Examining the effect of information channel on COVID-19 vaccine acceptance

Understanding the influence of social media on COVID-19 vaccine acceptance in a war-torn Syria: A cross-sectional study

Social media has become a source of disseminating information to the public during the COVID-19 outbreak which has been a great advantage for healthcare centers. However, foreign anti-vaccination campaigns on social media increased the disbelief in vaccine safety. To our knowledge, the effects of social media on COVID-19 vaccine acceptance are not well-studied in low-income countries. The primary objective of this survey is to investigate Syrians' dependence on social media platforms to get information about vaccines, and to what extent it affects their vaccination decision. A web-based cross-sectional study was conducted in Syria from May 26th to July 26th, 2022 using an online questionnaire as Google Form posted on various social media platforms. The questionnaire consisted of 53 questions related to each of the socio-demographic characteristics, beliefs, and knowledge about COVID-19 vaccination, willingness to get vaccinated, and social media frequency use and its effects. Univariate and multivariate logistic regression was performed to identify factors associated with vaccination behavior. A total of 780 questionnaires were completed; around 42.2% of study participants did not get the vaccine, and 24% would take it only under compulsory rules. Also, only 3.08% of the participants answered correctly on the knowledge-evaluation questions. Results of the univariate analysis showed that being female, living in an urban residential area, and having good vaccine knowledge were positive predictors of vaccine receiving. The unvaccinated group had a higher likelihood of being college students, not trusting in the vaccine, knowing relatively less about the vaccine, and not having previously been exposed to the virus. No significant correlation between vaccination status and using social media was shown in our investigation. However, our results show the importance of social media information in health-related decisions in war-torn countries and emphasize further investigations to confirm causality and determine the best health policy choice.

Knowledge, attitude, and perception towards COVID-19 vaccinations among the adults in Rwanda: a cross-sectional study

BACKGROUND

Multiple vaccinations have received approval for the prevention of the coronavirus illness. Nevertheless, the sluggish vaccination rate is mostly attributed to the general population's limited understanding and unwillingness to accept the use of vaccinations. Thus, it is important to investigate the Rwandan population's knowledge, attitudes, and perceptions toward COVID-19 vaccines.

METHODS

A cross-sectional survey was conducted among 370 participants from 11th to 17th February 2023. Demographic information was gathered, and knowledge, attitudes, and perceptions of COVID-19 vaccinations were assessed. A binary logistic regression analysis was undertaken to determine the parameters that determine the perception of COVID-19 vaccinations.

RESULTS

This study included 370 participants. Among them, 85% had good knowledge about COVID-19 vaccines, and 84% had a positive attitude towards them. Additionally, the study had a diverse group, with half of the participants being female and nearly half falling between the ages of 30 and 39. Several key findings emerged through logistic regression analysis. Those aged 30-39 had 1.39 times higher odds of positive perception than 18-28 (OR = 1.39, 95% CI = 1.08-3.24). Participants with a university education were twice as likely to have a positive perception compared to those without an education level (OR = 2.43, 95% CI = 1.30-6.20). Additionally, single individuals were three times more likely to have a positive perception than their married counterparts (OR = 3.39, 95% CI = 1.28-9.09). Vaccinated individuals had twice the odds of positive perception than non-vaccinated individuals (OR = 2.89, 95% CI = 1.01-8.89). Those receiving information from government health institutions were three times more likely to have a positive perception than those who received the information from friends (OR = 3.19, 95% CI = 1.02-12.7). Moreover, employed participants were four times more likely to have a positive perception non-employed individuals (OR = 4.21, 95% CI = 1.48-13.6). Besides, gender and COVID-19 diagnosis did not significantly correlate with positive COVID-19 vaccine perception.

CONCLUSION

The results indicate that the general public in Rwanda has good knowledge, positive attitudes, and a positive perception toward the COVID-19 vaccination, however, some of the participants had some misconceptions towards COVID-19. The findings of this study will be valuable for policymakers and healthcare authorities working to improve vaccination rates.

Vaccination homophily in ego contact networks during the COVID-19 pandemic

Vaccine hesitancy is an inevitable risk for societies as it contributes to outbreaks of diseases. Prior research suggests that vaccination decisions of individuals tend to spread within social networks, resulting in a tendency to vaccination homophily. The clustering of individuals resistant to vaccination can substantially make the threshold necessary to achieve herd immunity harder to reach. In this study, we examined the extent of vaccination homophily among social contacts and its association with vaccine uptake during the COVID-19 pandemic in Hungary using a contact diary approach in two cross-sectional surveys. The results indicate strong clustering among both vaccinated and unvaccinated groups. The most powerful predictor of vaccine uptake was the perceived vaccination rate within the egos' social contact network. Vaccination homophily and the role of the interpersonal contact network in vaccine uptake were particularly pronounced in the networks of close relationships, including family, kinship, and strong social ties of the ego. Our findings have important implications for understanding COVID-19 spread dynamics by showing that the strong clustering of unvaccinated individuals posed a great risk in preventing the spread of the disease.

What Caused the Narrowing of Black-White COVID-19 Vaccination Disparity in the US? A Test of 5 Hypotheses

Despite differential uptake of COVID-19 vaccination between Black and non-Hispanic White Americans early in the pandemic, the gap narrowed over time. We tested five hypotheses that could explain the reduction in the disparity. Using a national probability panel of over 1800 individuals surveyed from April 2021 to July 2022, we assessed receipt of recommended doses of COVID-19 vaccines along with (a) reported exposure to deaths due to COVID-19, (b) trust in US health authorities, such as the CDC, (c) knowledge about the safety and efficacy of COVID-19 vaccination, (d) media use as a source of information, and (e) access to COVID-19 vaccines. Only increases in knowledge about the safety and efficacy of COVID-19 vaccines uniquely mediated the increase in vaccination uptake among non-Hispanic Black compared to White, Asian and Hispanic panelists. While trust in CDC and exposure to COVID-19 deaths were related to vaccination acceptance at baseline, those factors were not associated with change in reported vaccination coverage. In addition, neither differential access nor media use explained the increase. Enhanced knowledge about the safety and efficacy of COVID-19 vaccination transmitted from within the Black community likely helped to increase vaccination relative to other racial-ethnic groups.

Between information campaign and controversy: a quantitative newspaper content analysis about COVID-19 vaccination in Switzerland and Austria

AIMS

Because media portrayal reflects and shapes public opinion and health policy, investigating news coverage of public health issues is highly relevant for public health research and practice. Addressing a topical issue, this study investigated how newspaper coverage framed COVID-19 vaccines in Austria and German-speaking Switzerland and how it developed over time.

METHODS

A quantitative newspaper content analysis of six newspapers from Austria and German-speaking Switzerland published between January 1 and 31, 2022 was conducted. Frames were identified for each country separately through hierarchical cluster analysis (Ward's method) based on frame elements.

RESULTS

Four frames were identified in both countries: (1) Evaluating new vaccines, (2) Discussing mandates, (3) Promoting vaccination, (4) Mentioning vaccines. In Frames 1 (Switzerland 86.4%, Austria 93.3%) and 3 (Switzerland 92.7%, Austria 98.9%), most articles included vaccine-endorsing statements, with Swiss coverage including additional negative statements more often than Austrian coverage (43.2%/44.6% vs 4.0%/3.3%). Frame 2 was closely linked to vaccine skepticism only in Austria and contained more evaluative statements in Austrian newspapers (25.4% endorsing, 35.4% rejecting; in Switzerland 14.5%/18.1%). The Austrian tabloid Kronen Zeitung published most articles (497/1091, 45.6%).

CONCLUSIONS

The commercialized and comparatively high share of tabloid news coverage in Austria may have contributed to oversimplified and polarizing COVID-19 vaccine debates in this context. Insufficiently balanced and adequate information may contribute to a loss of public trust in vaccination and may therefore affect vaccination uptake. Authorities and public health professionals should consider this effect when designing information campaigns.

Determinants of COVID-19 vaccination intention in Central and Eastern Europe: A cross-sectional study in Poland, Romania, and Slovenia

BACKGROUND

Identifying predictors of vaccination intention is critical to developing appropriate programs and campaigns targeting groups reluctant to be vaccinated. This study aimed to identify the determinants of vaccination intention at the beginning of the COVID-19 pandemic in three Central and Eastern European (CEE) countries: Poland, Romania, and Slovenia.

METHODS

In this cross-sectional study, a sample of unvaccinated 1723 Poles, Romanians, and Slovenians completed an online survey (April 2021). Questions included measures of vaccination intention, attitudes towards vaccines, conspiracy mindset, preference for a type of vaccine, and trust in information sources.

RESULTS

The results showed that mistrust of vaccine benefits and concerns about commercial profiteering negatively predicted vaccination intention. Conversely, trust in information from medical professionals and scientists, official sources, and traditional media was positively related to vaccination intention, while trust in digital media was negatively related to vaccination intention. In addition, preference for mRNA vaccine type was a positive significant predictor of vaccination intention. The differences between countries are discussed.

CONCLUSIONS

The study results deliver suggestions for developing appropriate vaccine uptake programs and campaigns that should consider presenting the positive outcomes of vaccines via official sources and traditional media based on scientific evidence and medical professionals' knowledge.

Influences of mpox disease perceptions, sources and contents of information exposure on mpox vaccine uptake among gay, bisexual, and other men who have sex with men in Hong Kong, China

BACKGROUND

Following the global mpox outbreak in 2022, multiple regions in Asia have been reporting ongoing mpox cases within high-risk groups, including gay, bisexual, and other men who have sex with men (GBMSM). An optimal level of vaccination rate is essential to prevent further mpox outbreaks. However, no existing studies have examined mpox vaccine uptake among GBMSM in East Asia.

METHODS

A cross-sectional survey was conducted among a sample of 531 GBMSM in Hong Kong, China, between March and October 2023. The study used multivariable logistic regression models to investigate the associations between mpox-related disease perceptions, exposures to sources and contents of mpox-related information, and mpox vaccine uptake.

RESULTS

The prevalence of mpox vaccine uptake among GBMSM in Hong Kong was 21.7%, with 7.7% completing one dose and 13.9% completing two doses. GBMSM who were younger or earning less monthly income were less likely to have been vaccinated. After adjusting for confounding variables, participants who perceived more negative impacts on their lives if they were to contract mpox, more severe symptoms, and a more coherent understanding of mpox were positively associated with mpox vaccine uptake. In addition, more frequent exposure to information through the following sources: TV, newspaper, radio and posters, government websites, news websites or apps, other people's social media, and communication over the phone or face-to-face was positively associated with mpox vaccine uptake. Finally, more frequent exposure to the following information contents: mpox statistics from other countries, the Hong Kong government's responses to mpox cases, negative information about patients with mpox, and information on prevention and treatment of mpox were positively associated with mpox vaccine uptake.

CONCLUSIONS

This study provides timely and evidence-based implications to address health communication and messaging needs in promoting mpox vaccination among GBMSM in Hong Kong, relevant to regions with similar sociocultural contexts.

How Information Repertoire Affects Vaccine Hesitancy: Processes of Information Verification and Cognitive Elaboration

As information consumption plays a critical role in addressing vaccine hesitancy in the hybrid media environment, it becomes crucial to understand how individuals' use of a combination of channels and sources affects their vaccine hesitancy. Based on information repertoire approaches emphasizing the multiplicity of channels and sources, we investigated different patterns of information repertoire related to the COVID-19 pandemic and how these patterns affected vaccine hesitancy through different informational mechanisms. Our results based on a U.S. sample suggest that while a richer information repertoire related to increased confidence in vaccines through increased information verification, this richness also corresponded with deepened vaccine hesitancy through heightened cognitive elaboration and perceived information inconsistency. Our findings support the utility of repertoire approaches for better understanding health information acquisition in the complex media ecology.

Symptoms and Severity of COVID-19 in Patients with Immune-Mediated Inflammatory Diseases: Experience of a University Medical Center

Background

The pandemic situation of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) and its associated disease (coronavirus disease 2019 (COVID-19)) represents a challenging condition with a plethora of aspects. The course of COVID-19 in patients with immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) and rheumatic diseases (RD) is not well known. Our study is one step toward closing this gap by collecting data on vaccination rates, infection-free survival, and individual symptom severity.

Methods

We conducted a prospective questionnaire-based study between April 2022 and October 2022 at our university hospital. Outward patients over the age of 18 years were screened for participation and reported about their infection/infection-free survival since the start of the pandemic.

Results

Finally, 156 patients were included in the study, 117 (75.0%) of which had inflammatory bowel disease and 39 (25.0%) patients with rheumatic disease. Altogether, 143 (91.7%) persons had received at least one vaccination against SARS-CoV-2. A total of 153 patients provided information regarding their COVID-19 history: 81 patients (52.0%) self-reported about their SARS-CoV-2 infection. In general, courses of infection were mild: only two patients (2.5% of patients with reported COVID-19) were hospitalized due to COVID-19 with one (1.2%) of the two needing intensive care. Asymptomatic COVID-19 had been described by 7 persons (8.6% of patients with reported COVID-19). Acute COVID-19 was accompanied by fatigue/tiredness in 58 persons (71.6% of patients with history of COVID-19) as the most frequent symptom. Other complaints were common cold (55 patients = 67.9%), cough (51 patients = 63.0%), headache (44 patients = 54.3%), and fever (35 patients = 43.2%). Stratified by vaccination status (unvaccinated vs. at least once vaccinated), the time to infection differed significantly (logrank test: p = 0.04, Chi2 4.1). At least once vaccinated people had a median COVID-19-free survival of 28.5 months (confidence interval (CI): 23.6 months-not reached). Without any vaccination, the estimated time to infection was 25.1 months (CI: 23.6 months-not reached).

Conclusion

Our IMID patients have a high rate of vaccination against SARS-CoV-2. Data show a significantly longer infection-free survival in vaccinated IMID patients as compared to unvaccinated patients. Discrimination between symptoms of COVID-19 and a concomitant inflammatory disease is difficult as complaints might be overlapping. This trial is registered with DRKS00028880.

Newspaper Coverage of Hospitals During a Prolonged Health Crisis: Longitudinal Mixed Methods Study

BACKGROUND

It is important for health organizations to communicate with the public through newspapers during health crises. Although hospitals were a main source of information for the public during the COVID-19 pandemic, little is known about how this information was presented to the public through (web-based) newspaper articles.

OBJECTIVE

This study aims to examine newspaper reporting on the situation in hospitals during the first year of the COVID-19 pandemic in the Netherlands and to assess the degree to which the reporting in newspapers aligned with what occurred in practice.

METHODS

We used a mixed methods longitudinal design to compare internal data from all hospitals (n=5) located in one of the most heavily affected regions of the Netherlands with the information reported by a newspaper covering the same region. The internal data comprised 763 pages of crisis meeting documents and 635 minutes of video communications. A total of 14,401 newspaper articles were retrieved from the LexisNexis Academic (RELX Group) database, of which 194 (1.3%) articles were included for data analysis. For qualitative analysis, we used content and thematic analyses. For quantitative analysis, we used chi-square tests.

RESULTS

The content of the internal data was categorized into 12 themes: COVID-19 capacity; regular care capacity; regional, national, and international collaboration; human resources; well-being; public support; material resources; innovation; policies and protocols; finance; preparedness; and ethics. Compared with the internal documents, the newspaper articles focused significantly more on the themes COVID-19 capacity (P<.001), regular care capacity (P<.001), and public support (P<.001) during the first year of the pandemic, whereas they focused significantly less on the themes material resources (P=.004) and policies and protocols (P<.001). Differences in attention toward themes were mainly observed between the first and second waves of the pandemic and at the end of the third wave. For some themes, the attention in the newspaper articles preceded the attention given to these themes in the internal documents. Reporting was done through various forms, including diary articles written from the perspective of the hospital staff. No indication of the presence of misinformation was found in the newspaper articles.

CONCLUSIONS

Throughout the first year of the pandemic, newspaper articles provided coverage on the situation of hospitals and experiences of staff. The focus on themes within newspaper articles compared with internal hospital data differed significantly for 5 (42%) of the 12 identified themes. The discrepancies between newspapers and hospitals in their focus on themes could be attributed to their gatekeeping roles. Both parties should be aware of their gatekeeping role and how this may affect information distribution. During health crises, newspapers can be a credible source of information for the public. The information can also be valuable for hospitals themselves, as it allows them to anticipate internal and external developments.

COVID-19 information seeking and individuals' protective behaviors: examining the role of information sources and information content

BACKGROUND

Seeking COVID-19 information promotes individuals to adopt preventive behaviors, including wearing a mask, social distancing, staying away from risky places, and washing hands. This study aims to investigate which information and sources individuals relied on in seeking COVID-19 information and further examine their roles in individuals' adoption of preventive behaviors.

METHODS

Through a statistical analysis of 1027 valid responses from citizens in different Chinese cities in 2022 to the self-designed items in an online survey, this study identified individuals' preferred information sources and content on COVID-19. Regarding the information sources and content, the study used multiple regression analysis to examine their associations with individuals' preventive behaviors, and further applied fuzzy-set qualitative comparative analysis (fsQCA) to explore their configurations that increase the likelihood of individuals adopting preventive behaviors.

RESULTS

Individuals preferred information about the newest prevention and control policies, precautions and treatment, and symptoms from the sources of workplace and community, social media, and social live streaming services. Additionally, individuals' preventive behaviors were positively related to the workplace and community (β = 0.202, p <.001), social live streaming services (β = 0.089, p <.01), government department websites (β = 0.079, p <.05), television (β = 0.073, p <.05), and online news media (β = 0.069, p <.05), but were negatively associated with newspapers (β=-0.087, p <.05). Regarding information content, precautions and treatments (β = 0.211, p <.001), the newest prevention and control policies (β = 0.173, p <.001), symptoms (β = 0.152, p <.001), and official rumor-dispelling information (β = 0.082, p <.05) had a positive relationship with individuals' preventive behaviors. In addition, fsQCA results presented eight configurations that promote individuals to adopt preventive behaviors. The total coverage and solution consistency values were 0.869 and 0.987, respectively. Furthermore, COVID-19 information content, the sources of social media and interpersonal sources, and official news media played an essential role in increasing the likelihood of individuals adopting preventive behaviors.

CONCLUSIONS

Our findings demonstrated that individuals seek various COVID-19 information from multiple sources. The direct and degree of association of information sources and content with individuals' preventive behaviors vary from source to source and from content to content. Information sources and content could combinatorially promote individuals to adopt preventive behaviors through several configurations.

Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations

RATIONALE

Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes.

OBJECTIVE

The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations.

METHOD

We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles.

RESULTS

The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions.

CONCLUSIONS

While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.

Did text-based news-media coverage about the COVID-19 pandemic increase vaccine uptake? A population-based study in Alaska

COVID-19 vaccinations protect against severe infection, hospitalisation, and death. News media can be an important source of information for the public during a health crisis. This study explores the extent to which local or statewide text-based news coverage of the pandemic was related to the uptake of initial doses of COVID-19 vaccines among adults in Alaska. Multilevel modelling was employed to explore the association between news media intensity and vaccine uptake rates across boroughs and census areas, while controlling for relevant covariates. Results suggest that the intensity of news media did not significantly influence vaccine uptake during the majority of this time period and had a negative affect during the Delta-surge in the fall of 2021. However, the political lean and median age of boroughs or census areas were significantly associated with vaccine uptake. Race, poverty, or education were not significant determinants of vaccine uptake suggesting there are unique differences in Alaska compared to the U.S., particularly amongst Alaska Native people. The political environment in Alaska surrounding the pandemic was polarized. Future research in communications and channels that can cut through this polarized and politicized environment, and reach younger adults is needed.

COVID-19 vaccine hesitancy worldwide and its associated factors: a systematic review and meta-analysis

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has taken a toll on humans, and the development of effective vaccines has been a promising tool to end the pandemic. However, for a vaccination program to be successful, a considerable proportion of the community must be vaccinated. Hence, public acceptance of coronavirus disease 2019 (COVID-19) vaccines has become the key to controlling the pandemic. Recent studies have shown vaccine hesitancy increasing over time. This systematic review aims to evaluate the COVID-19 vaccine hesitancy rate and related factors in different communities.

Method

A comprehensive search was performed in MEDLINE (via PubMed), Scopus, and Web of Science from January 1, 2019 to January 31, 2022. All relevant descriptive and observational studies (cross-sectional and longitudinal) on vaccine hesitancy and acceptance were included in this systematic review. In the meta-analysis, odds ratio (OR) was used to assess the effects of population characteristics on vaccine hesitancy, and event rate (acceptance rate) was the effect measure for overall acceptance. Publication bias was assessed using the funnel plot, Egger's test, and trim-and-fill methods.

Result

A total of 135 out of 6,417 studies were included after screening. A meta-analysis of 114 studies, including 849,911 participants, showed an overall acceptance rate of 63.1%. In addition, men, married individuals, educated people, those with a history of flu vaccination, those with higher income levels, those with comorbidities, and people living in urban areas were less hesitant.

Conclusion

Increasing public awareness of the importance of COVID-19 vaccines in overcoming the pandemic is crucial. Being men, living in an urban region, being married or educated, having a history of influenza vaccination, having a higher level of income status, and having a history of comorbidities are associated with higher COVID-19 vaccine acceptance.

Predictors of COVID-19 vaccine uptake among persons aged 18 years and above in Ga North Municipality, Ghana using the Health Belief Model: A community-based cross-sectional study

BACKGROUND

Although the coronavirus disease 2019 (COVID-19) vaccination rollout has been accepted by the population of the Ga North Municipality, a substantial proportion has developed hesitancy to COVID-19 vaccination uptake. This study determined the predictors of COVID-19 vaccine uptake among persons aged 18 years and above in the Ga North Municipality using the Health Belief Model.

METHODS

The study used a cross-sectional study design. Structured questionnaires were used to collect data from a multistage sample of 388 respondents. Multivariable binary logistic regression was used to determine the predictors of COVID-19 vaccination uptake at the level of 0.05 and 95% confidence interval.

RESULTS

Vaccination uptake was 72.2%. The odds of COVID-19 vaccination uptake were higher among men than women [AOR = 2.02, 95% Cl: 1.13-3.20] and among singles than the married [AOR = 1.90, 95% Cl: 1.07-3.36], but lower among Muslims than Christians [AOR = 0.33, 95%Cl: 0.18-0.60]. Perceived susceptibility [AOR = 2.43, 95% Cl: 1.36-4.35], perceived barriers [AOR = 0.54, 95%Cl: 0.31-0.95], cues to action [AOR = 2.23, 95% Cl: 1.19-4.21] and self-efficacy [AOR = 3.23 95% Cl: 1.82-5.71] were the significant predictors of COVID-19 vaccination uptake.

CONCLUSION

The uptake of the COVID-19 vaccine in GA North Municipality is high. Health promotion interventions should focus on increasing perceived susceptibility to COVID-19, minimising barriers to COVID-19 vaccine uptake, and promoting cues and self-confidence for COVID-19 vaccine uptake. It should also target women, the married, and Muslims.

COVID-19 vaccine-related misinformation identification among Chinese residents during a regional outbreak

Objectives

Misinformation about the COVID vaccines poses a significant challenge to vaccination efforts in many countries. This study examined Chinese citizens' ability to correctly identify COVID-19 vaccine misinformation in geographic areas with and without a regional outbreak. We also investigated the associations between misinformation identification and information source usage, source trust, perceived information quality, and demographic characteristics.

Setting

The online survey was conducted in four cities from June 8th to 15th, 2021 in Guangdong Province, two of which were experiencing a regional surge of COVID-19 delta variant infections, and four cities in Hunan Province, a neighboring province largely unaffected.

Participants

A total of 4,479 individuals aged 18 and above completed the online questionnaire. Given survey length, those who finished the study under 5 min were excluded, resulting in a final sample of 3,800.

Outcome measurements

Misinformation identification, source exposure, source trust, and perceived information quality.

Results

Results showed slightly higher levels of correct misinformation identification in surge vs. non-surge areas. Trust in official information sources was positively associated with correct misinformation identification in full sample analysis, while trust in informal sources was negatively associated with the same outcome. Perceived information quality was positively associated with correct misinformation identification in the full sample.

Conclusion

Information providers in China should enhance the quality of the vaccine information they provide, and the Chinese public should balance their usage of different sources of information to acquire vaccine knowledge.

Vaccine decision making among people who inject drugs: Improving on the WHO's 3C model of vaccine hesitancy

The objectives of this study were to 1) identify vaccination rates among PWID in Oregon at a time when vaccines were easily accessible, 2) quantitatively identify convergence with demographic correlates of vaccination willingness and uptake to promote generalizability, and 3) explore the factors PWID were considering when deciding whether or not to receive the COVID-19 vaccine. We conducted a mixed-methods study design including 260 quantitative surveys and 41 in-depth qualitative interviews with PWID, conducted July - September 2021 at syringe services programs in Lane County, Oregon. Among the 260 survey respondents, 37.3% indicated that they had received a COVID-19 vaccine by October 1, 2021. In the same period, an estimated 70.1% of the total Lane County population had completed their COVID-19 vaccinations (not including booster rounds). We explored alignment with the WHO's 3C model of vaccine hesitancy and identified, instead, five common factors as key motivators for vaccine decisions: confidence, convenience, concern, communication, and community implications among PWID. Interviews with PWID describe systemic barriers which prevented them from accessing healthcare resources. We highlight that our proposed 5C model may more accurately depict how PWID navigate vaccine decisions by incorporating the ways that social inequities, infrastructural barriers, and community values influence an individual's vaccine deliberation.

Examining spatial variation for immunisation coverage in pregnant women: A nationwide and geospatial retrospective cohort study in Aotearoa New Zealand

BACKGROUND

Maternal influenza and pertussis immunisation is crucial for protecting mothers during pregnancy and their babies in the first weeks of life against severe disease. We examined geospatial variation in maternal immunisation coverage among pregnant women in Aotearoa New Zealand and its health equity implications.

METHOD

We constructed a retrospective cohort including all pregnant women who delivered between 01 January 2013 and 31 December 2020 using administrative health datasets. Our outcomes were receipt of influenza or pertussis vaccine in any one of three relevant national databases (e.g. National Immunisation Register, Proclaims, or Pharmaceutical collection) during the eligible pregnancy.

RESULTS

Data from our retrospective cohort study show significant regional variation in maternal immunisation coverage for both influenza and pertussis from 2013 to 2020. Maximal coverage was around 50% in the best performing regions, which means that half of the women who were pregnant (183,737 women) were not protected. In addition, we found significant spatio-temporal variation and clustering of immunisation coverage. Our findings are interactively available to explore here: https://geohealthlab.shinyapps.io/hapumama/ CONCLUSION: Our study is one of the first to examine spatial variation in maternal vaccination coverage in pregnant women at a national level over space and time. This provides powerful tools to measure the impact of interventions to improve coverage at national and regional levels, with specific reference to inequities between ethnic groups, likely applicable to similar settings internationally.

Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study

People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.

COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario: A qualitative study

BACKGROUND

The burden of the current COVID-19 pandemic is not shared equally in Canadian society, with Indigenous Peoples being disproportionately affected. Moreover, there is a lack of research pertaining to vaccination behaviour in Métis communities. This Métis-specific and Métis-led qualitative study endeavours to understand COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario (MNO).

METHODS

Data was collected via one-on-one interviews. Participants were recruited via the MNO's existing social media channels. Participants filled out a screening survey indicating their intention to vaccinate against COVID-19 as yes, no, or unsure. Sixteen participants (9 yes, 3 unsure, 4 no) were interviewed. Interviews averaged 30 min, and the questions and probes were developed in collaboration with the MNO. The interviewer received Métis-specific cultural safety training. Interviews were transcribed verbatim and uploaded to NVivo 12.

RESULTS

A deductive analysis using the Social Ecological Model framework (SEM) for vaccine behaviour and two blinded coders was used to understand the data. An additional factor, COVID-19 public health measures, was added to the framework to better capture the experiences of participants during the COVID-19 pandemic. Overall, the factors with the greatest number of coded references included Vaccine roll-out and availability, Organization of the public into priority groups, Public discourse, Interpersonal influences, Interface with health professionals, Knowledge state, Trust, and Vaccine risk perception. Bandwagoning (following others' behaviour) and Freeloading (perceiving enough people have been vaccinated), both factors of the SEM, were not discussed. Yes, no, and unsure participant groups were compared to understand the influences of each factor based on COVID-19 vaccination intention.

CONCLUSIONS

MNO citizens COVID-19 vaccine behaviour was negatively and positively influenced by a number of factors. This information will allow the MNO and public health units to better tailor their messaging for COVID-19 vaccine uptake campaigns and future pandemic emergencies.

COVID-19 health information sources and their associations with preventive behaviors: A typological study with older residents in Seoul, South Korea

Considering that individuals' health information can enable their adoption of health behaviors, we examined the use of health information sources related to COVID-19 and its association with preventive behaviors in a sample of older residents in Seoul, South Korea (N = 400, M age = 76.1 years). Latent profile analysis of 12 sources of health information representing conventional media, online sources, interpersonal networks, and health professionals or authorities yielded a 4-group typology: limited, moderate/traditional, moderate/digital, and diverse. In a multivariate model with the diverse group as a reference, the limited group (B = -4.48, SE = 1.14, p < .001) and the moderate/digital group (B = -2.73, SE = 0.76, p < .001) were associated with lower adherence to COVID-19 preventive behaviors. Our findings support the heterogeneity in the use of health information sources and the hypothesis that groups with restricted sources of health information would report less desirable behaviors. The findings also underscored the importance of proper use of digital health information. Efforts should be made not only to help older adults with low education access diverse sources of health information, including digital sources, but also to empower them to build digital and health literacy.

Let's talk about COVID-19 vaccination: Relevance of conversations about COVID-19 vaccination and information sources on vaccination intention in Switzerland

BACKGROUND

COVID-19 vaccine hesitancy is known to be more pronounced among young people. However, there are a lack of studies examining determinants of COVID-19 vaccination intention in the general population in this young age-group in Switzerland, and in particular, studies investigating the influence of information sources and social networks on vaccination intention are missing.

METHODS

The cross-sectional study "COVIDisc - Discussion with young people about the corona pandemic" provided the opportunity to investigate COVID-19 vaccination intention in 893 individuals aged 15-34 years from the cantons of Zurich, Thurgau, and Ticino in Switzerland. An online survey was administered between 10 November 2020 and 5 January 2021. Associations of public information sources and conversations about COVID-19 with COVID-19 vaccination intention were analyzed with multivariable logistic regression and mediation analysis using generalized structural equation modeling.

RESULTS

51.5% of the participants intended or probably intended to get vaccinated once the vaccine would be available. Using print or online news (AOR 1.50, 95% CI 1.09-2.07) as an information source and having conversations about the COVID-19 vaccine (AOR 2.09, 95% CI 1.52-2.87) increased participants' COVID-19 vaccination intention. The effects of female gender (b = -0.267, p = 0.039) and risk perception (b = 0.163, p = 0.028) were partially mediated by having conversations about the COVID-19 vaccine. The effects of age (b = -0.036, p = 0.016), secondary educational level (b = 0.541, p = 0.010) and tertiary educational level (b = 0.726, p = 0.006) were fully mediated via having conversations about the COVID-19 vaccine.

CONCLUSIONS

Conversations and campaigns should start even before vaccines become available. Our data support interventions for young women and less educated people using social norms and supporting information seeking with news. Trust and risk perceptions are essential foundations for vaccine intentions.

Monitoring the COVID-19 Vaccine Acceptance Trend and its Determinants Among Iranian Adults

BACKGROUND

Vaccination seems to be the most critical means of halting the COVID-19 pandemic. It is crucial to understand the factors that influence COVID-19 vaccine acceptance to avoid low vaccination rates. This study intended to monitor the COVID-19 vaccine acceptance and its association with socio-demographic factors and prior diagnosis of COVID-19 in Iranian adults during the COVID-19 pandemic.

METHODS

The study utilized data from the COVID-19 Population Survey of Iran (COPSIR), a repeated national survey designed to monitor COVID-19-related behavioral insights. From April 2020 to November 2021, thirteen iterations of a series of cross-sectional studies involving computer-assisted telephone interviews were conducted.

RESULTS

The COVID-19 vaccine acceptance rate remained above 80% until the ninth wave in February 2021, when it dropped to 62.9%. However, throughout the next four surveys, it rose gradually from 72.0% to 85.7%. The multilevel regression model revealed that the COVID-19 vaccine acceptance was significantly and positively linked with age and education.

CONCLUSION

Despite the relatively high COVID-19 vaccine acceptance rate among Iranian adults, after the emergence of vaccines on the global market and controversies about their safety in Iran, the initially high vaccine acceptance rate dropped significantly, and then increased over time and returned to its peak level (85%). According to the Commodity Theory, this rise in vaccine acceptance can be attributed to the COVID-19 vaccine shortage in the country between January and July 2022. For Iranian adults to accept vaccines more readily, health promotion programs should target the youth and the less literate adults.

'They've all endorsed it…but I'm just not there:' a qualitative exploration of COVID-19 vaccine hesitancy reported by Black and Latinx individuals

OBJECTIVE

We sought to examine reasons for vaccine hesitancy among online communities of US-based Black and Latinx communities to understand the role of historical racism, present-day structural racism, medical mistrust and individual concerns about vaccine safety and efficacy.

DESIGN

A qualitative study using narrative and interpretive phenomenological analysis of online bulletin board focus groups.

SETTING

Bulletin boards with a focus-group-like setting in an online, private, chat-room-like environment.

PARTICIPANTS

Self-described vaccine hesitant participants from US-based Black (30) and Latinx (30) communities designed to reflect various axes of diversity within these respective communities in the US context.

RESULTS

Bulletin board discussions covered a range of topics related to COVID-19 vaccination. COVID-19 vaccine hesitant participants expressed fears about vaccine safety and doubts about vaccine efficacy. Elements of structural racism were cited in both groups as affecting populations but not playing a role in individual vaccine decisions. Historical racism was infrequently cited as a reason for vaccine hesitancy. Individualised fears and doubts about COVID-19 (short-term and long-term) safety and efficacy dominated these bulletin board discussions. Community benefits of vaccination were not commonly raised among participants.

CONCLUSIONS

While this suggests that addressing individually focused fear and doubts are central to overcoming COVID-19 vaccine hesitancy in Black and Latinx groups, addressing the effects of present-day structural racism through a focus on community protection may also be important.

Assessment of COVID-19 Website Communication in Languages Other than English by Local Health Departments in the United States

Managing the information needs of diverse populations through accessible, high-quality, and evidence-based health communication is critical to controlling the COVID-19 pandemic. Access to comprehensive information is especially important for the >25 million limited English proficient (LEP) individuals in the U.S. who prefer to communicate in languages other than English. We assessed the alignment of COVID-19 communication with LEP constituents' needs by examining multilingual content availability on the health department websites of the largest U.S. cities by population. To guide content analysis, we designed a codebook to evaluate six content types, six delivery modes, and three score measures for each website; for each, we measured Holsti's percent of agreement. We then compared the amount of information provided in all combined content types across cities and languages by delivery mode. We thematically analyzed open-ended responses about users' experiences with each city's webpages. We found that COVID-19 information was not presented consistently across languages: many cities provided less information among several delivery modes in other languages compared to English. We found a discrepancy in the amount of information, presentation quality, and ease of navigability of the information among languages and between cities. Users described having negative experiences with most cities' COVID-19 websites in languages other than English. Our findings indicate a gap in the application of the cultural sensitivity approach by local health departments to address issues related to equitable multilingual, multimodal emergency communication, and underscore the need to improve guidelines for communicating public health information as a component of advancing health equity.

Double Jab: Survey Evidence on Vaccine Hesitancy, Beliefs, and Attitudes in India

India witnessed a large surge in COVID-19 cases in April 2021, a second wave of nearly 350,000 daily new infections across the country. As of December 2021, cases have reduced drastically, in part due to greater vaccine coverage across the country. This study reports results on vaccine hesitancy, attitudes, and behaviors from an online survey conducted between February and March 2021 in nine Indian cities (N = 518). We find that vaccine hesitancy negatively predicts willingness to take the vaccine, and beliefs about vaccine effectiveness supersede hesitancy in explaining vaccine uptake. Furthermore, we find that mask-wearing and handwashing beliefs, information sources related to COVID-19, and past COVID-19 infection and testing status are all strongly associated with the hypothetical choice of vaccine. We discuss these findings in the context of behavioral theories as well as outline implications for vaccine-related health communication in India.

COVID-19 Vaccine Acceptance, Attitude, Hesitancy, and Its Associated Factors among Wolaita Sodo University Students: A Mixed-Method Study

Background

Countries in the world have been experiencing the ongoing impact and spread of the coronavirus disease (COVID-19) virus pandemic. The health and financial burden of the pandemic has prompted the need for timely and effective vaccination to be considered as the best strategy for controlling disease transmission. However, vaccine acceptability remains an area of concern in developing countries like Ethiopia.

Objective

To assess attitude, hesitancy in the COVID-19 vaccine acceptance, and associated factors among health science students at Wolaita Sodo University.

Methods

A triangulated mixed-method study was conducted. Quantitative data were entered into SPSS Windows version 25 for analysis, and the qualitative data were transcribed using open code version 4.3. A binary logistic regression model was used to establish the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the strengths of the association. Thematic approach was used for qualitative data analysis.

Results

A total of 352 students participated in this study. Having family members who were infected with COVID-19, information about COVID-19 vaccine, the need for a vaccine with the level of concern, intention to take COVID-19 vaccine, and academic year were strongly associated with vaccine acceptability. Graduating class and other senior students were about 4 and 2 times more likely to accept vaccination as compared to freshman-year students (AOR = 4.128; 95% CI: 1.351-12.610;P = 0.012) and (AOR = 2.195; 95% CI: 1.182-4.077; P value = 0.013), respectively. Even if 67% of students had a good attitude towards the vaccine, 56% of the students hesitated to take the vaccine.

Conclusion

The majority of respondents had a constructive attitude towards the COVID-19 vaccine, and only a few of them were vaccinated against the COVID-19 virus. It is of utmost importance to design an evidence-based strategy to increase the uptake of vaccination for healthcare students and other nonhealth science students in universities.

COVID-19 vaccine acceptance and related behavioral and psychological characteristics in individuals with mental disorders in Korea

Objective

This study aimed to investigate COVID-19 vaccine acceptance and related factors in individuals with mental disorders in Korea.

Methods

We surveyed 572 individuals with mental disorders about their attitudes toward COVID-19 vaccination using a 7-item self-rating questionnaire on vaccine acceptance and hesitancy. We categorized the respondents into groups based on their level of vaccine acceptance using hierarchical clustering. In addition, we evaluated the respondents' vaccination status and trust in sources of information regarding COVID-19 vaccines, and assessed their psychological characteristics using the Patient Health Questionnaire-9, Gratitude Questionnaire-6, and Big Five Inventory-10.

Results

Clustering revealed three groups according to vaccine acceptance: 'totally accepting' (n= 246, 43.0%), 'somewhat accepting' (n= 184, 32.2%), and 'hesitant' (n= 142, 24.8%) groups. Three quarters of all participants, who belonged to the 'totally accepting' or 'somewhat accepting' groups, were willing to receive a COVID-19 vaccine despite concerns about its side effects. Individuals in the high vaccine acceptance group were older (F= 12.52, p< 0.001), more likely to receive the influenza vaccine regularly, and more likely to trust formal information sources. Additionally, they had higher levels of gratitude (F= 21.00, p< 0.001) and agreeableness (F= 4.50, p= 0.011), and lower levels of depression (χ²= 11.81, p= 0.003) and neuroticism (F= 3.71, p= 0.025).

Conclusion

The present study demonstrated that individuals with mental disorders were generally willing to receive COVID-19 vaccination. However, they weighed its need and effectiveness against potential side effects before coming to a decision. It is important to understand the behavioral and psychological characteristics associated with vaccine acceptance, to effectively communicate its importance to individuals with mental disorders.

The Need for Systems Approaches for Precision Communications in Public Health

A major challenge in communicating health-related information is the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. To date, public health communications approaches have often not adequately accounted for the complexities of these systems to the degree necessary to have maximum impact. The virality of COVID-19 misinformation and disinformation has brought to light the need to consider these system complexities more extensively. Unaided, it is difficult for humans to see and fully understand complex systems. Luckily, there are a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. Using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.

Media Reporting Relating to COVID-19 Vaccination as a Driver of Vaccine Hesitancy Prior to the Second Wave of the COVID-19 Pandemic in India: A Content Analysis of Newspaper and Digital Media Reports

Background Over 2,40,000 deaths were attributed to the SARS-CoV-2 Delta (B.1.617.2) variant in India during the second wave of the pandemic from April to June 2021 with most deaths occurring in the unvaccinated population. High levels of coronavirus disease 2019 (COVID-19) vaccine hesitancy contributed to significantly reduced vaccination coverage in the eligible population especially among healthcare workers, comorbid and older people. The existing global evidence suggests misinformation through social media to accentuate, while newspaper and mainstream media reporting to be protective against vaccine hesitancy during the COVID-19 pandemic. Content analysis of regular press coverage of COVID-19 vaccination in India during the period of initial deployment and until the onset of the second wave of the pandemic can provide useful learnings and strengthen preparedness for addressing potential vaccine hesitancy concerns during future pandemics. Therefore, we conducted this inductive content analysis of press coverage related to the COVID-19 vaccine hesitancy in India prior to the second (Delta) wave of the COVID-19 pandemic. Methods We examined news reports related to COVID-19 vaccination in India for the period from 1st January 2021 to 28 February 2021 from a high circulation English language daily (Hindustan Times), Hindi (vernacular) language daily (Dainik Jagran), and English language news reports from selected digital news portals. The inclusion criterion was any news report related to COVID-19 vaccination including editorials and guest opinion pieces that could potentially generate COVID-19-related vaccine hesitancy. The news items were classified depending on their potential to drive vaccine hesitancy by either avoiding reporting of positive information related to COVID-19 vaccines, or attributing directly or indirectly, negative or misleading commentary relating to vaccine safety or efficacy. Reports with possible risk of increasing vaccine hesitancy were further analyzed based on content, source of information, and the extent of fact-checking. Results Most of the published newspaper reports examined in this study echoed official news sources and views from government health agencies promoting COVID-19 vaccine acceptance and dispelling doubts on concerns regarding vaccine safety. There were eight unique newspaper reports after excluding duplicated bilingual entries and four news items from online digital Indian news sources that met our criterion of reports with possible contribution to vaccine hesitancy. The reports possibly contributed to vaccine hesitancy were grouped into two themes: (i) Doubts on the safety and efficacy of local manufactured vaccines: most of these reports focused on the granting of emergency use authorization for Covaxin (BBV152) in 'clinical trial mode' without the completion and publication of Phase-3 efficacy data (ii). Doubts on vaccine requirement considering high seroprevalence and reduced virus transmission.  Conclusions Concerns about the efficacy and safety of Covaxin (BBV152), safety of the Covishield vaccine, and questioning the necessity of immunizing all adults with COVID-19 vaccines were observed in multiple press reports with attempts at politicization of vaccination-related decisions. The press reporting with potential for contributing to significant COVID-19 vaccine hesitancy since launch and until the Delta wave of the pandemic in India has important lessons in future pandemic preparedness.

The Roles of Information Valence, Media Literacy and Perceived Information Quality on the Association Between Frequent Social Media Exposure and COVID-19 Vaccination Intention

PURPOSE

This study aimed to examine the associations between frequent exposure to positive/negative information about vaccine efficacy/safety on social media and intention of COVID-19 vaccination, and to test if media literacy and perceived information quality would moderate such associations.

DESIGN

A multi-city cross-sectional survey.

SETTING

At five universities in different regions of China.

SUBJECTS

6922 university students (a response rate of 72.3%).

MEASURES

frequency of exposure to social media information about COVID-19 vaccination, media literacy, perceived information quality, intention of COVID-19 vaccination, and sociodemographic characteristics.

ANALYSIS

Logistic regression analysis was conducted to test main and interaction effects.

RESULTS

Higher exposure to positive information about vaccine efficacy (adjusted odds ratio [AOR] = 1.30, P < .001) and vaccine safety (AOR = 1.27, P < .001) were positively associated with vaccination intention. No significant associations were shown between exposure to negative information about vaccine efficacy/safety and vaccination intention. Higher net exposure to negative vs positive information was negatively associated with vaccination intention (AOR = .82, P < .001). High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. Perceived information quality was not a significant moderator.

CONCLUSION

The valence of social media information regarding the efficacy and safety of COVID-19 vaccines and individuals' media literacy jointly shaped COVID-19 vaccination intention. The findings can inform the development of effective health promotion strategies for enhancing COVID-19 vaccination.

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa

BACKGROUND

Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA).

METHODS

A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded 'not sure' or 'no' to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of 'vaccine hesitancy' and 'vaccine resistance', respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes.

RESULTS

The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper.

CONCLUSION

We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Moral expressions, sources, and frames: Examining COVID-19 vaccination posts by facebook public pages

Taking advantage of 3 million English-language posts by Facebook public pages, this study answers the following questions: How did the amount of COVID-19 vaccine-related messages evolve? How did the moral expressions in the messages differ among sources? How did both the sources and the five moral foundations in posts influence the number of likes to posts, after controlling for the public page's features (e.g., age, followers)? Our research findings suggest that moral expression is prevalent in the COVID-19 vaccination posts, surpassing nonmoral content. Media sources, despite the high volume of posts, on average elicited fewer likes than all other sources. Although care and fairness were the two most used moral foundations, they were negatively related to likes. In contrast, the least used two moral values of authority and sanctity were positively related to likes. We conclude with a discussion of theoretical contributions and a recommendation of possible interventions.

Mining Trends of COVID-19 Vaccine Beliefs on Twitter With Lexical Embeddings: Longitudinal Observational Study

Background

Social media plays a pivotal role in disseminating news globally and acts as a platform for people to express their opinions on various topics. A wide variety of views accompany COVID-19 vaccination drives across the globe, often colored by emotions that change along with rising cases, approval of vaccines, and multiple factors discussed online.

Objective

This study aims to analyze the temporal evolution of different emotions and the related influencing factors in tweets belonging to 5 countries with vital vaccine rollout programs, namely India, the United States, Brazil, the United Kingdom, and Australia.

Methods

We extracted a corpus of nearly 1.8 million Twitter posts related to COVID-19 vaccination and created 2 classes of lexical categories-emotions and influencing factors. Using cosine distance from selected seed words' embeddings, we expanded the vocabulary of each category and tracked the longitudinal change in their strength from June 2020 to April 2021 in each country. Community detection algorithms were used to find modules in positive correlation networks.

Results

Our findings indicated the varying relationship among emotions and influencing factors across countries. Tweets expressing hesitancy toward vaccines represented the highest mentions of health-related effects in all countries, which reduced from 41% to 39% in India. We also observed a significant change (P<.001) in the linear trends of categories like hesitation and contentment before and after approval of vaccines. After the vaccine approval, 42% of tweets coming from India and 45% of tweets from the United States represented the "vaccine_rollout" category. Negative emotions like rage and sorrow gained the highest importance in the alluvial diagram and formed a significant module with all the influencing factors in April 2021, when India observed the second wave of COVID-19 cases.

Conclusions

By extracting and visualizing these tweets, we propose that such a framework may help guide the design of effective vaccine campaigns and be used by policy makers to model vaccine uptake and targeted interventions.

Positive Emotion and Media Dependence: Measuring Risk Information Seeking and Perception in the COVID-19 Pandemic Prevention

Risk perception and information seeking behaviors are affected by individual psychological and situational factors. In the background of COVID-19 prevailing for a long period, this study examined Chinese people's information seeking and processing behavior by the RISP model, which focused on the impact of individual risk perception, affective response, perceived information-gathering capacity, and media trust and the impact of the above factors on information seeking. This study designed an online survey with gender and age quotas among the Chinese population, including a total of 675 valid samples. It was found that the Chinese public's risk perception to pandemic had a positive effect on perceived information-gathering capacity and media trust. Furthermore, both positive emotional responses and negative emotional responses had a positive effect on information seeking behavior. Nurturing positive emotion engendered a holistic perception in pandemic information seeking. In addition, media trust, perceived information-gathering capacity, and subjective norms also positively impact information seeking behavior.

A qualitative study on health stigma and discrimination in the first year of the COVID-19 pandemic: Lessons learnt from a public health perspective

Background

Stigmatisation, misinformation and discrimination have been magnified globally due to the COVID-19 pandemic. The healthcare sector was not spared from this. We conducted a transnational study, using the Health Stigma and Discrimination framework (HSDF) to explore public perception and reactions to the COVID-19 pandemic in a multicultural context. Findings from the Asian arm of the study, sited in Singapore, are reported in this paper.

Methods

This phenomenological research deployed semi-structured informant interviews using non-probability sampling approaches to recruit members of the public. Interviews were coded independently by two researchers and thematic analysis was used to analyse the responses.

Results

Twenty-nine members of the public (23-80 years old) were interviewed between Oct 2020 to Feb 2021. Five major themes were identified: (i) perception of stigma amongst respondents, (ii) experiences of stigma amongst respondents, (iii) views on what drove stigma and misinformation, (iv) facilitators in preventing and reducing stigma and misinformation, and (v) ageist attitudes towards older adults. Overall, construction workers living in dormitories, healthcare workers, and to some extent tourists from China, were perceived to have been stigmatised and shunned by the public. Place-based stigmatisation was common; participants responded by avoiding places that had confirmed cases of COVID-19. Perceived stigma was temporary and not enduring, driven at the outset by fear of being infected. This study also identified the role played by trust in reducing stigmatisation. The relative absence of politicising of issues and high-quality information readily disseminated to the public were reported as factors that could have reduced and prevented stigma and misinformation on the various groups. Ageist attitudes were observed in some participants with older adults being labelled as vulnerable, susceptible to misinformation and being less able to cope during the pandemic.

Conclusion

Through the lens of the HSDF, this study provided an exploratory account of the nature of stigma that resulted from the COVID-19 pandemic in an Asian context. It also shed light on facilitators in preventing and reducing stigma during an outbreak especially the role of trust and communications during a public health crisis.

Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021

COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national probability sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM.

The role of generalized trust in COVID-19 vaccine acceptance

Immunization by vaccination is one of the most important tools for fighting the COVID-19 pandemic. Yet in many countries, immunization campaigns have been hampered by vaccine hesitancy within the population. Building on the idea that vaccination decisions are embedded in the broader societal context, we study the role of generalized trust-the belief that most people can generally be trusted-in vaccine acceptance. Immunization campaigns face an inherent collective action problem: As all individuals benefit collectively from high immunization rates regardless of individual contribution, especially those with a low risk of severe COVID infection have an incentive to decide against the (perceived) costs and risks of vaccination. We argue that generalized trust may help to overcome this problem by encouraging the belief that cooperation for the common good is achievable and that those who cooperate are unlikely to be exploited by others. We further argue that the positive effect of generalized trust on vaccination decisions is weaker among individuals who are at higher risk of severe outcomes from the disease, as the collective action problem is less pronounced in this group. To test our predictions, we used data from the SOEP-CoV survey, which queried a representative probability sample of Germany's population between January and February 2021 on topics connected to the pandemic. Using multiple logistic regression models, and in line with expectations, we found a positive and robust link between generalized trust and the willingness to accept vaccination as soon as offered. However, overall, our examination of heterogeneous effects does not unequivocally support the idea that the role of generalized trust varies according to individual COVID risk.

Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale

BACKGROUND

The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online.

OBJECTIVE

This study aims to develop a tool measuring DVL and assess its psychometric properties.

METHODS

A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity.

RESULTS

We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01).

CONCLUSIONS

The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL.

Exploring vaccine hesitancy determinants during the COVID-19 pandemic: An in-depth interview study

On January 20, 2020, the CDC reported its first case of the novel coronavirus in the United States. Almost a year and a half after the first COVID-19 vaccine was given in the U.S., efforts to vaccinate individuals in the hopes of achieving herd immunity continue. Despite the amounts of scientific breakthroughs to create and disseminate the vaccines, people continue to express hesitancy. Existing research has explored vaccine hesitancy through survey data, restricting an in-depth understanding for why people remain hesitant. As a result, this research aimed to understand in-depth reasons for vaccine hesitancy as well as what finally got those who, although hesitant, went through with getting inoculated. In addition, we also wanted to know how the vaccine hesitant received information about the vaccine. Using in-depth interviews, we identified key elements that influenced vaccine hesitancy which include social pressure to not get vaccinated and lack of trust in the healthcare system. We also identified reasons why vaccine hesitant individuals ultimately decided to receive the COVID-19 vaccine. These reasons included becoming informed, getting back to normal, and societal pressure. Finally, we sought to understand what served as venues for COVID-19 information and those were media sources like traditional news outlets/legacy media (e.g., TV) and digital/social media, and interpersonal sources like family, friends, and co-workers. In revealing these factors through in-depth interviews, we show how complex vaccine hesitancy is and the elements public health practitioners need to take into consideration when constructing vaccine-related information/messages.

Kopfkino: Phases of quarantine among asymptomatic SARS-COV-2 carriers in Germany

Although a majority of SARS-COV-2 diagnosis are asymptomatic, presymptimatic or minimally symptomatic, little has been described and understood about the illness careers of these individuals. This study explored the lived experience of a SARS-COV-2 diagnosis and subsequent quarantine among individuals in Germany who were diagnosed with SARS-COV-2 during the second wave of the pandemic (late 2020-early 2021), but whose diagnosis was unexpected due to a lack of a known contact, or the asymptomatic nature of their case at the time of diagnosis. In-depth interviews (n ​= ​22) were conducted by phone or video call, audio-recorded, and transcribed verbatim. Routine debriefings guided data collection and facilitated analysis, which followed a framework approach. Regardless of age, gender or socioeconomic status, data consistently demonstrated a diagnosis and quarantine career marked by five emotional phases: overconfidence, shock and denial, coming to grips and asking questions, enduring, and cautious optimism as quarantine ended. These experiences suggest that providing trustworthy, easily accessible information regarding certain key aspects of the post diagnosis and quarantine period could benefit patients in terms of reducing stress, understanding the consequences of a diagnosis and mitigating foreseeable challenges in terms of personal, logistical and emotional issues. Follow-up research with providers and public health bureaus could inform how to best tailor such messaging for clients who experience an unexpected diagnosis.

Parents' Acceptance of COVID-19 Compared to Human Papillomavirus Vaccines

PURPOSE

The first vaccine against SARS-CoV-2 (COVID-19) for adolescents 16 years and older in the United States received Emergency Use Authorization in December 2020. Soon after its approval, parents expressed concerns about vaccine safety for adolescents. Similar concerns about vaccine safety partially explain suboptimal human papillomavirus (HPV) vaccine uptake. This qualitative study explores similarities and differences in parents' attitudes about these two vaccines.

METHODS

Parents were recruited through social media and at health centers in Alabama. Semi-structured interviews with parents of adolescents aged 9-17 years were conducted before and after Alabama expanded age eligibility to those 16 and older. Topics included knowledge about HPV and COVID-19 vaccines, and parents' intentions to have children vaccinated. Interviews were analyzed using thematic analysis.

RESULTS

From March 11, 2021 to April 24, 2021, 21 in-depth interviews were conducted. Parents discussed the importance of HPV and COVID-19 vaccines for protecting their children's health but differences between the two related to community protection. Parents were concerned about vaccine safety but media coverage about the COVID-19 vaccine led to more favorable attitudes about the benefits of vaccination, which was not observed for HPV vaccines. Instead for HPV vaccination, parents wanted their healthcare providers' opinions about the vaccine before making a vaccination decision.

DISCUSSION

Parents had similar concerns about HPV and COVID-19 vaccines. Although provider recommendations can improve vaccine uptake, local news reports were seen to have a positive impact on COVID-19 vaccine acceptance in lieu of provider recommendation. Disseminating information online could be beneficial to promote HPV and COVID-19 vaccines.

COVID-19 vaccine acceptance rate and its predictors in Ethiopia: A systematic review and meta-analysis

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I²), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P.

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0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P.

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0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P.

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0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Acceptance of COVID-19 vaccine and associated factors among health care workers at public hospitals in Eastern Ethiopia using the health belief model

Introduction

Acceptance of COVID-19 vaccination among Health Care Workers is mandatory to lessen and curve the spread of transmission of COVID-19. Even though the Health Belief Model is one of the most widely used models for understanding vaccination behavior against COVID-19 disease, COVID-19 vaccine acceptance among Health Care Workers in Ethiopia was not adequately explored by using the Health Belief Model domains.

Purpose

This study aimed to assess COVID-19 vaccine acceptance and associated factors among Health care workers in eastern, Ethiopia.

Methods

Institutional-based cross-sectional study design was used among 417 health care workers selected by a systematic random sampling method from June 1- 30/2021. The data were collected by face-to-face interviews using semi-structured questionnaires and analyzed using STATA version 14 statistical software. Multivariable binary logistic regression analysis with a 95% confidence interval was carried out to identify factors associated with willingness to COVID-19 vaccine acceptance and a statistical significance was declared at a P-value < 0.05.

Results

The willingness of health care workers to accept the COVID-19 vaccine was 35.6%. Age 30-39 (AOR = 4.16;95% CI: 2.51, 6.88), age ≥ 40 years (AOR = 3.29;95% CI: 1.47, 7.39), good attitude (AOR = 1.97; 95% CI: 1.00, 3.55), perceived susceptibility (AOR = 1.93; 95% CI: 1.12, 3.32), and perceived severity (AOR = 1.78; 95% CI: 1.03, 3.10) were factors significantly associated with Health Care Workers acceptance of COVID-19 vaccine.

Conclusion

The willingness to accept the COVID-19 vaccine among HCWs was low. Factors significantly associated with the willingness to accept the COVID-19 vaccine were age, good attitude, perceived susceptibility, and perceived severity of the disease. The low willingness of Health Care Workers to accept the COVID-19 vaccine was alarming and it needs more emphasis from the government in collaboration with other stakeholders to provide reliable information to avert misconceptions and rumors about the vaccine to improve the vaccine status of Health Care Workers to protect the communities.

Multilevel determinants on COVID-19 booster intention among Americans

The pandemic has disrupted public health and social well-being for more than two years. With the vaccine efficacy waning over time and the spread of new variants, a booster becomes increasingly imperative. This study investigates predictors of the American public's COVID-19 booster intention. A national survey was conducted from September 23rd to October 31st, 2021, on a representative sample. The survey data is merged with state-level indicators of vaccination rate, case rate, political context, and economic recovery. Multilevel regression modeling is adopted for statistical estimation. Results show that a higher proportion of vaccinated people in the network is positively related to one's chance of getting the booster (β = 0.593, p = 0.000). In comparison, a higher proportion of infected people in the network is negatively related to one's intention to become boosted (β = -0.240, p = 0.039). Additionally, the higher educated (β = 0.080, p = 0.001) and older (β = 0.004, p = 0.013) were more likely to say they would get the booster than their counterparts. Meanwhile, the odds of people taking the COVID-19 booster decrease by 3.541 points (p = 0.002) for each unit increase in the case rate at the state level. This study articulates that individual intention to take the booster is a function of their personal characteristics and is also rooted in social networks. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who intend to take/refuse the booster provides essential information to leverage certain factors and maximize booster uptake to mitigate the pandemic's devastating impact.

COVID-19 Vaccine Hesitancy and its Reasons in Addis Ababa, Ethiopia: A Cross-Sectional Study

Background

Coronavirus disease (COVID-19) vaccine hesitancy becomes the major bottleneck to the global healthcare system in minimizing the spread of the virus. This study aimed at assessing COVID-19 vaccine hesitancy and its reasons among residents of Addis Ababa, Ethiopia.

Methods

A community-based cross-sectional survey was conducted between May 16 to 29, 2021 in purposively selected four districts of Addis Ababa, Ethiopia. A structured questionnaire was developed and then designed on Google Forms platforms to collect data from study participants after obtaining a verbal consent form. A total of 422 study participants were included in the survey. Data were entered into Microsoft Excel and then exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis.

Results

Face masks and alcohol hand rub/ sanitizer are used by 50. 7 and 24.9% of respondents when required. COVID-19 was thought to have been generated by humans by a substantial percentage of study participants (38.2%). About half (50.7%) and 24.9% of respondents use face masks and alcohol hand rub/sanitizer always when it is required, respectively. A large number of study participants (38.2%) believed that origin of COVID-19 is man-made. Overall, 242 (57.4%) of study participants reported COVID-19 vaccine hesitancy. Fear of vaccine side effects (49.6%) was the most common reason for hesitancy. Doubt about its effectiveness (33.9%), not having enough information about the COVID-19 vaccine, preferring another way of protection, and unreliable of the vaccine (due to its short development period) were also the most frequently mentioned reasons for not receiving the COVID-19 vaccine.

Conclusions

COVID-19 vaccine hesitancy rate was high in Addis Ababa, Ethiopia during the study period. Fear of side effects, doubts about its effectiveness, and not having enough information about the COVID-19 vaccine were major reasons for hesitancy. Continuous awareness creation to the community on the importance of vaccination is warranted by health professionals and healthcare cadres.

COVID-19 Vaccine Hesitancy in Three Latin American Countries: Reasons Given for Not Becoming Vaccinated in Colombia, Ecuador, and Venezuela

Although vaccines have been developed to prevent COVID-19, vaccine hesitancy is a significant barrier for vaccination programs. Most research on COVID-19 vaccine hesitancy has blamed misinformation and misstated concerns about effectiveness, safety, and side effects of these vaccines. The preponderance of these studies has been performed in the Global North. Although Latin American has been substantially and negatively impacted by COVID-19, few studies have examined COVID-19 vaccine hesitancy there. We explored reasons volunteered for COVID-19 vaccine hesitancy from a sample of 1,173 Colombians, Ecuadorians, and Venezuelans. Overall, COVID-19 vaccine hesitancy in these three countries is higher than desirable, but most people who are COVID-19 vaccine hesitant offered one reason or fewer. The reasons offered are diverse, including myths and exaggerations, but also individual-level contraindications for vaccination and structural barriers. Because of the diversity of reasons, single-issue mass campaigns are unlikely to bring about large shifts in COVID-19 vaccine hesitancy in Colombia, Ecuador, and Venezuela. Our data suggest that interpersonal communication, particularly in Ecuador, and addressing structural concerns, particularly in Venezuela, are likely to have the greatest impact on vaccine uptake.

Mediating Effects of Attitudes, Risk Perceptions, and Negative Emotions on Coping Behaviors

Based on the perspectives of social risk amplification and the knowledge-attitudes-practice model, this study aimed to test how the level of knowledge about COVID-19 and information sources can predict people's behavioral changes and to examine the effect mechanisms through the mediating roles of attitude, risk perception, and negative emotions in a survey of 498 older Chinese adults. The results showed that (1) older people had a lower level of factual knowledge regarding the variant strains and vaccines; (2) in the information sources-behavior, information sources had a critical influence on elderly individuals' coping behaviors; and (3) in the knowledge-behavior, factual knowledge had a significant effect on elderly individuals' coping behaviors. Specifically, for prevention behaviors, both risk perception and negative emotions played full mediating roles. The findings have significant implications for the development of an effective COVID-19 prevention program to older adults coping with pandemic conditions.

Impact of an Education Intervention on COVID-19 Vaccine Hesitancy in a Military Base Population

BACKGROUND

Coronavirus disease 2019 (COVID-19) vaccine hesitancy is a major impediment to achieving herd immunity and overcoming the current pandemic. Our aim was to decrease the prevalence of vaccine hesitancy through an education intervention.

METHOD

An education intervention, consisting of a PowerPoint presentation addressing the two mRNA COVID-19 vaccine concerns/myths and a question and answer panel comprising health care providers from various specialties, was implemented to address vaccine hesitancy among personnel associated with Wright-Patterson Air Force Base through a series of virtual and in-person seminars. Participants completed a post-seminar survey as a retrospective self-assessment to identify attitudes and views surrounding vaccine hesitancy and the impact of the education intervention. Chi-squared test was used to examine relationships between categorical variables, and multiple logistic regression was used to identify risk factors for vaccine hesitancy pre- and post-seminar. All analyses were done using SPSS Statistics Version 25.0 (IBM, Armonk, NY). Institutional Review Board approval was not obtained before this study as it began as a non-research initiative and received non-research determination post hoc.

RESULTS

Five hundred participants completed the survey. Mean age was 44.7 years with 13.4 and 86.6% medical and non-medical personnel, respectively. Nearly all (98.8%) had not received their first shot of the vaccine series. 402 (80.9%) were receptive to vaccination, and 95 (19.1%) were hesitant post-seminar. Of the 139 participants who reported they were initially hesitant after our intervention, 50 (36%) indicated that they were now receptive to the vaccine, while 89 (64%) remained hesitant. Of those 50, 48 (96%) had moderate to great amount of trust in COVID-19 vaccine information presented by physicians/other providers. Six respondents who wanted the vaccine before the intervention no longer wanted the vaccine. A medical occupation (OR = 4.85, 95% CI = 2.63-8.96, P < .001), little or no trust in COVID-19 vaccine information from physicians/other providers (OR = 19.48, 95% CI = 7.31-51.90, P < 0.001), and being age 30 or younger (OR = 1.81, 95% CI = 1.02-3.2, P = 0.041) were independent predictors of vaccine hesitancy. Trust in providers was a significant factor in change of intent from vaccine hesitant to receptive post-intervention (OR 0.13, 95% CI = 0.03-0.59, P = .008). Age and occupation were not significant factors associated with change in intent.

CONCLUSION

Our education intervention was effective in reducing COVID-19 vaccine hesitancy in a military base population. Study limitations include applications toward other military and non-military populations, the possibility of nonresponse bias, and absence of prior validated interventions. Area for future studies includes improvement upon educational intervention, development of other effective methods, and application of intervention in other populations.