderslott
- Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.
| | - Patricia Kingori
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Sam Martin
- Department of Targeted Intervention, University College London, London, UK; Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK
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32
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Ramirez LG, Wickner PG, Cline NB, Rehman N, Wu AC, Pien LC, Stukus D. How Likes and Retweets Impacted Our Patients During the COVID-19 Pandemic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3356-3364. [PMID: 37536500 DOI: 10.1016/j.jaip.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
The growing dependence on social media for health-related information boomed during the COVID-19 pandemic, posing unprecedented challenges in navigating the vast amounts of information available right at our fingertips. Social media had a major impact on clinical decision-making affecting individuals, communities, and societies at large. In this review, we discuss the role of social media in amplifying information and misinformation as well as factors contributing to its reliance and prevalence. We review how medical providers have been impacted by this changing landscape, useful communication strategies to employ with in-office patient encounters, and how we can be active players in using social media as a tool for health promotion, correcting misinformation, and preparing for future pandemics.
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Affiliation(s)
- Lourdes G Ramirez
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Paige G Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nicholas B Cline
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Narmeen Rehman
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Lily C Pien
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Department of Pediatrics, College of Medicine, the Ohio State University, Columbus, Ohio
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Barakat M, Abdaljaleel M, Atawneh N, Alkhazaleh R, Aburumman D, Hamed E, Sallam M. Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan. Vaccines (Basel) 2023; 11:1672. [PMID: 38006004 PMCID: PMC10674877 DOI: 10.3390/vaccines11111672] [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: 10/13/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan;
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Maram Abdaljaleel
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Nada Atawneh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Rawan Alkhazaleh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dana Aburumman
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Eman Hamed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
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Malekzadeh R, Abedi G, Ziapour A, Yıldırım M, Amirkhanlou A. Analysis of ethical considerations of COVID‑19 vaccination: lessons for future. BMC Med Ethics 2023; 24:91. [PMID: 37891543 PMCID: PMC10612281 DOI: 10.1186/s12910-023-00969-y] [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: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, different countries sought to manufacture and supply effective vaccines to control the disease and prevent and protect public health in society. The implementation of vaccination has created many ethical dilemmas for humans, which must be recognized and resolved. Therefore, the present study was conducted to analyze the ethical considerations in vaccination against COVID-19 from the perspective of service providers. METHODS The present qualitative research was conducted in 2022 in the north of Iran. The participants included 23 health workers with at least five years of work experience and members of the COVID-19 vaccination team. The data were initially collected through systematic semi-structured interviews, then snowball sampling and finally continued until data saturation. The next steps were transcription of interviews, identification of meaning units, coding, categorization based on similarity and symmetry, extraction of themes and the analysis of themes through content analysis. RESULTS The analysis of participants' experiences led to the extraction of five main categories of themes and fifteen sub-categories of the ethical considerations of COVID-19 vaccination. Safe and standard vaccine production, vaccine supply, fairness, respect for autonomy, and accountability were the main categories. The subcategories included compliance with scientific and ethical procedures, effectiveness and profitability of vaccine, absence of severe adverse effects, allocation of resources for vaccine supply, vaccine availability, diversity and comprehensiveness of alternative vaccines, vaccination prioritization, prioritization of the vulnerable populations of society, autonomy of patient (equal rights), autonomy of community, autonomy of service providers, reporting correct information, reporting vaccine side effects, public trust and acceptance. CONCLUSION The health system managers should be adequately prepared to solve the ethical problems posed by COVID-19 vaccination. Therefore, it is recommended to avoid haste in vaccination and pay more attention to vaccination safety standards, provide sufficient resources for a comprehensive vaccine supply, pay close attention to collective interests versus individual interests, and meet community needs.
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Affiliation(s)
- Roya Malekzadeh
- Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Ghasem Abedi
- Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Ağrı, Türkiye
- Graduate Studies and Research, Lebanese American University, Beirut, Lebanon
| | - Afshin Amirkhanlou
- General Practitioner, Shohada Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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Bedford H, Skirrow H. Action to maximise childhood vaccination is urgently needed. BMJ 2023; 383:2426. [PMID: 37875295 DOI: 10.1136/bmj.p2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, UK
| | - Helen Skirrow
- School of Public Health, Imperial College London, UK
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Eichelberger L, Hansen A, Cochran P, Fried R, Hahn M. "In the beginning, I said I wouldn't get it.": Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021. Soc Sci Med 2023; 334:116197. [PMID: 37666096 DOI: 10.1016/j.socscimed.2023.116197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by 'hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.
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Affiliation(s)
- Laura Eichelberger
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Amanda Hansen
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Patricia Cochran
- Alaska Native Science Commission. 429 L Street, Anchorage, AK 99501, USA.
| | - Ruby Fried
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
| | - Micah Hahn
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
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Milionis C, Ilias I, Tselebis A, Pachi A. Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1744. [PMID: 37893462 PMCID: PMC10608755 DOI: 10.3390/medicina59101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Athanasios Tselebis
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
| | - Argyro Pachi
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
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Restivo V, Bruno A, Minutolo G, Pieri A, Riggio L, Zarcone M, Candiloro S, Caldarella R, Immordino P, Amodio E, Casuccio A. Changes in Students' Perceptions Regarding Adolescent Vaccinations through a Before-After Study Conducted during the COVID-19 Pandemic: GIRASOLE Project Study. Vaccines (Basel) 2023; 11:1524. [PMID: 37896928 PMCID: PMC10610628 DOI: 10.3390/vaccines11101524] [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: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic caused a reduction in vaccination coverage for all age groups, especially in non-infant age. The main objective of the present study is to evaluate the effectiveness of an online intervention conducted among adolescents during the COVID-19 pandemic in increasing knowledge and positive attitudes toward vaccinations. The study, which took place online from March to May 2021, involved 267 students from six lower secondary schools in Palermo city (Italy); they filled out the questionnaire before and after the intervention. The questionnaire was based on the protection motivation theory (PMT), which estimates the improvement in vaccination-related knowledge and attitudes. The pre- and post-intervention comparison showed a significant increase in the perception of the disease severity: strongly agree pre-intervention n = 150 (58.6%) and post-intervention n = 173 (67.6%, p < 0.001), rated on a five-point Likert scale. In a multivariate analysis, the factor associated with the improvement in the score after the intervention was the school dropout index (low vs. very high dropout index OR 4.5; p < 0.03). The educational intervention was more effective in schools with lower early school leaving rates, an indirect index of socio-economic status. The topic of vaccination has caught the adolescents' attention, it is, therefore, important that interventions tackling teenagers are tailored to reduce their emotional tension about the perception of adverse effects and improve vaccination coverage.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Alessandra Bruno
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Giuseppa Minutolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Alessia Pieri
- Clinical Epidemiology and Cancer Registry Unit, University Hospital “P. Giaccone”, Via del Vespro 133, 90127 Palermo, Italy; (A.P.); (M.Z.); (R.C.)
| | - Luca Riggio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, University Hospital “P. Giaccone”, Via del Vespro 133, 90127 Palermo, Italy; (A.P.); (M.Z.); (R.C.)
| | - Stefania Candiloro
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Rosalia Caldarella
- Clinical Epidemiology and Cancer Registry Unit, University Hospital “P. Giaccone”, Via del Vespro 133, 90127 Palermo, Italy; (A.P.); (M.Z.); (R.C.)
| | - Palmira Immordino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Emanuele Amodio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.B.); (G.M.); (L.R.); (S.C.); (P.I.); (E.A.); (A.C.)
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Morrison K, Cullen L, James AB, Chua V, Sullivan C, Robertson C, Carruthers J, Wood R, Jeffrey K, MacDonald C, Shah SA, Rudan I, Simpson CR, McCowan C, Vittal Katikireddi S, Grange Z, Ritchie L, Sheikh A. Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: Two retrospective cohort analyses of the primary schedule and third dose. Vaccine 2023; 41:5863-5876. [PMID: 37598025 DOI: 10.1016/j.vaccine.2023.07.070] [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: 05/11/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Vaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death. AIM To identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one. METHODS We conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors. RESULTS Of 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period. The most strongly associated predictors for not receiving the second dose were: being aged 18-29 (reference: 50-59 years; aOR:4.26; 95% confidence interval (CI):4.14-4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29-4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16-3.32). The most strongly associated predictors for not receiving the third dose were: being 18-29 (reference: 50-59 years aOR:4.44; 95%CI: 4.38-4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53-2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30-2.46). Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule. CONCLUSION We observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.
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Affiliation(s)
| | - Lucy Cullen
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Vera Chua
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Chris Robertson
- Public Health Scotland, Glasgow, Scotland, UK; University of Strathclyde, Glasgow, UK
| | | | - Rachael Wood
- Public Health Scotland, Glasgow, Scotland, UK; Usher Institute, University of Edinburgh, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Scotland, UK
| | | | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Scotland, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Scotland, UK; School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, Scotland, UK; School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Zoe Grange
- Public Health Scotland, Glasgow, Scotland, UK
| | - Lewis Ritchie
- School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Scotland, UK
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Appelqvist E, Danielsson M, Jama A, Ask LS, Stenhammar C, Lindstrand A, Riesbeck K, Roth A. Parental views and the key role of nurses for high vaccine acceptance in Sweden - a focus group study. BMC Public Health 2023; 23:1786. [PMID: 37710197 PMCID: PMC10500778 DOI: 10.1186/s12889-023-16678-5] [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: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND In Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden. METHODS Parents of children aged 1-2 years and 8-12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1-2 years) and older (8-12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis. RESULTS Parents of children aged 1-2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet. For parents to children aged 8-12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation. CONCLUSION Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.
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Affiliation(s)
- Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden.
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Madelene Danielsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Asha Jama
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lina Schollin Ask
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Stenhammar
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, Unit Essential Programme On Immunization, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Adam Roth
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Albaker AR, Azer SA, AlKhorayef M, Dakheel NKB, AlMutairi S, AlHelal S, Aljohani R, Maghrabi S. Physicians' knowledge, attitude and perceptions towards vaccine-hesitant parents: a cross-sectional study. BMC MEDICAL EDUCATION 2023; 23:637. [PMID: 37667302 PMCID: PMC10478439 DOI: 10.1186/s12909-023-04590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Research has shown that physicians are encountering an increase in vaccine-hesitant parents (VHPs) numbers. This study examined physicians' vaccination knowledge, vaccine-related discussions with VHPs, beliefs about and responses to vaccine hesitancy, and challenges faced while discussing immunization with VHPs. METHODS This cross-sectional, descriptive study was performed at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in September 2020. The data were collected through a questionnaire distributed via email. The sample comprised 90 physicians who routinely treat children and reported they frequently have appropriate vaccine discussions when encountering VHPs. RESULTS Ninety participants (59% were females) completed the questionnaire. Of these, 37.8% were from family medicine, 7.8% from primary care, and 54.4% from paediatrics. The most discussed topics were vaccine necessity, reasons for vaccine refusal, and vaccine safety. Seventeen participants (18.8%) reported being extremely confident, and (42.2%) were confident in their vaccine-specific knowledge. Regarding confidence in communication skills, 22.2% reported being extremely confident and (45.6%) were confident. Determinants of higher confidence in the knowledge and communication skills were physician age (p = 0.001 and p = 0.0001, respectively), years of practice (p = 0.002 and (p = 0.005), and patients seen per workday (p = 0.0001 and p = 0.024). Other factors such as physician sex (p = 0.062), the field of practice (p = 0.329), and hours of work per week (p = 0.061) were not significantly different. Forty-six (51%) physicians sometimes find it challenging to conduct appropriate vaccine-related discussions because of having too many other issues to discuss during the consultation. Furthermore, 53 (59%) participants agreed/strongly agreed that parental refusal to vaccinate would raise suspicions of negligence. On the other hand, 59 (65%) disagreed/strongly disagreed that parental refusal of vaccines is a parental right. Participants expressed the need to refer VHPs to a specialised advisory clinic with excellent experience and negotiation skills to overcome the challenges. CONCLUSION Vaccine safety and necessity are the topics of most concern to VHPs, and a knowledgeable physician with competent communication skills is critical in responding to such situations. This study highlights the most reported barriers to successful vaccine-related discussions. It raises underlying ethical principles such as parental autonomy and the need to train physicians in VHPs. To train physians for succucful vaccine counceling of VHPs.
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Affiliation(s)
- Asma R. Albaker
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samy A. Azer
- College of Medicine, Department of Medical Education, King Saud University, P O Box 2925, 11461 Riyadh, Saudi Arabia
| | | | | | | | - Sarah AlHelal
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Roaa Aljohani
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Sarah Maghrabi
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
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Valencic E, Naviglio S, Ronfani L, Abbracciavento G, Tommasini A. Group medical information for parents: A COVID-19 experience between fear of the pandemic and vaccine hesitancy. Acta Paediatr 2023; 112:1941-1943. [PMID: 37098818 DOI: 10.1111/apa.16804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 04/27/2023]
Affiliation(s)
- Erica Valencic
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Samuele Naviglio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Alberto Tommasini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Trangerud HA. "What is the problem with vaccines?" A typology of religious vaccine skepticism. Vaccine X 2023; 14:100349. [PMID: 37484867 PMCID: PMC10362305 DOI: 10.1016/j.jvacx.2023.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Research has identified religion as one of numerous factors that may contribute to delay or refusal of vaccination. The influence of religion on vaccine decisions may be accidental, or it may involve explicit religious objections. By presenting a typology of religious vaccine skepticism, this article seeks to give a comprehensive overview of the essence of these objections and to clarify differences and similarities between them. This knowledge is useful for policy-makers and others who wish to better understand the influence of religion on vaccine decision-making. The typology consists of five main types: (1) a worldview clash type, in which vaccines do not make sense as a health intervention; (2) a divine will type, which represents a form of passive fatalism; (3) an immorality type, which considers some vaccines unethical because of their production or effect; (4) an impurity type, pointing to ingredients that will defile the body; and (5) a conspiracy type, in which a vaccine plot is targeting a religious group.
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Abdi I, Bolsewicz K, Bullivant B, Marques MD, Steffens MS. Understanding the factors that influence communication about COVID-19 vaccines with patients: Perspectives of Australian immunisation providers. Vaccine X 2023; 14:100304. [PMID: 37091729 PMCID: PMC10108559 DOI: 10.1016/j.jvacx.2023.100304] [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: 12/22/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background COVID-19 immunisation providers have been at the forefront of the pandemic, and their ability to communicate effectively with patients is key to encouraging COVID-19 vaccine acceptance and uptake. This study explored providers' perspectives on the factors influencing communication with patients about COVID-19 vaccines. Methods We used an explanatory-sequential mixed-methods approach to conduct the study between December 2021 and March 2022. Phase I involved a cross-sectional survey with immunisation providers in New South Wales (n = 341; 189 general practitioners, 118 nurses and 34 pharmacists), followed by Phase II: semi-structured, in-depth qualitative interviews (n = 19; 10 nurses, 9 pharmacists). We generated descriptive results for the survey. We analysed the qualitative data thematically using an inductive approach. Results Almost half of survey participants reported communicating often with people who were hesitant about COVID-19 vaccines (49 %; 166/341), however, 21 % (71/341) reported inadequate time to address concerns during consultations. Interview participants reported communication challenges, including time constraints, difficulties addressing and eliciting patient concerns, and keeping up to date with changing information. Conversely, interview participants reported that easy access to government information resources, time to learn about COVID-19 vaccines proactively, knowing about and being able to use tailored strategies to support Aboriginal and Torres Strait Islander and CALD patients were helpful when communicating with patients. Conclusions Immunisation providers play an important role in patient vaccine acceptance and uptake. Our findings indicate that whilst providers were largely confident in their interactions with patients, further communication support would strengthen providers' skills in communicating with patients who have questions and concerns about COVID-19 vaccines.
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Affiliation(s)
- Ikram Abdi
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Katarzyna Bolsewicz
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Bullivant
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mathew D. Marques
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Maryke S. Steffens
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, 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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45
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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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46
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Kikut AI. The doctor knows or the evidence shows: An online survey experiment testing the effects of source trust, pro-vaccine evidence, and dual-processing in expert messages recommending child COVID-19 vaccination to parents. PLoS One 2023; 18:e0288272. [PMID: 37478116 PMCID: PMC10361505 DOI: 10.1371/journal.pone.0288272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/24/2023] [Indexed: 07/23/2023] Open
Abstract
Increasing child vaccination rates is a critical step toward mitigating the spread of COVID-19. Both distrust in expert sources and concern about the safety and efficacy of vaccines may contribute to parent vaccine hesitancy. The present study is the first to test the effectiveness of building trust and providing evidence supporting child COVID-19 vaccines in recommendation messages for parents. Based on dual-processing theories, emphasis on source trustworthiness and pro-vaccine evidence may each be particularly effective when the other is not present. It was hypothesized that these two approaches would have main and interaction effects on perceived message effectiveness and pro-vaccine beliefs. A between-subjects 2 (trust-building appeal vs. no trust-building appeal) X 2 (pro-vaccine evidence vs. no pro-vaccine evidence) online survey experiment was conducted in December 2021 and January 2022 with United States parents/guardians of children <18 years old (n = 401). As hypothesized, trust and pro-vaccine evidence each had significant simple main effects on both outcomes. Analysis of variance showed a significant negative interaction effect of trust and pro-vaccine evidence on perceived message effectiveness [F(3, 394) = 6.47; η2 = 0.02, p = 0.002; 95% CI (0.01, 0.11)], supporting the dual-processing hypothesis. The interaction effect on pro-vaccine beliefs was also negative but not significant [F(3, 394) = 2.69; η2 = 0.01; p = 0.102; 95% CI (0.00, 0.03)]. Either highlighting evidence supporting vaccines or building trust in expert sources can influence parent vaccine support. Messages which include strong evidence supporting recommended behaviors may influence recommendation acceptance even among those with lower trust in expert sources and establishing trust may reduce the need to describe available evidence.
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Affiliation(s)
- Ava Irysa Kikut
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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47
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Uthoff SAK, Zinkevich A, Franiel D, Below M, Splieth H, Iwen J, Biedermann M, Heinemeier D, Ansmann L. A complex intervention on vaccination uptake among older adults (≥ 60 years) in Germany - a study protocol with a mixed methods design. BMC PRIMARY CARE 2023; 24:148. [PMID: 37452283 PMCID: PMC10349490 DOI: 10.1186/s12875-023-02101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates. METHODS A complex intervention will be implemented and evaluated in 1057 GPs' practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses. DISCUSSION In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients' vaccine-related health literacy and knowledge, and patients' intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention's effectiveness. TRIAL REGISTRATION Trial registration number: DRKS00027252 (retrospectively registered).
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Affiliation(s)
- Sarah A K Uthoff
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstrasse 140, 29123, Oldenburg, Germany.
| | - Anna Zinkevich
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstrasse 140, 29123, Oldenburg, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Chair of Medical Sociology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Dominika Franiel
- Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587, Berlin, Germany
| | - Maike Below
- Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587, Berlin, Germany
| | - Helene Splieth
- Association of Substitute Health Funds (Vdek) e.V, Askanischer Platz 1, 10963, Berlin, Germany
| | - Julia Iwen
- Association of Substitute Health Funds (Vdek) e.V, Askanischer Platz 1, 10963, Berlin, Germany
| | - Marc Biedermann
- The National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623, Berlin, Germany
| | - Dorothee Heinemeier
- Communication Lab Erfurt, Bahnhofstraße. 16/Büßleber Gasse, 99084, Erfurt, Germany
| | - Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstrasse 140, 29123, Oldenburg, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Chair of Medical Sociology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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48
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Leonardelli M, Mele F, Marrone M, Germinario CA, Tafuri S, Moscara L, Bianchi FP, Stefanizzi P. The Effects of the COVID-19 Pandemic on Vaccination Hesitancy: A Viewpoint. Vaccines (Basel) 2023; 11:1191. [PMID: 37515007 PMCID: PMC10386622 DOI: 10.3390/vaccines11071191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Vaccination hesitancy is considered by the World Health Organization as a danger to global health. In recent years, vaccine hesitancy rates to COVID-19 have been studied worldwide. In our study, we aim to provide an overview of the concept of vaccine hesitancy, with regard to the post-COVID era, and to provide prevention and management strategies. A search of the international literature until March 2023 was conducted in the PubMed database. The 5723 papers found were divided into two groups: prior to the COVID-19 era and from 2021 onward. Papers about the vaccine hesitation phenomenon are becoming more common during the SARS-CoV-2 pandemic and following the marketing that the vaccine companies have carried out on the different types of COVID-19 vaccines. It is advisable that healthcare authorities, at the national and international level, as well as healthcare professionals, at the local level, should promote a series of activities to reduce the vaccine hesitancy rate.
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Affiliation(s)
- Mirko Leonardelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Federica Mele
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | - Lorenza Moscara
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | | | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
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49
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White P, Alberti H, Tang E, Rowlands G, Dubé È. How much should we care about vaccine hesitancy in UK primary care? Br J Gen Pract 2023; 73:295-296. [PMID: 37385766 PMCID: PMC10325600 DOI: 10.3399/bjgp23x733209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Philip White
- National Institute for Health and Care Research (NIHR) Academic Clinical Fellow in General Practice, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Eugene Tang
- NIHR Clinical Lecturer in General Practice, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gill Rowlands
- Population Health Sciences Institute, Newcastle University; Training Lead, North East and North Cumbria Applied Research Collaboration, Newcastle-upon-Tyne, UK
| | - Ève Dubé
- Department of Anthropology, Laval University, Quebec City, Canada
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50
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Wiedermann CJ, Koler P, Tauber S, Plagg B, Psaier V, Barbieri V, Piccoliori G, Engl A. Unravelling Vaccine Scepticism in South Tyrol, Italy: A Qualitative Analysis of Personal, Relational, and Structural Factors Influencing Vaccination Decisions. Healthcare (Basel) 2023; 11:1908. [PMID: 37444742 DOI: 10.3390/healthcare11131908] [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: 05/05/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Low vaccine uptake in South Tyrol, particularly for non-coronavirus and SARS-CoV-2 vaccines, poses a significant public health challenge in the northernmost province of Italy. This qualitative study conducted in-depth interviews with a purposive sample of vaccine-sceptical parents to examine the factors that contribute to their vaccination decisions. The ten participants' children had varied vaccination statuses, ranging from unvaccinated to partially vaccinated or vaccinated as late as possible. Only one adult participant received the SARS-CoV-2 vaccine. Using Grounded Theory analysis, the emergent meta-category of 'self-relatedness' was identified, highlighting the importance of individual experiences and the social context. The study found that participants' social circles consisted of individuals with similar vaccination attitudes, often characterized by a shared affinity for nature. Although they accepted individuals with different views, they remained uninfluenced. Participants perceived healthcare professionals as one-sided and uncritical, expressing distrust toward state orders. They believed that parents should be responsible for their children's well-being rather than the state. Distrust in the state and healthcare system, exacerbated by the SARS-CoV-2 pandemic, was rooted in negative experiences. In contrast, the participants had positive experiences with natural healing, homeopathy, and trusting the natural course of events. They perceived themselves as tolerant, non-radical, curious, health-conscious, yet critical and questioning. Participants resisted coercion, fear-mongering, and state sanctions and sought alternatives to mandatory vaccination. To address the complex social and behavioural factors underlying vaccination refusal, this study suggests that vaccination advocates, policymakers, and information providers should engage in appreciative, personal, and well-founded information exchanges with vaccine-hesitant individuals. Broad and comprehensible information dissemination, flexibility, and freedom of decision are essential for increasing informed decision making. Further research is required to better understand the epistemic basis of vaccine hesitancy.
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Affiliation(s)
- Christian J Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, BZ, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Austria
| | - Peter Koler
- Nonprofit Organization Forum Prevention, 39100 Bolzano, BZ, Italy
| | - Sara Tauber
- Nonprofit Organization Forum Prevention, 39100 Bolzano, BZ, Italy
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, BZ, Italy
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, BZ, Italy
| | - Vera Psaier
- Nonprofit Organization Forum Prevention, 39100 Bolzano, BZ, Italy
| | - Verena Barbieri
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, BZ, Italy
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, BZ, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, BZ, Italy
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