A pilot study on COVID-19 vaccine hesitancy among healthcare workers in the US

Nurses' COVID-19-related fear and anxiety and their attitudes to the COVID-19 vaccine: A descriptive and correlational study

BACKGROUND

The novel coronavirus disease 2019 has caused psychological distress such as anxiety and fear among nurses worldwide. Nurses are a creditable source of vaccine-related information and have a primary role in building confidence regarding vaccines.

AIM

The present study was designed to investigate the fear and anxiety of nurses regarding novel coronavirus disease 2019 (COVID-19) and their attitudes towards the COVID-19 vaccine. The predictors of fear, anxiety and attitudes towards the vaccine were also investigated.

METHODS

A descriptive and correlational design was used. The study was conducted in three public hospitals from different parts of the Turkey, and 405 nurses from the three hospitals were recruited by stratified sampling.

RESULTS

Anxiety and negative attitudes towards the vaccine were positively related to fear of COVID-19. Age and fear were also positively associated with anxiety related to COVID-19. Nurses who had received the vaccine and those who were fearful had a positive attitude towards the vaccine.

CONCLUSION

Psychosocial support programmes should be implemented to improve psychological resilience and coping strategies in nurses and organized education programmes are needed to increase positive attitudes towards vaccination.

The COVID-19 Vaccine Hesitancy Among Healthcare Workers: An Exploration of Hesitancy Reasons and Suggestions to Improve Vaccination Rates

Objective

Vaccine hesitancy among healthcare workers (HCWs) represents a significant challenge and threat in pandemics. This study aims to identify the predictive factors influencing COVID-19 vaccine hesitancy among HCWs and offer strategies to increase the COVID-19 vaccination rate in healthcare settings.

Materials and Methods

This study constitutes the qualitative portion (second part) of a mixed-methods doctoral thesis employing an explanatory design. It was conducted in two distinct pandemic hospitals and involved 23 vaccine-hesitant HCWs. To conduct the interviews, the researchers developed a semi-structured interview form based on the Health Belief Model (HBM).

Results

Upon analyzing the in-depth interviews, we identified six primary reasons for vaccine hesitancy and four different sub-reasons that reinforce vaccine hesitancy. We also collected four key suggestions from vaccine-hesitant HCWs that could potentially persuade them to receive the COVID-19 vaccine.

Conclusion

This study's findings, which encompass the identification of reasons for COVID-19 vaccine hesitancy, clarification of underlying factors contributing to hesitancy towards the COVID-19 vaccines, and gathering suggestions from HCWs on how to persuade them to get vaccinated, hold significant value for guiding vaccination campaigns during potential future pandemics.

Assessment of Covid-19 vaccine confidence among healthcare personnel in the safety-net sector in the United States and Puerto Rico

BACKGROUND

This study aimed to assess COVID-19 vaccine confidence among healthcare personnel in the safety net sector of the United States and Puerto Rico. This study aimed to examine the extent to which increased knowledge and positive attitudes toward COVID-19 vaccine safety and efficacy were associated with healthcare workers' COVID-19 vaccination status and their recommendation of the vaccine to all patients.

METHODS

Online survey data were collected from health care workers working in Free and Charitable Clinics across the United States and Federally Qualified Health Centers in Puerto Rico. The survey consisted of 62 questions covering various demographic measures and constructs related to healthcare workers' vaccination status, beliefs, and recommendations for COVID-19 vaccination. Statistical analyses, including multivariate analysis, were conducted to identify the factors associated with the COVID-19 vaccine status and recommendations among healthcare personnel.

RESULTS

Among the 2273 respondents, 93% reported being vaccinated against COVID-19. The analysis revealed that respondents who believed that COVID-19 vaccines were efficacious and safe were three times more likely to be vaccinated and twice as likely to recommend them to all their patients. Respondents who believed they had received adequate information about COVID-19 vaccination were 10 times more likely to be vaccinated and four times more likely to recommend it to all their patients.

CONCLUSIONS

The study results indicate that healthcare workers' confidence in COVID-19 vaccines is closely tied to their level of knowledge, positive beliefs, and attitudes about vaccine safety and efficacy. The study emphasizes the significance of healthcare workers feeling well informed and confident in their knowledge to recommend the vaccine to their patients. These findings have important implications for the development of strategies to boost COVID-19 vaccine confidence among healthcare workers and increase vaccine uptake among patients.

Operation CoVER Saint Louis (COVID-19 Vaccine in the Emergency Room): Impact of a Vaccination Program in the Emergency Department

Introduction

Coronavirus 2019 (COVID-19) inequitably impacted minority populations and regions with limited access to healthcare resources. The Barnes-Jewish Emergency Department in St. Louis, MO, serves such a population. The COVID-19 vaccine is an available defense to help achieve community immunity. The emergency department (ED) is a potential societal resource to provide access to a vaccination intervention. Our objective in this study was to describe and evaluate a novel ED COVID-19 vaccine program, including its impact on the local surrounding underserved community.

Methods

This was a retrospective, post-protocol implementation review of an ED COVID-19 vaccination program. Over the initial six-month period, we compiled data on all vaccinated patients out of the ED to evaluate demographic data and the impact on underserved regional areas.

Results

We report a successful ED-based COVID-19 vaccine program (with over 1,000 vaccines administered). This program helped raise regional and state vaccination rates. Over 50% of the population that received the COVID-19 vaccine from the ED were from defined socially vulnerable patient populations. No adverse effects were documented.

Conclusion

Operation CoVER (COVID-19 Vaccine in the Emergency Room) Saint Louis was able to successfully vaccinate a socially vulnerable patient population. This free, COVID-19 ED-based vaccine program with dedicated pharmacy support, was novel in emergency medicine practice. Similar ED-based vaccine programs could help with future vaccine distribution.

Sociodemographic and Occupational Characteristics Associated with Early and Continued COVID-19 Vaccine Uptake Among Healthcare Personnel: Monroe County, NY

OBJECTIVE

Identify characteristics of healthcare personnel (HCP) who did not have timely initiation of the COVID-19 primary series, as well as HCP who did not receive a booster vaccine.

METHODS

Characteristics of HCP enrolled in a COVID-19 vaccine effectiveness study between 12/28/2020-12/01/2022 were compared by timing of receipt of 1st mRNA dose, and by receipt of a booster dose. Data for this retrospective cohort analysis came from HCP working at a large healthcare system in Monroe County, New York, and included standardized questionnaires and verified vaccination status. HCP were categorized by whether they received their 1stmRNA COVID-19 vaccine between 12/14/2020-03/30/2021 (earlier) or 04/01/2021-09/28/2021 (later) based on timing of local vaccine eligibility and mandates, and by whether they received a 3rdmRNA booster dose by 12/01/22. Logistic regression models were run to identify characteristics of HCP who had later 1stdose receipt or did not receive a booster.

RESULTS

3,375 HCP were enrolled. Of these, 86.8 % had early initiation of their 1stCOVID-19 vaccine, and 85.0 % received a booster dose. Low education, low household income, younger age (<50), non-White race and public health insurance were all significant predictors of later receipt of 1stdose and lack of uptake of a booster. However, advanced professional role was only found to be a significant predictor of early 1stdose receipt.

CONCLUSIONS

Continual monitoring of COVID-19 vaccine uptake among HCP to identify those less likely to receive new booster doses will be crucial to support targeted vaccine campaigns in this important population.

Developing scientific literacy with a cyclic independent study assisted CURE detecting SARS-CoV-2 in wastewater

The COVID-19 pandemic has exposed a high level of scientific illiteracy and mistrust that pervades the scientific and medical communities. This finding has proven the necessity of updating current methods used to expose undergraduates to research. The research in traditional course-based undergraduate research experiences (CUREs) is limited by undergraduate time constraints, skill level, and course structure, and consequently it does not attain the learning objectives or the high-impact, relevant studies achieved in graduate-level laboratories using a cyclic trainee/trainer model. Although undergraduate independent study (ISY) research more closely matches the structure and learning objectives of graduate-level research, they are uncommon as professors and universities typically view them as a significant time and resource burden with limited return. Cyclic independent study-assisted CUREs (CIS-CUREs) combine many positive aspects of ISY graduate-level research, and CUREs by pre-training ISY research lead to facilitate CURE proposal and project semesters in a cyclic model. The CIS-CURE approach allowed undergraduate students at Stetson University to perform and disseminate more rigorous, involved, long-term, and challenging research projects, such as the surveillance of SARS-CoV-2 in wastewater. In doing so, all students would have the opportunity to participate in a high-impact research project and consequently gain a more comprehensive training, reach higher levels of research dissemination, and increase their competitiveness after graduating. Together, CIS-CUREs generate graduates with higher scientific literacy and thus combat scientific mistrust in communities.

The Role of Medication Beliefs in COVID-19 Vaccine and Booster Uptake in Healthcare Workers: An Exploratory Study

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire-measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake-was targeted to HCWs via social media platforms between May-July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity-Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity-Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers.

The Relationship between Substance Use Stigma and COVID-19 Vaccine Hesitancy

Two parallel public health epidemics affecting the United States include the COVID-19 pandemic and a rise in substance use disorders (SUDs). Limited research has examined the potential relationship between these two epidemics. Our objective was therefore to perform an exploratory study in order to examine the association between public stigma toward people with a past history of opioid, methamphetamine, cocaine, and alcohol use disorder and COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 6515) completed a survey which assessed the degree of negative perceptions toward individuals with a past history of substance use disorders (referred to as substance use stigma) and COVID-19 vaccine hesitancy, along with variables such as racial prejudice, source of health news, and other demographics. We evaluated four multivariable logistic regression models to predict COVID-19 vaccine hesitancy, utilizing substance use stigma toward opioids, methamphetamine, cocaine, and alcohol use as independent variables. We found that COVID-19 vaccine hesitancy was positively associated with substance use stigma toward opioid (AOR = 1.34, p < 0.05), methamphetamine (AOR = 1.40, p < 0.01), and cocaine (AOR = 1.28, p < 0.05) use, but not alcohol use (AOR = 1.06, n.s.). Predictive models that incorporate substance use stigma may therefore improve our ability to identify individuals that may benefit from vaccine hesitancy interventions. Future research to understand the underlying reasons behind the association between substance use stigma and COVID-19 vaccine hesitancy may help us to construct combined interventions which address belief systems that promote both substance use stigma and vaccine hesitancy.

Cultivating COVID-19 Vaccine Confidence in Pharmacy Professionals

Pharmacists promote vaccinations and challenge misconceptions about vaccine hesitancy, yet pharmacists' knowledge of vaccine confidence has not been assessed. The objective of this study was to compare pharmacists' knowledge of coronavirus disease 2019 (COVID-19) vaccine confidence before and after a live continuing education (CE) session. This pretest-posttest study evaluated the differences before and after a live CE session on COVID-19 vaccine confidence provided to pharmacists at a nationwide health technology company. Participants' total pretest and posttest scores were compared using paired t-tests, while pretest and posttest scores for each item were compared using chi-squared tests. A Bonferroni correction was applied, resulting in an alpha level of 0.005. A total of 279 pharmacists participated in this study. After the CE session, mean knowledge scores increased (5.2 ± 1.5 to 7.4 ± 1.35, p < 0.0001). After the CE session, there was no significant increase in pharmacists' knowledge about the approach that is not recommended when discussing vaccination beliefs with a patient (71.3% to 77.4%, p = 0.099), determinants of vaccine uptake (83.9% to 87.8%, p = 0.182), and social determinants of health that can influence vaccination rates (93.6% to 96.4%, p = 0.121). There was a significant change in pre- and posttest knowledge for the remaining seven items.

COVID-19 vaccine refusal associated with health literacy: findings from a population-based survey in Korea

BACKGROUND

Poor health literacy is associated with lower utilization of preventable services. However, the relationship between health literacy and COVID-19 vaccine hesitancy remains controvertible.

METHODS

This study used data from 229,242 individuals who completed the Community Health Survey in Korea from August 16 to October 31 in 2021. To operationalize COVID-19 vaccine hesitancy, we measured vaccine refusal, which is defined as not having been vaccinated and not intending to get vaccinated against COVID-19. Health literacy is operationalized in two dimensions; the ability to understand spoken directions from health professionals and the ability to understand written information regarding health. Covariates include sex, age, educational level, marital status, employment status, basic living security pension status, and subjective health status. Two multivariable logistic regression models were run to determine factors associated with COVID-19 vaccine refusal. Model 1 included sociodemographic characteristics and subjective health status. Model 2 added two health literacy variables. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

Only 3.9% of the Korean adult population were estimated to refuse COVID-19 vaccine. The most commonly cited reasons for COVID-19 vaccine refusal were concerns about vaccine adverse events (47.6%), followed by the assessment of one's own health status (29.5%). Individuals who found spoken directions very difficult to understand were more likely to refuse COVID-19 vaccine than those who found spoken directions very easy (OR = 1.55, 95% CI: 1.28-1.87, p < 0.001). People who did not pay attention to written information were more likely to refuse COVID-19 vaccine than those who reported it to be very easy to understand (OR = 1.28, 95% CI: 1.13-1.45, p < 0.001). People in all other categories of the literacy spectrum for either spoken or written information did not have an increased risk of COVID-19 vaccine refusal.

CONCLUSION

Health literacy was significantly associated with COVID-19 vaccine refusal. Health literacy programs could be beneficial to reduce vaccine refusal, particularly for the people who find spoken directions from health professionals very difficult to understand and those who do not pay attention to written information.

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria

Introduction

Since becoming available, vaccines against COVID-19 have been a focus of public debate. This is particularly relevant among healthcare and social workers, who interact with vulnerable patients and clients on a daily basis. With employers implementing educational programs and offering incentives to raise vaccine willingness among their staff, it is crucial to understand drivers of vaccine acceptance and hesitancy as well as the impact employers can play on vaccine decision-making.

Methods

We conducted a cross-sectional study via computer-assisted telephone and web interviews. We recruited from a pool of employees from nursing and social care institutions in Vienna and Lower Austria operated by one healthcare NGO. Variables included in the analysis were socio-demographic attributes, reasons for or against the vaccine, sources of information, opinions of mandatory vaccination, and whether respondents had previously been infected with COVID-19 or knew someone who had.

Results

86.2% of respondents had received at least one dose of the COVID-19 vaccine. 13.8% were unvaccinated. Vaccinated respondents' main reason for getting the vaccine was to protect themselves (79.6%) as well as others (74.1%), while non-vaccinated respondents cited a fear of short or long-term side effects (58.8 and 42.4%, respectively) as their primary reason for not getting vaccinated. 72.8% of the unvaccinated said no incentive would make them change their mind, while 17.4% specified abstract concepts or systemic change as effective incentives. Monetary incentives were not seen as a motivator. Unvaccinated respondents were significantly more worried about the future than vaccinated respondents (78.8 vs. 26.3%, p < 0.001). They were also significantly more likely to view their employers' vaccine recommendations as "manipulative" (50.6 vs. 12.4%, p < 0.001), while vaccinated respondents were significantly more likely to view them as "supportive" (68.0 vs. 25.9%, p < 0.001).

Conclusion

While employers have the means to mediate public health decision-making by providing information, deciding to become vaccinated is a more complex process including public debate, world views, political influences, and the uptake of information. Employers can act as mediators for public health decision-making, moving policy measures beyond an individualized view of health choices and health literacy toward more structural, systemic, and community-based efforts.

COVID-19 Vaccine Booster Dose Acceptance: Systematic Review and Meta-Analysis

The World Health Organization (WHO) recommended coronavirus disease 2019 (COVID-19) booster dose vaccination after completing the primary vaccination series for individuals ≥18 years and most-at-risk populations. This study aimed to estimate the pooled proportion of COVID-19 vaccine booster dose uptake and intention to get the booster dose among general populations and healthcare workers (HCWs). We searched PsycINFO, Scopus, EBSCO, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, Web of Science, Google Scholar, and ScienceDirect according to PRISMA guidelines. From a total of 1079 screened records, 50 studies were extracted. Meta-analysis was conducted using 48 high-quality studies according to the Newcastle-Ottawa Scale quality assessment tool. Using the 48 included studies, the pooled proportion of COVID-19 vaccine booster dose acceptance among 198,831 subjects was 81% (95% confidence interval (CI): 75–85%, I² = 100%). The actual uptake of the booster dose in eight studies involving 12,995 subjects was 31% (95% CI: 19–46%, I² = 100%), while the intention to have the booster dose of the vaccine was 79% (95% CI: 72–85%, I² = 100%). The acceptance of the booster dose of COVID-19 vaccines among HCWs was 66% (95% CI: 58–74%), I² = 99%). Meta-regression revealed that previous COVID-19 infection was associated with a lower intention to have the booster dose. Conversely, previous COVID-19 infection was associated with a significantly higher level of booster dose actual uptake. The pooled booster dose acceptance in the WHO region of the Americas, which did not include any actual vaccination, was 77% (95% CI: 66–85%, I² = 100%). The pooled acceptance of the booster dose in the Western Pacific was 89% (95% CI: 84–92%, I² = 100), followed by the European region: 86% (95% CI: 81–90%, I² = 99%), the Eastern Mediterranean region: 59% (95% CI: 46–71%, I² = 99%), and the Southeast Asian region: 52% (95% CI: 43–61%, I² = 95). Having chronic disease and trust in the vaccine effectiveness were the significant predictors of booster dose COVID-19 vaccine acceptance. The global acceptance rate of COVID-19 booster vaccine is high, but the rates vary by region. To achieve herd immunity for the disease, a high level of vaccination acceptance is required. Intensive vaccination campaigns and programs are still needed around the world to raise public awareness regarding the importance of accepting COVID-19 vaccines needed for proper control of the pandemic.