Relationship between Citizens' Health Engagement and Intention to Take the COVID-19 Vaccine in Italy: A Mediation Analysis

Vaccination status and self-reported side effects after SARS-CoV-2 vaccination in relation to psychological and clinical variables in patients with multiple sclerosis

The recent SARS-CoV-2 pandemic and the vaccination campaign posed a challenge to patients with autoimmune disease, such as multiple sclerosis (MS). We aimed for investigating whether psychological/sociodemographic/clinical characteristics of MS patients are associated with SARS-CoV-2 vaccination status and self-reported vaccination side effects (SEs). We have asked patients with MS about their willingness to receive recommended standard vaccinations pre-pandemically since June 2019. Between 10/2021 and 01/2022, we surveyed 193 of these MS patients about their current SARS-CoV-2 vaccination status, their perception of vaccination-related SEs, and reasons for and against SARS-CoV-2 vaccination. 75.6% of the patients declared their willingness to receive standard vaccinations before the pandemic. 84.5%, 78.2%, and 13.0% of the patients had received the first, second, and third SARS-CoV-2 vaccination, respectively, until the follow-up survey. The most common reason for not getting vaccinated against SARS-CoV-2 was concern about possible side effects (82.1%), followed by the belief that the vaccines had not been adequately tested (64.3%). Vaccination-related SEs were reported by 52.8% of the patients. Younger age, higher education, lower degree of disability, relapsing disease course, shorter disease duration, not receiving a disease-modifying therapy and higher anxiety and depression levels were associated with the occurrence of certain vaccination-related SEs. Concerns about novel vaccines are widespread among MS patients and necessitate targeted education of the patients, especially to those with more severe psychopathological symptoms (anxiety or depression) and those who are generally skeptical of vaccination.

Antecedents of patient health engagement in the radiotherapy service (evidence from Indonesia)

Background

Private radiotherapy (RT) facilities in emerging countries are growing with cancer incidence. Private healthcare providers must provide better care based on patient perspectives to reach more patients.

Aim

This study investigated the relationship between antecedents of patient health engagement (PHE) with revisit intention (RVI) and intent to recommend (ITR) in private RT facilities.

Setting

The survey was conducted in a private hospital with a RT service in Central Java province, Indonesia.

Methods

A quantitative, cross-sectional design with a purposive sampling method was used. Patient questionnaire survey modified from validated self-administered radiotherapy experience (RTEQ) and PHE questionnaire were used to collect data. Partial least squares-structural equation modelling was used to analyse the data.

Results

In this study, 173 respondents consented to participate, which demonstrated that seven of the eight experience antecedents of PHE measured by reliable and valid RTEQ and were significantly related to PHE (p-value <0.05). At the same time, the degree of PHE has a significant relationship with RVI and ITR (p-value <0.05).

Conclusion

Patient informational needs elements from the patient experience, followed by situational repose, were shown to have a prominent relation to PHE. The management of private RT facilities needs to focus more on these elements to encourage PHE to establish hospital performance.

Contribution

The findings denote that six elements of RTEQ relate to PHE and further hospital outcomes. Hospital management could utilise this approach to improve the quality of care in RT facilities, specifically in private hospitals in emerging countries.

Determinants for COVID-19 vaccination intention in Mexico

This investigation aims to determine the predictors that have the most significant influence over COVID-19 vaccination intention for the population of 18 years or above in Mexico. This will be done through a comprehensive theoretical model comprising: the theory of planned behaviour, the health belief model, and the model of goal-directed behaviour. An exploratory, cross-sectional study with a quantitative approach was carried out. The structured questionnaire was applied to 1085 adults in the first trimester of 2021 through Google Forms in social media groups. The data analysis was carried out through partial least square structural equation modelling. Positive anticipated emotions, desire, subjective norms, attitude, and perceived behavioural control were the most significant predictors of intention. The model that combines the theoretical perspectives explains mostly the vaccination intention. The study can be a valuable theoretical perspective for understanding similar behavioural intentions related to health risks. The results are also valuable for public health decision-makers to design strategies that promote vaccination.

The Role of Hyperarousal and Aberrant Salience in the Acceptance of Anti-COVID-19 Vaccination

Background and Objectives: This present study was aimed at exploring hyperarousal and aberrant salience in a sample of the Italian general population to understand their possible role in the acceptance of anti-COVID-19 vaccination. Materials and Methods: Sociodemographic data questions, the "Acceptance of Vaccination" measure, the Hyperarousal Scale (H-Scale), and the Aberrant Salience Inventory (ASI) were sent as an unpaid online survey to the general population (age range 18-80 years) within the Italian territory. Results: The enrolled subjects were divided into two subgroups: "Pro-vax" (n = 806; 87.4%) and "No-vax" (n = 116; 12.6%). Statistical analysis showed significant differences between groups in the "Education Level" (p = 0.001) category, higher in the "Pro-vax" group, and in the ASI "Senses Sharpening" (p = 0.007), "Heightened Emotionality" (p = 0.008), and "Heightened Cognition" (p = 0.002) subscales with the "Total Score" (p = 0.015), all higher in "No-vax" subjects. Furthermore, a linear regression model evidenced that only "Education Level" (β = 0.143; p < 0.0001) and "Senses Sharpening" (β = -0.150; p = 0.006) were, respectively, direct and inverse predictors of "Acceptance of Vaccination". Conclusions: Our results show that several subthreshold conditions, such as somatosensory amplification, anxiety traits, and panic experiences, should be taken into account by authoritative sources involved in health education, communication, and policy to alleviate public concerns about vaccine safety, for the present and also future pandemics, and to provide more inclusive, informed, and accurate public health preventive and treatment programs.

Using the increasing vaccination model and the moderating roles of chronic medical conditions and education to understand COVID-19 vaccination uptake in Singapore

COVID-19 vaccination programmes have helped reduce deaths and morbidity from the pandemic and allowed for the resumption of normal life. However, vaccine hesitancy remains an issue even with recurrent surges in COVID-19 cases due to new SARS-CoV-2 variants. Purpose: To elucidate psychosocial factors that contribute to our understanding of vaccine hesitancy. 676 Participants in Singapore took part in an online survey on vaccine hesitancy and uptake between May and June 2021. Data on demographics, perception of the COVID-19 pandemic, and vaccine willingness and hesitancy factors were collected. The responses were analyzed using structural equation modeling (SEM). The study found that confidence in the COVID-19 vaccines and risk perception of the COVID-19 situation are significantly associated with vaccination intention, while vaccination intention is also significantly associated with reported vaccination status. Additionally, certain chronic medical conditions moderate the relationship between vaccine confidence/risk perception and vaccine intention. This study contributes to our understanding of factors behind vaccination uptake which can help anticipate challenges to future vaccination campaigns for the next pandemic.

Does the Message Frame Promote People's Willingness to Vaccinate when they Worry about Side Effects from the COVID-19 Vaccine? Evidence from an Online Survey Experiment in China

Vaccination is an effective strategy for controlling the coronavirus disease 2019 (COVID-19) pandemic. However, worrying about side effects (WSE) from the COVID-19 vaccine is the leading concern making people hesitant to get vaccinated. Regrettably, there are few studies on alleviating the negative impacts of WSE on COVID-19 vaccination. This study aimed to assess whether message framing (gain- and loss-framed) can moderate the impacts of WSE on the willingness to vaccinate. We conducted an online self-administered survey experiment with three groups: control group (non-framed group), gain-framed groups, and loss-framed groups. In total, 981 participants were randomly assigned to one of the three groups, and their willingness to vaccinate themselves, their children, and elderly members was recorded. People with a higher level of WSE exhibited a lower willingness to vaccinate against COVID-19. However, the gain- and loss-framed messages increased people's willingness to vaccinate themselves, their children, and the elderly. Compared to the gain-framed messages, the loss-framed messages had a greater impact on enhancing people's willingness to self-vaccinate, but not on vaccinating their children and the elderly. Although the gain- and loss-framed messages weakened the negative impacts of WSE on the willingness to be vaccinated, their buffer effect was non-significantly different. The findings in this study suggest that a loss-framed messaging strategy could be a valuable tool in disseminating information on vaccination against COVID-19.

Health care workers' self-perceived infection risk and COVID-19 vaccine uptake: A mixed methods study

Vaccination is the most cost-effective way of preventing Coronavirus Disease 2019 (COVID-19) although there was a considerable delay in its institution in Tanzania. This study assessed health care workers' (HCWs) self-perceived infection risk and uptake of COVID-19 vaccines. A concurrent embedded, mixed methods design was utilized to collect data among HCWs in seven Tanzanian regions. Quantitative data was collected using a validated, pre-piloted, interviewer administered questionnaire whereas in-depth interviews (IDIs) and focus group discussions (FGDs) gathered qualitative data. Descriptive analyses were performed while chi-square test and logistic regression were used to test for associations across categories. Thematic analysis was used to analyze the qualitative data. A total of 1,368 HCWs responded to the quantitative tool, 26 participated in the IDIs and 74 in FGDs. About half of the HCW (53.6%) reported to have been vaccinated and three quarters (75.5%) self-perceived to be at a high risk of acquiring COVID-19 infection. High perceived infection risk was associated with increased COVID-19 vaccine uptake (OR 1.535). Participants perceived that the nature of their work and the working environment in the health facilities increased their infection risk. Limited availability and use of personal protective equipment (PPE) was reported to elevate the perceived infection risks. Participants in the oldest age group and from low and mid-level health care facilities had higher proportions with a high-risk perception of acquiring COVID-19 infection. Only about half of the HCWs reported to be vaccinated albeit the majority recounted higher perception of risk to contracting COVID-19 due to their working environment, including limited availability and use of PPE. Efforts to address heightened perceived-risks should include improving the working environment, availability of PPE and continue updating HCWs on the benefits of COVID-19 vaccine to limit their infection risks and consequent transmission to their patients and public.

Narrative versus statistical messages: The interplay of perceived susceptibility and misperceptions on vaccine intention

Although there is enough scientific evidence to show the benefits and safety of vaccines, vaccine rates are low, while misperceptions about vaccines are on the rise. The main purposes of the current study are to 1) examine the effects of narrative vs. statistical messages on vaccine intention, 2) test the mediating role of perceived expectancies, and 3) examine the moderating roles of perceived susceptibility and misperceptions on vaccine intention. Data were collected with an online experiment through Amazon Mturk. The online experiment was conducted via Qualtrics once the study was considered exempt by the Institutional Research Board of a large University in the U.S. A total of 300 participants aged 18 and above completed the survey. Findings show that perceived expectancies mediate the relationship between message manipulation and vaccine intention. Our findings also show a three-way interaction which indicates that among individuals with high misperceptions, statistical messages are more persuasive for individuals with high perceived susceptibility, while narrative messages are more influential for individuals with low perceived susceptibility.

Reliability and validity evaluation of the chinese revision of the attitude towards adult vaccination scale

BACKGROUND

Although vaccination is one of the critical interventions to address global health issues, inadequate vaccination rates has become an international challenge. Vaccine hesitancy is the key to affecting inadequate vaccination rates. According to the WHO SAGE working group's definition, vaccine hesitancy refers to delaying or refusing vaccination and has been ranked as one of the top 10 health threats. There has yet to be a scale that evaluates vaccination attitudes among Chinese adults. However, an attitude quantity, the adult vaccination attitude scale, has been developed to assess adult vaccination attitudes and reasons for vaccine hesitancy.

OBJECTIVE

The Adult Attitudes to Vaccination Scale (ATAVAC) was initially developed by Professor Zoi Tsimtsiou et al. This study aimed to analyze the structure of the Chinese version of the ATAVAC and explore the relationship between adult vaccination attitudes, e-health literacy, and medical distrust.

METHODS

After obtaining author permission for the initial scales, the study was translated using the Brislin back-translation method. 693 adults were enrolled to the study. To validate this hypothesis, participants finished the socio-demographic questionnaire, the Chinese version of the ATAVAC, the electronic Health Literacy Scale (e-HEALS) and the Medical Mistrust Index (MMI). The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the underlying structure of the factors of the Chinese version of the Adult Vaccination Attitude Scale and to measure its reliability and validity.

RESULTS

The Cronbach's alpha coefficient for the Chinese version of the ATAVAC was 0.885, with Cronbach's alpha coefficients ranging from 0.850 to 0.958 for each dimension. The content validity index was 0.90, and the retest reliability was 0.943. The exploratory factor analysis (EFA) supported the 3-factor structure of the translation instrument, and the scale had good discriminant validity. The confirmatory factor analysis (CFA) revealed a degree of freedom of 1.219, a model fit index (GFI) of 0.979, a normative fit index (NFI) of 0.991, a Tucker-Lewis index (TLI) of 0.998, a comparability index (CFI) of 0.998 and a root mean square error of approximation (RMSEA) of 0.026.

CONCLUSION

The results show that the Chinese version of the ATAVAC has demonstrated good reliability and validity. Hence, it can be used as an effective tool to assess vaccination attitudes among Chinese adults.

Politics of COVID-19 vaccination in Japan: how governing incumbents' representation affected regional rollout variation

BACKGROUND

Despite initial delay, Japan's COVID-19 vaccination accelerated remarkably from May to September 2021 under the leadership of Prime Minister Yoshihide Suga. His "campaign" for vaccination, however, did not yield uniform results nationwide.

METHODS

To highlight political determinants for the regional variation, we employ ordinary least squares regression analyses to investigate how the share/presence of incumbent politicians belonging to the governing parties, the Liberal Democratic Party and Komei Party, influenced the varying progress of rollouts across prefectures as well as across cities/towns/villages. The data on the vaccination rate for all 47 prefectures was obtained from Government Chief Information Officer (CIO)'s Portal, Japan (GCPJ) approximately one month prior to the anticipated general election, the national election for the more important House of Representatives of Japan's bicameral parliament (Diet). The data for lower administrative units, though its availability was limited to only three prefectures, was obtained from the respective governments of Kagawa and Ehime and from a local newspaper in Gifu.

RESULTS

The findings reveal that at both prefectural and sub-prefectural administrative levels, the share/presence of the governing parties' representation in the national parliament had a positive and statistically significant effect on the region's vaccination progress, after controlling for the local proliferation of COVID-19 and demographic characteristics.

CONCLUSION

Our findings contribute insights into the understudied area of the contemporary COVID-19 health environment, namely how the political dynamics of democracy affect the pattern of vaccine dissemination in Japan.

TRIAL REGISTRATION

Not applicable.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

Cognitive and Behavioral Factors Predicting the Decision to Vaccinate against COVID-19 in Clinical Psychiatric Population-A Cross-Sectional Survey

The spread of the COVID-19 virus created more than a medical crisis, while it also negatively affected the mental health of the general population. This context increased the vulnerability of the psychiatric population. While research interest highly targeted vaccine hesitancy and acceptance, many studies focused on trust issues-both in vaccine efficacy and in communication with authorities. Less is known about the psychological underpinnings of the COVID vaccination decision, specifically in the high-uncertainty circumstances due to the novelty of the virus. In a cross-sectional study, we investigated the predictive value of several cognitive (perceived risk, vulnerability, uncertainty, and trust in one's decision) and behavioral (previous vaccinations, social media use, and practicing preventive behavior) factors, for the vaccination decision against COVID-19, for 252 psychiatric inpatients (data collected between September 2021 and February 2022). Demographics and diagnostics were also considered. We found a significant relationship between the "Perceived risk of vaccination" and the choice of vaccination (χ²(2, N = 252) = 58.59, p ≤ 0.001), and between the "Trust in own decision to vaccinate" and the decision to vaccinate (χ²(2, N = 252) = 31,5, p ≤ 0.001). The overall regression model was statistically significant (χ² (9, N = 252) = 97.1, p < 0.001), with between 30% and 45% of the variance in the odds of a positive decision explained by the predictor set. The model coefficients analysis showed that an individual with a psychiatric disorder but with higher confidence in their decision had significant (p < 0.001) increased odds of the decision to vaccinate against COVID-19 by 893%. A former voluntary vaccination did not significantly associate with the decision to vaccinate against COVID-19 (χ²(1, N = 252) = 2.74, p > 0.05) in this special population. No other behavioral factors, diagnosis, or demographics were significant as predictors, for the clinical psychiatric population surveyed, except the educational level. Implications for future vaccination acceptance of this special population are discussed.

In or Out? Identifying the Factors Playing a Role in Covid-19 Decision Making in Turkiye

OBJECTIVE

The study aimed at investigating the social, demographic, and economic factors affecting Covid-19 vaccine decisions before the vaccination started in Turkey. The study also aimed to understand the attitudes towards Covid-19 vaccines.

METHODS

The study was conducted by exploiting the data of 693 individuals living in Turkey. The data was collected via a virtually applied questionnaire according to snowball sampling in late 2020 when the vaccination program had not started in Turkey yet. Multinomial logistic regression design was used to identify the factors affecting Covid-19 vaccine decisions.

RESULTS

It was observed that Covid-19 vaccine acceptance was notably low before the vaccination started in Turkey. Further, almost 50% of the participants were indecisive about getting vaccinated. It was identified that age, gender, educational status, and residential status, as well as occupational status, the number of dependents, smoking, and the vaccination of governmental authorities, have associations with Covid-19 vaccination decisions.

CONCLUSIONS

Covid-19 vaccine acceptance is generally low, although it is relatively high among vulnerable groups (i.e., the elderly and smokers), and among those who are unable to isolate themselves. In addition, the vaccination of governmental authorities is remarkably effective on Covid-19 vaccine acceptance in Turkey.

Factors Associated with Handwashing Behaviors During the COVID-19 Pandemic: An Analysis of the Community Health Survey in Korea

Introduction

Handwashing is the most effective preventive behavior for coronavirus disease-19 (COVID-19) infection. However, research has shown the lower handwashing behaviors among Korean adults.

Objectives

This study aims to analyze factors associated with handwashing as a preventive behavior for COVID-19 infection based on the health belief model (HBM) and the theory of planned behavior (TPB) behavioral theories.

Methods

This secondary data analysis utilized the Community Health Survey developed by Disease Control and Prevention Agency conducted in 2020. Sampling method was stratified and targeted 900 people living in the territory of each community public health center. In total, 228,344 cases were used in the analysis. Handwashing behavior, perceived susceptibility, perceived severity, subjective norm, and influenza vaccine uptake were used in the analysis. Regression analysis using weighing strategy by stratification and domain analysis was used.

Results

Less washing hand was associated with older age (B = 0.01, p < .001), males (B = 0.42, p < .001), not receiving an influenza vaccine (B = 0.09, p < .001), perceived susceptibility (B = 0.12, p < .001), subjective norm (B = 0.05, p < .001), and perceived severity (B = -0.04, p < .001).

Conclusion

While perceived susceptibility and social norm had positive association, perceived severity had a negative association with handwashing. Considering the Korean culture, creating a shared norm for frequent handwashing could be beneficial to promote handwashing rather than emphasizing the disease and its consequences.

Cueing quality: Unpacking country-of-origin effects on intentions to vaccinate against COVID-19 in Taiwan

While existing studies have reported and recognized country-of-origin effects on the intentions to vaccinate against COVID-19 among individual citizens in some countries, the causal mechanism behind such effects to inform public health policymakers remain unexplored. Adding up a quality cue explanation for such effects to the existing literature, the authors argue that individual consumers are less willing to get a vaccine designed and manufactured by a country with a significantly lower quality perception than other countries. A survey experiment that recruited a nationally representative sample of Taiwanese adults (n = 1951) between December 13, 2020 and January 11, 2021 was designed and conducted to test the argument. We find that all else equal, Taiwanese respondents were on average less likely to express stronger willingness to take a vaccine from China than from the US, Germany, and Taiwan. Furthermore, even when the intrinsic quality of the vaccine was held constant by the experimental design, respondents still had a significantly lower quality perception of the vaccine from China, both in terms of perceived protection and severe side effects. Further evidence from casual mediation analyses shows that about 33% and 11% of the total average causal effects of the "China" country-of-origin label on vaccine uptake intention were respectively mediated through the perceived efficacy of protection and perceived risk of experiencing severe side effects. We conclude that quality cue constitutes one of many casual mechanisms behind widely reported country-of-origin effects on intention to vaccinate against COVID-19.

Bireylerin Aşılara Yönelik Tutumları Üzerine COVID-19 Korkusunun Etkisi

Giriş: Covid-19 hastalığının psikolojik etkileri devam etmektedir. Hastalığa ilişkin yaşanılan korku bireylerin Covid-19 aşılarına yönelik tutumlarını etkilemektedir. Amaç: Bireylerin Covid-19 aşısına yönelik tutumları üzerine Covid-19 korkusunun etkisini belirlemektir. Yöntem: Niceliksel araştırma yöntemlerinden tanımlayıcı tipte bir araştırmadır. Çalışmanın verileri 1 Temmuz- 31 Ağustos 2021 tarihleri arasında kartopu örnekleme tekniği kullanılarak online olarak toplanmıştır. Belirtilen süre içerisinde araştırmaya gönüllü olarak katılmayı kabul eden ve formu eksiksiz dolduran 221 kişi araştırmanın örneklemini oluşturmuştur. Veri toplama araçları “Katılımcı Bilgi Formu”, “Covid-19 Korku Ölçeği” ve “Covid-19 Aşısına Yönelik Tutumlar Ölçeği” dir. Bulgular: Araştırmaya katılan bireylerin Covid-19 korku ölçeği puan ortalaması 17.84 ± 6.65; Covid-19 aşısına yönelik olumlu tutum alt boyut puan ortalaması 3.79 ± 1.12; Covid-19 aşısına yönelik olumsuz tutum alt boyut puan ortalaması 3.57 ± 1.23 olarak tespit edilmiştir. Covid-19 korku ve Covid-19 aşısına yönelik olumlu tutum değişkenleri arasında pozitif yönde, anlamlı (r = .28; p = .000) bir ilişki saptanmıştır. Ayrıca, Covid-19 korkusunun bireylerin Covid-19 aşına yönelik olumlu tutum düzeyi üzerinde anlamlı bir etkiye sahip olduğu görülmüştür (t = 4.396; p = .000). Sonuç: Covid-19 korkusu bireylerin Covid-19 aşısına yönelik tutumunu olumlu şekilde etkilemiştir

The effect of vaccination beliefs regarding vaccination benefits and COVID-19 fear on the number of vaccination injections

The Coronavirus disease pandemic of 2019 is a vast worldwide public health hazard, impacting people of all ages and socioeconomic statuses. Vaccination is one of the most effective methods of controlling a pandemic like COVID-19. This study aims to investigate the relationship between the number of vaccination injections and fear of COVID-19 and test whether beliefs benefit from vaccination COVID-19 mediate the effect of fear of COVID-19 on the number of vaccination injections. A total of 649 Vietnamese adults were enrolled online to finish answering, including scales The Health Belief Model (HBM) and The Fear of COVID-19 (FCV-19S), consisting of 340 (52.4%) males and 309 (47.6%) females. The data were analyzed using variance, regression, and a simple mediation model. The total score of COVID-19 fear was M = 22.26, SD = 5.49. Vietnamese fear of COVID-19 was at a medium level. Our results suggest that 18- to 20-year-olds are more fearful of COVID-19 than others. People who received the first dosage exhibited a greater fear of COVID-19 than those who received the second dose and were not inoculated. Additionally, the beliefs benefit of vaccination COVID-19 has a role in the relationship between the number of vaccination injections and fear of COVID-19. During the pandemic, adults in Vietnam are more afraid of COVID-19 than during prior outbreaks. Besides, the Vietnamese populace demonstrated a considerable demand for and high acceptability of the COVID-19 vaccine. The current study indicates that psychological counselors and therapists should counsel clients on the value of vaccination and address the fear of COVID-19 as public understanding of the benefits of vaccines increases. To further clarify the effect of this issue on the correlation between fear of COVID-19 and the number of vaccinations, the results of this study indicate that the existing vaccine communication factor for COVID-19 vaccination should be modified to increase confidence in the benefits of immunization.

Relationship of spirituality, health engagement, health belief and attitudes toward acceptance and willingness to pay for a COVID-19 vaccine

PURPOSE

To explore the wider determinant factor of citizens' spirituality, health engagement, health belief model, and attitudes towards vaccines toward acceptance and willingness to pay for a Coronavirus disease 2019 (COVID-19) vaccination.

METHODS

A community-based cross-sectional online investigation with convenience sampling was utilized to recruit 1423 citizens from 18 districts across Indonesia between December 14, 2020 and January 17, 2021. Descriptive statistics, One-way analysis of variance, Pearson correlation, Independent t-tests, and multiple linear regression were examined.

RESULTS

Spirituality, health engagement and attitude toward vaccines, as well as health beliefs constructs (all scores of perceived benefits and barriers) were significant key factors of acceptance of vaccines. Interestingly, the spirituality, attitude toward vaccine, and health beliefs constructs including perceived susceptibility, and benefits indicated a significantly higher willingness.

CONCLUSIONS

Results demonstrated the utility of spirituality, health engagement, health belief model, and attitudes towards vaccines in understanding acceptance and willingness to pay for a vaccine. Specifically, a key obstacle to the acceptance of and willingness to pay COVID-19 vaccination included a high score of the perceived barrier construct. Moreover, the acceptance of and willingness to pay could be impaired by worries about the side-effects of a COVID-19 vaccination.

Healthcare Workers and Nonhealthcare Workers Pro-Vaccination Attitude and Its Associated Factors towards COVID-19 Vaccine Globally: A Systematic Review and Meta-Analysis

Introduction

Coronavirus disease 2019 (COVID-19) pandemic has not been managed and controlled globally. The aim of this systematic review and meta-analysis were to determine the global pro-vaccination attitude and associated factors towards COVID-19 vaccine among healthcare workers (HCWs) and nonhealthcare workers (non-HCWs).

Methods

Different databases such as PubMed, Scopus, EMBASE, and Google Scholar were used. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 flowchart diagram and PRISMA checklist were used for study screening, selection, and inclusion into this systematic review and meta-analysis. Newcastle-Ottawa Scale (NOS) quality assessment criteria for cross-sectional studies were used to assess the included articles.

Results

A total of 51 studies were included into this systematic review and meta-analysis. The meta-analysis revealed that the global pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine among both HCWs and non-HCWs was 61.30% (95%CI: 56.12, 66.47, I 2 = 99.8%: p=0.000). Subgroup analysis showed that the global pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine was the lowest (59.77%, 95%CI (51.56, 67.98); I 2 = 99.6%, p=0.000) among the HCWs participants and the highest (62.53%, 95%CI (55.39, 69.67); I 2 = 99.8%, p=0.000) among the non-HCWs participants and the lowest (54.31%, 95%CI (43, 65.63); I 2 = 99.5%, p=0.000) for sample size <700 and the highest (66.49%, 95%CI (60.01, 72.98); I 2 = 99.8%, p=0.000) for sample size >700; the lowest (60.70%, 95%CI (54.08, 67.44); I 2 = 93.0%, p=0.000) for studies published in 2020 year and the highest (61.31%, 95%CI (55.93, 66.70); I 2 = 99.8%, p=0.000) for the studies published after 2020 years. From this systematic review, factors significantly associated with pro-vaccination attitude towards COVID-19 vaccine among HCWs were such as age, gender, race, work experience, home location, having no fear of injections, being a non-smoker, profession, presence of chronic illnesses, allergies, confidence in pharmaceutical companies, history of taking influenza vaccine, vaccine recommendation, perceived risk of new vaccines, perceived utility of vaccine, receiving a seasonal flu vaccination in the last 5 years, working in a private hospital, a high perceived pandemic risk index, low vaccine harm index, high pro-socialness index, being in close contact with a high-risk group, knowledge about the virus, confidence in and expectations about personal protective equipment, and behaviors. The level of positive attitude towards COVID-19 vaccine among non-HCWs ranged from 21.40% to 91.99%. Factors associated with the attitude towards COVID-19 vaccine among non-HCWs were such as age, gender, educational level, occupation, marital status, residency, income, ethnicity, risk for severe course of COVID-19, direct contact with COVID-19 at work, being a health profession, being vaccinated against seasonal flu, perceived benefits, cues to actions, having previous history of vaccination, fear of passing on the disease to relatives, and the year of medical study, studying health-related courses, COVID-19 concern, adherence level to social distancing guidelines, history of chronic disease, being pregnant, perceived vaccine safety, having more information about vaccine effectiveness, mandatory vaccination, being recommended to be vaccinated, lack of confidence in the healthcare system to control epidemic, and belief in COVID-19 vaccines protection from COVID-19 infection.

Conclusion

This meta-analysis revealed that the global estimated pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine among both HCWs and non-HCWs was unsatisfactory. Globally, there is a need for a call for action to cease the crisis of this pandemic.

Understanding change in COVID-19 vaccination intention with network analysis of longitudinal data from Dutch adults

Prior research into the relationship between attitudes and vaccination intention is predominantly cross-sectional and therefore does not provide insight into directions of relations. During the COVID-19 vaccines development and enrollment phase, we studied the temporal dynamics of COVID-19 vaccination intention in relation to attitudes toward COVID-19 vaccines and the pandemic, vaccination in general, social norms and trust. The data are derived from a longitudinal survey study with Dutch participants from a research panel (N = 744; six measurements between December 2020 and May 2021; age 18–84 years [M = 53.32]) and analyzed with vector-autoregression network analyses. While cross-sectional results indicated that vaccination intention was relatively strongly related to attitudes toward the vaccines, results from temporal analyses showed that vaccination intention mainly predicted other vaccination-related variables and to a lesser extent was predicted by variables. We found a weak predictive effect from social norm to vaccination intention that was not robust. This study underlines the challenge of stimulating uptake of new vaccines developed during pandemics, and the importance of examining directions of effects in research into vaccination intention.

Mapping the Prevalence of COVID-19 Vaccine Acceptance at the Global and Regional Level: A Systematic Review and Meta-Analysis

Despite the availability of effective and safe vaccines, the acceptance of COVID-19 vaccination is suboptimal. In this meta-analysis we quantified the prevalence estimates of COVID-19 vaccine acceptance with a specific focus on worldwide geographical differences. We searched PubMed, Scopus, Web of Science and PsycInfo up to April 2021 (PROSPERO ID: CRD42021235328). Generalized random-effects linear models with a logit link were used to calculate the pooled estimated rate of vaccine acceptance at both the global and regional level. A meta-regression analysis was performed to assess the association between COVID-19 vaccine acceptance and various characteristics of the studies. Overall, 71 articles yielding 128 prevalence estimates were included. The pooled prevalence of COVID-19 vaccination acceptance rate was 66% (95% CI: 61-71%). This varied by geographic area, ranging from 36% (95% CI: 18-60%) in Africa to 83% (95% CI: 82-84%) in Oceania, and there was high variability between countries (15.4% Cameroon-100% Bhutan). Meta-regression analysis showed that studies that investigated COVID-19 vaccination intentions using multiple choice/scoring gave a vaccine acceptance prevalence lower than studies with only two possible answers (yes/no) (ß: -1.02 95% CI: -1.41 to -0.63). Despite some variation in the estimates, the results showed that one in three people may refuse/delay COVID-19 vaccination.

Perceived health literacy and COVID-19 vaccine acceptance among Chinese college students: A mediation analysis

BACKGROUND

Although COVID-19 vaccines hold the potential to dramatically alter the COVID-19 pandemic, vaccine hesitancy remains a serious threat to the management and control of COVID-19 infections. Vaccination of young adults plays a crucial role in achieving herd immunity. However, the determinants of COVID-19 vaccine acceptance among the youth in China have not been fully explored. Our study aims to investigate the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance.

METHODS

This survey was conducted among Chinese college students during September and October, 2020. COVID-19 vaccine acceptance was defined as the likelihood that participants would get a COVID-19 vaccine. A mediation analysis was employed to explore the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance.

RESULTS

A total of 2,587 college students were included in our study. The results of the survey revealed that the majority (80.40%) of the participants expressed high COVID-19 vaccine acceptance. After controlling for demographic characteristics, the relationship between perceived health literacy and COVID-19 vaccine acceptance was mediated by positive attitudes toward general vaccination (std.β = 0.004, p = 0.037) and self-efficacy of COVID-19 vaccine (std.β = 0.053, p < 0.001).

CONCLUSIONS

The findings suggest that interventions targeting health literacy to promote COVID-19 vaccination coverage might consider placing greater emphasis on enhancing the positive attitude towards and self-efficacy of vaccines among youth.

COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region

Background

Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19.

Objectives

To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region.

Method

An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and August 2021.

Results

Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would increase if given adequate information and if their doctor recommended it.

Conclusion

Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.

Behind the Scenes of COVID-19 Vaccine Hesitancy: Psychological Predictors in an Italian Community Sample

Psychological variables may be crucial in favoring or discouraging health-related behaviors, including vaccine acceptance. This study aimed to extend the previous literature by outlining the psychological profile associated with COVID-19 vaccine hesitancy in a sample of Italian citizens. Between April and May 2021, 1122 Italian volunteers completed a web survey on COVID-19 vaccine acceptance, also including several self-reported psychological measures. A multiple hierarchical logistic regression analysis was performed to identify the psychological variables associated with vaccine hesitancy. Low confidence in COVID-19 vaccine efficacy and safety, low collective responsibility, high complacency, and high calculation (i.e., extensive information searching, and costs–benefit estimates) predicted higher hesitancy. Our results suggest that to be effective, vaccine-related communications should be as clear, understandable, and sound as possible, preventing the spreading of misunderstandings, or even fake information, that may foster people’s insecurities and distrust. Furthermore, the advantages and necessity of vaccination, both at the individual and community-level, should be clearly emphasized. Efficacious vaccine-related communications may be crucial, not only to maintain an adequate immunity rate for COVID-19, but also to inform policymakers and public authorities in the case of possible future infectious outbreaks.

COVID-19 vaccine side effect: age and gender disparity in adverse effects following the first dose of AstraZeneca COVID-19 vaccine among the vaccinated population in Eastern Ethiopia: a community-based study

Objective:

The pandemic of coronavirus disease 2019 (COVID-19) is a major threat to community health, and vaccinations are a safe and effective way to reduce disease loads around the world. This study aimed to assess the age and gender disparity in adverse effects following the first dose of the AstraZeneca COVID-19 vaccine among the vaccinated population in Eastern Ethiopia.

Methods:

A community-based cross-sectional study design was conducted among 832 randomly selected individuals from December 1st to 20th, 2021, in eastern Ethiopia. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were analyzed using the SPSS V26. Descriptive summary statistics were done. A chi-square test statistic was computed to assess the difference in adverse effects between age groups and both genders.

Result:

Out of 832 study participants who had taken the first dose of AstraZeneca vaccine, 96.3% of them felt at least one adverse effect. The magnitude of adverse reactions was higher among male participants. The reported adverse reactions were significantly higher in the age group of 50–60 years with comorbidity than those of <50 and >60 years of age.

Conclusion:

Overall, there is a significant age and gender difference in adverse effects following the first dose of the AstraZeneca COVID-19 vaccine. In addition, adverse reactions were higher among people with comorbidity in the age group of 50–60 years. The Harari Regional Health Bureau should provide training for frontline healthcare workers on early recognition and response to adverse effects of the COVID-19 vaccine. In addition, information and education should be provided to the community as a whole regarding recognition and the appropriate measures to be taken.

Three dimensions of COVID-19 risk perceptions and their socioeconomic correlates in the United States: A social media analysis

Social media analysis provides an alternate approach to monitoring and understanding risk perceptions regarding COVID-19 over time. Our current understandings of risk perceptions regarding COVID-19 do not disentangle the three dimensions of risk perceptions (perceived susceptibility, perceived severity, and negative emotion) as the pandemic has evolved. Data are also limited regarding the impact of social determinants of health (SDOH) on COVID-19-related risk perceptions over time. To address these knowledge gaps, we extracted tweets regarding COVID-19-related risk perceptions and developed indicators for the three dimensions of risk perceptions based on over 502 million geotagged tweets posted by over 4.9 million Twitter users from January 2020 to December 2021 in the United States. We examined correlations between risk perception indicator scores and county-level SDOH. The three dimensions of risk perceptions demonstrate different trajectories. Perceived severity maintained a high level throughout the study period. Perceived susceptibility and negative emotion peaked on March 11, 2020 (COVID-19 declared global pandemic by WHO) and then declined and remained stable at lower levels until increasing once again with the Omicron period. Relative frequency of tweet posts on risk perceptions did not closely follow epidemic trends of COVID-19 (cases, deaths). Users from socioeconomically vulnerable counties showed lower attention to perceived severity and susceptibility of COVID-19 than those from wealthier counties. Examining trends in tweets regarding the multiple dimensions of risk perceptions throughout the COVID-19 pandemic can help policymakers frame in-time, tailored, and appropriate responses to prevent viral spread and encourage preventive behavior uptake in the United States.

A model-based opinion dynamics approach to tackle vaccine hesitancy

Uncovering the mechanisms underlying the diffusion of vaccine hesitancy is crucial in fighting epidemic spreading. Toward this ambitious goal, we treat vaccine hesitancy as an opinion, whose diffusion in a social group can be shaped over time by the influence of personal beliefs, social pressure, and other exogenous actions, such as pro-vaccine campaigns. We propose a simple mathematical model that, calibrated on survey data, can predict the modification of the pre-existing individual willingness to be vaccinated and estimate the fraction of a population that is expected to adhere to an immunization program. This work paves the way for enabling tools from network control towards the simulation of different intervention plans and the design of more effective targeted pro-vaccine campaigns. Compared to traditional mass media alternatives, these model-based campaigns can exploit the structural properties of social networks to provide a potentially pivotal advantage in epidemic mitigation.

The proximal and distal effects of mortality salience on COVID-19-related health perceptions and intentions

Health preventative measures are important in reducing transmission of COVID-19, yet death-related thoughts might hinder preventative action. Using two online samples (N = 948), we examined how mortality salience (MS) may produce health-related proximal and distal defenses relevant to COVID-19, examining health optimism and appearance self-worth as moderators. MS decreased perceived vulnerability as a proximal defense for those with high health optimism (Study 1), while those with low health optimism decreased perceived response efficacy of face masks and intention to wear a protective face mask (Study 2). Additionally, those with high appearance self-worth displayed increased intention to wear an aesthetically appealing face mask as a distal defense to MS (Study 2). Our findings demonstrate the importance of considering how mortality concerns may channel health-defeating and health-promoting behaviors in respect to COVID-19 and provide insight into how to produce sustained engagement in health preventative action to combat the pandemic.

Factors Affecting the Psychological Well-Being of Health Care Workers During the COVID-19 Crisis

Background

Health care workers (HCWs) are a group that especially suffered during the COVID-19 pandemic. In addition to facing the stress of dealing with patients and social isolation, they had to worry about being infected themselves and transmitting the infection to their families. This study evaluated the fear, anxiety, and depression experienced by HCWs during the COVID-19 crisis.

Subjects and Methods

The sample size was 541 HCWs. Data collection was done using an online validated questionnaire through Google Docs, sent to HCWs by email and WhatsApp groups. We assessed depression and anxiety with the 4-item Patient Health Questionnaire-4 (PHQ-4), while evaluating fear with the Fear of COVID-19 Scale (FCV-19S).

Results

A statistically significant difference was found in the perception of fear between married and unmarried people, and between those with colleagues who had died from COVID-19 infection and those without. There was a significant relation between HCWs’ anxiety and a history of death from COVID-19 infection, either of friends or of close relatives. The prevalence of depression was 18.48% in the tested sample of HCWs. Participants who had close relatives or friends infected with COVID-19 showed a significantly higher degree of depression. The age group <30 and those working 20 to 30 hours weekly showed higher degrees of anxiety and depression.

Conclusion

Sociodemographic variables such as age, marital status, and working area had a significant impact on the mental and psychological health of HCWs during the COVID-19 crisis. HCWs who lost patients due to COVID-19 had a significantly higher prevalence of fear, depression, and anxiety.

COVID-19 Vaccine Hesitancy in Israel Immediately Before the Vaccine Operation

The development of a vaccine for COVID-19 presented hope for a way out of the global crisis caused by the virus. However, a potential barrier may be vaccine hesitancy, and identifying the factors that affect it is critical, especially concerning a new vaccine technology. The purpose of this research is to identify the factors that effects vaccine hesitancy by using a holistic view. The data were collected from 504 people in December 2020, 3 days before the vaccine operation started in Israel. The analysis included three categories of determinants: (1) contextual influences; (2) health records; and (3) perceived health attitudes. The results indicate that different sets of variables affect willingness to accept the vaccine among the whole spectrum of the vaccine-hesitant and the undecided subsample. In the full sample, gender, age, income, influenza vaccine, perceived trust, perceived susceptibility, perceived benefits, and perceived barriers affected vaccine acceptance. The perceived level of suffering from COVID-19 was associated with willingness to vaccinate, and when religious beliefs increased, the intention to vaccinate decreased. For the undecided subsample, the factors included gender, influenza vaccine, trust in the vaccine company, and perceived vaccine benefits and barriers. The results suggest that efforts of governments and health institutions should focus on women and highlight the vaccine as an opportunity to "go back to normal" without worries. Those results will help implement vaccine strategy in the following cases: if infant vaccination is pursued and if emergency vaccines or new vaccine technologies emerge for another pandemic as well.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Hesitancy of COVID-19 vaccines: Rapid systematic review of the measurement, predictors, and preventive strategies

Vaccine hesitancy is one of the top ten global health threats and the first threat to fighting COVID-19 through vaccination. With the increasing level of COVID-19 vaccine hesitancy amidst the rising level of confirmed cases and death tolls, this paper provides rapid systematic literature reviews on the measurement of COVID-19 vaccine hesitancy, key determinants and evidence-based strategies to prevent COVID-19 vaccine hesitancy. The findings reveal three standard measures of vaccine hesitancy: optional response questions, Likert scale, and linear scale measurements. Factors such as sociodemographic/economic factors, occupational factors, knowledge on the vaccine, vaccine attributes, conspiracy belief and psychological factors are the major predictors of COVID-19 vaccine hesitancy. Evidence-based findings identified measures such as effective education on the vaccine, clear and consistent communication to build public confidence and trust, health education on vaccination and its social benefit, outreach program and targeted messaging to minimize COVID-19 vaccine hesitancy.

Do Attitudes, Mental Health Status, and Interpersonal Factors Predict COVID-19 Vaccine Hesitancy at the Early Phase of the Pandemic? A Longitudinal Study in Chinese College Students

Purpose

The present study examined whether and how attitudes toward the COVID-19 vaccine (i.e., safety, efficacy, and price), mental health statuses (i.e., perceived stress and depression), and interpersonal factors (i.e., online social support, perceived social support) would predict COVID-19 vaccine hesitancy.

Patients and methods

The two-wave longitudinal surveys were conducted in December 2019 and 2020 in Chinese medical college students (N = 194). Well- validated measures were used, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale, the Online Social Support Questionnaire, and the Perceived Social Support Scale. Perceived safety, efficacy, price of COVID-19 vaccine, vaccine hesitancy, and actual intake were also measured.

Results

Only 2.1% of participants had been vaccinated against COVID-19 in the early stages of the pandemic; 13.4% intended to get vaccinated in the next 3 months, and 66% intended to have it in the next 12 months upon follow-up. Multiple regression analyses revealed that perceived stress (βm = -0.15, p < 0.05) and depression (βm = -0.15, p < 0.05) were risk factors for positive attitudes toward the COVID-19 vaccine; online social support (ORm = 1.41, p < 0.01) and positive attitudes toward the COVID-19 vaccine (ORm = 1.83, p < 0.01) were protective factors of intention to get vaccinated in future.

Conclusion

Findings suggest that intervention efforts should be made to reduce negative attitudes toward the COVID-19 vaccine among people with poor mental health and enhance online social support to promote COVID-19 vaccination.

COVID-19 vaccine hesitancy and acceptance: a comprehensive scoping review of global literature

As countries continue the third year of the pandemic, we believe that there has been unfair attention to COVID-19 vaccine efficacy and safety, while tacitly ignoring serious challenges with vaccine uptake, without which vaccination may not be effective against the spread of COVID-19. While several studies have been published on COVID-19 vaccine hesitancy, there remains a need to conduct a comprehensive global analysis of vaccine hesitancy. We conducted a scoping review of 60 studies published globally on vaccine hesitancy and acceptance. We conducted a qualitative analysis to identify motivators and barriers to vaccination across several cultural and demographic contexts. We found the following factors to be relevant in any discussion about addressing or minimizing vaccine hesitancy: risk perceptions, trust in health care systems, solidarity, previous experiences with vaccines, misinformation, concerns about vaccine side effects and political ideology. We combine our insights from this comprehensive review of global literature to offer an important and practical discussion about two strategies that have been used to improve vaccine uptake: (i) communication and education and (ii) vaccine rollout and logistics.

COVID-19 vaccine hesitancy in Addis Ababa, Ethiopia: a mixed-method study

OBJECTIVE

Data on COVID-19 vaccine hesitancy is limited in Ethiopia and other parts of Africa. Therefore, the aim of this study was to determine the level of COVID-19 vaccine hesitancy and its associated factors in Addis Ababa, Ethiopia.

DESIGN

A community-based concurrent mixed-method study.

SETTING

In a community setting.

PARTICIPANTS

Adult residents (n=422) of Akaki Kality subcity who were recruited by a two stage sampling technique and 24 adults who were selected purposively were included for the quantitative and qualitative part of the study respectively.

OUTCOME MEASURES

Data were collected by face-to-face interview using a semistructured questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified by multivariable binary logistic regression model.

RESULTS

One out five (19.1%, 95% CI 15.3% to 24.6%) participants were not willing to get vaccinated. In the multivariable analysis, vaccine hesitancy was significantly associated with being female (aOR=1.97; 95% CI 1.10 to 3.89), having negative attitude towards COVID-19 and its preventive measures (aOR=1.75; 95% CI 1.08 to 3.02), and primary information source being social media (internet) (aOR=3.59; 95% CI 1.75 to 7.37). Study participants have predominantly stated that they did not have enough information about the vaccine, feared it would not be effective or have too many side effects, and reflected their uncertainty towards the quality of the vaccine.

CONCLUSIONS

A considerable proportion of the people in Addis Ababa have concerns on COVID-19 vaccines and unwilling to accept them. This was due to the misconceptions, negative attitudes and use of social media as their primary source of information. Providing the community with health education and consistent efforts to enhance the prevention measures are important, particularly using different medias including social media.

Medical and non-medical students' knowledge, attitude and willingness towards the COVID-19 vaccine in China: a cross-sectional online survey

In the context of the novel Coronavirus outbreak and China’s official policy of free vaccination against COVID-19 for all, medical students’ attitudes and knowledge toward vaccines can influence public acceptance to some extent, however, the large base of non-medical students cannot be ignored. We aimed to investigate the knowledge, attitude, and willingness toward the COVID-19 vaccine among medical and non-medical students. Online surveys were completed by 652 medical students and 590 non-medical students to compare differences in knowledge and attitude of COVID-19 vaccine and vaccination willingness from three universities in the Zhejiang Province. The awareness rate of the vaccine among medical students (65.3%) was higher than that of non-medical students (53.6%). The approval rate of medical students for the safety and efficacy of the COVID-19 vaccine was higher than that of non-medical students. 81.8% of university students were willing to be vaccinated against COVID-19; Multiple stepwise regression analyses showed that lower class grades, rural students’ origin, COVID-19 vaccine attitude and higher cognition level of health self-management influenced the acceptance of COVID-19 vaccination among medical students. However, urban origin, COVID-19 vaccine attitude were the factors hindering non-medical students’ vaccination against COVID-19. The knowledge, attitude and willingness toward the COVID-19 vaccine on medical and non-medical students had different characteristics. Moreover, health self-management was associated with COVID-19 vaccination willingness. Staff involved in the university should pay more attention to the self-managementability of students, send out accurate and transparent information to enhance their cognitive level, further improving the students’ willingness to receive the COVID-19 vaccine.

Acceptance of COVID-19 vaccine and determinant factors in the Iranian population: a web-based study

BACKGROUND

Iran had a high rate of death in several COVID 19 waves. Vaccination is a method for prevention and control of the COVID-19 pandemic. Success in controlling the pandemic is not solely dependent on the effectiveness of the vaccines. It is also dependent on the global acceptance and vaccine coverage rate. This study aimed to determine the acceptance rate of COVID-19 vaccination in the Iranian population and the factors affecting it.

METHODS AND MATERIALS

This study was a cross-sectional research on 1564 Iranian people above 18. Study data were collected using a web-based questionnaire and analyzed using linear regression analysis and logistics at a significance level of 0.05 using SPSS.

RESULTS

Approximately 70% of the participants reported acceptance of the vaccines. Ten percent of the people were against and 20% were hesitant to get vaccinated. The results showed that risk perception (P = .003), Knowledge of the disease (P < .001), trust in the health system (P < .001), attitude towards vaccination (P < .001), and vaccination literacy (P < .001) were predictors of vaccine acceptance. People with higher levels of education and mistrust towards the health system had a reduced vaccine acceptance rate.

CONCLUSIONS

The acceptance rate of the COVID-19 vaccine in Iran was higher than in the other countries in the Middle East. Extensive interventions are important to increase the trust in the health system and improve the knowledge of vaccine efficacy and literacy.

Indonesian nursing students' intention to accept COVID-19 vaccines: an online, multicentre survey

BACKGROUND

The determinants of intention to accept the COVID-19 vaccine and associated factors among nursing students during this pandemic need to be identified.

AIMS

The study assessed nursing students' attitudes to vaccination, health engagement and trust in government, as well as their intention to have a COVID-19 vaccination.

METHODS

A cross-sectional study was carried out among nursing students in three provinces of Java, Indonesia, from December 2020 to February 2021. Convenience sampling was used to gather primary data from 640 participants through a structured online survey. Multiple linear regression was used to analyse the results.

FINDINGS

All items of vaccine attitude and health engagement as well as trust in government were positive predictors of vaccine acceptance after adjusting for confounding factors.

CONCLUSION

Nursing students were more likely to accept vaccination if they had a positive attitude to vaccination, high levels of health engagement and trust in the government regarding tackling the COVID-19 pandemic.

Willingness to receive the COVID-19 vaccine and associated factors among residents of Southwestern Ethiopia: A cross-sectional study

Introduction

The COVID-19 vaccine is a key intervention toward containing the pandemic. Vaccines are thought to be a form of defense. One of the major challenges to managing the COVID-19 pandemic is the uncertainty or willingness to accept vaccinations. Our study aimed willingness to get the COVID-19 vaccine and the factors that influence it in Mettu Woreda, Ilu Ababor Zone, Ethiopia.

Methodology

Cross-sectional study design was conducted from August 1, 2021, to September 1, 2021, among rural residents of Mettu woreda's of Ilu Ababor Zone, Oromia, Ethiopia. The semi-structured data collection format was prepared to assess the magnitude of the communities' acceptance of the COVID-19 vaccine. A multivariable logistic regression analysis was used to determine the predictors of communities' acceptance of the COVID-19 vaccine at 95% CI.

Results

Of 350 participants from the study area, 59% of them were males and 41% females. Less than one-third (29.8%) of participants were willing to accept the COVID-19 vaccine. The results multivariable logistic regression revealed that the age group of ≥50 years (OR=0.29; 95% CI: -3.1-0.34) as compare with the 18-29 years, low monthly income (OR=0.85; 95% CI: -0.74-2.33), low perception level (OR=0.35; 95% CI: -2.03-0.24), government unemployed (OR=0.86; 95% CI: -0.72-0.1), low Level of acceptance (OR=0.72; 95% CI: -0.67, 0.08) and unwillingness to test COVID-19 (OR=0.13; 95% CI: -4.47, 0.58) were predictors of willingness to receive COVID-19 vaccine.

Conclusion

Less than one-third of the study, participants were willing to accept the COVID-19 vaccine. The likelihood of Willingness to accept the COVID-19 vaccine was low in the study area. Overall; low education, low vaccination perception, low income, jobless occupation, older age, and unwillingness to test for COVID-19 were associated with greater willingness to take the COVID-19 vaccine and are significantly associated with willingness to get the COVID-19 immunization.

COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination

Background

The hesitancy in taking the COVID-19 vaccine is a global challenge. The need to identify predictors of COVID-19 vaccine reluctance is critical. Our objectives were to evaluate sociodemographic, psychological, and behavioral factors, as well as attitudes and beliefs that influence COVID-19 vaccination hesitancy in the general population of Italy.

Methods

A total of 2,015 people were assessed in two waves (March, April and May, 2021). Participants were divided into three groups: (1) individuals who accepted the vaccination (“accepters”); (2) individuals who refused the vaccination (“rejecters”); and (3) individuals who were uncertain about their attitudes toward the vaccination (“fence sitters”). Group comparisons were performed using ANOVA, the Kruskal-Wallis test and chi-square tests. The strength of the association between the groups and the participants' characteristics was analyzed using a series of multinomial logistic regression models with bootstrap internal validation (one for each factor).

Results

The “fence sitters” group, when compared to the others, included individuals of younger age, lower educational level, and worsening economic situation in the previous 3 months. After controlling for sociodemographic factors, the following features emerged as the main risk factors for being “fence sitters” (compared with vaccine “accepters”): reporting lower levels of protective behaviors, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and higher conspirative mentality. Higher levels of COVID-19 perceived risk, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and protective behaviors were associated with a higher likelihood of becoming “fence sitters” rather than vaccine “rejecters.”

Conclusions

The “fence sitters” profile revealed by this study is intriguing and should be the focus of public programmes aimed at improving adherence to the COVID-19 vaccination campaign.

COVID-19 vaccines: awareness, attitude and acceptance among undergraduate University students

Background

The myths and conspiracy theories on the COVID-19 vaccine cause people to be hesitant and maleficent towards the vaccine.

Objectives

To assess COVID-19 vaccine-related awareness, attitude and acceptance and to assess reasons for refusing the vaccine among undergraduate Jimma University Institute of Health students.

Methods

A cross-sectional study was conducted among 387 undergraduate students of Jimma University Institute of Health. Self-administered questionnaires were used to collect the data and summarized by descriptive statistics. A multivariable regression model was used to assess predictable variables for good awareness and positive attitude. A p value of < 0.05 was used to declare the statistical association.

Results

Only 41% of the students had a good awareness of the COVID-19 vaccine, and more than half, 224 (57.9%) of them had a positive attitude towards the COVID-19 vaccine. Age [(AOR: 95% CI) 1.18 (1.03, 1.35)] and having good awareness [(AOR: 95% CI) 2.39 (1.55, 3.68)] were associated with positive attitude of students towards the COVID-19 vaccine. However, only 27.1% of the students were willing to take the vaccine for COVID-19. Afraid of long term effects (49.1%), not being convinced of the safety standards (38.8%), lack of information about the vaccine (37.2%), and too short time for development (39.9%) was common reasons for refusing the COVID-19 vaccine.

Conclusions

According to the present study, the majority of the participants had a positive attitude towards COVID-19 vaccine. However, only less than half of the participants had a good awareness of the vaccine. In addition, the acceptability of the vaccine is low. Afraid of long term effects, not being convinced of the safety profile, lack of information about the vaccine, and the time used for the development were the common reasons for refusing the vaccine. Therefore, all stakeholders are advised to increase awareness, positive attitude, and acceptance of the vaccine.

Willingness to Receive a COVID-19 Vaccine and Associated Factors among Older Adults: A Cross-Sectional Survey in Shanghai, China

Background: Older individuals have a high risk of morbidity and mortality due to COVID-19, and one of the most effective ways to prevent COVID-19 is vaccination. Little is known about older people’s willingness to receive a COVID-19 vaccine. Therefore, the objective of this study was to assess the acceptance of and factors influencing the intention to receive a COVID-19 vaccination among older adults in Shanghai, China. Methods: A cross-sectional study was conducted among older adults (≥60 years old) in Shanghai. Face-to-face interviews with a questionnaire were conducted in community health service centers, recording several parameters: demographic information, health-related factors; perceived likelihood, severity, and burden of COVID-19; perceived safety, effectiveness, necessity, and benefit of the COVID-19 vaccine, as well as their trust in the vaccine delivery system and doctors; willingness to receive a COVID-19 vaccination. Bivariate analysis between several survey items and the willingness to receive a COVID-19 vaccination was conducted using a chi-square test. Logistic regression was used to assess to what degree each variable affected the willingness to receive a COVID-19 vaccination. Results: Of the 1067 participants, 90.91% (970/1067) confirmed that they were willing to receive a COVID-19 vaccination. The participants were more likely to be willing to be vaccinated if they were immigrants (OR = 1.988, 95%CI = 1.062−3.717), had an education level of junior high school (OR = 2.724, 95%CI = 1.000−7.423) or high school or above (OR = 3.993, 95%CI = 1.576−10.119), and had a monthly income of CNY 3000−5000 (OR = 32.770, 95%CI = 1.144−6.711) or CNY >5000 (OR = 2.309, 95%CI = 1.003−5.319). The participants were also more likely to be willing to be vaccinated if they had received a pneumonia vaccination previously (OR = 2.138, 95%CI = 1.016−4.500), perceived the safety of the COVID-19 vaccine (OR = 1.508, 95%CI = 1.073−2.119), perceived the necessity of the COVID-19 vaccine (OR = 2.604, 95%CI = 1.946−3.484), or trusted the suggestions of doctors (OR = 1.706, 95%CI = 1.115−2.618). The participants were less likely to be willing to be vaccinated if they were aged ≥76 years (OR = 0.498, 95%CI = 0.264−0.939), reported a physical health condition of bad or below (OR = 0.229, 95% CI = 0.095−0.549), or were worried about the adverse effects of a COVID-19 vaccination (OR = 0.503, 95%CI = 0.364−0.695). Conclusions: Under the free vaccination policy for COVID-19, older adults have a high intention to be vaccinated to prevent COVID-19 in Shanghai, China. Widely publicizing the safety and necessity of COVID-19 vaccination is necessary.

Facilitating free and paid vaccine acceptance in Malaysia: effectiveness of vaccine and fear of COVID-19

Purpose

This study aims to examine how demographic and psychological predictors of free and paid vaccine acceptance operate within an infectious environment. The psychological predictors were derived from the protection motivation theory (PMT), including the appraised effectiveness of vaccine in containing the pandemic and the fear of COVID-19.

Design/methodology/approach

A representative data set that consists of responses from 2,850 Malaysians was used in this study. Multi-level modelling was used to analyse the data.

Findings

Results indicated that the acceptance of free and paid vaccination did not differ by region. This suggests that the effects of the included psychological predictors on vaccine acceptance are independent from the environment. Malaysians are more likely to endorse both free and paid vaccination when it is perceived as effective in controlling the pandemic. When the vaccine is deemed as an effective preventive of COVID-19, Malaysians tend to seek free vaccination. Although fear of COVID-19 did significantly predict the endorsement of vaccination, it is a weaker predictor than the perceived effectiveness of vaccine.

Originality/value

This research used a large representative data set and the PMT framework in addressing vaccine acceptance in Malaysia.

Investigating COVID-19 risk perception and preventive behaviours in third-level students in Ireland

Objectives

The novel coronavirus outbreak required the population's compliance with public health measures yet young adults have been identified as having low risk perceptions and relatively low adherence with preventive measures. This study investigated third-level students' COVID-19 risk perception, knowledge and attitudes, and preventive behaviours between February and June 2021 to further understand young adults' beliefs and behavioural response to the COVID-19 pandemic in Ireland.

Design

Cross-sectional quantitative online survey design.

Methods

Three hundred and sixty-four university students completed an online survey which measured risk perception, preventive behaviours, knowledge of COVID-19, vaccination attitude and source of COVID-19 information.

Results

University students in Ireland reported high levels of knowledge of COVID-19 and high adherence to preventive behaviours. While risk perception levels were moderately high, students displayed higher concern for others than for themselves. High levels of risk perception significantly predicted preventive behaviours while general knowledge of the virus increased the likelihood of vaccine uptake. Over two-thirds of participants were willing to take the COVID-19 vaccine if available.

Conclusions

Vaccination hesitancy remains a concern among the young adult population requiring urgent attention from public health officials. The implication for health policymakers is that positive behavioural responses of the young population can be reinforced by targeting risk perceptions and by increasing the public's knowledge and understanding of COVID-19.

Do conspiracy theory and mistrust undermine people's intention to receive the COVID-19 vaccine in Austria?

Conspiracy theories flourish during the coronavirus disease 2019 (COVID-19) pandemic especially regarding vaccinations. As the vaccination reluctancy in Austria is high, it is important to understand the antecedents of vaccination intention at the preapproval stage of the vaccination process. An online survey was conducted in August 2020 in Austria with 217 primarily younger, female, educated participants. A two-step cluster analysis resulted in a sceptics cluster with a clear antivaccination tendency along with a right-wing political position, lower trust in general vaccines and lower education levels and the reference cluster. A considerable percentage of participants reported their reluctancy to have a COVID-19 vaccine. Although vaccination intention can be explained by attitude and subjective norm, this decision-making process is undermined by underlying factors such as conspiracy ideation and political position. Policy makers and health interventionists should take political background into consideration in efforts to increase vaccine compliance.

COVID-19-Related Vaccine Hesitancy among Community Hospitals’ Healthcare Workers in Singapore

COVID-19 has culminated in widespread infections and increased deaths over the last 3 years. In addition, it has also resulted in collateral economic and geopolitical tensions. Vaccination remains one of the cornerstones in the fight against COVID-19. Vaccine hesitancy must be critically evaluated in individual countries to promote vaccine uptake. We describe a survey conducted in three Singapore community hospitals looking at healthcare workers’ vaccine hesitancy and the barriers for its uptake. The online anonymous survey was conducted from March to July 2021 on all staff across three community hospital sites in SingHealth Singapore. The questionnaire was developed following a scoping review and was pilot tested and finalized into a 58-item instrument capturing data on demographics, contextual features, knowledge, attitudes, perceptions, and other vaccine-related factors in the vaccine hesitancy matrix. Logistic regression analysis was employed for all co-variates that are significant in univariate analysis. The response rate was 23.9%, and the vaccine hesitancy prevalence was 48.5% in the initial phase of the pandemic. On logistic regression analysis, only being female, a younger age, not having had a loved one or friend infected with COVID-19 and obtaining information from newspapers were associated with vaccine hesitancy in healthcare workers in Singapore community hospitals.

Attitudes and perceptions of Nigerians regarding receiving COVID-19 vaccines: an online cross-sectional study

Introduction

the success of controlling pandemics like COVID-19 can be achieved through its vaccination program. Besides masks, social distance, and good hand hygiene, a rapid vaccine program is crucial in controlling this COVID-19 pandemic. Thus, this study aimed to assess the attitudes and perceptions of Nigerians regarding accepting the COVID-19 vaccine.

Methods

a cross-sectional study was carried out among 334 respondents aged 18 and above from the Southeastern region of Nigeria. A validated questionnaire was used for the data collection through an online Google form. The data analysis was done using SPSS version 25. The association of socio-demographics with attitudes and perceptions was analysed using chi-square tests and Fisher exact tests. At the 95 percent confidence level, a p-value of 0.05 was deemed statistically significant.

Results

sixty point two percent (60.2%) (n = 201) of respondents showed positive attitudes with a mean of (13.96±2.97). Gender was the only demographic factor associated with attitudes (p< 0.001). Respondents with poor perceptions were higher by 53.0% (n = 177) with a mean value of (3.30±1.17). Age, education, gender, and marital status were seen to be associated with perceptions of vaccine acceptance (p<0.05). There was a link between attitudes and perceptions (P> 0.001), as those with positive attitudes also exercised good perceptions.

Conclusion

this study revealed that respondents had positive attitudes regarding COVID-19 vaccination acceptance but negative perceptions of it. As a result, community and health promotion professionals, religious leaders, and local celebrities should use their platforms to raise awareness about the benefits of COVID-19 immunization.

COVID-19 vaccination hesitancy among Iraqi general population between beliefs and barriers: An observational study

Background: Vaccine apprehension poses a serious threat to global health. While there has been a tremendous global effort to create a vaccine against coronavirus disease 2019 (COVID-19), little is known about its reception in  Iraq. Therefore, we sought to examine COVID-19 vaccine acceptance, hesitation, and related elements in the Iraqi population. Methods: Between the 19th of May and the 22nd of September 2021, a descriptive, cross-sectional web-based survey was conducted employing a quantitative approach. Respondents from both sexes aged 18 years and above who live in Iraq and agreed to participate were included. An anonymized online structured questionnaire was designed based on data from prior research on vaccine  hesitation in general,  and COVID-19 vaccination reluctance specifically. Results: A total of 1221 eligible participants from various regions in Iraq actively participated in the short web-based questionnaire. The overall acceptance rate of the COVID-19 vaccine was 56.2%, with a greater acceptance rate among younger male participants (p<0.05). Marital status had no significant association (p=0.834). Urbanization influenced the acceptance rate significantly (p=0.002). The barriers to receiving the COVID-19 vaccine were exemplified by the vaccine not being evaluated for a sufficient period in 51.4% of the responses, as well as concerns about future side effects in 76.6% of the responses and a lack of efficacy in 55.7% of the responses. The Pfizer-BioNTech vaccine received 39.6% preference and participants confidence, followed by the Oxford/AstraZeneca vaccine at 18.1% and the Sinopharm vaccine at 14.6%. Conclusions: COVID-19 vaccination apprehension was discovered in almost half of the study population. Lack of understanding about vaccination eligibility, anxiety about adverse events and vaccine efficacy, and distrust in the government were independently predictive of vaccine hesitation.