Student nurses' intention to get the influenza vaccine

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

Vaccine Hesitancy in Israel: Exploring the Relationships with Vaccination History, Knowledge, and Attitudes towards Influenza Vaccines

Influenza vaccination is a highly effective strategy for mitigating all the repercussions of influenza infections. Despite the potential severity of influenza and the accessibility of secure vaccinations, worldwide rates of influenza vaccination continue to be low, particularly among students. This study examines the correlative relationships between influenza vaccine history, knowledge, attitudes toward influenza vaccines, and vaccine hesitancy among college students. To that end, we used an online questionnaire to conduct a cross-sectional study encompassing 610 students. A significant majority of participants reported having experienced influenza (82%), with slightly more than half having received influenza vaccinations in the past (57%). With respect to the current research year, health sciences students exhibited a higher likelihood of either having been vaccinated or intending to receive the vaccine than did their counterparts. Among students who had been vaccinated previously, approximately one-fifth opted for vaccination in the present year (21%). Similarly, 22% of the students whose parents were vaccinated chose to get vaccinated this year. Notable disparities in knowledge about influenza vaccines were observed across various departments, with health sciences students demonstrating the highest levels of awareness. Moreover, a negative relationship was found between knowledge, attitudes, and vaccine hesitancy. These results suggest that targeted lectures by professionals emphasizing vaccine safety and university-hosted events addressing this subject in collaboration with the Ministry of Health, incorporating influenza vaccination stations, could be instrumental in bolstering the vaccination rate.

Acceptance of and hesitancy about COVID-19 vaccination among nursing students in clinical practice

BACKGROUND

Although vaccination of nursing students in clinical practice is important due to the possibility of COVID-19 infection and subsequent transmission to patients, some nursing students are hesitant to get vaccinated. Thus, it is necessary to identify the actual intentions and motivations of nursing students who have been vaccinated for COVID-19, even if their decisions were driven by clinical practice policy. The purpose of this study was to understand the nature of COVID-19 vaccine hesitancy among vaccinated nursing students in clinical practice and to examine their reasons for getting vaccinated despite such hesitancy.

METHOD

A cross-sectional, descriptive study was conducted at two tertiary hospitals in South Korea from November 20, 2021, to December 17, 2021. The study recruited a convenience sample of 125 nursing students who were vaccinated for COVID-19. Data were analyzed using the chi-square test, Fisher's exact test, and independent t-test.

RESULTS

Of the 125 nursing students, 51 (40.8%) reported vaccine hesitancy, among whom 88.2% reported that their hesitancy was due to the adverse effects and instability of the vaccine. It was also found that 70.6% of nursing students in the vaccine-hesitant group were eventually vaccinated due to clinical practice policy, whereas 67.6% of nursing students in the non-hesitant group were vaccinated to protect their health.

CONCLUSIONS

COVID-19 vaccine hesitancy is prevalent among nursing students. Therefore, specific efforts should be made to provide education focusing on the safety, benefits, and efficacy of COVID-19 vaccines, implement mandatory vaccination policies for clinical practice, and give priority to vaccination opportunities to nursing students in order to reduce the hesitancy of nursing students to vaccines.

Factors Associated With Airline Cabin Crews' Influenza Vaccination Intention in the Workplace-based Setting

BACKGROUND

Yearly influenza vaccination is the best way to prevent influenza. Workplace vaccination program for airline cabin crews is an important countermeasure in the management of infectious diseases. Understanding the influenza vaccination behavior of cabin crews is essential to establishing strategies to promote vaccine uptake. This study aimed to examine factors associated with airline cabin crews' influenza vaccination intention in a workplace-based setting. We applied the theory of planned behavior (TPB) to explain the vaccination behavior of employees.

METHODS

A cross-sectional study was performed in April 2021. Participants self-reported the structured questionnaires that consisted of TPB variables, and reasons for influenza vaccination/nonvaccination in 2020. A total of 253 crew members participated, and 242 were included in the analysis.

FINDINGS

The influenza vaccination rate was 70.7% in 2020, and vaccination intention was 5.92 of 7 points in 2021. Multiple linear regression showed that influenza vaccination intention was associated with subjective norms (β = .394, p < .001), positive attitude (β = .145, p = .007), perceived behavioral control (β = .170, p = .004), actual behavioral control (β = .145, p = .010), and the previous year's vaccination (β = .163, p < .001). The model accounted for 57% of the variance in influenza vaccination intention (F = 40.959, p < .001).

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings indicate that TPB is useful in explaining employees' influenza vaccination intention and influencing factors. Focusing on positive messages that emphasize the social effects of vaccination and providing free vaccination on specific dates are potential strategies to increase intention. It can be applied to help design on-site workplace vaccination programs for essential frontline workers.

College students' influenza vaccine hesitation: a reasoned action investigation with quantitative and qualitative data

This two-wave longitudinal study (performed pre-COVID), using both quantitative and qualitative data, investigated college students’ influenza vaccine hesitancy and confidence using the theory of planned behavior (TPB). At Time 1, college students (n = 277) completed TPB measures and reported past influenza vaccine behavior. At Time 2 (30 days later), participants indicated whether they received the influenza vaccine since Time 1. At Time 2, participants who indicated that they had not received the influenza vaccine since Time 1 also described their most important reasons for not doing so. The TPB model fit the quantitative data well; direct paths from attitude and norms to intention, and from intention to future behavior, were strong and significant. The TPB model explained 71% of the variance in intention and 28% of the variance in future behavior. Neither perceived behavioral control nor past behavior improved the model’s ability to predict intentions or future behavior. From the qualitative data, participants’ reasons for not getting vaccinated focused on perceived behavioral control (e.g., time cost) and attitudes (e.g., unimportance and low susceptibility). Theoretical implications for message development are discussed.

The Attitude towards Vaccination of Health Sciences Students at a Spanish University Improved over the First 18 Months of the COVID-19 Pandemic

It is important to know the attitudes of students of health sciences (SHSs) towards vaccination since they will be tomorrow's health professionals. Vaccination is a powerful tool in the fight against COVID-19. The aim of the present, cross-sectional study was to examine how the COVID-19 pandemic has influenced the attitude of SHSs towards vaccination. Data were collected in the form of a questionnaire from all students of nursing, physiotherapy and chiropody matriculated at a Madrid University for the academic year 2019/2020 (i.e., before the start of the pandemic [Q1]), and from all those matriculated for the year 2021/22 (i.e., c18 months after the pandemic was declared [Q2]). A multivariate analysis was performed to identify the influence of sex, degree being studied, course year and the time of answering (Q1 or Q2), on the dimensions Beliefs, Behaviours and General Attitude. Overall, 1894 questionnaires were returned (934 [49.3%] for Q1, and 960 [50.7%] for Q2), of which 70.5% were completed by students of nursing, 14% by students of physiotherapy and 15.4% by those studying chiropody. In Q2, the results for all three dimensions were significantly better (p < 0.05). The most important influencing factors were being a student of nursing, being in the final years of training (years 3 or 4), female gender and answering at the time of Q2. The results obtained are encouraging since student nurses (who showed Q1 and Q2 General Attitude scores of 3.34 and 3.47 (maximum possible 4), respectively [p < 0.05]) are the health professionals of tomorrow most likely to be involved in vaccination programmes.

Attitude towards Vaccination among Health Science Students before the COVID-19 Pandemic

Health science students are tomorrow's health professionals, the duties of whom could include vaccination. This work examines the general attitude towards vaccination in students attending the Faculty of Nursing, Physiotherapy and Chiropody at a university in Madrid, Spain, using the 'Attitudes and Behaviour With Regard To Vaccination Among Health Science Students Questionnaire'. The results were subjected to multivariate analysis to identify the influence of sex, the degree being pursued, and 'course year'. The number of students vaccinated against influenza in the campaign preceding the present study was also recorded, as were the factors that influenced decision-making in this regard. A total of 934 students completed the questionnaire. Their beliefs regarding vaccination were positive (mean score 3.23 points out of 4), as was their behaviour (3.35/4). Their general attitude (all variables taken together) was therefore also good (3.27/4). Only 26.8% of the students had been vaccinated against influenza. Beliefs scores among the students of nursing in their more senior course years were significantly better than those recorded for all other groups. These students also showed the best general attitude towards vaccination and formed the largest group vaccinated against influenza. The results obtained are encouraging since nursing students are the most likely of future healthcare professionals to be involved in vaccination programmes.

Impact of the COVID-19 pandemic on intention to use traditional Chinese medicine: A cross-sectional study based on the theory of planned behavior

Objective

Coronavirus disease 2019 (COVID-19) has become an increasingly severe public health emergency. Although traditional Chinese medicine (TCM) has helped to combat COVID-19, public perception of TCM remains controversial. We used the theory of planned behavior (TPB) to identify factors that affect the intention to use TCM.

Methods

A cross-sectional web-based survey of 10,824 individuals from the general public was conducted between March 16 and April 2, 2020. The participants were recruited using a snowball sampling method. Data were collected using a self-administered questionnaire, based on the TPB. The questionnaire consisted of demographic characteristics and TPB structures. Structural equation modeling was used to identify predictors of intention.

Results

The results indicated the model explained 77.5% and 71.9% of intention and attitude variance. Intention to use TCM had the strongest relationship with attitude (P < 0.001), followed by past behavior (P < 0.001), subjective norms (P < 0.001) and perceived behavioral control (P < 0.001). Attitudes toward TCM were significantly affected by perceived behavioral control (P < 0.001), subjective norms (P < 0.001) and cognition of TCM (P < 0.001).

Conclusion

Attitude is a key factor in determining the intention to use TCM, followed by past behaviors, subjective norms and perceived behavioral control. Our results offer important implications for health policy makers to promote the use of TCM.

To Get Vaccinated or Not? Psychological Safety as a Catalyst for the Alignment Between Individual Beliefs and Behavior

While many studies have investigated the consequences of psychological safety for behavior, there is little theorizing on the mechanisms that account for these effects. Since psychological safety makes individuals feel safe to express their true self, we argue that it should act as a catalyst for alignment between individual beliefs and behavior. Drawing on the reasoned action model, we postulate that psychological safety interacts with individuals’ attitudes and perceived norms in predicting intention and behavior. We tested our model with physicians’ influenza vaccination behavior. We surveyed 208 physicians from a Swiss hospital before and after the vaccination phase. Results show that the effect of attitude, but not perceived norm, on intention to get vaccinated was moderated by perceived psychological safety in the physicians’ team: High psychological safety strengthened the effect of physicians’ attitude on their intention, which in turn predicted actual vaccination behavior. We provide first evidence that high psychological safety may render individuals more comfortable to act in accordance with their attitudes. Depending on whether attitudes are in line with organizational goals, increasing psychological safety could facilitate positive or negative consequences. This more differentiated understanding of psychological safety can fruitfully inform both future research and organizational practice.

Evaluation of a 'serious game' on nursing student knowledge and uptake of influenza vaccination

Background

Influenza is a serious global healthcare issue that is associated with between 290,000 to 650,000 deaths annually. The aim of this study is to evaluate the effect of a ‘serious game’ about influenza, on nursing student attitude, knowledge and uptake of the influenza vaccination.

Methods

1306 undergraduate nursing students were invited, via email, to play an online game about influenza between September 2018 and March 2019. 430 nursing students accessed the game and completed an 8-item questionnaire measuring their attitudes to influenza between September 2018 and March 2019. In April 2019, 356 nursing students from this sample completed a follow-up 2-item questionnaire about their uptake of the influenza vaccination. A larger separate 40-item knowledge questionnaire was completed by a year one cohort of 124 nursing students in August 2018 prior to receiving access to the game and then after access to the game had ended, in April 2019. This sample was selected to determine the extent to which the game improved knowledge about influenza amongst a homogenous group.

Results

In the year preceding this study, 36.7% of the sample received an influenza vaccination. This increased to 47.8% after accessing to the game. Nursing students reported perceived improvements in their knowledge, intention to get the vaccination and intention to recommend the vaccination to their patients after playing the game. Nursing students who completed the 40-item pre- and post-knowledge questionnaire scored an average of 68.6% before receiving access to the game and 85.2% after. Using Paired T-Tests statistical analysis, it was determined that this 16.6% increase was highly statistically significant (P < 0.001).

Conclusions

The research highlights that the influenza game can improve knowledge and intention to become vaccinated. This study suggests that improvement in influenza knowledge is likely to encourage more nursing students to receive the influenza vaccination.

Vaccine hesitancy and perceived behavioral control: A meta-analysis

OBJECTIVES

The World Health Organization recognizes that vaccine hesitancy is a top threat to the public health. To address vaccine hesitancy, much research guided by behavioral theories attempted to examine factors that contribute to vaccination intentions. The current study synthesizes the summary effects of attitude, norms and perceived behavioral control on vaccination intentions.

METHODS

We searched five databases with relevant keyword combinations without time constraints. A sample of 5149 participants was included for final analysis.

RESULTS

Attitude, norms and perceived behavioral control were significant predictors of vaccination intentions with attitude being the strongest. Type of recipient significantly moderated the PBC-intention relationship, while norm-intention correlations were significantly moderated by type of norm measures. Formative belief elicitation research had no moderating influences.

CONCLUSION

Our findings demonstrate clear support for the utility of theory of planned behavior in explaining vaccine hesitancy. Research is needed on how interventions can change these constructs to motivate vaccination.

Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network

Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent's intention to vaccinate his/her child. Informed by the Theory of Planned Behaviour (TPB) this study assesses potential associations between parents' knowledge, attitudes and beliefs toward vaccination and their intention to vaccinate their child in the future. A national sample of Canadian parents of children aged 24-59 months (N = 2013) was surveyed using an online survey methodology. Half of the surveyed parents strongly intended to have their child vaccinated in the future. Parents' information needs and searches as well as parents' trust in different institutions were associated with intention to vaccinate. Parents who reported having frequently looked for vaccine information, who considered that it was their role as parents to question vaccines, or who had previously experienced difficulty accessing vaccination services were less likely to strongly intend to vaccinate their child in the future. Parents who had a high level of trust in doctors and public health were most likely to strongly intend to vaccinate their child. Results of the multivariate analysis showed that positive attitudes (aOR = 8.0; 95% CI: 6.0, 10.4), higher perceived social support (aOR = 3.0; 95% CI: 2.3, 3.93), and higher perceived behavioural control (aOR = 1.8; 95% CI: 1.4, 2.43) were associated with parents' intention to vaccinate their child. Findings of this study suggest that trust-building interventions that promote pro-vaccine social norms and that address negative attitudes toward vaccination could enhance vaccine acceptance among Canadian parents.

Factors affecting the willingness of nursing students to receive annual seasonal influenza vaccination: A large-scale cross-sectional study

Nursing students are at high risk of exposure to vaccine-preventable diseases such as seasonal influenza. However, due to the limited number of studies conducted in this area, the prevalence and factors affecting annual seasonal influenza vaccination (ASIV) uptake remain unclear. This was a large-scale cross-sectional survey study conducted among 902 nursing students in different years of study. The questionnaire was developed based on the Health Belief Model (HBM), and logistic regression was used to determine the predictors of ASIV uptake. The results of our study reveal that only 15.2% of nursing students declared having the vaccine in the previous year, and that ASIV uptake was self-reported. ASIV uptake was associated with perceived susceptibility (odds ratio=2.76), perceived seriousness (odds ratio=2.06) and perceived barriers (odds ratio=0.50). The odds of receiving ASIV were 17.96times higher for those participants having had ASIV at least once than those who had not received ASIV in the previous five years. In addition, the odds of receiving ASIV were 4.01times higher for master's than undergraduate students. Our study concludes that the ASIV uptake among nursing students is low. In order to increase vaccination uptake in subsequent years, future studies should promote vaccination based on HBM, focusing on nursing students in undergraduate studies by emphasizing not only vaccination knowledge, but also their social responsibility to protect patients. Influenza vaccination can be viewed as an ethical professional responsibility and a patient safety issue, as well as being an infection control strategy.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assessing determinants of the intention to accept a pertussis cocooning vaccination: A survey among Dutch parents

INTRODUCTION

Pertussis cocooning is one of the strategies aiming to prevent the potential harm of pertussis in infants by vaccinating (among others) their parents. Several countries adopted this strategy, but uptake is a problem. Determinants of parental uptake are important in the design of an effective vaccination programme. Therefore, this study aims to assess parents' intention to accept a pertussis cocooning vaccination and its determinants.

METHODS

A 98 item questionnaire was developed based on a theoretical framework, assessing parents' intention to accept a pertussis cocooning vaccination and its personal and psychosocial determinants. In addition, beliefs underlying parents' attitude towards pertussis cocooning vaccination were assessed. Both logistic and linear regression analysis were used to assess univariate and multivariate associations amongst study variables.

RESULTS

Parents returned 282 questionnaires. The majority of the parents (78%) reported a positive intention to accept a pertussis cocooning vaccination. Attitude (OR 6.6, p<.001), anticipated negative affect in response to non acceptance (OR 1.65, p<.001), anticipated negative affect in response to acceptance (OR 0.55, p .040) and decisional uncertainty (OR 0.52, p .002) were significantly associated with intention. General vaccination beliefs (β 0.58, p<.001), moral norm (β 0.22, p<.001), perceived susceptibility of pertussis in children (β 0.10, p.004), and efficacy outcome expectations (β 0.15, p.011) were significant correlates of attitude towards pertussis cocooning vaccination.

CONCLUSION

The parental intention to accept a pertussis cocooning vaccination in this study is rather high. Targeting the identified determinants of parents' acceptance in a pertussis cocooning vaccination programme is crucial to secure that intention is translated into actual vaccination uptake.

Using behavior change frameworks to improve healthcare worker influenza vaccination rates: A systematic review

BACKGROUND

Influenza vaccination of healthcare workers (HCW) is important for protecting staff and patients, yet vaccine coverage among HCW remains below recommended targets. Psychological theories of behavior change may help guide interventions to improve vaccine uptake. Our objectives were to: (1) review the effectiveness of interventions based on psychological theories of behavior change to improve HCW influenza vaccination rates, and (2) determine which psychological theories have been used to predict HCW influenza vaccination uptake.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, The Joanna Briggs Institute, SocINDEX, and Cochrane Database of Systematic Reviews were searched for studies that applied psychological theories of behavior change to improve and/or predict influenza vaccination uptake among HCW.

RESULTS

The literature search yielded a total of 1810 publications; 10 articles met eligibility criteria. All studies used behavior change theories to predict HCW vaccination behavior; none evaluated interventions based on these theories. The Health Belief Model was the most frequently employed theory to predict influenza vaccination uptake among HCW. The remaining predictive studies employed the Theory of Planned Behavior, the Risk Perception Attitude, and the Triandis Model of Interpersonal Behavior. The behavior change framework constructs were successful in differentiating between vaccinated and non-vaccinated HCW. Key constructs identified included: attitudes regarding the efficacy and safety of influenza vaccination, perceptions of risk and benefit to self and others, self-efficacy, cues to action, and social-professional norms. The behavior change frameworks, along with sociodemographic variables, successfully predicted 85-95% of HCW influenza vaccination uptake.

CONCLUSION

Vaccination is a complex behavior. Our results suggest that psychological theories of behavior change are promising tools to increase HCW influenza vaccination uptake. Future studies are needed to develop and evaluate novel interventions based on behavior change theories, which may help achieve recommended HCW vaccination targets.

A/H1N1 vaccine intentions in college students: an application of the theory of planned behavior

OBJECTIVE

To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine.

PARTICIPANTS

Undergraduate communication students at a metropolitan southern university.

METHODS

In January-March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N=198; 70% Caucasian).

RESULTS

The TPB model explained 51.7% (p<.001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block.

CONCLUSIONS

For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.