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Brohman I, Blank G, Mitchell H, Dubé E, Bettinger JA. Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study. Hum Vaccin Immunother 2024; 20:2326779. [PMID: 38517252 PMCID: PMC10962613 DOI: 10.1080/21645515.2024.2326779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Despite the availability of school-based immunization programs (SBIPs) in Canada, human papillomavirus (HPV) vaccine uptake remains suboptimal. Vaccine education may improve vaccine uptake among adolescents. The objective of this qualitative study was to identify opportunities for HPV vaccine education in British Columbia, Canada, by exploring the perspectives of students, parents, school staff, and public health nurses on the current SBIP. Individual semi-structured interviews were conducted with adult participants and focus groups were conducted with grade 6 students between November 2019 and May 2020. The interviews and focus groups were transcribed and then analyzed using reflexive thematic analysis. Opportunities for HPV vaccine education were identified in three themes: 1) making SBIPs student-centered; 2) adopting a collaborative and interdisciplinary approach to vaccine education; and 3) actualizing parent education opportunities. Broad support existed for a formal, collaborative HPV grade 6 vaccine curriculum delivered by teachers and public health nurses to provide evidence-based health information. Participants voiced that the curriculum should integrate students' perspectives on topics of interest and address needle associated pain and anxiety. Parents were identified as the primary vaccine decisionmakers, therefore, participants stated it was crucial to also provide parent-directed vaccine education as part of SBIP. Our findings support the development of a collaborative HPV vaccine curriculum directed to and informed by students and parents to buttress current SBIPs in British Columbia.
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Affiliation(s)
- Isabella Brohman
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gabriel Blank
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Laval, QC, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Dubé E, Renaud MP, Lyonnais MC, Pelletier C, Fletcher C. "The needle is already ready to go": communities' and health care professionals' perceptions of routine vaccination in Nunavik, Canada. Int J Circumpolar Health 2024; 83:2295042. [PMID: 38105644 PMCID: PMC10732179 DOI: 10.1080/22423982.2023.2295042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Canada
- Département d’anthropologie, Université Laval, Québec, Canada
| | - Marie-Pierre Renaud
- École d’études autochtones, Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | | | - Catherine Pelletier
- Axe Maladies infectieuses et immunitaires, Centrre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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Vivion M, Reid V, Dubé E, Coutant A, Benoit A, Tourigny A. How older adults manage misinformation and information overload - A qualitative study. BMC Public Health 2024; 24:871. [PMID: 38515081 PMCID: PMC10956171 DOI: 10.1186/s12889-024-18335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19. METHODS A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis. RESULTS Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information. CONCLUSIONS This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.
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Affiliation(s)
- M Vivion
- Department of Social and Preventive Medecine, Université Laval, Quebec, Canada.
- CHU de Québec-Université Laval Research Center, Quebec, Canada.
| | - V Reid
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
| | - E Dubé
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Department of Anthropology, Université Laval, Quebec, Canada
| | - A Coutant
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
- Université du Québec à Montréal (UQAM), Montreal, Canada
| | - A Benoit
- GDR AREES (Groupe de recherche: Arctique: Enjeux pour l'environnement et les sociétés) du CRNS, Paris, France
| | - A Tourigny
- Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada
- VITAM Centre de recherche en santé durable, Quebec, Canada
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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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Pelletier C, Gagnon D, Dubé E. "It's not that I don't trust vaccines, I just don't think I need them": Perspectives on COVID-19 vaccination. PLoS One 2024; 19:e0293643. [PMID: 38359042 PMCID: PMC10868828 DOI: 10.1371/journal.pone.0293643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 02/17/2024] Open
Abstract
In Quebec (Canada), the roll-out of the vaccination started slowly in December 2020 due to limited vaccine supply. While the first and second doses were well-accepted among adults and vaccine uptake was above 90%, in late 2021 and 2022, vaccine acceptance decreased for children vaccination and receipt of a 3rd or a 4th dose. In the autumn of 2022, four focus groups were conducted with vaccine-hesitant parents of children aged 0-4 and adults who expressed little intention to receive a booster dose. The objective of this study was to gather participants' perspectives on vaccination in general, on the COVID-19 vaccination campaign and the information available, and to gain insights into the underlying reasons for their low intention of either having their child(ren) vaccinated, or receiving an additional dose of vaccine. A total of 35 participants took part in the focus groups. While participants expressed a certain level of trust and confidence in public health and government authorities regarding pandemic management and the vaccination campaign, they were also concerned that transparent information was lacking to support an informed decision on booster doses and children's vaccination. Many participants felt adequately protected against the infection during the focus groups, citing a lack of perceived benefits as the primary reason for refusing a booster dose. Parents who refused to administer the COVID-19 vaccine to their young children felt that the vaccine was not useful for children and were concerned about potential side effects. The majority reported that their opinions regarding other recommended vaccines had not changed since the beginning of the pandemic. While these results are reassuring, our findings highlight the importance of transparency in public health communications about vaccines to increase confidence and to develop strategies to address vaccine fatigue and complacency toward COVID-19 vaccines.
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Affiliation(s)
- Catherine Pelletier
- Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Dominique Gagnon
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Eve Dubé
- Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
- Département d’anthropologie, Université Laval, Québec, Québec, Canada
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Humble RM, Dubé E, Olson J, Scott SD, MacDonald SE. Routine childhood vaccination among ethnocultural groups in Canada during the COVID-19 pandemic: A national cross-sectional study. Prev Med Rep 2023; 36:102435. [PMID: 37822977 PMCID: PMC10562748 DOI: 10.1016/j.pmedr.2023.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Some ethnocultural groups in Canada experience low routine childhood vaccination, with social locations and discriminations contributing to inequities. This study aimed to characterize routine childhood vaccination in the context of the COVID-19 pandemic, including the influence of discriminatory experiences when accessing health services. We conducted a cross-sectional national survey to assess parents' acceptance of routine vaccines for their children ≤ 17 years in Oct/Nov 2021. Descriptive statistics were used to explore differences among ethnocultural groups and logistic regression to assess associations with parents' low acceptance. Of 2531 parents, 21.8 % self-identified as Racialized minorities, 7.7 % Indigenous, 23.3 % newcomers, 10.0 % spoke minority languages most often, and 69.6 % belonged to a reference group who did not report these characteristics. Statistically significant findings included 36.6 % of Indigenous parents reporting that the pandemic made them realize that routine vaccines were more important compared to 16.7 % of newcomers. Discrimination/racism when accessing health services was most often experienced by Indigenous (27.8 %) and Racialized minorities (20.2 %), compared to the reference group (4.8 %). Racialized minorities were more likely to report low acceptance of routine vaccination (aOR = 2.19, 95 % CI: 1.18-4.05), and younger parents and those with only preschool-aged children were less likely to have low acceptance (aOR = 0.59, 95 % CI: 0.37-0.94; aOR = 0.53, 95 % CI: 0.36, 0.79). Low acceptance was associated with everyday stress preventing vaccination (aOR = 2.18, 95 % CI: 1.41-3.38). Public health decision-makers should ensure equitable access to routine childhood vaccination that targets the inclusion of ethnocultural groups, who may experience disproportionate barriers and low acceptance.
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Affiliation(s)
- Robin M. Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Chen R, Guay M, Gilbert NL, Dubé E, Witteman HO, Hakim H. Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey. BMC Public Health 2023; 23:2327. [PMID: 38001412 PMCID: PMC10668395 DOI: 10.1186/s12889-023-17079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). METHOD The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. RESULTS Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. CONCLUSION Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.
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Affiliation(s)
- Ruoke Chen
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Mireille Guay
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Nicolas L Gilbert
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
- University of Montreal School of Public Health, Quebec, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Quebec, Canada
- Department of Anthropology, Laval University, Quebec, Canada
| | | | - Hina Hakim
- Faculty of Medicine, Laval University, Quebec, Canada
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Robitaille A, Chadi A, Gabet M, Dubé E, Monnais L, David PM. Community Pharmacists and Influenza Vaccination: Opportunities and Challenges From a Public Health Perspective. J Pharm Pract 2023; 36:1184-1191. [PMID: 35486586 PMCID: PMC10515463 DOI: 10.1177/08971900221094932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context: In Quebec, Bill 31, adopted on March 18, 2020, extended vaccination to pharmacists. Despite many advantages, this new practice comes with public health issues reinforced in the context of COVID-19. Therefore, it is essential to understand the opportunities and challenges of the participation of community pharmacists in influenza vaccination, from a public health perspective by (i) describing the year of 2020-2021 influenza vaccination offer, (ii) its opportunities and challenges, and (iii) its impact on the accessibility of this service newly offered by pharmacists to the most vulnerable people. Methods: This research is a case study from one of the most affected areas by COVID-19 in Canada: Laval. Our method combines documentary analysis and semi-structured interviews with health professionals and public health actors (n = 23). Researchers used a thematic analysis to analyze these results. Results: Most partners (pharmacists, public health administrators) underlined multiple opportunities of this new practice, ie, pharmacists who can vaccinate, particularly for chronically ill patients. However, structural and strategical challenges remain. More specifically, vaccination seemed to only rely on a "first come, first served" basis, which questions public health objectives of vaccination, such as equitable access. Conclusion: The introduction of new actors, such as pharmacists, represents a major opportunity to improve vaccination coverage and reduce the burden of COVID-19 on the health system. However, this delegation of a public health activity to the private sector undoubtedly requires closer coordination with public health institutions.
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Affiliation(s)
| | - Alexandre Chadi
- Faculty of Pharmacy Université de Montréal, Montreal, QC, CA
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Dubé E, Trottier ME, Gagnon D, Bettinger JA, Greyson D, Graham J, MacDonald NE, MacDonald SE, Meyer SB, Witteman HO, Driedger SM. Exploring parents' views of the use of narratives to promote childhood vaccination online. PLoS One 2023; 18:e0284107. [PMID: 37467300 DOI: 10.1371/journal.pone.0284107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Negative information about vaccines that spreads online may contribute to parents' vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination. METHODS We identified three ∼4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician's clinical experience with vaccine-preventable diseases (prevention of still existing diseases); and a mother's experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention. RESULTS Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider's and parent's narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web. CONCLUSION While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention.
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Affiliation(s)
- Eve Dubé
- Department of Anthropology, Laval University, Quebec, Quebec, Canada
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Marie-Eve Trottier
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Dominique Gagnon
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Julie A Bettinger
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Greyson
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Holly O Witteman
- Department of Family Medicine, Laval University, Quebec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Malo B, Labbé F, Meyer SB, Filice E, Graham JE, MacDonald NE, Bettinger JA, Greyson D, MacDonald SE, Driedger SM, Kawchuk G, Dubé E. "I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice. Vaccine 2023:S0264-410X(23)00553-4. [PMID: 37210310 DOI: 10.1016/j.vaccine.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/22/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.
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Affiliation(s)
- Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; Département d'anthropologie, Université Laval, Québec, Canada
| | - Fabienne Labbé
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Eric Filice
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | | | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | | | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gregory Kawchuk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Eve Dubé
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; Département d'anthropologie, Université Laval, Québec, Canada; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada.
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11
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Etienne D, Archambault PM, Aziaka D, Chipenda Dansokho S, Dubé E, Fallon CS, Hakim H, Kindrachuk J, Krecoum D, MacDonald SE, Ndjaboué R, Noubi M, Paquette JS, Parent E, Witteman HO. A personalized avatar-based web application to help people understand how social distancing can reduce the spread of COVID-19: a cross-sectional observational pre-post study. JMIR Form Res 2023; 7:e38430. [PMID: 36961787 PMCID: PMC10170367 DOI: 10.2196/38430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND To reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. OBJECTIVE This study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the healthcare system, and society. METHODS We used Scrum, an agile framework, JavaScript (Vue.js framework), and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8-9, 2020. RESULTS After 26 days, the application received >3600 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly all (96.0%) already practicing distancing and (97.2%) indicated that they intended to practice distancing in the coming week. Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. CONCLUSIONS We developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The non-randomized design of this rapid study prevents us from concluding the application's effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission. CLINICALTRIAL
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Affiliation(s)
- Doriane Etienne
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, CA
| | - Patrick M Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Québec, CA
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, CA
| | - Donovan Aziaka
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Eve Dubé
- Department of Anthropology, Université Laval, Québec, CA
| | - Catherine S Fallon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Québec, CA
| | - Hina Hakim
- Maladies infectieuses et immunitaires, CHU de Quebec, Université Laval, Québec, CA
| | - Jason Kindrachuk
- Laboratory of Emerging Viruses, Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, CA
| | - Dan Krecoum
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Shannon E MacDonald
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, CA
| | - Ruth Ndjaboué
- Centre de recherche sur le Vieillissement, Sherbrooke, CA
| | - Magniol Noubi
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
| | | | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
- Research Centre of the CHU de Québec, Québec, CA
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12
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Stevens G, Johnson LC, Saunders CH, Schmidt P, Sierpe A, Thomeer RP, Little NR, Cantrell M, Yen RW, Pogue JA, Holahan T, Schubbe DC, Forcino RC, Fillbrook B, Sheppard R, Wooten C, Goldmann D, O’Malley AJ, Dubé E, Durand MA, Elwyn G. The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines. BMC Public Health 2023; 23:384. [PMID: 36823559 PMCID: PMC9948785 DOI: 10.1186/s12889-023-15266-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs' characteristics and other factors mediate and moderate the interventions' effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. METHODS We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. DISCUSSION Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. TRIAL REGISTRATION NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.
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Affiliation(s)
- Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, US.
| | - Lisa C. Johnson
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Catherine H. Saunders
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Peter Schmidt
- grid.137628.90000 0004 1936 8753Department of Neurology, Grossman School of Medicine, New York University, New York, NY US
| | - Ailyn Sierpe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachael P. Thomeer
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - N. Ruth Little
- grid.255364.30000 0001 2191 0423Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC US
| | - Matthew Cantrell
- National Association of Health Care Assistants, Carl Junction, MO US
| | - Renata W. Yen
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Jacqueline A. Pogue
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Timothy Holahan
- grid.16416.340000 0004 1936 9174Department of Geriatric Medicine, University of Rochester, Rochester, NY US
| | - Danielle C. Schubbe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachel C. Forcino
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | | | | | | | - Don Goldmann
- grid.418700.a0000 0004 0614 6393Institute for Healthcare Improvement, Boston, MA US
| | - A. James O’Malley
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Eve Dubé
- grid.23856.3a0000 0004 1936 8390Department of Anthropology, Faculty of Social Sciences, Laval University, Quebec City, QC Canada
| | - Marie-Anne Durand
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US ,grid.511931.e0000 0004 8513 0292Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, Lausanne Switzerland ,CERPOP, Université de Toulouse, Inserm, Toulouse, UPS France
| | - Glyn Elwyn
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
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13
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Humble RM, Scott SD, Dubé E, Olson J, MacDonald SE. The impact of the COVID-19 pandemic on parents' perceptions and acceptance of routine childhood vaccination in Canada: A national longitudinal study. Vaccine 2023; 41:407-415. [PMID: 36462954 PMCID: PMC9684123 DOI: 10.1016/j.vaccine.2022.11.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A decline in routine vaccination was reported by some countries early in the COVID-19 pandemic. In the context of the pandemic, determinants of routine childhood vaccination may have changed. Changes over time in parents' perceptions of routine vaccines and intentions for their children during the pandemic have not been fully explored. Understanding changes provides opportunities to promote routine childhood vaccines and address factors that may compromise parents' acceptance. METHODS We conducted longitudinal analysis of two sequential national surveys during the pandemic (Dec 2020 and Oct/Nov 2021) to assess changes over time in Canadian parents' perceptions of routine childhood vaccines, intentions to vaccinate, access for their children ≤ 17 years, and differences among sociodemographic characteristics. McNemar-Bowker tests were used to determine changes in parents' responses collected at two time points. RESULTS Of the 650 parents in the sample, 25.1% with a child ≤ 6 years and 20.5% with a child 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Between the two time points, parents' confidence in the safety (72.8% to 80.2%, p <.001) and effectiveness (81.7% to 85.2%, p =.007) of routine vaccines increased, parents were more engaged in vaccine decision-making (73.4% to 79.8%, p =.006), and everyday stress preventing vaccination decreased (78.8% to 68.5%, p <.001). Acceptance of routine vaccines increased (82.9% to 86.5%, p =.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p =.002). Compared to parents with 1 child, those with 2 children reported increased vaccination acceptance (82.6% to 87.4%, p =.024). INTERPRETATION Under the spotlight of COVID-19, parents' confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Vaccination providers should support parents' decision-making as they navigate routine childhood vaccine uncertainties. Differences in parents' acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines.
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Affiliation(s)
- Robin M. Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada,Corresponding author at: Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada.
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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14
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Garrison A, Karlsson L, Fressard L, Fasce A, Rodrigues F, Schmid P, Taubert F, Holford D, Lewandowsky S, Nynäs P, Anderson EC, Gagneur A, Dubé E, Soveri A, Verger P. International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries. Expert Rev Vaccines 2023; 22:726-737. [PMID: 37507356 DOI: 10.1080/14760584.2023.2242479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries. RESEARCH DESIGN AND METHODS After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions. RESULTS 2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors. CONCLUSION This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.
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Affiliation(s)
- Amanda Garrison
- Faculté des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS) PACA, Marseille, France
| | - Linda Karlsson
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Lisa Fressard
- Faculté des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS) PACA, Marseille, France
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Frederike Taubert
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn Holford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Potsdam, Potsdam, Germany
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Peter Nynäs
- Faculty of Arts, Psychology and Theology, Abo Akademi University, Turku, Finland
| | | | - Arnaud Gagneur
- Department of Pediatrics, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Eve Dubé
- Département d'anthropologie, Faculté des Sciences Sociales, Université Laval, Laval, Canada
| | - Anna Soveri
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Pierre Verger
- Faculté des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS) PACA, Marseille, France
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15
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Pollard AJ, MacDonald NE, Dubé E, Lamden K, Baxter PD, Suggitt D, Donovan H, Gibney Y, Rappuoli R, Wright C, Rodgers E, Trotter C, Stuart J, Blake N, Glennie L, Lucidarme J, Bai X, Lekshmi A, Willeton L, Clark SA, Borrow R. Presentations at the UK National Immunisation Conference. Hum Vaccin Immunother 2022; 18:2087411. [PMID: 36441135 PMCID: PMC9766481 DOI: 10.1080/21645515.2022.2087411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrew J Pollard
- Department of Pediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Center, Oxford UK
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, Nova Scotia, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Ken Lamden
- Retired consultant in health protection, Lancashire, UK
| | - Professor David Baxter
- Director of Medical Education / Consultant in Public Health and Clinical Skills Tutor, Stepping Hill hospital, Stockport, SK2 7JE
| | - Debbie Suggitt
- Director of Medical Education / Consultant in Public Health and Clinical Skills Tutor, Stepping Hill hospital, Stockport, SK2 7JE
| | - Helen Donovan
- Professional lead for public health nursing, Royal College of Nursing, Nursing Department, 20 Cavendish Square, London W1G 0RN
| | - Yvonne Gibney
- Member, Faculty of Travel Medicine, Royal College of Physicians and Surgeons, Glasgow
| | - Rino Rappuoli
- Vaccine Research and Development, GlaxoSmithKline Vaccines, Siena, Italy
| | - C. Wright
- Meningitis Research Foundation, Research, Evidence and Policy, Bristol, UK
| | - E. Rodgers
- Meningitis Research Foundation, Research, Evidence and Policy, Bristol, UK
| | - C. Trotter
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - James Stuart
- University of Bristol, Population Health Sciences, Bristol, UK
| | - N. Blake
- Meningitis Research Foundation, Research, Evidence and Policy, Bristol, UK
| | - L. Glennie
- Meningitis Research Foundation, Research, Evidence and Policy, Bristol, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Xilian Bai
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Laura Willeton
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Stephen A. Clark
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
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16
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Guay M, Maquiling A, Chen R, Lavergne V, Baysac DJ, Kokaua J, Dufour C, Dubé E, MacDonald SE, Gilbert NL. Sociodemographic Disparities in COVID-19 Vaccine Uptake and Vaccination Intent in Canada. Health Rep 2022; 33:37-54. [PMID: 36542362 DOI: 10.25318/82-003-x202201200004-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction This study's objective was to examine sociodemographic disparities in COVID-19 vaccine uptake and vaccination intent in the Canadian provinces by identifying factors associated with vaccine uptake in seniors prioritized for vaccination at the time of the survey and vaccination intent in all adults. Data and methods A cross-sectional survey of Canadian adults was conducted in all provinces from mid-April to mid-May 2021. In addition to sociodemographic characteristics, respondents (n=10,678) provided information on their COVID-19 vaccination status or their intent to get vaccinated. Logistic regression models were fitted using sociodemographic factors as explanatory variables and vaccination status (unvaccinated vs at least one dose) or vaccination intent (unlikely versus likely or already vaccinated) as outcomes. To account for vaccine prioritization groups, multiple regression models were adjusted for province of residence, age, Indigenous identity and health care worker status. Results Seniors with a lower household income (less than $60,000) and those living in smaller communities (fewer than 100,000 inhabitants) had higher odds of being unvaccinated. Among Canadian adults, the odds of being unlikely to get vaccinated were higher for males (adjusted odds ratio [AOR] 1.3), individuals younger than 60 (AOR between 3.3 and 5.1), non-health care workers (AOR 3.3), those with less than a high school education (AOR 3.4) or a household income of less than $30,000 (AOR 2.7) and individuals who do not identify as South Asian, Chinese, Black, Filipino, Arab, Latin American, Southeast Asian, West Asian, Korean or Japanese (AOR 1.7). Interpretation COVID-19 vaccine uptake (80%) and vaccination intent (95%) were high among Canadians; however, relative disparities were observed among specific groups. Continued efforts targeted toward these groups are essential in reducing potential inequity in access or service provision.
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Affiliation(s)
- Mireille Guay
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ontario, Canada
| | - Aubrey Maquiling
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ontario, Canada
| | - Ruoke Chen
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ontario, Canada
| | - Valérie Lavergne
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ontario, Canada
| | | | - Jackie Kokaua
- Centre for Social Data Integration and Development; Social, Health and Labour Statistics, Statistics Canada, Ontario, Canada
| | - Catherine Dufour
- Centre for Social Data Integration and Development; Social, Health and Labour Statistics, Statistics Canada, Ontario, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec, Canada.,Département d'anthropologie, Université Laval, Québec, Canada
| | | | - Nicolas L Gilbert
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ontario, Canada.,École de santé publique, Université de Montréal, Québec, Canada
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17
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Dubé E, MacDonald NE. Foreword. Can J Public Health 2022; 113:1-3. [PMID: 36508152 PMCID: PMC9744025 DOI: 10.17269/s41997-022-00721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, Québec, Canada.
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada.
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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18
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MacDonald SE, Graham B, Paragg J, Foster-Boucher C, Waters N, Shea-Budgell M, McNeil D, Kunyk D, Bedingfield N, Dubé E, Kenzie L, Svenson LW, Littlechild R, Nelson G. One child, one appointment: how institutional discourses organize the work of parents and nurses in the provision of childhood vaccination for First Nations children. Hum Vaccin Immunother 2022; 18:2048558. [PMID: 35358016 PMCID: PMC9196738 DOI: 10.1080/21645515.2022.2048558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To effectively support childhood vaccine programs for First Nations Peoples, Canada's largest population of Indigenous Peoples, it is essential to understand the context, processes, and structures organizing vaccine access and uptake. Rather than assuming that solutions lie in compliance with current regulations, our aim was to identify opportunities for innovation by exploring the work that nurses and parents must do to have children vaccinated. In partnership with a large First Nations community, we used an institutional ethnography approach that included observing vaccination clinic appointments, interviewing individuals involved in childhood vaccinations, and reviewing documented vaccination processes and regulations (texts). We found that the 'work' nurses engage in to deliver childhood vaccines is highly regulated by standardized texts that prioritize discourses of safety and efficiency. Within the setting of nursing practice in a First Nations community, these regulations do not always support the best interests of families. Nurses and parents are caught between the desire to vaccinate multiple children and the requirement to follow institutionally authorized processes. The success of the vaccination program, when measured solely by the number of children who follow the vaccine schedule, does not take into consideration the challenges nurses encounter in the clinic or the work parents do to get their children vaccinated. Exploring new ways of approaching the processes could lead to increased vaccination uptake and satisfaction for parents and nurses.
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Affiliation(s)
| | | | - Jillian Paragg
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Nicola Waters
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| | | | - Deborah McNeil
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Canada
| | - Lisa Kenzie
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | | | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
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19
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Dubé E, Labbé F, Malo B, Manca T, Aylsworth L, Driedger SM, Graham J, Greyson D, MacDonald N, Meyer SB, Parsons Leigh J, Sadarangani M, Wilson S, MacDonald SE. " I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2088970. [PMID: 35767434 PMCID: PMC9621068 DOI: 10.1080/21645515.2022.2088970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients. METHODS Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted. RESULTS Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program. CONCLUSIONS While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Wilson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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20
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Guay M, Maquiling A, Chen R, Lavergne V, Baysac DJ, Racine A, Dubé E, MacDonald SE, Gilbert NL. Measuring inequalities in COVID-19 vaccination uptake and intent: results from the Canadian Community Health Survey 2021. BMC Public Health 2022; 22:1708. [PMID: 36076208 PMCID: PMC9454405 DOI: 10.1186/s12889-022-14090-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By July 2021, Canada had received enough COVID-19 vaccines to fully vaccinate every eligible Canadian. However, despite the availability of vaccines, some eligible individuals remain unvaccinated. Differences in vaccination uptake can be driven by health inequalities which have been exacerbated and amplified by the pandemic. This study aims to assess inequalities in COVID-19 vaccination uptake and intent in adults 18 years or older across Canada by identifying sociodemographic factors associated with non-vaccination and low vaccination intent using data drawn from the June to August 2021 Canadian Community Health Survey (CCHS). METHODS The CCHS is an annual cross-sectional and nationally representative survey conducted by Statistics Canada, which collects health-related information. Since September 2020, questions about the COVID-19 pandemic are asked. Adjusted logistic regression models were fitted to examine associations between vaccination uptake or intent and sociodemographic and health related variables. Region, age, gender, level of education, Indigenous status, visible minority status, perceived health status, and having a regular healthcare provider were considered as predictors, among other factors. RESULTS The analysis included 9,509 respondents. The proportion of unvaccinated was 11%. Non-vaccination was associated with less than university education (aOR up to 3.5, 95% CI 2.1-6.1), living with children under 12 years old (aOR 1.6, 95% CI 1.1-2.4), not having a regular healthcare provider (aOR 1.6, 95% CI 1.1-2.2), and poor self-perceived health (aOR 1.8, 95% CI 1.3-2.4). Only 5% of the population had low intention to get vaccinated. Being unlikely to get vaccinated was associated with the Prairies region (aOR 2.2, 95% CI 1.2-4.1), younger age groups (aOR up to 4.0, 95% CI 1.3-12.3), less than university education (aOR up to 3.8, 95% CI 1.9-7.6), not being part of a visible minority group (aOR 3.0, 95% CI 1.4-6.4), living with children under 12 years old (aOR 1.8, 95% CI 1.1-2.9), unattached individuals (aOR 2.6, 95% CI 1.1-6.1), and poor self-perceived health (aOR 2.0, 95% CI 1.3-2.9). CONCLUSIONS Disparities were observed in vaccination uptake and intent among various sociodemographic groups. Awareness of inequalities in COVID-19 vaccination uptake and intent is needed to determine the vaccination barriers to address in vaccination promotion strategies.
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Affiliation(s)
- Mireille Guay
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Aubrey Maquiling
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Ruoke Chen
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Valérie Lavergne
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Donalyne-Joy Baysac
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Audrey Racine
- Centre for Population Health Data, Statistics Canada, Ottawa, ON, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Québec, QC, Canada.,Département d'anthropologie, Université Laval, Québec, QC, Canada
| | | | - Nicolas L Gilbert
- Vaccine Rollout Task Force, Public Health Agency of Canada, Ottawa, ON, Canada.,École de santé publique de l'Université de Montréal, Montréal, QC, Canada
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21
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Garrison A, Fressard L, Karlsson L, Soveri A, Fasce A, Lewandowsky S, Schmid P, Gagneur A, Dubé E, Verger P. Measuring psychosocial determinants of vaccination behavior in healthcare professionals: validation of the Pro-VC-Be short-form questionnaire. Expert Rev Vaccines 2022; 21:1505-1514. [PMID: 35938710 DOI: 10.1080/14760584.2022.2108800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs' confidence in and commitment to vaccination. RESEARCH DESIGN AND METHODS A cross-sectional survey among 2,696 HCPs established a long-form tool to measure 10 dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resource score was constructed from summing the responses of the dimensions that can influence HCPs' pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities. RESULTS The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long-form tool. The immunization resource score showed excellent criterion validity. CONCLUSIONS The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form and can therefore be used to measure determinants of vaccination behaviors among HCPs.
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Affiliation(s)
- Amanda Garrison
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Lisa Fressard
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Linda Karlsson
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Anna Soveri
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Philipp Schmid
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada.,Département de Pédiatrie, Université de Sherbrooke-Campus de la Santé, Sherbrooke, Quebec, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Pierre Verger
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
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22
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Reifferscheid L, Marfo E, Assi A, Dubé E, MacDonald NE, Meyer SB, Bettinger JA, Driedger SM, Robinson J, Sadarangani M, Wilson SE, Benzies K, Lemaire-Paquette S, Gagneur A, MacDonald SE. COVID-19 vaccine uptake and intention during pregnancy in Canada. Can J Public Health 2022; 113:547-558. [PMID: 35476258 PMCID: PMC9045023 DOI: 10.17269/s41997-022-00641-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
Objective To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors. Methods We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 (n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either received or intend to receive a COVID-19 vaccine during pregnancy), factors associated with vaccine acceptance, and rationale for accepting/not accepting the vaccine. Results Of 193 respondents, 57.5% (n = 111) reported COVID-19 vaccine acceptance. Among those who did not accept the vaccine, concern over vaccine safety was the most commonly cited reason (90.1%, n = 73), and 81.7% (n = 67) disagreed with receiving a vaccine that had not been tested in pregnant people. Confidence in COVID-19 vaccine safety (aOR 16.72, 95% CI: 7.22, 42.39), Indigenous self-identification (aOR 11.59, 95% CI: 1.77, 117.18), and employment in an occupation at high risk for COVID-19 exposure excluding healthcare (aOR 4.76, 95% CI: 1.32, 18.60) were associated with vaccine acceptance. Perceived personal risk of COVID-19 disease was not associated with vaccine acceptance in the multivariate model. Conclusion Vaccine safety is a primary concern for this population. Safety information should be communicated to this population as it emerges, along with clear messaging on the benefits of vaccination, as disease risk is either poorly understood or poorly valued in this population.
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Affiliation(s)
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec City, QC, Canada.,Department of Anthropology, Université Laval, Québec City, QC, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Arnaud Gagneur
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada.,Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
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23
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MacDonald SE, Reifferscheid L, Bettinger JA, Robinson J, Sadarangani M, Dubé E, MacDonald NE, Marfo E, Assi A, Gagneur A, Driedger SM. Authors' response: Re: Reifferscheid et al., "COVID-19 vaccine uptake and intention during pregnancy in Canada". Can J Public Health 2022; 113:560-561. [PMID: 35641850 PMCID: PMC9154208 DOI: 10.17269/s41997-022-00657-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec City, QC, Canada.,Department of Anthropology, Université Laval, Québec City, QC, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Arnaud Gagneur
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada.,Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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24
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Dubé E, Gagnon D, MacDonald N. Between persuasion and compulsion: The case of COVID-19 vaccination in Canada. Vaccine 2022; 40:3923-3926. [PMID: 35637068 PMCID: PMC9134169 DOI: 10.1016/j.vaccine.2022.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
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25
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Dubé E, Trottier ME, Vivion M, Ouakki M, Brousseau N, Guay M, Laghdir Z, Boucoiran I, Tapiéro B, Quach C. Do intentions lead to action? Results of a longitudinal study assessing determinants of Tdap vaccine uptake during pregnancy in Quebec, Canada. BMC Pregnancy Childbirth 2022; 22:477. [PMID: 35698053 PMCID: PMC9189261 DOI: 10.1186/s12884-022-04809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Canada, vaccination against pertussis (Tdap) during pregnancy has been recommended since 2018, with suboptimal uptake. We aimed to assess the determinants of intention and uptake of Tdap vaccine among pregnant women in Quebec. Methods Participants (< 21 weeks of pregnancy) were recruited in four Quebec regions. Two online surveys were administered during pregnancy (< 21 weeks and > 35 weeks). One measured vaccination intention and the other assessed the actual decision. Questionnaires were informed by the Theory of Planned Behaviour (TPB). We used logistic multivariate analysis to identify determinants of Tdap vaccination uptake during pregnancy using responses to both questionnaires. Results A total of 741 women answered the first survey and 568 (76.7%), the second survey. In the first survey most participants intended to receive the Tdap vaccine during their pregnancy (76.3%) and in the second survey, 82.4% reported having been vaccinated against Tdap during their pregnancy. In multivariate analysis, the main determinants of vaccine uptake were: a recommendation from a healthcare provider (OR = 7.6), vaccine intention (OR = 6.12), social norms (or thinking that most pregnant women will be vaccinated (OR = 3.81), recruitment site (OR = 3.61 for General Family Medicine unit) perceived behavioral control (or low perceived barriers to access vaccination services, (OR = 2.32) and anticipated feeling of guilt if not vaccinated (OR = 2.13). Safety concerns were the main reason for not intending or not receiving the vaccine during pregnancy. Conclusion We observed high vaccine acceptance and uptake of pertussis vaccine in pregnancy. The core components of the TPB (intention, social norms and perceived behavioral control) were all predictors of vaccine uptake, but our multivariate analysis also showed that other determinants were influential: being sufficiently informed about Tdap vaccination, not having vaccine safety concerns, and anticipated regret if unvaccinated. To ensure high vaccine acceptance and uptake in pregnancy, strong recommendations by trusted healthcare providers and ease of access to vaccination services remain instrumental. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04809-6.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada. .,Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec -Université Laval, Quebec City, Qc, Canada.
| | - Marie-Eve Trottier
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
| | - Maryline Vivion
- Direction de la valorisation scientifique et qualité, Institut national de la santé publique du Québec, Québec City, Qc, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada.,Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec -Université Laval, Quebec City, Qc, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada.,Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Zineb Laghdir
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada.,Department of Obstetrics & Gynecology and School of Public Health, Université de Montréal, Montréal, Qc, Canada
| | - Bruce Tapiéro
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Caroline Quach
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada.,Departments of Microbiology, Infectious Diseases and Immunology and of Pediatrics, Université de Montréal, Montreal, Qc, Canada.,Infection Prevention and Control, Department of Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, Qc, Canada
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26
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Affiliation(s)
- Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada.
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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27
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Verger P, Botelho-Nevers E, Garrison A, Gagnon D, Gagneur A, Gagneux-Brunon A, Dubé E. Vaccine hesitancy in health-care providers in Western countries: a narrative review. Expert Rev Vaccines 2022; 21:909-927. [PMID: 35315308 DOI: 10.1080/14760584.2022.2056026] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant. AREAS COVERED This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience. EXPERT OPINION Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.
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Affiliation(s)
- Pierre Verger
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France
| | - Amanda Garrison
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec, Canada
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Quebec, Canada.,Faculté de médecine et des sciences de la santé, Département de pédiatrie, Université de Sherbrooke-Campus de la Santé, Quebec, Canada
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France.,CIC INSERM Vaccinology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Eve Dubé
- Deptartment of Anthropology, Laval University, Quebec, Canada
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Abstract
The Pfizer-BioNTech COVID-19 vaccine was recently authorized for Canadian children aged 5 to 11 years old. Previous studies have indicated that low parental vaccination intention can be anticipated. To better understand drivers of vaccine hesitancy among parents of 5–11 years old children, four focus group discussions were conducted. Interviewed parents generally showed little concern about the risk of COVID-19 for their child(ren) and many mentioned that children are at low risk of complications from COVID-19. Out of 28 participants, seven intended to vaccinate their child(ren) while the remaining were unsure or unwilling. Even if parents were themselves vaccinated, many hesitated for their child(ren). These parents perceived that it was unnecessary (due to low risk of complications) and were concerned about risks of side effects. Clear communication on vaccine safety and usefulness will be critical to reassure parents and foster vaccine acceptance.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec, Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec, Québec, Canada
| | - Catherine Pelletier
- Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada
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29
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Humble RM, Sell H, Dubé E, MacDonald NE, Robinson J, Driedger SM, Sadarangani M, Meyer SB, Wilson S, Benzies KM, Lemaire-Paquette S, MacDonald SE. Canadian parents' perceptions of COVID-19 vaccination and intention to vaccinate their children: Results from a cross-sectional national survey. Vaccine 2021; 39:7669-7676. [PMID: 34688500 PMCID: PMC8500474 DOI: 10.1016/j.vaccine.2021.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Background Vaccinating children (≤17 years old)
is important for controlling the COVID-19 pandemic. As parents are
primary decision makers for their children, we aimed to assess parents’
perceptions and intentions regarding COVID-19 vaccination for their
children, including for some underserved populations (e.g., newcomers,
Indigenous peoples, and visible minority groups). Methods We conducted a cross-sectional
national survey of Canadian parents in December 2020, just as COVID-19
vaccines were approved for adults, to assess intention to vaccinate their
children (aged 0-17 years) against COVID-19, perceptions of COVID-19
disease and vaccines, previous uptake of influenza and routine vaccines,
and sociodemographic characteristics. Binomial logistic regression was
used to assess the association between parents' COVID-19 vaccination
intention for their children and exposure variables. Results Sixty-three percent of parents
(1074/1702) intended to vaccinate their children against COVID-19. Those
employed part-time (compared to full-time) had lower intention to
vaccinate their children (aOR=1.73, 95% CI: 1.06-2.84), while those who
spoke languages other than English, French, or Indigenous languages were
less likely to have low intention (aOR=0.55, 95% CI: 0.32-0.92). Low
vaccination intention was also associated with children not receiving
influenza vaccine pre-pandemic (aOR=1.51, 95% CI: 1.04-2.21), parents
having low intention to vaccinate themselves against COVID-19 (aOR=9.22,
95% CI: 6.43-13.34), believing COVID-19 vaccination is unnecessary
(aOR=2.59, 95% CI: 1.72-3.91) or unsafe (aOR=4.21, 95% CI: 2.96-5.99),
and opposing COVID-19 vaccine use in children without prior testing
(aOR=3.09, 95% CI: 1.87-5.24). Interpretation Parents’ COVID-19 vaccination
intentions for their children are better predicted by previous decisions
regarding influenza vaccination than routine childhood vaccines, and
other perceptions of COVID-19 vaccine-related factors. Public
communication should highlight the safety and necessity of COVID-19
vaccination in children to support a return to normal activities. Further
research should assess actual COVID-19 vaccination uptake in children,
particularly for underserved populations.
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Affiliation(s)
- Robin M Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sell
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Noni E MacDonald
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Wilson
- Public Health Ontario, ICES, Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
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30
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Adongo CA, Amenumey EK, Kumi-Kyereme A, Dubé E. Beyond fragmentary: A proposed measure for travel vaccination concerns. Tour Manag 2021; 83:104180. [PMID: 32952254 PMCID: PMC7487078 DOI: 10.1016/j.tourman.2020.104180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 05/05/2023]
Abstract
The travel medicine literature points to travelers' concerns as significant promoters of their under-vaccinations. Therefore, this study researches the hitherto understudied concept of vaccination concern and its theoretical scope in the international travel space. It attempts a conceptualization of the concept by delimiting its theoretical scope and proposes a measure for it. An exploratory sequential mixed-methods design was used to conduct four interlocking studies using data from a netnography, field interviews, and surveys among varied international travelers. A scale with six dimensions, comprising safety, efficacy, cost, time, access, and autonomy concerns were revealed. The scale significantly explained mainstream and segments-based tourists' uptake attitudes and behavior for their eligible vaccines. The findings suggest that anti-travel vax sentiments and public vax sentiments despite conceptually similar are considerably distinct. The broad nature of the scale and its prediction of travelers' vaccine uptake make it clinically relevant for tracking and resolving concerns for increased vaccine uptake.
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Affiliation(s)
- Charles Atanga Adongo
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Hospitality and Tourism Management, University of Cape Coast, Cape Coast, Ghana
| | - Edem Kwesi Amenumey
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Hospitality and Tourism Management, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Kumi-Kyereme
- College of Humanities and Legal Studies, Faculty of Social Sciences, Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eve Dubé
- Quebec National Institute of Public Health, Research Center of the CHU de Quebec, Canada
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31
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Kochhar S, Dubé E, Graham J, Jee Y, Memish ZA, Menning L, Nohynek H, Salmon D, Top KA, MacDonald NE. COVID-19 vaccine safety questions and answers for healthcare providers (CONSIDER). Vaccine 2021; 39:2504-2505. [PMID: 33836897 PMCID: PMC7983421 DOI: 10.1016/j.vaccine.2021.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, United States; Global Healthcare Consulting, India.
| | - Eve Dubé
- Quebec National Institute of Public Health, Canada; Laval University, Canada
| | | | - Youngmee Jee
- GSPA, Seoul National University, Republic of Korea; Special Representative for Health Diplomacy, Korea Foundation, Republic of Korea
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Lisa Menning
- WHO HQ Department of Immunization, Vaccines, and Biologicals, Geneva, Switzerland
| | - Hanna Nohynek
- Deputy Head of Unit, Finnish Institute for Health and Welfare THL, Finland
| | - Daniel Salmon
- Institute for Vaccine Safety, Johns Hopkins University School of Public Health, United States
| | - Karina A Top
- Pediatrics and Community Health & Epidemiology, Dalhousie University, Canada
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32
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Attwell K, Betsch C, Dubé E, Sivelä J, Gagneur A, Suggs LS, Picot V, Thomson A. Increasing vaccine acceptance using evidence-based approaches and policies: Insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting. Int J Infect Dis 2021; 105:188-193. [PMID: 33578012 DOI: 10.1016/j.ijid.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) flagged vaccine hesitancy as one of the top 10 threats to global health. The drivers of and barriers to under-vaccination include logistics (access to and awareness of affordable vaccines), as well as a complex mix of psychological, social, political, and cultural factors. INCREASING VACCINE UPTAKE There is a need for effective strategies to increase vaccine uptake in various settings, based on the best available evidence. Fortunately, the field of vaccine acceptance research is growing rapidly with the development, implementation, and evaluation of diverse measurement tools, as well as interventions to address the challenging range of drivers of and barriers to vaccine acceptance. ANNUAL VACCINE ACCEPTANCE MEETINGS Since 2011, the Mérieux Foundation has hosted Annual Vaccine Acceptance Meetings in Annecy, France that have fostered an informal community of practice on vaccination confidence and vaccine uptake. Mutual learning and sharing of knowledge has resulted directly in multiple initiatives and research projects. This article reports the discussions from the 7th Annual Vaccine Acceptance Meeting held September 23-25, 2019. During this meeting, participants discussed emergent vaccine acceptance challenges and evidence-informed ways of addressing them in a programme that included sessions on vaccine mandates, vaccine acceptance and demand, training on vaccine acceptance, and frameworks for resilience of vaccination programmes.
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Affiliation(s)
- Katie Attwell
- School of Social Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.
| | - Cornelia Betsch
- University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany.
| | - Eve Dubé
- Centre de Recherche du CHU de Québec-Université Laval, 2400 D'Estimauville, Quebec, QC, G1E 7G9, Canada.
| | - Jonas Sivelä
- Infectious Disease Control and Vaccinations, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - Arnaud Gagneur
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - L Suzanne Suggs
- BeCHANGE Research Group, Institute of Public Health, Faculty of Communication Sciences, Università della Svizzera Italiana, via G. Buffi 13, Lugano, Switzerland; Swiss School of Public Health (SSPH+), Zurich, Switzerland; Institute for Global Health Innovation, Imperial College London, London, UK.
| | - Valentina Picot
- Scientific Conferences and Public Health Initiatives, Fondation Mérieux, 17 Rue Bourgelat, 69002, Lyon, France.
| | - Angus Thomson
- Sanofi Pasteur, 14 Espace Henry Vallee, 69007, Lyon, France.
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33
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Verger P, Scronias D, Dauby N, Adedzi KA, Gobert C, Bergeat M, Gagneur A, Dubé E. Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020. ACTA ACUST UNITED AC 2021; 26. [PMID: 33478623 PMCID: PMC7848677 DOI: 10.2807/1560-7917.es.2021.26.3.2002047] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.
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Affiliation(s)
- Pierre Verger
- ORS PACA (Southeastern Health Regional Observatory), Faculty of Medicine, Marseille, France
| | - Dimitri Scronias
- Centre d'investigation clinique de l'Hôpital Cochin-Pasteur (CIC 1417), Assistance Publique des Hôpitaux de Paris, Paris, France.,ORS PACA (Southeastern Health Regional Observatory), Faculty of Medicine, Marseille, France
| | - Nicolas Dauby
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Infectious Diseases, CHU Saint-Pierre - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kodzo Awoenam Adedzi
- Centre de recherche du CHU de Québec - Université Laval, D'Estimauville, Quebec City, Canada
| | - Cathy Gobert
- General Practice, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Maxime Bergeat
- Maxime Bergeat (MS) - French Ministry for Solidarity and Health - Statistical Service (DREES), Paris, France
| | - Arnaud Gagneur
- Université de Sherbrooke-campus de la santé, Sherbrooke, Quebec, Canada.,Department of Pediatrics, centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Eve Dubé
- Anthropology Department, Laval University, Quebec City, Canada.,Centre de recherche du CHU de Québec - Université Laval, D'Estimauville, Quebec City, Canada
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34
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Elbarazi I, Al-Hamad S, Alfalasi S, Aldhaheri R, Dubé E, Alsuwaidi AR. Exploring vaccine hesitancy among healthcare providers in the United Arab Emirates: a qualitative study. Hum Vaccin Immunother 2020; 17:2018-2025. [PMID: 33369524 DOI: 10.1080/21645515.2020.1855953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Healthcare providers (HCPs) are at the frontline to curb the spread of vaccine hesitancy in the community. However, HCPs themselves may delay or refuse vaccines. In light of the emerging vaccine hesitancy in the United Arab Emirates (UAE), we aimed to explore HCPs doubts and concerns regarding vaccination. We conducted face-to-face interviews with 33 HCPs from 7 ambulatory healthcare services in the Al Ain region, UAE. An interview guide was developed based on the European Center for Disease Prevention and Control guide for vaccine hesitancy among HCPs. An inductive thematic framework was employed to explore the main and emerging themes conceptualizing the predisposing, reinforcing, and enabling factors that influence HCPs' hesitancy regarding vaccinations for themselves and while recommending, prescribing, or discussing vaccines with their patients. The sample included general practitioners, family physicians, nurses, pharmacists, and other administrative staff. The major themes included positive predisposing factors such as trust in the system and the government, previous education, and social responsibility. Positive enabling factors included affordability and availability of vaccination services. Many participants were hesitant to receive the mandatory influenza vaccination. Misinformation regarding vaccines on social media was a major concern. However, HCPs showed little interest in being active on social media. Most participants reported never receiving any training on how to address vaccine hesitancy among patients. Because HCPs play an important role in influencing patients' decisions regarding undergoing vaccination, their confidence in addressing vaccine hesitancy must be improved.
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Affiliation(s)
- Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Sania Al-Hamad
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Salma Alfalasi
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Ruwaya Aldhaheri
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Eve Dubé
- Département des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, Canada.,Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Ahmed R Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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35
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Lorcy A, Gilca R, Dubé E, Rochette M, De Serres G. Feasibility and ethical issues: experiences and concerns of healthcare workers regarding a new RSV prophylaxis programme in Nunavik, Quebec. Int J Circumpolar Health 2020; 79:1742564. [PMID: 32191589 PMCID: PMC7144279 DOI: 10.1080/22423982.2020.1742564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: The respiratory syncytial virus (RSV) is a major cause of hospitalisation in young Inuit children. Prophylaxis with palivizumab is routinely recommended for premature infants and those with severe pulmonary or cardiac diseases. In the fall 2016, the Quebec Ministry of Health expanded the criteria to include healthy full-term (HFT) newborns from Nunavik based on their high RSV hospitalisation rates. Objectives: The aim of this study was to describe the impact of this programme on Nunavik health services during the first RSV season after its implementation (2016–2017) by studying challenges, concerns and needs of healthcare workers (HCWs). Methods: An ethnographic approach was used. Semi-structured interviews focusing on HCWs experiences, and opinions to improve the new programme were conducted with 20 HCWs involved in its implementation. Results: Main reported challenges and concerns were: additional work(over)load, lack of information and evidence about the need and efficacy of palivizumab in HFT newborns, communication issues between stakeholders, and ethical issues regarding the Inuit population. Conclusion: The study revealed significant feasibility and acceptability issues. The programme was highly resource consuming. To address HCWs’ concerns, evidence-based data regarding palivizumab effectiveness in HFT infants, as well as consultation and involvement of Inuit population are warranted.
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Affiliation(s)
- Armelle Lorcy
- Infectious and immune diseases, CHU De Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Enseignement Et Recherche En Ethnologie Amérindienne (EREA), Centre of the LESC (CNRS, UMR 7186), Paris, France
| | - Rodica Gilca
- Infectious and immune diseases, CHU De Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Département de risque biologique et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Eve Dubé
- Département de risque biologique et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Marie Rochette
- Department of Public Health, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Nunavik, Quebec, Canada
| | - Gaston De Serres
- Infectious and immune diseases, CHU De Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Département de risque biologique et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Quebec, Canada
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36
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MacDonald NE, Comeau J, Dubé E, Bucci L, Graham JE. A public health timeline to prepare for COVID-19 vaccines in Canada. Can J Public Health 2020; 111:945-952. [PMID: 33151510 PMCID: PMC7643523 DOI: 10.17269/s41997-020-00423-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022]
Abstract
For control of COVID-19, community immunity is required, necessitating widespread immunization. COVID-19 vaccines are coming to Canada, with the government announcing in August 2020 agreements with four different companies for their COVID-19 vaccine if their trials are successful. Never before has public health had to rapidly develop a vaccine introduction program for multiple new but differing vaccines with the added pressure that the program is needed across all ages and in all Canadian communities and there is high probability of not enough vaccine to go around at the start. Traditional public health vaccine introduction planning will need to be both accelerated and more comprehensive to ensure optimal uptake across the country. This overview highlights a number of points for consideration by public health in their planning for COVID-19 vaccines before these COVID-19 vaccines are available, once they are available, once supplies are plentiful, and throughout the vaccine program. Targeted and tailored communications are key elements needed to reach and positively influence diverse communities, regions, ages, languages, education levels and lived experiences.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Jeannette Comeau
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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37
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination during pregnancy: Canadian maternity care providers' opinions and practices. Hum Vaccin Immunother 2020; 16:2789-2799. [PMID: 32271655 DOI: 10.1080/21645515.2020.1735225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Eliana Castillo
- Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Institute for Clinical Evaluative Sciences and University of Toronto , Toronto, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada.,Research Institute, Children's Hospital of Eastern Ontario , Ottawa, Canada
| | - William Fisher
- Department of Psychology, Western University , London, Canada
| | - Arnaud Gagneur
- Département des soins de santé communautaire, Université de Sherbrooke , Sherbrooke, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada.,Centre de recherche de l'hôpital Charles Le Moyne , Longueuil, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University , Antigonish, Canada
| | - Scott A Halperin
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre , Halifax, Canada
| | - Shannon MacDonald
- Faculty of Nursing, School of Public Health, University of Alberta , Edmonton, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo , Waterloo, Canada
| | - Nancy M Waite
- Department of Pharmacy, University of Waterloo , Waterloo, Canada
| | | | - Holly O Witteman
- Département de médecine familiale et de médecine d'urgence, Université Laval , Québec, Canada
| | - Mark Yudin
- Department of Obstetrics and Gynecology, University of Toronto , Toronto, Canada
| | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
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38
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Hakim H, Bettinger JA, Chambers CT, Driedger SM, Dubé E, Gavaruzzi T, Giguere AMC, Kavanagh É, Leask J, MacDonald SE, Orji R, Parent E, Paquette JS, Roberge J, Sander B, Scherer AM, Tremblay-Breault M, Wilson K, Reinharz D, Witteman HO. A Web Application About Herd Immunity Using Personalized Avatars: Development Study. J Med Internet Res 2020; 22:e20113. [PMID: 33124994 PMCID: PMC7665952 DOI: 10.2196/20113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. OBJECTIVE This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. METHODS Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. RESULTS Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. CONCLUSIONS Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Éric Kavanagh
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Julie Leask
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth Parent
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | | | - Jacynthe Roberge
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Beate Sander
- University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, United States
| | | | - Kumanan Wilson
- Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
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Affiliation(s)
- Pierre Verger
- Research department, Southeastern Health Regional Observatory , Marseille, France.,Aix Marseille University, IRD, AP-HM, SSA, VITROME , Marseille, France
| | - Eve Dubé
- Institut de santé publique du Québec, Centre de recherche du CHU de Québec - Université Laval , D'Estimauville, QC, Canada
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40
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Affiliation(s)
- Eve Dubé
- Centre de recherche du CHU de Québec - Université Laval, Institut National de santé publique du Québec , Québec, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University , Halifax, Canada
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Sabahelzain MM, Dubé E, Moukhyer M, Larson HJ, van den Borne B, Bosma H. Psychometric properties of the adapted measles vaccine hesitancy scale in Sudan. PLoS One 2020; 15:e0237171. [PMID: 32760162 PMCID: PMC7410231 DOI: 10.1371/journal.pone.0237171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
Background There is a need for reliable and validated tools to identify, classify, and quantify vaccine-hesitancy in low and middle-income countries, such as Sudan. We evaluated the psychometric properties of an adapted version of the measles vaccine hesitancy scale by assessing its reliability, convergent validity, and criterion validity in Sudan. The vaccine hesitancy scale (VHS) was originally developed by the WHO/SAGE Working Group of Vaccine Hesitancy. Methods A community-based survey among parents was conducted in February 2019 in Khartoum state. We conducted exploratory and confirmatory factor analysis to examine the structure of the adapted measles VHS (aMVHS). We computed Cronbach’s alphas, correlations with other vaccine hesitancy measurements including the Parental Attitude towards Childhood Vaccination (PACV) and the Vaccine Confidence Index (VCI), and performed a Mann-Whitney U test for assessing the reliability and the convergent and criterion validity, respectively. Moreover, to examine whether the aMVHS can predict the child’s vaccination status, the area under the curve (AUC) was estimated using receiver operator characteristic (ROC) curves. Results The questionnaire was completed by 500 parents. Most were women (87.2%) between the ages of 20 and 47 (M = 31.15, SD = 5.74). The factor analyses indicated that the aMVHS comprises of two factors (sub-scales): 'confidence' and 'complacency'. The aMVHS sub-scales correlated weakly to moderately with the PACV and VCI scales. The area under the curve was 0.499 at most (P >0.05) and the aMVHS score did hardly differ between actually vaccinated and non-vaccinated children. Conclusion Our findings underscore that the aMVHS and its confidence and complacency sub-scales are reliable and have a moderately good convergent validity. However, the aMVHS has a limitation in predicting the concurrent child's vaccination status. More work is needed to revise and amend this aMVHS, particularly by additionally including the 'convenience' construct and by further evaluating its validity in other contexts.
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Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Eve Dubé
- Institut National de Santé Publique du Québec (INSPQ), Québec City, Québec, Canada
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Heidi J. Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, University of America
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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42
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Dubé E, Wilson S, Gagnon D, Deeks SL, Dubey V. " It takes time to build trust": a survey Ontario's school-based HPV immunization program ten years post-implementation. Hum Vaccin Immunother 2020; 17:451-456. [PMID: 32643527 DOI: 10.1080/21645515.2020.1775456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Describe Ontario's school-based human papillomavirus (HPV) vaccination program from the perspective of local public health units (PHUs). METHODS In 2018, Vaccine Preventable Diseases (VPD) managers at each of Ontario's 35 PHUs were invited to participate in an online survey regarding the organization and delivery of their HPV vaccination program. Questions were asked on the school-based program, training and support of vaccine providers, communication and promotion, assessing coverage rates and perceptions of the program's strengths and challenges. Descriptive statistics were generated for close-ended items. A thematic content analysis was performed for open-ended items. RESULTS Eighteen PHUs (54%, n = 19/35) responded. All responding PHUs provided the HPV vaccine in publicly funded schools but only 6 reported being permitted to provide HPV vaccine in private schools. Fact sheets, Q&As or other written information locally developed by the PHUs were the main tools used to communicate with parents (n = 17), students (n = 13), school personnel (n = 13) and school board officials (n = 9). The most frequently reported barriers were: limited program resources, negative perceptions held by parents and/or school staff regarding the HPV vaccine, logistical issues (e.g., getting the consents forms returned, collaboration with schools for vaccine delivery) and the fact that HPV vaccination is not mandatory under Ontario legislation. CONCLUSION Local public health units that implement HPV vaccine programs in schools identified logistical barriers, public perceptions about the HPV vaccine and the voluntary nature of the program as the main barriers.
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Affiliation(s)
- Eve Dubé
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec-Université Laval , Québec, Canada.,Université Laval , Québec, Canada
| | - Sarah Wilson
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,ICES , Ontario, Canada
| | - Dominique Gagnon
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada
| | - Shelley L Deeks
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada
| | - Vinita Dubey
- Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,Toronto Public Health and the Canadian Immunization Research Network , Ontario, Canada
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Habersaat KB, Betsch C, Danchin M, Sunstein CR, Böhm R, Falk A, Brewer NT, Omer SB, Scherzer M, Sah S, Fischer EF, Scheel AE, Fancourt D, Kitayama S, Dubé E, Leask J, Dutta M, MacDonald NE, Temkina A, Lieberoth A, Jackson M, Lewandowsky S, Seale H, Fietje N, Schmid P, Gelfand M, Korn L, Eitze S, Felgendreff L, Sprengholz P, Salvi C, Butler R. Ten considerations for effectively managing the COVID-19 transition. Nat Hum Behav 2020; 4:677-687. [PMID: 32581299 DOI: 10.1038/s41562-020-0906-x] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voice, be informed and engaged, and participate in this transition phase. We propose ten considerations to support this principle: (1) implement a phased approach to a 'new normal'; (2) balance individual rights with the social good; (3) prioritise people at highest risk of negative consequences; (4) provide special support for healthcare workers and care staff; (5) build, strengthen and maintain trust; (6) enlist existing social norms and foster healthy new norms; (7) increase resilience and self-efficacy; (8) use clear and positive language; (9) anticipate and manage misinformation; and (10) engage with media outlets. The transition phase should also be informed by real-time data according to which governmental responses should be updated.
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Affiliation(s)
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Margie Danchin
- The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Victoria, Australia
| | | | - Robert Böhm
- Department of Psychology, Department of Economics, and Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Armin Falk
- University of Bonn and Institute on Behavior and Inequality (BRIQ), Bonn, Germany
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Saad B Omer
- Yale Institute for Global Health, Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale School of Nursing, New Haven, CT, USA
| | - Martha Scherzer
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Sunita Sah
- Cambridge Judge Business School, Cambridge University, Cambridge, UK
| | - Edward F Fischer
- Department of Anthropology, Vanderbilt University, Nashville, TN, USA
| | - Andrea E Scheel
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Shinobu Kitayama
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Eve Dubé
- Département d'Anthropologie, Université Laval, Québec City, Québec, Canada
| | - Julie Leask
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohan Dutta
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Aotearoa, New Zealand
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Temkina
- Department of Sociology, European University of St. Petersburg, St, Petersburg, Russia
| | - Andreas Lieberoth
- Danish School of Education, Interacting Minds Center, Aarhus University, Aarhus, Denmark
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health and WHO Collaborating Centre on Culture and Health, University of Exeter, Exeter, UK
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- University of Western Australia, Perth, Western Australia, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nils Fietje
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Philipp Schmid
- Department of Psychology, University of Erfurt, Erfurt, Germany
| | - Michele Gelfand
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Sarah Eitze
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Lisa Felgendreff
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Philipp Sprengholz
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Cristiana Salvi
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Robb Butler
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
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Abstract
Vaccine hesitancy (the reluctance to accept recommended vaccines) is a complex issue that poses risk communication challenges for public health authorities and clinicians. Studies have shown that providing too much evidence on vaccine safety and efficacy to those who are vaccine-hesitant has done little to stem the growth of hesitancy-related beliefs and fears. The objective of this paper is to describe good practices in developing communication materials to address vaccine hesitancy. An inventory of vaccination communication materials in Canada was assessed according to the Council of Canadian Academies Expert Panel on Health Product Risk Communication Evaluation (2015). Many of the current communication products could be improved to better align with evidence-based risk communication best practices. Five best practices were identified. First, identify target audience and establish trust. Second, provide both the risks and benefits of vaccination, as most people are looking for balanced information. Third, give the facts before addressing the myths. Fourth, use visual aids. Fifth, test communication material prior to launch. Applying these best practices to current or future communication products will help vaccine providers (including physicians, nurse practitioners, pharmacists, public health professionals) to develop communication materials that are sensitive to the complex ways that people process and value information and thus more likely to optimize vaccine uptake in their communities.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC
- Correspondence:
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Wilson R, Zaytseva A, Bocquier A, Nokri A, Fressard L, Chamboredon P, Carbonaro C, Bernardi S, Dubé E, Verger P. Vaccine hesitancy and self-vaccination behaviors among nurses in southeastern France. Vaccine 2020; 38:1144-1151. [DOI: 10.1016/j.vaccine.2019.11.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
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Vivion M, Hennequin C, Verger P, Dubé E. Supporting informed decision-making about vaccination: an analysis of two official websites. Public Health 2020; 178:112-119. [DOI: 10.1016/j.puhe.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022]
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Sabahelzain MM, Moukhyer M, Dubé E, Hardan A, van den Borne B, Bosma H. Towards a further understanding of measles vaccine hesitancy in Khartoum state, Sudan: A qualitative study. PLoS One 2019; 14:e0213882. [PMID: 31220092 PMCID: PMC6586394 DOI: 10.1371/journal.pone.0213882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is one of the contributors to low vaccination coverage in both developed and developing countries. Sudan is one of the countries that suffers from low measles vaccine coverage and from measles outbreaks. In order to facilitate the future development of interventions, this study aimed at exploring the opinions of Expanded Program on Immunization officers at ministries of health, WHO, UNICEF and vaccine care providers at Khartoum-based primary healthcare centers. METHODS Qualitative data were collected using semi-structured interviews during the period January-March 2018. Data (i.e. quotes) were matched to the categories and the sub-categories of a framework that was developed by the WHO-SAGE Working Group called ''Determinants of Vaccine Hesitancy Matrix''. FINDINGS The interviews were conducted with 14 participants. The majority of participants confirmed the existence of measles vaccine hesitancy in Khartoum state. They further identified various determinants that were grouped into three domains including contextual, groups and vaccination influences. The main contextual determinant as reported is the presence of people who can be qualified as "anti-vaccination". They mostly belong to particular religious and ethnic groups. Parents' beliefs about prevention and treatment from measles are the main determinants of the group influences. Attitude of the vaccine providers, measles vaccine schedule and its mode of delivery were the main vaccine related determinants. CONCLUSION Measles vaccine hesitancy in Sudan appears complex and highly specific to local circumstances. To better understand the magnitude and the context-specific causes of measles vaccine hesitancy and to develop adapted strategies to address them, there is clearly a further need to investigate measles vaccine hesitancy among parents.
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Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail: ,
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Eve Dubé
- Institut National de Santé Publique du Québec (INSPQ), Québec, Canada
| | | | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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48
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Carpiano RM, Polonijo AN, Gilbert N, Cantin L, Dubé E. Socioeconomic status differences in parental immunization attitudes and child immunization in Canada: Findings from the 2013 Childhood National Immunization Coverage Survey (CNICS). Prev Med 2019; 123:278-287. [PMID: 30904601 DOI: 10.1016/j.ypmed.2019.03.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
Childhood vaccination efforts in Canada have been negatively impacted by parents' vaccine hesitancy based on their knowledge, attitudes, and beliefs (KAB) about vaccinations. Less understood is the extent to which child vaccination receipt and KAB vary by parents' socioeconomic status (SES). Analyzing different age groups of children and vaccinations, we examine the extent to which (a) family SES (parent education, household income) is a determinant of Canadian parents' vaccination KAB and child vaccination receipt, and (b) whether SES was indirectly associated with receipt via KAB. In 2017, we analyzed 2013 Childhood National Immunization Coverage Survey (CNICS) data. We estimated models for parental KAB and child vaccination receipt for measles, mumps, and rubella (MMR) at age 2 (n = 3620); diphtheria, pertussis, and tetanus (DPT) at age 7 (n = 3465); and human papillomavirus (HPV) at ages 12-14 (n = 5213 females). SES is inconsistently associated with KAB and vaccine receipt across the three age groups. SES differences in KAB mostly center on vaccine-specific side effect and safety concerns, with lower education and income levels associated with higher odds of being concerned. Non-receipt of minimum age-specific vaccination dosages was associated with concerns about vaccine effectiveness (DPT, HPV) and side effects (MMR, HPV) and lower perceived importance of immunizing a child (MMR, HPV). KAB mediation was mostly limited to SES patterns in MMR. We discuss the implications of these findings for designing general and population-specific vaccination education strategies and future studies of KAB and undervaccination.
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Affiliation(s)
- Richard M Carpiano
- School of Public Policy, University of California, Riverside, Riverside, CA, USA; Department of Sociology, University of California, Riverside, USA; Center for Healthy Communities, School of Medicine, University of California, Riverside, USA.
| | - Andrea N Polonijo
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Gilbert
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Lyne Cantin
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Eve Dubé
- Institut national de santé publique du Quebec, Quebec City, Quebec, Canada
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Wilson R, Scronias D, Zaytseva A, Ferry MA, Chamboredon P, Dubé E, Verger P. Seasonal influenza self-vaccination behaviours and attitudes among nurses in Southeastern France. Hum Vaccin Immunother 2019; 15:2423-2433. [PMID: 30829102 DOI: 10.1080/21645515.2019.1587274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite seasonal influenza vaccination (SIV) being recommended to healthcare professionals to protect themselves and their patients, uptake is low, especially among nurses. We sought to study self-vaccination behaviours, attitudes and knowledge about SIV among nurses in Southeastern France. METHODS A cross-sectional survey with community and hospital-based hospital nurses was conducted with the same standardised questionnaire. Multi-model averaging approaches studied factors associated with the following dependent variables: self-reported SIV uptake; and considering SIV a professional responsibility. RESULTS 1539 nurses completed the questionnaire (response rate: 85%). SIV was the most frequently cited vaccine (49%) regarding nurses' unfavourable opinions towards specific vaccines. Thirty-four percent of nurses reported being vaccinated at least once during the 2015-2016 or 2016-2017 seasons. A lack of perceived personal vulnerability to influenza, a fear of adverse effects, and a preference for homeopathy constituted the main deterrents of SIV. Nurses held various misconceptions about the SIV, but 69% considered its benefits to be greater than its risks. The multi-model averaging approach showed that considering SIV as a professional responsibility was the main factor associated with SIV uptake among nurses (Nagelkerke's partial R-squared: 15%). This sense of responsibility was strongly associated with trust in various vaccine information sources. CONCLUSION Nurses had low SIV uptake rates and held various concerns and a lack of knowledge surrounding the vaccine. This is concerning considering the impact that these factors can have on nurses and patients' health, especially considering the increased role that nurses could have surrounding SIV in the near future.
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Affiliation(s)
- Rose Wilson
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Dimitri Scronias
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Anna Zaytseva
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Marie-Ange Ferry
- Conseil Inter-Régional de l'Ordre des Infirmiers (CIROI) PACA , Corse , France
| | - Patrick Chamboredon
- Conseil Inter-Régional de l'Ordre des Infirmiers (CIROI) PACA , Corse , France
| | - Eve Dubé
- Department of Social and Preventive Medicine, Institut National de Santé publique du Québec , Québec , Canada
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
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50
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Dubé E, Gagnon D, Clément P, Bettinger JA, Comeau JL, Deeks S, Guay M, MacDonald S, MacDonald NE, Mijovic H, Paragg J, Rubincam C, Sauvageau C, Steenbeck A, Wilson S. Challenges and opportunities of school-based HPV vaccination in Canada. Hum Vaccin Immunother 2019; 15:1650-1655. [PMID: 30633622 DOI: 10.1080/21645515.2018.1564440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary prevention of human papillomavirus (HPV) through vaccination is a high priority in Canada's cancer prevention efforts. All Canadian provinces and territories have introduced publicly funded, school-based vaccination programs against HPV, but vaccine uptake remains suboptimal in some jurisdictions. We conducted a descriptive qualitative study to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance using the socio-ecological model. In Quebec, interviews and focus groups were held in 2015-2016 with 70 key informants including immunization managers, school nurses, school principals, teachers and parents of Grade 4 students (9 years of age). Our findings showed that HPV vaccine uptake was dependent on many interrelated factors at the individual and interpersonal level (e.g. knowledge and attitudes of the different players involved in the vaccination system), at the community level (e.g. social group values and norms, media coverage around the HPV vaccine), at the organizational level (e.g. allocated resources, information provision, consent process, immunization setting and environment) and at the policy level (e.g. changes in provincial HPV vaccine program). We are using the data collection and interpretation tools and approaches developed by our team and used in Quebec to expand our study to four other provinces (British Columbia, Alberta, Ontario and Nova Scotia). We are conducting environmental scans, semi-structured interviews and a survey to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance. Having an in-depth understanding of the determinants of HPV vaccination in school settings is critical in order to identify root causes of the suboptimal vaccine uptake and to develop tailored interventions to address these on both supply- and demand-side issues.
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Affiliation(s)
- Eve Dubé
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Dominique Gagnon
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Paule Clément
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Julie A Bettinger
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jeannette L Comeau
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Shelley Deeks
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Maryse Guay
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Shannon MacDonald
- i Faculty of Nursing, University of Alberta , Edmonton , AB , Canada
| | - Noni E MacDonald
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Hana Mijovic
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jillian Paragg
- h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Clara Rubincam
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Chantal Sauvageau
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Audrey Steenbeck
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Sarah Wilson
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
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