Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South

OBJECTIVE

The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South.

METHODS

Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews.

RESULTS

Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions.

CONCLUSIONS

In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician.

PRACTICE IMPLICATIONS

The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

SARS-CoV-2 infections and attitudes towards COVID-19 vaccines among healthcare workers in the New York Metropolitan area, USA

OBJECTIVE

Because of their increased interaction with patients, healthcare workers (HCWs) face greater vulnerability to COVID-19 exposure than the general population. We examined prevalence and correlates of ever COVID-19 diagnosis and vaccine uncertainty among HCWs.

DESIGN

Cross-sectional data from the Household Pulse Survey (HPS) conducted during July to October 2021.

SETTING

HPS is designed to yield representative estimates of the US population aged ≥18 years nationally, by state and across selected metropolitan areas.

PARTICIPANTS

Our primary analytical sample was adult HCWs in the New York Metropolitan area (n=555), with HCWs defined as individuals who reported working in a 'Hospital'; 'Nursing and residential healthcare facility'; 'Pharmacy' or 'Ambulatory healthcare setting'. In the entire national sample, n=25 909 HCWs completed the survey. Descriptive analyses were performed with HCW data from the New York Metropolitan area, the original epicentre of the pandemic. Multivariable logistic regression analyses were performed on pooled national HCW data to explore how HCW COVID-19-related experiences, perceptions and behaviours varied as a function of broader geographic, clinical and sociodemographic characteristics.

RESULTS

Of HCWs surveyed in the New York Metropolitan area, 92.3% reported being fully vaccinated, and 20.9% had ever been diagnosed of COVID-19. Of the subset of HCWs in the New York Metropolitan area not yet fully vaccinated, 41.8% were vaccine unsure, 4.5% planned to get vaccinated for the first time soon, 1.6% had got their first dose but were not planning to receive the remaining dose, while 52.1% had got their first dose and planned to receive the remaining dose. Within pooled multivariable analysis of the national HCW sample, personnel in nursing/residential facilities were less likely to be fully vaccinated (adjusted OR, AOR 0.79, 95% CI 0.63 to 0.98) and more likely to report ever COVID-19 diagnosis (AOR 1.35, 95% CI 1.13 to 1.62), than those working in hospitals. Of HCWs not yet vaccinated nationally, vaccine-unsure individuals were more likely to be White and work in pharmacies, whereas vaccine-accepting individuals were more likely to be employed by non-profit organisations and work in ambulatory care facilities. Virtually no HCW was outrightly vaccine-averse, only unsure.

CONCLUSIONS

Differences in vaccination coverage existed by individual HCW characteristics and healthcare operational settings. Targeted efforts are needed to increase vaccination coverage.

Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia

Objectives

This study aimed to assess the awareness of the general population regarding vaccines to determine the prevalence of vaccine hesitancy in Aseer Region in the southern part of Saudi Arabia.

Methods

A descriptive cross-sectional approach was used, targeting all parents in Aseer Region. The study was carried out from January to April 2020. The data for this study were collected using a structured questionnaire, which was developed by the researchers after an intensive literature review and consultation with experts. The questionnaire covered aspects such as parents’ sociodemographic data, their awareness regarding vaccine safety and efficacy for children and their attitude and adherence to children’s vaccination, including their hesitancy towards vaccines.

Results

The survey included 796 participants (response rate: 100%) whose ages ranged from 18 to 55 years. Two-thirds (63.4%) of the participants were female. Regarding vaccination adherence and hesitancy among participants, more than three-quarters completely adhered to the vaccination schedule for their children, and only 3.9% were non-adherent. With regards to participants’ awareness regarding vaccine safety and efficacy for children, 89.3% agreed that vaccination keeps children healthy, 84.2% reported that vaccines are safe and effective for children and 83.4% reported that all scheduled vaccines in Saudi Arabia are effective.

Conclusion

Vaccine hesitancy among participants was not low, and this should be taken into account notwithstanding their high awareness levels. The recorded antivaccine action was mostly related to vaccine safety and not its efficacy.

Influenza Vaccination During COVID-19 in a Rural Community: A Cross-sectional Survey

Vaccination behavior is an informative metric for assessing flu seasons and is especially important to understand for the 2020–2021 flu season, which coincided with the COVID-19 pandemic. This study aimed to estimate flu vaccine behavior and assess vaccine perceptions during the pandemic season. Using a cross-sectional descriptive study design, we conducted an online survey to assess vaccination behavior and perceptions of both COVID-19 and the flu. Patients were identified as recently seen by providers in an academic internal medicine practice (n = 827) and surveys were distributed as messages in the Epic electronic medical record system. We found that 88.3% of respondents (188/206) had received their flu vaccination for the season at the time of their survey response in December 2020–February 2021. Of those that had not yet received the flu vaccine, only 13.6% indicated they planned on getting one. 12.5% of respondents said they had changed their flu vaccine plans due to the COVID-19 pandemic. Looking at differences from past season’s behavior, more individuals switched to getting the flu vaccine than those that switched to not getting the vaccine this season. The most frequently cited reasons for not receiving the flu vaccination were concerns about side effects and not being in a priority group. Changes in flu vaccination behavior from previous seasons represent a net positive in the direction of vaccine acceptance. Barriers to vaccination were identified and results from this study provide more information on vaccine perceptions, beliefs, and behavior, which can benefit future vaccination programs.

Pediatric and Parents' Attitudes Towards COVID-19 Vaccines and Intention to Vaccinate for Children

BACKGROUND

Coronavirus disease 2019 (COVID-19) vaccination is necessary to reach herd immunity and essential for mitigating the spread of the pandemic. In May 2021, the US FDA and the EU have expanded the emergency use authorization for a COVID-19 vaccine to children aged 12 to 15. The aim of this study was to investigate parental acceptability of COVID-19 vaccination for their children, factors affecting their acceptability, and children's perceptions of COVID-19 vaccines in Republic of Korea.

METHODS

We conducted a questionnaire survey at two tertiary hospitals from May 25, 2021 to June 3, 2021. Subjects were parents having children under 18 years and children aged 10-18 years.

RESULTS

Two hundred twenty-six parents and 117 children aged 10-18 years were included in the final analysis. Overall, 76.5% and 64.2% of parents intended to get vaccinated against COVID-19 and intended to have their children vaccinated, respectively. However, only 49.6% of children responded that they would get COVID-19 vaccination. In the multivariate analysis, high confidence in the safety of COVID-19 vaccines (adjusted odds ratio [AOR], 4.87; 95% confidence interval [CI], 1.32-24.12), parents' willingness to vaccinate themselves (AOR, 19.42; 95% CI, 6.85-64.00), and awareness of the need to vaccinate children against COVID-19 (AOR, 13.15; 95% CI, 4.77-41.27) were associated with positive factors intention to vaccinate their children.

CONCLUSION

This study provides insight into how parents think about the COVID-19 vaccine for their children in South Korea. Our findings could be referenced in establishing a policy for childhood COVID-19 vaccination in the future.

Vaccine hesitancy in Argentina: Validation of WHO scale for parents

BACKGROUND

The WHO SAGE Working Group on Vaccine Hesitancy developed the Vaccine Hesitancy Scale (VHS) to identify and compare hesitancy in different global settings. The objectives of the study were to describe and analyze vaccine hesitancy and to validate the VHS in a group of parents in Buenos Aires city, Argentina.

METHODS

A cross-sectional survey was conducted in parents of 1-3 and 12-15 year-old children at three health centres in Buenos Aires City, between June 2018 and May 2019. Sociodemographic data were collected together with history of refusal and/or delay in children's vaccination (defined as hesitancy). The 10-item VHS using 5-point Likert-scale (higher scores indicating lower hesitancy) was administered and children's immunization record cards were verified. Link between hesitancy and socio-demographic variables, and hesitancy and vaccination status was analyzed for five specific vaccines. Cronbach's α was used to determine internal consistency reliability and factor analysis to confirm survey subdomains. Simple and multiple regression analysis was used to examine associations between VHS scores and hesitancy, and VHS scores and vaccination status.

RESULTS

Six hundred parents were surveyed and 469 immunization cards verified; 11.5% (n = 69) parents were hesitant. High maternal educational level showed significant association with hesitancy (OR 2.66 95% CI: 1.20-5.9) in the adjusted model. Hesitancy was significantly associated with incomplete MMR vaccination in children (OR 4.43 95% CI: 1.08-8.20) and HPV vaccination in adolescents (OR 3.75 95% CI: 1.54-9.12). Cronbach's α was 0.66 and factor analysis identified three underlying constructs: "Benefits", "Harms" and "Confidence in healthcare system". High scores in VHS were associated with lack of hesitancy (OR 1.2 95% CI: 1.13-1.27) and complete vaccination status (OR 1.07 95% CI: 1.02-1.12).

CONCLUSIONS

Hesitancy was associated with high maternal educational level, and incomplete MMR and HPV immunization status in children and adolescents. VHS was a reliable and valid tool in this population.

Determinants of COVID-19 vaccine acceptance in a high infection-rate country: a cross-sectional study in Russia

Background:

COVID-19 vaccine development is proceeding at an unprecedented pace. Once COVID-19 vaccines become widely available, it will be necessary to maximize public vaccine acceptance and coverage.

Objective:

This research aimed to analyze the predictors of COVID-19 vaccine acceptance in Russia.

Methods:

A cross-sectional online survey was conducted among Russian adults from September 26^th to November 9^th, 2020. Predictors of the intent to take up COVID-19 vaccination were explored using logistic regression.

Results:

Out of 876 participants, 365 (41.7%) would be willing to receive the vaccine if it became available. Acceptance increased for a vaccine with verified safety and effectiveness (63.2%). Intention to receive the COVID-19 vaccine was relatively higher among males (aOR=2.37, 95% CI 1.41-4.00), people with lower monthly income (aOR=2.94, 95%CI 1.32-6.57), and with positive trust in the healthcare system (aOR=2.73, 95% CI 1.76-4.24). The Russian people were more likely to accept the COVID-19 vaccine if they believed that the vaccine reduces the risk of virus infection (aOR=8.80, 95%CI 5.21-14.87) or relieves the complications of the disease (aOR=10.46, 95%CI 6.09-17.96). Other barriers such as being unconcerned about side-effects (aOR=1.65, 95%CI 1.03-2.65) and the effectiveness and safety of the vaccination (aOR=2.55, 95%CI 1.60-4.08), also affected acceptance.

Conclusions:

The study showed the usefulness of the health belief model constructs in understanding the COVID-19 vaccination acceptance rate in the Russian population. This rate was influenced by sociodemographic and health-related characteristics, and health beliefs. These findings might help guide future efforts for policymakers and stakeholders to improve vaccination rates by enhancing trust in the healthcare system.

["If there is a risk, I should have a choice:" Risk management and risk perception in Italian vaccine hesitancy movements]

In Italy, the passing of mandatory pediatric vaccinations in 2017 was a consequence of increasing vaccine hesitancy in the country, a phenomenon that has largely spread on social networks. This article examines risk management and risk perception regarding pediatric vaccinations through an analysis of online content shared by Italian vaccine hesitancy movements between December of 2019 and April of 2020. Results show that these movements carry out a reinterpretation of risk, scientific evidence, and parental responsibility, especially with regard to the alleged correlation between the measles vaccine and autism. The limitations of political decisions surrounding vaccines are due to the application of punitive measures such as administrative penalties and licensing bans for doctors who express "anti-vax" ideas, aspects which may increase distrust towards the political establishment and the medical profession.

Altered Influenza Vaccination Coverage and Related Factors in Pregnant Women in Korea from 2007 to 2019

BACKGROUND

Pregnant women are at a high-risk of influenza infection. We have previously reported a low influenza vaccination coverage rate (4.0%) in Korea during the 2006-2007 influenza season. We conducted follow-up studies in 2011-2012 and 2018-2019 to observe changes in influenza vaccination coverage.

METHODS

Women who delivered at Inha University Hospital (Incheon, Korea) in 2011-2012 and 2018-2019 were enrolled in the study. We surveyed the rate of influenza vaccination, perception scores, and related factors through telephonic interviews and compared the results from 2011-2012 and 2018-2019 with those from 2006-2007.

RESULTS

The number of survey respondents was 227 in 2006-2007, 152 in 2011-2012, and 171 in 2018-2019. The rate of vaccination coverage increased from 4.0% in 2006-2007 to 42.0% in 2011-2012 and 59.3% in 2018-2019. Perception scores also increased progressively from 3.8 in 2006-2007 to 4.2 in 2011-2012 and 5.1 in 2018-2019. Physician recommendations for influenza vaccination also increased from 4.8% in 2006-2007 to 36.8% in 2011-2012 and 49.7% in 2018-2019. The most common reason for not getting vaccinated was the lack of awareness of influenza vaccination during pregnancy (36.9%). The perception scores and physician recommendation rates were significantly lower for unvaccinated women (3.87 and 8.4%, respectively) than for vaccinated women (5.14 and 69.1%, respectively).

CONCLUSION

The influenza vaccination coverage rate in pregnant women has increased significantly since our study in 2006-2007. However, further improvement in the coverage rate is needed. There is a need for active and comprehensive publicity and education regarding this issue among physicians and pregnant women.

Attitudes towards COVID-19 vaccination, vaccine hesitancy and intention to take the vaccine

BACKGROUND

The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake.

OBJECTIVE

The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine.

METHODS

Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling.

RESULTS

A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p<0.00005). Opinions of significant others- family and friends (r=0.22, p<0.005) and health professionals (r=0.74, p<0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p=0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine.

CONCLUSIONS

COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women.

Finding Reasons for Vaccination Hesitancy: Evaluating Semi-Automatic Coding of Internet Discussion Forums

Computer-assisted text coding can facilitate the analysis of large text collections. To evaluate the functionality of providing an analyst with a ranked list of suggestions for suitable text codes, we used a data set of discussion posts, which had been manually coded for reasons given for taking a stance on the topic of vaccination. We trained a logistic regression classifier to rank these reasons according to the probability that they would be present in the post. The approach was evaluated for its ability to include the expected reasons among the n top-ranked reasons, using an n between 1 and 6. The logistic regression-based ranking was more effective than the baseline, which ranked reasons according to their frequency in the training data. Providing such a list of possible codes, ranked by logistic regression, could therefore be a useful feature in a tool for text coding.