Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

Implications of social media misinformation on COVID-19 vaccine confidence among pregnant women in Africa

It has been over a year since the World Health Organization (WHO) declared the outbreak of COVID-19 as a Public Health Emergency of International Concern and subsequently a global pandemic. The world has experienced a lot of uncertainty since then as we all get used to this new ‘normal’ with social distancing measures, lockdowns, the emergence of new variants, and an array of hope with the development of vaccines. Having an abstract understanding of vaccine delivery, public perceptions of vaccines, and promoting acceptance of vaccines are critical to tackling the pandemic. The advent of the pandemic has led to the emergence of an ‘infodemic’ or rampant misinformation surrounding the virus, treatment, and vaccines. This poses a critical threat to global health as it has the potential to lead to a public health crisis by exacerbating disease spread and overwhelming healthcare systems. This ‘infodemic’ has led to rising vaccine hesitancy which is of paramount concern with the WHO even identifying it as one of the ten main threats to Global health almost 2 years before the approval of COVID-19 vaccines. Pregnant African women are one of the most vulnerable population groups in a region with an already burdened healthcare system. Currently, there isn’t ample research in the literature that explores vaccine hesitancy in this subpopulation and the impact of social media misinformation surrounding it. The aim of this paper is to highlight the implications of this ‘infodemic’ on the pregnant African population and suggest key recommendations for improved healthcare strategies.

Impact of corona-phobia on attitudes and acceptance towards COVID-19 vaccine among cancer patients: a single-center study

Aim: This study aimed to assess the impact of COVID-19 phobia and related factors on attitude towards COVID-19 vaccine in cancer patients. Methods: A prospective cross-sectional descriptive study was conducted with 300 adult patients using a validated COVID-19 Phobia Scale (C19P-S) and related survey to determine the factors affecting vaccine acceptance between May-June 2021. Results: Regarding the COVID-19 vaccine willingness, 86.7% accepted vaccination, 6.3% were hesitant and 7% refused vaccination. Patients that accepted vaccination had significantly higher C19P-S scores in general, and in psychological and psychosomatic subdivisions. Univariate analysis revealed that increased age, being retired, and being married were significantly associated with willingness to be vaccinated against COVID-19. Conclusion: The majority of patients had high 'coronophobia' levels which were associated with increased willingness for the COVID-19 vaccines. Minimizing negative attitudes towards vaccines will most likely be achieved by raising awareness in the cancer population about COVID-19 vaccine.

Factors influencing COVID-19 vaccination intention: The roles of vaccine knowledge, vaccine risk perception, and doctor-patient communication

OBJECTIVE

This study aims to investigate factors influencing COVID-19 vaccination intention in the United States.

METHODS

A cross-sectional survey was conducted with 800 respondents recruited from an online panel managed by a survey company. Path analysis was employed to examine the relationships between the study variables.

RESULTS

First, perceived susceptibility to COVID-19 vaccine side effects was negatively associated with vaccination intention whereas perceived severity did not show any significant impact. Second, vaccine-related knowledge was not directly related to vaccination intention, but it had an indirect and positive effect on vaccination intention via decreasing perceived susceptibility. Third, doctor-patient communication strengthened the negative effect of vaccine knowledge on perceived susceptibility and severity.

CONCLUSION

The results of this study offer insights on how to increase people's vaccination intention and reduce their psychological concerns when making COVID-19 vaccine-related decisions.

PRACTICE IMPLICATIONS

Government agencies should actively promote the effectiveness and importance of vaccination, while addressing concerns about vaccine safety in the public; Health initiatives also need to enhance the level of knowledge about COVID-19 vaccines through various media channels; Doctors can start the conversations about COVID-19 vaccination with their patients at the point of care and/or via online communication platforms.

Looking ahead: Caregivers' COVID-19 vaccination intention for children 5 years old and younger using the health belief model

COVID-19 vaccine hesitancy is a significant public health issue. While vaccines are not yet available for children, clinical trials are underway, and children will likely be an important factor in the U.S. reaching herd immunity. However, little research has been conducted to examine parents’ intention to vaccinate their young children for COVID-19.

Method

An online survey with a national U.S. sample of 682 primary caregivers of children under age six assessed variables associated with intention to accept the COVID-19 vaccine for their children from November 13, 2020, to December 8, 2020.

Results

Caregivers whose child received a recent influenza vaccine, as well as those with previous experience COVID-19, were more likely to express COVID-19 vaccination intention for their young child. Identifying as female was associated with lower COVID-19 vaccination intention, while identifying as Hispanic or Latino was associated with higher intention. Health Belief Model variables of perceived severity of COVID-19 for their child, as well as vaccine confidence, were positive predictors of COVID-19 vaccine intention and mediated the relationship between prior behavior, demographic variables, and intention.

Conclusions

The findings highlight the importance of early, proactive COVID-19 vaccination education efforts directed at caregivers, including those with young children. Vaccines for young children will likely become a necessary part of ending the pandemic’s impact in school settings. Operationally, COVID-19 vaccination may also become a part of childhood vaccination schedules. Understanding the beliefs and intentions of caregivers of young children before vaccinations are recommended for children will enable public health officials and medical practitioners to prepare in advance.

Exploring Communication Strategies to Encourage COVID-19 Vaccination: Motivation-Based Message Appeals, Incidental Emotions, and Risk Perception

Motivation-based message appeals and incidental emotions have the potential to encourage COVID-19 vaccination, especially when the motivation components of the two agree. Risk perception may also interact with self vs. other-oriented message appeals. Results from a 2 (message appeal) × 4 (incidental emotion) online experiment (N = 306) indicate that when exposed to an altruistic message, those who experienced self-transcendent emotions reported higher COVID vaccination intention than those amused or not induced with emotions. This effect, however, was not identified in the egoistic message condition. Risk perception was positively associated with self-vaccination intention but did not interact with message appeals. The main effect of risk perception and interaction effects between incidental emotions and message appeals provide important implications for addressing vaccine hesitancy and increasing vaccine uptake.

COVID-19 vaccine hesitancy in patients with mental illness: strategies to overcome barriers—a review

Background

People with mental health problems are at particular risk both for infection with COVID-19 and for more severe course of illness. Understanding COVID-19 vaccine hesitancy is crucial in promoting vaccine acceptance among people with mental health diagnoses. This review aims to identify the prevalence and discuss factors associated with COVID-19 vaccine hesitancy among the mentally ill population.

Main body

We conducted a detailed literature search and included 15 articles for discussion in this review. Several studies showed varying trends of vaccine hesitancy rates among different countries. Major factors involved in vaccine hesitancy in general include mistrust, misinformation, believing in conspiracy theories, and negative attitudes towards vaccines. It was surprising that none of the studies were focused on vaccine acceptance rates and factors associated with vaccine hesitancy among the mentally ill population. However, studies do show that COVID-19 is associated with worse healthcare outcomes for psychiatric patients, and vaccine hesitancy correlated with a lower likelihood of receiving mental health treatment and vaccinations. Psychiatrists need to address issues among patients who are particularly vulnerable to the fear of vaccines which include anxiety, panic attacks, certain phobias including trypanophobia and agoraphobia, obsessive-compulsive disorder, and certain types of traumas. Psychiatrists need to communicate effectively, show respect, empathy, and deliver accurate and honest information about the vaccines. Motivational interviewing, getting people with mental health illness to organize vaccine campaigns, and involving families with mental health problems may promote vaccine acceptance among this group.

Conclusion

Existing literature on the rates of vaccine hesitancy among people with mental health illness is limited. The mental health illness may increase the risk of hesitancy especially in patients having certain emotional disorders such as anxiety and phobia. More studies addressing vaccine hesitancy rates and factors associated with the mentally ill population need to be done in the future.

Using a Machine Learning Approach to Monitor COVID-19 Vaccine Adverse Events (VAE) from Twitter Data

Social media can be used to monitor the adverse effects of vaccines. The goal of this project is to develop a machine learning and natural language processing approach to identify COVID-19 vaccine adverse events (VAE) from Twitter data. Based on COVID-19 vaccine-related tweets (1 December 2020-1 August 2021), we built a machine learning-based pipeline to identify tweets containing personal experiences with COVID-19 vaccinations and to extract and normalize VAE-related entities, including dose(s); vaccine types (Pfizer, Moderna, and Johnson & Johnson); and symptom(s) from tweets. We further analyzed the extracted VAE data based on the location, time, and frequency. We found that the four most populous states (California, Texas, Florida, and New York) in the US witnessed the most VAE discussions on Twitter. The frequency of Twitter discussions of VAE coincided with the progress of the COVID-19 vaccinations. Sore to touch, fatigue, and headache are the three most common adverse effects of all three COVID-19 vaccines in the US. Our findings demonstrate the feasibility of using social media data to monitor VAEs. To the best of our knowledge, this is the first study to identify COVID-19 vaccine adverse event signals from social media. It can be an excellent supplement to the existing vaccine pharmacovigilance systems.

Pharmacists-physicians collaborative intervention to reduce vaccine hesitancy and resistance: A randomized controlled trial

Purpose

Given their negative influence on community health, vaccine hesitancy and resistance are emerging challenges that require healthcare intervention. Therefore, this study aimed to assess the impact of physician-pharmacist collaborative health coaching on rates of hesitancy and resistance for a COVID-19 vaccine.

Methods

After an initial assessment of rates of hesitancy and resistance for a COVID-19 vaccine was conducted, hesitant and resistant participants were approached, recruited, and randomized into an active and control group. Pharmacists-physicians collaborative coaching intervention was delivered to active group subjects over two months through Facebook live sessions. The outcome measures were assessed in both groups before coaching, directly after coaching, and a month after coaching.

Results

The proportions of hesitancy and resistance for a COVID-19 vaccine among subjects in the active group were significantly reduced from 64.3% and 35.7% before coaching to 20.1% and 7.8% directly after coaching, respectively. These proportions were further reduced to 11.1% and 3.3% a month after coaching, respectively. Furthermore, the mean scores for knowledge on, and attitude towards COVID-19 vaccine were significantly increased from 4.6 ± 1.8 and 4.1 ± 1.7 before coaching to 7.5 ± 3.1 and 8.9 ± 3.8 directly after coaching, respectively. However, the change in mean score of beliefs about COVID-19 vaccines among active group subjects was not significant.

Conclusion

High rates of hesitancy and resistance for a COVID-19 vaccine were found in Jordan. These rates can be significantly reduced through online pharmacists-physicians collaborative coaching, which can also improve knowledge of and attitude towards COVID-19 vaccines.

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis-implications for public health communications in Australia

OBJECTIVE

To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study.

DESIGN AND SETTING

Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021.

PARTICIPANTS

Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19).

MAIN OUTCOME MEASURES

Primary outcome: responses to question 'If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'.Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions.

RESULTS

Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine.

CONCLUSIONS

Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates.

SOCIO-PSYCHOLOGICAL BARRIERS OF INDIVIDUAL REGARDING COVID-19 VACCINE ACCEPTANCE

OBJECTIVE

The aim: The aim of the article is to analyse the socio-psychological barriers to the COVID-19 vaccination process in the world and in Ukraine.

PATIENTS AND METHODS

Materials and methods: Electronic databases of Web of Science, Scopus and PubMed were searching using keyword searches.

CONCLUSION

Conclusions: The implementation of an effective scientific strategy of health education and communication between representatives of the medical sphere and representatives of different social groups, gender and age is relevant today. At the moment it is difficult for the medical community and society to give an unambiguous assessment of the facts about COVID-19, because it is still unknown about the long-term impact of the COVID-19 pandemic on individual. To increase the vaccination coverage, vaccination evidence should be standardized and a choice of conditions, algorithm of beliefs instead of a standard approach should be proposed. Further research on individual health benefits is needed to identify and address socio-psychological barriers on COVID-19 vaccine acceptance.

Public Health Messaging during the COVID-19 Pandemic and Beyond: Lessons from Communication Science

The COVID-19 pandemic has made it clear that effective public health messaging is an indispensable component of a robust pandemic response system. In this article, we review decades of research from the interdisciplinary field of communication science and provide evidence-based recommendations for COVID-19 public health messaging. We take a principled approach by systematically examining the communication process, focusing on decisions about what to say in a message (i.e., message content) and how to say it (i.e., message executions), and how these decisions impact message persuasiveness. Following a synthesis of each major line of literature, we discuss how science-based principles of message design can be used in COVID-19 public health messaging. Additionally, we identify emerging challenges for public health messaging during the COVID-19 pandemic and discuss possible remedies. We conclude that communication science offers promising public health messaging strategies for combatting COVID-19 and future pandemics.

Who is likely to vacillate in their COVID-19 vaccination decision? Free-riding intention and post-positive reluctance

Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are still vacillating in their decision to vaccinate. In this study, we considered the effect of two relevant contextual issues on vaccination intention: the number of people infected with COVID-19 is increasing, and the pace of vaccination is gaining speed. Specifically, we hypothesized that having already contracted SARS-CoV-2 (post-positive reluctance) could lead people to underestimate the importance of vaccination. Moreover, as the number of vaccinated people increases, more hesitant people could fall into the free-riding intention category, benefitting from the immunity provided by others' vaccinations. Vaccine hesitancy becomes more critical as the vaccination campaign proceeds: at one point, it will be inevitable to deal with hesitant people. This study is part of a WHO Regional Office for Europe project and involved a representative sample of 5006 Italians interviewed in January-February 2021. In case of post-positive reluctance, both young age and female gender increase vaccine hesitancy, while a high level of education reduces free-riding intention. Considering post-positive reluctance and free riding, a protective effect on hesitancy is associated with negative affective states, adherence to protective behaviors, trust in health information sources, and resilience. In contrast, increased vaccine hesitancy is associated with a high level of conspiracy-mindedness and trust in media information sources. Recognizing and studying the post-positive reluctance and the phenomenon of free-riding people can help us to become more efficient in combatting the virus.

Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.

Predictors of Intention to Vaccinate Against COVID-19 in a Peruvian Sample

BACKGROUND

Vaccination against COVID-19 is considered one of the most effective strategies to control this global public health crisis. However, vaccine hesitancy is one of the main threats to mitigating the pandemic. The present study aimed to identify predictors of intention to vaccinate against COVID-19 in 3 geographical regions of Peru.

METHODS

An online analytical cross-sectional study was conducted. Participants were selected by non-probability convenience sampling and size was estimated using the online statistical calculator proposed by Soper. A total of 529 Peruvian nationals completed the questionnaires. Student's t-test and Fisher's F test (ANOVA) were used. A significance level of .05 was considered.

RESULTS

Face-to-face work (β = 2.037, P < .001), fear of COVID-19 (β = .461, P < .001), vaccine confidence (β = 2.881, P < .001) and trust in health care institutions (β = .432, P < .01) predict a higher intention to receive the vaccine. However, the variables perception of a worldwide conspiracy (β = -1.900, P < .001), and practice Protestant religion (β = -2.274, P < .001) predict negatively their acceptance.

CONCLUSION

Several positive predictors of intention to vaccinate against COVID-19 have been identified. However, having a perception of a global conspiracy and practice Protestant religion are shown to be risk variables for vaccine acceptance. Therefore, there is a need to develop strategies to ensure high uptake and success of COVID-19 vaccination campaigns.

An Evaluation of a Microlearning Intervention to Limit COVID-19 Online Misinformation

As part of a design-based research project, we designed, developed, and evaluated a web-based microlearning intervention in the form of a comic into the problem of COVID-19 online misinformation. In this paper, we report on our formative evaluation efforts. Specifically, we assessed the degree to which the comic was effective and engaging via responses to a questionnaire (n = 295) in a posttest-only non-experimental design. The intervention focused on two learning objectives, aiming to enable users to recognize (a) that online misinformation is often driven by strong emotions like fear and anger, and (b) that one strategy for disrupting the spread of misinformation can be the act of stopping before reacting to misinformation. Results indicate that the comic was both effective and engaging in achieving these learning objectives.

Influence of Parental Psychological Flexibility on Pediatric COVID-19 Vaccine Hesitancy: Mediating Role of Self-Efficacy and Coping Style

Background: Pediatric COVID-19 vaccine hesitancy hinders the establishment of immune barrier in children. Psychological flexibility may be a key contributing factor to pediatric COVID-19 vaccine hesitancy, and self-efficacy and coping style play an important role in the relationship, but the underlying mechanisms remain unknown.

Methods: A cross-sectional study was conducted on parents from June 2021 to July 2021. A total of 382 parents were recruited for an online-investigation. Serial mediation models were used to examine whether self-efficacy and coping style mediated in the psychological flexibility-pediatric COVID-19 vaccine hesitancy linkage.

Result: Psychological flexibility was negatively related to pediatric COVID-19 vaccine hesitancy (r = −0.198, P < 0.001). Coping styles rather than self-efficacy played a mediating role independently (95% CI: −0.263 to −0.058). Serial mediation analyses indicated that self-efficacy and coping style co-play a serial mediating role in the association of psychological flexibility and pediatric COVID-19 vaccine hesitancy (95% CI: −0.037 to −0.001).

Conclusion: The present study showed that high psychological flexibility, high self-efficacy, and positive coping style were conducive to the lower pediatric COVID-19 vaccine hesitancy.

Ending the Pandemic: How Behavioural Science Can Help Optimize Global COVID-19 Vaccine Uptake

Governments, public health officials and pharmaceutical companies have all mobilized resources to address the COVID-19 pandemic. Lockdowns, social distancing, and personal protective behaviours have been helpful but have shut down economies and disrupted normal activities. Vaccinations protect populations from COVID-19 and allow a return to pre-pandemic ways of living. However, vaccine development, distribution and promotion have not been sufficient to ensure maximum vaccine uptake. Vaccination is an individual choice and requires acceptance of the need to be vaccinated in light of any risks. This paper presents a behavioural sciences framework to promote vaccine acceptance by addressing the complex and ever evolving landscape of COVID-19. Effective promotion of vaccine uptake requires understanding the context-specific barriers to acceptance. We present the AACTT framework (Action, Actor, Context, Target, Time) to identify the action needed to be taken, the person needed to act, the context for the action, as well as the target of the action within a timeframe. Once identified a model for identifying and overcoming barriers, called COM-B (Capability, Opportunity and Motivation lead to Behaviour), is presented. This analysis identifies issues associated with capability, opportunity and motivation to act. These frameworks can be used to facilitate action that is fluid and involves policy makers, organisational leaders as well as citizens and families.

Are midwifery students ready for the COVID-19 vaccine? The decision to vaccinate and affecting factors

AIM

This study aims to determine the decision of midwifery students, who are the midwives of the future, on getting the COVID-19 vaccine and affecting factors.

METHOD

The sample of this online cross-sectional study consisted of 1879 midwifery students in Turkey. The data collection tools of the study included a sociodemographic data form, the Health Literacy Index, Perception of Causes of COVID-19 and Attitudes Toward the COVID-19 Vaccine Scale. Descriptive statistics, correlation and linear regression analyses were used in the analysis of the data.

FINDINGS

Among the participants, 65.7% (1235) did not want to get the COVID-19 vaccine. In this study, those who found childhood vaccines beneficial among the students, those reporting positive attitudes toward vaccinations and those who listened to the recommendations of health-care workers had higher rates of not wanting to get the COVID-19 vaccine. It was found that the students' decisions to get the vaccine were not affected by their health literacy levels. However, their attitudes toward vaccination were negatively effective, and their perceptions of COVID-19 causes were positively effective.

CONCLUSION

In our study, the midwifery students who perceived the cause of COVID-19 as a conspiracy did not want to be vaccinated. Midwifery students should move away from the perception of conspiracy, and they should be informed about COVID-19 with scientific facts.

Knowledge, Perception, and Willingness towards Immunization among Bangladeshi Population during COVID-19 Vaccine Rolling Period

Vaccine willingness among the mass populace, as well as their proper knowledge and perception regarding vaccines and the vaccination process, may contribute extensively towards attaining their anticipated vaccination rates. The current study endeavored to ascertain the Bangladeshi population's knowledge, perception, and willingness towards COVID-19 vaccination. Relevant information was collected from 1201 adults aged 18 years or older by employing an online-based survey from 1 to 30 July 2021. Descriptive statistics, the chi-square (χ2) test, and a binary logistic regression analysis were applied in order to compare the extent of knowledge and perception prevalent among different demographic groups and correlate such prevalence with respective vaccine willingness. The participants expressed mean (± standard deviation) knowledge and perception scores of 6.48 ± 1.13 out of 8 and 5.37 ± 1.22 out of 7, respectively. A multivariate analysis confirmed the significant association (p < 0.05) of gender, age, and family income with the knowledge score, whereas age and knowledge level significantly influenced perception. Current living area, family income, and age were considerable contributors to COVID-19 vaccine willingness. Overall vaccine willingness was found to be significantly curtailed by inadequate knowledge (AOR 0.514, CI 95% 0.401-0.658, p < 0.001) and perception (AOR 0.710, CI 95% 0.548-0.920, p = 0.010) among the participants. All of the concerned authorities' efforts are warranted in order to improve public understanding, perception, and inclination towards vaccination.

Changes of the Public Attitudes of China to Domestic COVID-19 Vaccination After the Vaccines Were Approved: A Semantic Network and Sentiment Analysis Based on Sina Weibo Texts

Introduction: On December 31, 2020, the Chinese government announced that the domestic coronavirus disease-2019 (COVID-19) vaccines have obtained approval for conditional marketing and are free for vaccination. This release drove the attention of the public and intense debates on social media, which reflected public attitudes to the domestic vaccine. This study examines whether the public concerns and public attitudes to domestic COVID-19 vaccines changed after the official announcement.

Methods: This article used big data analytics in the research, including semantic network and sentiment analysis. The purpose of the semantic network is to obtain the public concerns about domestic vaccines. Sentiment analysis reflects the sentiments of the public to the domestic vaccines and the emotional changes by comparing the specific sentiments shown on the posts before and after the official announcement.

Results: There exists a correlation between the public concerns about domestic vaccines before and after the official announcement. According to the semantic network analysis, the public concerns about vaccines have changed after the official announcement. The public focused on the performance issues of the vaccines before the official approval, but they cared more about the practical issues of vaccination after that. The sentiment analysis showed that both positive and negative emotions increased among the public after the official announcement. “Good” was the most increased positive emotion and indicated great public appreciation for the production capacity and free vaccination. “Fear” was the significantly increased negative emotion and reflected the public concern about the safety of the vaccines.

Conclusion: The official announcement of the approval for marketing improved the Chinese public acceptance of the domestic COVID-19 vaccines. In addition, safety and effectiveness are vital factors influencing public vaccine hesitancy.

Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just "Anti" vs. "Pro" Vaccine

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as "anti-vaccine vs. pro-vaccine" may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

COVID-19 vaccine uptake and hesitancy among HIV-infected men who have sex with men in mainland China: a cross-sectional survey

BACKGROUND

Men who have sex with men (MSM), a population bearing the greatest HIV burden in many countries, may also be vulnerable to COVID-19. COVID-19 vaccines are essential to containing the pandemic. However, vaccine hesitancy may compromise vaccine coverage. We aimed to understand the uptake of COVID-19 vaccine and factors associated with COVID-19 vaccine hesitancy among HIV-infected MSM in mainland China.

METHODS

A cross-sectional online survey among HIV-infected MSM was conducted between 13 and 21 February 2021 in mainland China. Variables including demographics, mental health status, HIV characteristics, and knowledge of and attitudes toward COVID-19 pandemic and COVID-19 vaccine were collected. Chi-square tests and multivariable logistic regression were used to analyze factors associated with COVID-19 vaccine hesitancy.

RESULTS

A total of 1295 participants were included. The median age was 29.3 years (interquartile range [IQR] 25.2-34.0 years). The uptake of COVID-19 vaccine was 8.7%. Two main reasons for receiving vaccines were "regarded vaccination as self-health protection" (67.3%) and "trust in domestic medical technology" (67.3%). Among participants who did not initiate vaccination, concern about side effects (46.4%) and disclosure of HIV infection (38.6%) were top two reasons, and 47.2% had higher vaccine hesitancy. Men who had with high antiretroviral therapy (ART) adherence (adjusted odds ratio [aOR] 0.53, 95% confidence interval [CI] 0.35-0.80), often (0.26, 0.17-0.40) or sometimes (0.46, 0.31-0.67) paid attention to information about the COVID-19 vaccine, preferred domestic vaccines (0.37, 0.24-0.59), thought the pandemic had moderate (0.58, 0.38-0.90) and moderately severe or severe impact (0.54, 0.38-0.78) on immunity, who were waiting for vaccination programs organized at workplace (0.60, 0.44-0.81) and who were unaware of where to get COVID-19 vaccine (0.61, 0.45-0.82) had lower degree of COVID-19 vaccine hesitancy. Men who were concerned about the efficacy (1.72, 1.16-2.54) and side effects (2.44, 1.78-3.35) had higher degree of COVID-19 vaccine hesitancy.

CONCLUSION

COVID-19 vaccine uptake among HIV-infected MSM is still suboptimal. Understanding influencing factors of vaccine hesitancy among this group and making tailored measures to alleviate hesitancy would help improve the coverage of COVID-19 vaccination in this population.

Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil

OBJECTIVE:

To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil.

METHODS:

Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy.

RESULTS:

Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception (“Very Bad” with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05).

CONCLUSION:

Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs).

Exposure to "Vaccination Selfies" Relate to Readers' Vaccination Intention: The Moderating Role of Partisan Media Use and the Mediating Role of Affective Responses

As vaccines for COVID-19 become accessible to the U.S. public, vaccinated individuals often post "vaccination selfies" on social media to encourage unvaccinated others to be inoculated. This study explores the relationship between exposure to these vaccination posts and post readers' vaccination intention. Drawn upon the functional affect theories, the authors proposed integral affective responses to the vaccination posts to explain readers' vaccination intention. Social media users' partisan media use was proposed to explain readers' different affective responses. Results from a cross-sectional survey (N = 343) showed that only exposure to proximal others' (e.g., friends), not distal others' (e.g., celebrities), vaccination posts was significantly associated with vaccination intention through positive affective responses. Conservative media use enhanced readers' negative affective response to vaccination posts whereas liberal media use was associated with positive affective responses. The findings highlighted the importance of social norms and positive affection appeals in pro-vaccination campaigns.

"Please, you go first!" preferences for a COVID-19 vaccine among adults in the Netherlands

Background

Vaccination is generally considered the most direct way to restoring normal life after the outbreak of COVID-19, but the available COVID-19 vaccines are simultaneously embraced and dismissed. Mapping factors for vaccine hesitancy may help the roll-out of COVID-19 vaccines and provide valuable insights for future pandemics.

Objectives

We investigate how characteristics of a COVID-19 vaccine affect the preferences of adult citizens in the Netherlands to take the vaccine directly, to refuse it outright, or to wait a few months and first look at the experiences of others.

Methods

An online sample of 895 respondents participated between November 4th and November 10th, 2020 in a discrete choice experiment including the attributes: percentage of vaccinated individuals protected against COVID-19, month in which the vaccine would become available and the number of cases of mild and severe side effects. The data was analysed by means of panel mixed logit models.

Results

Respondents found it important that a safe and effective COVID-19 vaccine becomes available as soon as possible. However, the majority did not want to be the first in line and would rather wait for the experiences of others. The predicted uptake of a vaccine with the optimal combination of attributes was 87%, of whom 55% preferred to take the vaccine after a waiting period. This latter group tends to be lower-educated. Older respondents gave more weight to vaccine effectiveness than younger respondents.

Conclusions

The willingness to take a COVID-19 vaccine is high among adults in the Netherlands, but a considerable proportion prefers to delay their decision to vaccinate until experiences of others are known. Offering this wait-and-see group the opportunity to accept the invitation at a later moment may stimulate vaccination uptake. Our results further suggest that vaccination campaigns targeted at older citizens should focus on the effectiveness of the vaccine.

Racial/ethnic disparities in intent to obtain a COVID-19 vaccine: A nationally representative United States survey

Black, Latino, Pacific Islander, and American Indian/Alaska Native adults are more likely than White adults to experience SARS-CoV-2-related infections, hospitalizations, and mortality. We assessed intent to be vaccinated and concerns among 7 U.S. racial/ethnic groups (1,000 Black/African American, 500 American Indian/Alaska Native, 1,000 Asian, 1,000 Latino (500 English- and 500 Spanish-speaking), 500 Pacific Islander, 500 multiracial, and 1,000 White adults) in a cross-sectional online survey conducted December 2020-February 2021, weighted to be nationally representative within groups. Intent to be vaccinated was ascertained with: "If a COVID-19 vaccine becomes available, how likely are you to get vaccinated?" (not at all/slightly/moderately/very/extremely likely). Respondents identified which concerns would keep them from being vaccinated: cost, not knowing where, safety, effectiveness, side-effects, and other. Multinomial logistic regression models assessed associations of race/ethnicity with odds of being extremely/very/moderately, slightly likely to be vaccinated (ref = not at all), controlling for demographics and health. Overall, 30% were extremely likely, 22% not at all likely, and 48% unsure. Compared to White respondents, American Indian/Alaska Native (Adjusted Odds Ratio (AOR) = 0.66, 95% CI, 0.47-0.92) and Black/African American (AOR = 0.54, 95% CI, 0.41-0.72) respondents were less likely, and Asian (AOR = 2.21, 95% CI, 1.61-3.02) and Spanish-speaking Latino respondents (AOR = 3.74, 95% CI, 2.51-5.55) were more likely to report being extremely likely to be vaccinated. Side-effects (52%) and safety (45%) were overriding concerns. Intent and vaccination rates are changing rapidly; these results constitute a comprehensive baseline for ongoing vaccination efforts among U.S. racial and ethnic groups.

Implications of attitudes and beliefs about COVID-19 vaccines for vaccination campaigns in the United States: A latent class analysis

Unprecedented global efforts in vaccine development have resulted in effective vaccines for COVID-19. The pandemic response in the US has been highly politicized, resulting in significant opposition to public health efforts, including vaccines. We aimed to understand patterns of attitudes and beliefs about the COVID-19 vaccine to inform vaccination campaigns. 583 English speaking United States adults were surveyed November 18-29, 2020. Participants answered 11 questions about their attitudes and beliefs about a COVID-19 vaccine, including perceived vaccine effectiveness, likelihood of getting vaccinated, and concerns that vaccine development was rushed/influenced by politics. We conducted a latent class analysis to identify profiles of attitudes/beliefs about a COVID-19 vaccine. We identified four classes of COVID-19 vaccine beliefs. The pro-vaccine class (28.8%) was willing to get vaccinated and had broadly positive beliefs about the vaccine. The development concerns class (27.8%) was willing to get vaccinated but was concerned about the development process. The third class (22.6%) was largely unsure if they would get vaccinated and if their peer groups would be vaccinated. The forth class (anti-vaccine, 20.8%) was dominated by an unwillingness to get vaccinated, vaccine distrust, vaccine development concerns, and peers groups with negative vaccine intentions. Given the large proportion of individuals who were concerned about the COVID-19 vaccine development process, messaging about rigor and approval processes may be critical to securing this group's commitment to vaccination. Having scientific and cultural leaders endorse vaccination may also be influential.

COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

A vaccine tax: ensuring a more equitable global vaccine distribution

While COVID-19 vaccines provide light at the end of the tunnel in a difficult time, they also bring forth the complex ethical issue of global vaccine distribution. The current unequal global distribution of vaccines is unjust towards the vulnerable living in low-income countries. A vaccine tax should be introduced to remedy this. Under such a scheme, a small fraction of the money spent by a country on vaccines for its own population would go into a fund, such as COVAX, dedicated to buying vaccines and distributing them to the world's poorest. A vaccine tax would provide a much-needed injection of funds to remedy the unequal distribution of vaccines. The tax allows for a distribution that, to a lesser degree, reflects the ability to pay and is superior to a donation-based model because it minimises the opportunity for free-riding.

Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation

Purpose

This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination.

Design

Cross-sectional survey data.

Setting

Online Qualtrics recruitment panel.

Subject

Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%).

Measures

Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors.

Analysis

We conducted multivariate linear regressions on each outcome variable after controlling for covariates.

Result

Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β = .37, 95% confidence interval [CI] = .25–.48), child (β = .32, .21–.44), and HPV for child (β = .38, .27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β = .46, .33–.59), child (β = .41, .28–.53), and HPV for child (β = .75, .64–.85).

Conclusion

Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.

Detecting and describing stability and change in COVID-19 vaccine receptibility in the United Kingdom and Ireland

COVID-19 continues to pose a threat to global public health. Multiple safe and effective vaccines against COVID-19 are available with one-third of the global population now vaccinated. Achieving a sufficient level of vaccine coverage to suppress COVID-19 requires, in part, sufficient acceptance among the public. However, relatively high rates of hesitance and resistance to COVID-19 vaccination persists, threating public health efforts to achieve vaccine-induced population protection. In this study, we examined longitudinal changes in COVID-19 vaccine acceptance, hesitance, and resistance in two nations (the United Kingdom and the Republic of Ireland) during the first nine months of the pandemic, and identified individual and psychological factors associated with consistent non-acceptance of COVID-19 vaccination. Using nationally representative, longitudinal data from the United Kingdom (UK; N = 2025) and Ireland (N = 1041), we found that (1) COVID-19 vaccine acceptance declined in the UK and remained unchanged in Ireland following the emergence of approved vaccines; (2) multiple subgroups existed reflecting people who were consistently willing to be vaccinated ('Accepters': 68% in the UK and 61% in Ireland), consistently unwilling to be vaccinated ('Deniers': 12% in the UK and 16% in Ireland), and who fluctuated over time ('Moveable Middle': 20% in the UK and 23% in Ireland); and (3) the 'deniers' and 'moveable middle' were distinguishable from the 'accepters' on a range of individual (e.g., younger, low income, living alone) and psychological (e.g., distrust of scientists and doctors, conspiracy mindedness) factors. The use of two high-income, Western European nations limits the generalizability of these findings. Nevertheless, understanding how receptibility to COVID-19 vaccination changes as the pandemic unfolds, and the factors that distinguish and characterise those that are hesitant and resistant to vaccination is helpful for public health efforts to achieve vaccine-induced population protection against COVID-19.

Mental Health Issues During and After COVID-19 Vaccine Era

The COVID-19 pandemic has persisted for more than a year, and post-COVID-19 sequelae of neurological complications, including direct and indirect effects on the central nervous system (CNS), have been recognized. There is a plethora of evidence for neurological, cognitive, and emotional deficits in COVID-19 patients. Acute neurological symptoms like neuroinflammation, cognitive impairment, loss of smell, and brain stroke are common direct effects among SARS-CoV-2 infected individuals. Work-associated stress, lockdowns, social distancing, and quarantine in response to contain SARS-CoV-2 have also affected the mental health of large populations, regardless of age. Public health emergencies have affected individuals and communities, resulting in emotional reactions and unhealthy behaviors. Although vaccines have been widely distributed and administered among large populations, vaccine hesitancy still exists and may be due to apprehension about vaccine efficacy, preliminary trials, and associated side effects. This review highlights the impact of COVID-19 on the CNS by outlining direct and indirect effects and factors contributing to the decline in people's mental health throughout the COVID-19 pandemic both during and after vaccine administration. Furthermore, we also discuss reasons for vaccine hesitancy and why some groups of people are deprived of vaccines. Finally, we touched upon the social determinants of mental health and their impact on disadvantaged populations during times of crisis which may help policymakers set up some action plans to mitigate the COVID-19 mental health turmoil during this ongoing pandemic.

Development of Personas to Communicate Narrative-Based Information About the HPV Vaccine on Twitter

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents.

Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with adolescents ages 9–14, we used both qualitative and quantitative data (e.g., the National Immunization Survey—Teen, focus groups, and social media) to create personas. These data sources were used to identify and develop key characteristics for personas to reflect a range of parents and their diverse understandings and experiences related to HPV vaccination. A parent advisory board provided insight and helped refine persona development.

Results: Four personas emerged and were characterized as the (1) Informed Altruist, (2) Real Talker, (3) Information Gatherer, and (4) Supporter. Characteristics differed across personas and provided insights into targeted narrative strategies. Described attributes included demographics, psychographics, communication style, vaccine goals and aspirations, vaccine challenges and frustrations, and vaccine hesitancy.

Discussion: This work demonstrates how multiple data sources can be used to create personas to deliver social media messages that can address the diverse preferences and needs of parents for HPV vaccine information. With increasing usage of social media for health information among parents, it is important for researchers to consider marketing and design thinking to create health communication messages that resonate with audiences.

Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis

BACKGROUND

As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter.

OBJECTIVE

The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media.

METHODS

To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity.

RESULTS

After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy.

CONCLUSIONS

This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust.

Theoretical Considerations for Communication Campaigns to Address Vaccine Hesitancy

Vaccine hesitancy, declared one of the top-10 public health threats in 2019, has become a high priority for public health professionals. Health communication campaigns have the potential to be an effective component of health behavior interventions, including those to promote vaccination. There is limited research examining the effects of theory-based health communications campaigns focused on vaccine hesitancy. Communication campaigns that use stage-matched theoretical constructs as the basis for messages are more likely to be successful in encouraging vaccine uptake by organizing behavioral intent to vaccinate along each stage and identifying which theoretical constructs are most relevant to where individuals are in the behavior change process. This article focuses on the underlying factors affecting adult decisions to get vaccinated and proposes a model through which to segment populations and determine appropriate theory-based communication campaigns to address vaccine hesitancy.

The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses

COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

BACKGROUND

Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh.

METHODS

An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations.

RESULTS

The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.

CONCLUSIONS

The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.

Factors determining intention to vaccinate against Covid-19: A developing nation perspective

India is more challenged than developed nations in reducing the Covid-19 cases and lowering death rates due to the huge population and unprepared health care system. As intention to vaccinate is contextual and its availability does not translate into their de facto adoption., this paper examines the factors that determine intention to vaccinate against COVID-19 in India. A research model was tested using 222 responses was tested using structural equation modeling. Findings suggested that credibility and awareness positively impacted whereas vaccine hesitancy and perceived risk negatively influenced intention to vaccinate. The fear of side effects did not impact the intention to vaccinate.

Predicting COVID-19 Vaccination Intention: The Determinants of Vaccine Hesitancy

Do people want to be vaccinated against COVID-19? Herd immunity is dependent on individuals' willingness to be vaccinated since vaccination is not mandatory. Our main goal was to investigate people's intention to be vaccinated and their intentions to vaccinate their children. Moreover, we were interested in understanding the role of the personal characteristics, psychological factors, and the lockdown context on that decision. Therefore, we conducted an online survey during the lockdown in Portugal (15 January 2021 until 14 March 2021). Participants completed a socio-demographic questionnaire, questions about their intentions of being vaccinated, concerns about the vaccine, a COVID-19 attitudes and beliefs scale, a COVID-19 vaccine attitudes and beliefs scale, and the Domain-Specific Risk-Taking (DOSPERT) Scale. Our results showed that from the 649 participants, 63% of the participants reported being very likely to have the vaccine, while 60% reported being very likely to vaccinate their children. We conducted two linear regression models, explaining 65% of the variance for personal vaccination and 56% of the variance for children vaccination. We found that the COVID-19 vaccine general beliefs and attitudes were the main determinants of vaccination intention. Additionally, our proposed artificial neural network model was able to predict with 85% accuracy vaccination intention. Thus, our results suggest that psychological factors are an essential determinant of vaccination intention. Thus, public policy decision makers may use these insights for predicting vaccine hesitancy and designing effective vaccination communication strategies.

Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey

Since health professionals provide frontline care to COVID-19 patients, information on vaccine acceptance among healthcare workers is needed. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbach’s alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy, and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. The appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates amongst healthcare workers.

Socio-demographic, psychological, and experiential predictors of COVID-19 vaccine hesitancy in South Korea, October-December 2020

Vaccine hesitancy is the primary barrier to controlling the COVID-19 pandemic in South Korea. We used logistic multivariate regression modeling to investigate (1) the prevalence and reasons for COVID-19 vaccine hesitancy, (2) sub-groups that had higher rates of vaccine hesitancy, and (3) vaccine hesitancy predictors. We used a national survey of representatively sampled households (n = 13,021 adults) from October to December 2020. A self-report questionnaire asked about vaccination intention and reasons for hesitancy and gathered data on socio-demographic, demographic, psychological, and experiential factors. Our study indicated that 39.8% of the participants answered that they hesitated or refused to be vaccinated. The most common reason for vaccine hesitancy was a lack of confidence in the COVID-19 vaccine (77.9%). Less or no fear of COVID-19 (OR = 2.08, 95% CI = 1.92–2.26; OR = 1.79, 95% CI = 1.54–2.08), unstable job status (OR = 1.42, 95% CI = 1.18–1.70), decreased family income (OR = 1.40, 95% CI = 1.21–1.61), and worsening health status (OR = 1.38, 95% CI = 1.13–1.68) were predictors of vaccine hesitancy. Younger age, no religious affiliation, political conservatism, and lower family income were also significantly associated with vaccine hesitancy. Effective health communication and policies need to consider the target subgroup population and predictors of vaccine hesitancy to attain herd immunity at an early stage.

Attitudes and intentions towards COVID-19 vaccines and associated factors among Egyptian adults

BACKGROUND

Herd immunity through vaccination is the target of public health interventions against COVID-19, but vaccine refusal or hesitancy is one of the global threats that make achievement of community immunity very difficult. The aim of this study was to determine negative attitudes and intentions and their predictors towards COVID-19 vaccines.

METHODS

This was cross sectional survey, that targeted 1011 Egyptians aged 18 years and above, from 24 governorates, during the period from 7 January 2021, to 30 March 2021. Using a convenient sampling technique, the data were collected through an online self-administered, structured questionnaire, which was composed of two main sections, that involved sociodemographic and health related factors, intentions, and attitudes towards COVID-19 vaccines.

RESULTS

The mean age of participants was 29.35 ± 10.78 years, (16.6 %) of them had COVID-19. (54%) of respondents, reported COVID-19 vaccine hesitancy and 21% of them reported vaccine non-acceptance while (27.1%) of participants preferred receiving Pfizer vaccine. (51.8%) of the respondents expressed strong worries about unforeseen effects of the vaccine which was associated with younger age groups, married, females, absence of history of allergy to food or drugs, perceived susceptibility to COVID 19 and never having flu vaccination. Vaccine hesitancy was associated with female sex, urban residence, university/post graduate, married respondents, those never had flu vaccine, and those did not have confidence in the ability of health system to control the epidemic. Female sex, urban residence and having concerns about unforeseen effects were predictors for vaccine hesitancy and vaccine non-acceptance.

CONCLUSION

The observed high level of worries about unforeseen effects of COVID-19 vaccines and widespread vaccine hesitancy amongst Egyptians and its predictors should be considered during implementation of public health intervention campaigns to change negative attitudes and improve acceptance and uptake of COVID-19 vaccines in Egypt.

Schoenberg N. COVID-19 and the impact on rural and black church Congregants: Results of the C-M-C project

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.

Go Greener, Less Risk: Access to Nature Is Associated with Lower Risk Taking in Different Domains during the COVID-19 Lockdown

Specific risk attitude and risky behavior had an important boost during the coronavirus disease 2019 (COVID-19) pandemic. In this contribution, we hypothesize that access to nature during home confinement will decrease both the tendency to passive risk taking and alcohol intake. To do so, we interviewed through an online survey two samples of Italian residents during the strict lockdown due to the first wave of the COVID-19 pandemic. Specifically, in Study 1, participants were 1519 Italian residents coming from different Italian regions, whilst in Study 2, participants were 182 students at a university of southern Italy who were monitored for one week. In Study 1, the hierarchical regression analysis attested that access to nature during the lockdown mitigated the tendency to passive risk taking, over and beyond the effect of socio-demographic variables and the psychological construct of impulsiveness, an important personality correlate of risk taking. In Study 2, the hierarchical regression showed that access to green was associated with fewer glasses of alcohol drunk in a week of lockdown. This effect held over and above the effect of socio-demographic variables and the drinking behavior before the outbreak of the COVID-19 pandemic. In both studies, findings confirmed the beneficial effect of access to nature in specific risk-taking domains. Theoretical future directions, as well as practical implications for the management of the COVID-19 emergency by policymakers, are discussed.

Overcoming COVID-19 Vaccine Hesitancy: Insights from an Online Population-Based Survey in the United States

This study sought to identify individual-level determinants of COVID-19 vaccine hesitancy based on the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). An online population-based survey was distributed in English and Spanish. Data were derived from 1208 U.S. adults (52% female; 38.7% minorities), 43.5% of whom reported vaccine hesitancy. Multivariable analysis revealed that unemployed individuals were more likely (OR = 1.78, 95% CI: 1.16-2.73, p = 0.009) and married (OR = 0.57, 95% CI: 0.39-0.81, p = 0.002) and higher income individuals (OR = 0.52, 95% CI 0.32-0.84, p = 0.008) were less likely to be hesitant. Individuals with greater perceived susceptibility to COVID-19 (OR = 0.82, 95% CI: 0.71-0.94, p = 0.006), who perceived vaccination as being convenient (OR = 0.86, 95% CI: 0.74-1.00, p = 0.047), and who afforded greater importance to cues to action from government (OR = 0.84, 95% CI: 0.74-0.95, p = 0.005), public health (OR = 0.70, 95% CI: 0.59-0.82, p < 0.001), and healthcare experts (OR = 0.59, 95% CI: 0.50-0.69, p < 0.001) were also less likely to be hesitant. Findings suggest that HBM and TPB constructs may be useful in informing strategies to improve COVID-19 vaccine uptake. Specifically, framing appeals based on perceptions of COVID-19 susceptibility, making vaccination convenient, and rebuilding trust through unified cues to action may help to overcome vaccine hesitancy.

Anticipating pride or regret? Effects of anticipated affect focused persuasive messages on intention to get vaccinated against COVID-19

Understanding the factors that increase intention to receive COVID-19 vaccines is essential to maximise the vaccination campaign effectiveness. The present experimental study evaluated the effect of exposure to messages targeting cognitive attitude plus anticipated positive (pride) or negative (regret) affective reactions on intention to get vaccinated. Participants included 484 Italian adults randomly allocated to one of four conditions: 1) cognitive attitude message; 2) cognitive attitude plus positive affect message; 3) cognitive attitude plus negative affect message; 4) control condition (no message). Results showed that participants in the second condition reported greater intention to get vaccinated against COVID-19 compared with those in the control condition. Parallel mediation analysis indicated that the effect of the second condition on intention was fully mediated by cognitive attitude and anticipated positive affect. These findings suggest that future campaigns aimed at promoting COVID-19 vaccination intention could usefully target both cognitive attitude and anticipated positive affect.