What Indians Think of the COVID-19 vaccine: A qualitative study comprising focus group discussions and thematic analysis

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Are People Willing to Take Regular COVID-19 Vaccines? Prevalence and Determinants of Hesitancy for Regular COVID-19 Vaccination: A Random Population-Based Survey in Hong Kong

The emergence of new coronavirus variants and evidence of waning immunity offered by COVID-19 vaccines draw attention to the need for regular vaccination. Vaccine hesitancy is one of the top ten threats to global health. There is a dearth of knowledge on people's hesitancy to take regular COVID-19 vaccines. This study aimed to investigate the prevalence and determinants of hesitancy for regular COVID-19 vaccination. A population-based, random telephone survey was performed in Hong Kong in April 2022 (n = 1213). The age-standardized hesitancy rate for regular COVID-19 vaccines among Hong Kong adults was 39.4% (95% CI = 35.3-44.1%), exhibiting a sloping S-shape with age. Regression analyses revealed that females, young adults, self-perceived fair/bad health, low COVID-19 vaccine uptake, and believing there are better ways for prevention of infection were positive determinants of hesitancy for regular vaccination. Vaccine confidence, perceived severity and availability, trust in manufacturers and government, and civic duty inclination were negative determinants. Tailored vaccine promotions are needed for females, young adults, and people perceiving poor health and receiving fewer doses. Information on infection severity, vaccine availability, and trust in suppliers, products, and governments are key attitude-change facilitators to decrease hesitancy for regular COVID-19 vaccination and cope with future pandemics.

Double Jab: Survey Evidence on Vaccine Hesitancy, Beliefs, and Attitudes in India

India witnessed a large surge in COVID-19 cases in April 2021, a second wave of nearly 350,000 daily new infections across the country. As of December 2021, cases have reduced drastically, in part due to greater vaccine coverage across the country. This study reports results on vaccine hesitancy, attitudes, and behaviors from an online survey conducted between February and March 2021 in nine Indian cities (N = 518). We find that vaccine hesitancy negatively predicts willingness to take the vaccine, and beliefs about vaccine effectiveness supersede hesitancy in explaining vaccine uptake. Furthermore, we find that mask-wearing and handwashing beliefs, information sources related to COVID-19, and past COVID-19 infection and testing status are all strongly associated with the hypothetical choice of vaccine. We discuss these findings in the context of behavioral theories as well as outline implications for vaccine-related health communication in India.

Determination of factors influencing young adults' intention to have COVID-19 vaccine in the Philippines: An integration of Health Belief Model and the Theory of Planned Behavior

Objectives

The COVID-19 pandemic continues to increase around the world and businesses and markets across the world significantly decreased. The purpose of this study was to determine the factors that affect the intention to be vaccinated for the COVID-19 vaccine among young Filipino adults by integrating the Health Belief Model and Extended Theory of Planned Behavior.

Study design

A cross-sectional study design was utilized.

Methods

Factors such as understanding of the COVID-19 vaccine, self-efficacy, cues to action, perceived barriers, perceived benefits, perceived side effects, perceived behavioral control, attitude, subjective norm, and intention to be vaccinated were analyzed by utilizing Structural Equation Modeling (SEM).

Results

With 865 young Filipino adults who answered a self-administered survey, it was seen that Understanding of the COVID-19 vaccine has the highest direct significant effect on cues to action, followed by perceived barriers, and perceived benefits. Interestingly, the primary factor was Understanding COVID-19 vaccines which had an indirect significant effect on the intention to get vaccinated. This is because knowing what the vaccine is for, its effects, and the application would lead to the acceptance of the COVID-19 vaccine. Moreover, the impact of being known to have the COVID-19 vaccine would lead to the intention to get vaccinated.

Conclusions

The findings of this study can be utilized especially by the government in developing strategies for encouraging people to take the COVID-19 vaccine. Finally, the model construct of the study can be applied to explore more factors that can affect the intention to be vaccinated with the COVID-19 vaccine and other vaccines people worldwide.

Exploring the Influencing Factors of COVID-19 Vaccination Willingness among Young Adults in China

Vaccine uptake is considered as one of the most effective methods of defending against COVID-19 (coronavirus disease 2019). However, many young adults are hesitant regarding COVID-19 vaccines, and they actually play an important role in virus transmission. Based on a multi-theory model, this study aims to explore the influencing factors related to COVID-19 vaccine willingness among young adults in China. Using semi-structured interviews, this study explored the factors that would motivate young adults with vaccine hesitancy to get the COVID-19 vaccine. Thematic analysis was used to analyze the interview data with topic modeling as a complementarity method. After comparing the differences and similarities of results generated by thematic analysis and topic modeling, this study ultimately identified ten key factors related to COVID-19 vaccination intention, including the effectiveness and safety of vaccines, application range of vaccine, etc. This study combined thematic analysis with machine learning and provided a comprehensive and nuanced picture of facilitating factors for COVID-19 vaccine uptake among Chinese young adults. Results may be taken as potential themes for authorities and public health workers in vaccination campaigns.

When good messages go wrong: Perspectives on COVID-19 vaccines and vaccine communication from generally vaccine accepting individuals in Canada

Vaccines are one of the most important and successful public health interventions to reduce the spread of infectious diseases. However, unlike childhood diseases and routine vaccines, COVID-19 is a novel threat, and COVID-19 vaccines may elicit specific anxieties. Through focus groups, we examine the concerns and attitudes toward the COVID-19 vaccine expressed by individuals who accept routine vaccinations in Canada. We also conducted a pre-focus group survey to document participant attitudes towards vaccines in general. While most participants had received at least one dose of the COVID-19 vaccine or had the intention to get it, many had concerns. First, participants felt anxious about the quick development and approval of the vaccines, even if they recognized that the vaccines have undergone clinical trials. Second, participants felt confused about shifting public health guidelines regarding vaccine safety, changing the interval between doses, and mixing different vaccine brands. Finally, participants said they felt abandoned when deciding whether to get vaccinated or not. People who generally accept vaccines expressed concerns about COVID-19 vaccines, mostly related to the inevitable uncertainties of a new vaccine (i.e. novelty, safety, mandates, etc.). COVID-19 vaccine hesitancy, understood as concerns about the novelty of a vaccine and the rapid implementation of it, could be useful for understanding questioning attitudes towards COVID-19 vaccines from people who accept routine vaccinations. Understanding COVID-19 vaccine hesitancy can also provide valuable insights as booster doses are periodically needed and people may not be as accepting of these additional doses.

Determinants of coronavirus disease 2019 vaccine acceptance, hesitancy, and barriers among healthcare workers in Ismailia, Egypt: a mixed methods study

BACKGROUND

Coronavirus disease 2019 vaccine acceptance among healthcare workers (HCWs) plays a fundamental role in combating the COVID-19 pandemic. Vaccination acceptance depends on perceptions of competence and motives of the providers, producers, health professionals, and policymakers. This study aimed to identify the frequency and determinants of COVID-19 vaccine uptake acceptance, hesitancy, and barriers among HCWs.

METHODS

A total of 500 HCWs from 3 different hospital affiliations in Ismailia Governorate, Egypt, were included in this mixed methods study. The study was conducted between March and April 2021 through two phases. Phase 1 included a cross-sectional study using a self-administered questionnaire with inquiries about different determinants of vaccine acceptance, hesitancy, and barriers, which was completed either electronically in a Google form or a hard printed copy. Phase 2 included four focus group discussions to explore the determinants in depth.

RESULTS

The mean age of participants was 33.9 ± 7.9 years, 70% were females, 51.2% were nurses, and 28.6% were physicians. Of the 500 HCWs, only 27.8% accepted taking the vaccine immediately, 49.2% refused, and 23% were hesitant. Vaccine safety was the highest associated factor with vaccine acceptance (odds ratio (OR) = 6.3, 95% confidence interval (CI) 3.132-12.619), followed by previous uptake of influenza vaccine (OR = 3.3, 95% CI 2.048-5.217) and vaccine effectiveness (OR = 2.6, 95% CI 1.282-5.262). The main barriers to vaccine acceptance were mistrust in governmental policies during the pandemic or in the healthcare facility they work in. Hesitancy was common among females and nurses and was attributed to three prominent factors, including safety concerns, negative stories, and personal knowledge.

CONCLUSIONS

The vaccine acceptance frequency among HCWs was considered low, as the majority either refused or was hesitant about taking the vaccine. Concerns about vaccine safety and effectiveness were significant determinants of vaccine acceptance. Factors related to trust were the main barriers to vaccine uptake. The health authority should establish a surveillance system for side effects of the COVID-19 vaccine and communicate this information between HCWs to decrease their worries about safety and increase vaccine uptake.

Adverse reactions of different COVID-19 vaccines among healthcare professionals: A qualitative study in Mosul, Iraq

Background

COVID-19 disease was highly infectious causing a declaration of a global pandemic and the scientists believed that developing a safe and effective vaccine was the solution. Various vaccine candidates were announced by different health authorities. Many factors affect the acceptance of vaccines. This study aims to explore the perceptions, attitudes, and expectations of healthcare professionals (HCPs) toward COVID-19 vaccines.

Method

A qualitative study approach was conducted by using face-to-face semi-structured interviews with HCPs in Mosul city, Iraq.

Results

Twenty-five HCPs participated in the interviews. After qualitative analysis four main themes emerged: perception of vaccines; participants believed that vaccines were vital inventions, motivations to take the vaccine; most HCPs were motivated based on the scientific evidence regarding COVID-19 vaccines, expectations about the safety and efficacy of COVID-19 vaccines; participants had different opinions based on the type of the vaccine and the available data, side effects experienced; severe side effects were expected but only mild adverse reactions were experienced by the majority.

Conclusion

HCPs had good knowledge about COVID-19 vaccines which was not affected by rumors and misinformation. In contrast to their expectations, the experienced side effects of the first and the second doses were mild to moderate in severity. The majority of HCPs based their choice of the vaccine on the efficacy and safety profile of the available options.

COVID-19 Vaccination and Mental Stress within Diverse Sociodemographic Groups

In this study, we surveyed 635 participants to determine: (a) major causes of mental stress during the pandemic and its future impacts, and (b) diversity in public perception of the COVID-19 vaccination and its acceptance (specifically for children). Statistical results and intelligent clustering outcomes indicate significant associations between sociodemographic diversity, mental stress causes, and vaccination perception. For instance, statistical results indicate significant dependence between gender (we will use term 'sex' in the rest of the manuscript) and mental stress due to COVID-19 infection (p = 1.7 × 10^-5). Over 25% of males indicated work-related stress compared to 35% in females, however, females indicated that they were more stressed (17%) due to relationships compared to males (12%). Around 30% of Asian/Arabic participants do not feel that the vaccination is safe as compared to 8% of white British and 22% of white Europeans, indicating significant dependence (p = 1.8 × 10^-8) with ethnicity. More specifically, vaccination acceptance for children is significantly dependent with ethnicity (p = 3.7 × 10^-5) where only 47% participants show willingness towards children's vaccination. The primary dataset in this study along with experimental outcomes identifying sociodemographic information diversity with respect to public perception and acceptance of vaccination in children and potential stress factors might be useful for the public and policymakers to help them be better prepared for future epidemics, as well as working globally to combat mental health issues.

COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.

Causes of Vaccine Hesitancy in Adults for the Influenza and COVID-19 Vaccines: A Systematic Literature Review

Background: Vaccine hesitancy was labelled as one of the top ten threats to global health by the World Health Organization in 2019 and is associated with negative health outcomes. Previous reviews on cause of vaccines have not included vaccine hesitancy related to the COVID-19 vaccine. This review aimed to fill this gap by synthesising the findings of studies identifying causes of vaccine hesitancy to the COVID-19 and influenza vaccines. Methods: A systematic literature review was conducted. Searches were carried out in the PubMed, EMBASE and Cochrane databases. Following data extraction, a thematic analysis was conducted of the causes of vaccine hesitancy in adults for the influenza and COVID-19 vaccines. Results: Fourteen papers were included. Four themes were identified as causes of vaccine hesitancy comprising: concerns over safety, lack of trust, lack of need for vaccination and cultural reasons. While concerns over safety were found in all countries, some of these were specific to particular countries and cultures. Our findings suggest that scientific knowledge of vaccines and size of clinical trials during their development reduce vaccine hesitancy. However, pharmaceutical companies were not a trusted source of information. Conclusion: Our findings build on those of previous research to suggest specific information that may be helpful in addressing vaccine hesitancy. Targeted approaches from trusted sources are needed to address specific safety concerns.

COVID-19 vaccine hesitancy and its associated factors in Malaysia

The success of the COVID-19 vaccination programme to achieve herd immunity depends on the proportion of the population inoculated. COVID-19 vaccination hesitancy is a barrier to reaching a sufficient number of people to achieve herd immunity. This study aims to determine the prevalence of COVID-19 vaccine hesitancy and to identify the reasons contributing to vaccine hesitancy using the Theory of Planned Behavior. A cross-sectional online survey was conducted between May 2021 to June 2021. Using exponential non-discriminative snowball sampling, participants were recruited via social media and telecommunication platforms. We used a questionnaire that obtained information on participant socio-demographics, vaccine hesitancy, pseudoscientific practices, conspiracy beliefs, subjective norms, perceived behavioural control, main reasons for not intending to get the COVID-19 vaccine; influential leaders, gatekeepers and anti-or pro-vaccination lobbies; and global vaccine hesitancy. A total of 354 responses (mean age = 32.5 years old ±13.6; 70.3% females) were included for analysis. The prevalence of COVID-19 vaccine hesitancy was 11.6%. COVID-19 vaccine hesitancy was significantly and positively associated with those who agreed with influential leaders, gatekeepers, and anti- or pro-vaccination lobbies (adjusted B coefficient = 1.355, p = 0.014), having a “wait and see” attitude to see if the COVID-19 vaccine is safe (adjusted B coefficient = 0. 822, p <0.001), perceiving that the vaccine will give them COVID-19 (adjusted B coefficient = 0.660, p <0.002), planned to use masks/others precautions instead (adjusted B coefficient = 0.345, p = 0.038) and having higher scores in conspiracy beliefs (adjusted B coefficient = 0.128, p <0.001). Concern about the costs associated with the vaccine (adjusted B coefficient = -0.518, p <0.001), subjective norms (adjusted B coefficient = -0.341, p <0.001), and perceived behavioural control (adjusted B coefficient = -0.202, p = 0.004) were negatively associated with vaccine hesitancy. COVID-19 vaccine hesitancy in Malaysia is low. Several factors were identified as being associated with vaccine hesitancy. Factors associated with vaccine hesitancy would be useful in tailoring specific interventions involving positive messages by influential leaders, which address vaccine misinformation and the wait-and-see attitude which may delay the uptake of COVID-19 vaccines.

A qualitative study of pregnant women's opinions on COVID-19 vaccines in Turkey

Objectives

to examine pregnant Turkish women's opinions on COVID-19 vaccines.

Design

a qualitative approach was used to gather data through semi-structured interviews.

Participants and setting

16 women about to receive a vaccine during their pregnancy and who did or did not experience vaccine hesitancy participated.

Analysis

qualitative content analysis.

Findings

three main themes emerged regarding the pregnant women's opinions on COVID-19 vaccines: fear, security/insecurity and social support.

Key conclusions and implications for practice

pregnant women mostly recalled their babies and fears about COVID-19 vaccines. Although the fear of vaccines created vaccine hesitancy during pregnancy, the fear of contracting COVID-19 led to a positive attitude to the vaccines. It is critical to provide pregnant women with information about COVID-19 and vaccines for the disease in order to enhance vaccination rates among pregnant women.

COVID-19 vaccine knowledge, attitudes, perceptions and uptake among healthcare workers of Pune district, Maharashtra

Background

Healthcare workers play a vital role in vaccine promotion and acceptance through community dialogue, education, and myth-busting. Vaccinated healthcare workers will likely recommend the vaccine to their families and community.

Methods

A cross-sectional study was conducted with healthcare workers (n=357) to understand their knowledge, attitudes, perceptions, and acceptance of the coronavirus disease 2019 (COVID-19) vaccine. The study was conducted in two blocks (Haveli and Velhe) of Pune, Maharashtra.

Results

The findings showed that over 90% of healthcare workers knew about COVID-19 vaccination and had a positive attitude towards COVID-19 vaccination. Among them, vaccine uptake was high (93% with two doses and 4% with a single dose). 98% of healthcare workers believed that vaccine is safe to use. However, few gaps existed around vaccine safety, side effects and allergic reactions, as 27.7% believed that the COVID-19 vaccine could increase the risk of allergic reactions, 51.8% believed that acquiring natural immunity by contacting the virus is better than vaccination, 16.5% believed that it is possible to reduce the incidence of COVID-19 without vaccination, 28.9% believed that vaccine might have side effects and 14% believed vaccine is not the most likely way to control the pandemic.

Conclusions

Addressing the existing gaps and reinforcing the relevance of the COVID-19 vaccine through a structured program is critical to empower health workers to disseminate accurate information to the community, consecutively improve vaccination uptake, and boost vaccination efforts in India.

Listening to Voices from African American Communities in the Southern States about COVID-19 Vaccine Information and Communication: A Qualitative Study

The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo 12. Participants worked primarily in colleges, churches, and health agencies. We found that the challenges of accessing reliable vaccine information in AA communities primarily included structural barriers, information barriers, and a lack of trust. Community stakeholders recommended recruiting trusted messengers, using social events to reach target populations, and conducting health communication campaigns through open dialogue among stakeholders. Health communication interventions directed at COVID-19 vaccine uptake should be grounded in ongoing community engagement, trust-building activities, and transparent communication about vaccine development. Tailoring health communication interventions to different groups may help reduce misinformation spread and thus promote vaccination in AA communities in the southern states.

Barriers and Facilitators to Receiving the COVID-19 Vaccination and Development of Theoretically-Informed Implementation Strategies for the Public: Qualitative Study in Hong Kong

Objectives: enhancing uptake of COVID-19 vaccines is an important tool for managing the pandemic. However, in Hong Kong, the COVID-19 vaccination rate in the general population was unsatisfactory during the early phase of the vaccination program. This two-part study aimed to (i) identify barriers and facilitators to receiving vaccinations, and (ii) develop theoretically-informed implementation strategies for promoting uptake. Methods: in part 1, 45 Hong Kong residents who differed in their willingness to vaccinate (willing (n = 15), were unwilling (n = 15), and were hesitant (n = 15)), were interviewed individually in February 2021. They were invited to express their perceptions of receiving the COVID-19 vaccination. The theoretical domains framework (TDF) was applied to guide the interviews and analyses. Behavioral diagnoses from these findings were then used to develop theoretically-informed implementation strategies in part 2, composed of behavior change techniques (BCTs) informed by the established BCT taxonomy. Results: in part 1, the five main barriers were (i) concerns on severe and long-term side effects; (ii) low confidence in the safety and effectiveness due to concerns of their accelerated development; (iii) unclear information on logistical arrangements of the vaccination program; (iv) insufficient data on safety and effectiveness; and (v) perceived low protection ability conferred by the vaccines. The five main facilitators included (i) healthcare professionals’ recommendations; (ii) news from TV, radio, and newspapers as main sources of trustworthy information; (iii) vaccine-related health education delivered by healthcare professionals; (iv) expectations of resuming to a normal social life; and (v) perceived benefits outweighing risks of mild and short-term side effects. Conclusions: seven implementation strategies were developed in part 2 based on the results above, namely (i) providing trustworthy vaccine-related information and scaling up the promotion; (ii) encouraging healthcare professionals to recommend vaccinations; (iii) giving incentives; (iv) using social influence approaches; (v) allowing a selection of COVID-19 vaccine brands; (vi) increasing accessibility for vaccinations; and (vii) emphasizing social responsibility.

Acceptance or Rejection of the COVID-19 Vaccine: A Study on Iranian People's Opinions toward the COVID-19 Vaccine

We aimed to assess the Iranian people’s attitude and confidence in the COVID-19 vaccine, their concerns about the safety of vaccines, and their reasons for accepting or rejecting the COVID-19 vaccine. We conducted a web-based cross-sectional study with a mixed qualitative−quantitative approach from December 2020 to February 2021. Our questionnaire consisted of a COVID-19 vaccine attitude questionnaire, a COVID-19 vaccine confidence inventory, a modified vaccine safety scale, and questions about participants’ decision to accept or refuse the COVID-19 vaccine, and their explanations for their decisions. The research included 1928 people with an average age of 34.88 years with 1236 (64.1%) being female. A total of 1330 participants desired to have the COVID-19 vaccine (69%). Female gender, lower educational levels, following COVID-19 news through sources other than websites and social media, not following COVID-19 news, and loss of a first-degree relative due to COVID-19 were all associated with a more negative attitude toward the COVID-19 vaccine (p < 0.01). To conclude, the acceptance rate of the COVID-19 vaccine among Iranians is comparable to the international average; however, it is still unfavorable. There are serious challenges to the vaccination program in Iran, such as older adults’ lower intention to undergo the COVID-19 vaccine and misinformation.

Perceptions of and hesitancy toward COVID-19 vaccination in older Chinese adults in Hong Kong: a qualitative study

Background

COVID-19 vaccination is recommended for older adults by the World Health Organization. However, by July 15, 2021, only 26% of individuals over 60 years old in Hong Kong had received a first dose of the vaccine. The health belief model and the theory of planned behavior have been used to understand the determinants for COVID-19 vaccination in past literature. However, vaccination determinants can be complex and involve social and cultural factors that cannot be explained by micro-individual factors alone; hence, the health belief model and the theory of planned behavior cannot provide a complete understanding of vaccine hesitancy. Few studies on the barriers to, hesitancy toward, and motivations for COVID-19 vaccination among older Chinese adults have been performed. The aim of this study is to fill this gap by conducting a comprehensive analysis of this subject using the critical medical anthropology framework, extending the health belief model and the theory of planned behavior in understanding vaccination determinants among the older adult population.

Methods

Between November 2020 and February 2021, 31 adults (24 women and 7 men) over the age of 65 took part in semi-structured, one-on-one interviews. The data we gathered were then analyzed through a phenomenological approach.

Results

Two major themes in the data were examined: barriers to vaccination and motivations for vaccination. The participants’ perceptions of and hesitancy toward vaccination demonstrated a confluence of factors at the individual (trust, confidence, and social support networks), microsocial (stigma toward health care workers), intermediate-social (government), and macrosocial (cultural stereotypes, civic and collective responsibility, and economic considerations) levels according to the critical medical anthropology framework.

Conclusions

The decision to receive a COVID-19 vaccination is a complex consideration for older adults of low socioeconomic status in Hong Kong. Using the critical medical anthropology framework, the decision-making experience is a reflection of the interaction of factors at different layers of social levels. The findings of this study extend the health belief model and the theory of planned behavior regarding the understanding of vaccination perceptions and relevant behaviors in an older adult population.

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

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

Awareness, Beliefs and Perspectives Regarding Weight Retention and Weight Gain among Postpartum Women in India: A Thematic Analysis of Focus Group Discussions and In-Depth Interviews

Background and Aims

The pregnancy weight is usually retained in the form of abdominal fat during the postpartum period. The willingness to lose weight is influenced by knowledge, attitude, beliefs and practices. This study aims to comprehend the awareness, beliefs and perspectives of postpartum women regarding their perceived factors, barriers and facilitators associated with post-pregnancy weight status.

Methods

Overweight and obese postpartum women aged between 20 and 40 years and had delivered an infant in the last 2 years were recruited via convenience and purposive sampling techniques. The final sample comprised 27 participants with a mean age of 29.96 ± 4.50 years. Four focus group discussions and eight in-depth interviews carried out were audio-recorded and transcribed verbatim. Codes, sub-themes and themes were generated using Atlas.ti 9 software.

Results

Major themes identified were perceived factors causing postpartum weight retention/weight gain including social and cultural beliefs related to diet and exercise specifically associated with this period, perceived motivators and deterrents of weight loss including eagerness to lose weight and perceived facilitators and barriers to weight loss including intrinsic and extrinsic factors such as time, energy, evidence-based knowledge about diet and physical activity, family support and obligation to family’s advice.

Conclusion

The unique challenges and barriers associated with postpartum weight loss efforts should be taken into consideration by healthcare professionals and public health policy-makers to design strategies specific to postpartum women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-022-01644-9.

Perceived risk factors for weight gain, barriers, and facilitators related to weight loss experienced by perimenopausal women: focus group discussion and thematic analysis

OBJECTIVE

This study aims to understand middle-aged perimenopausal women's perspectives and beliefs regarding their body weight status, and evaluate the barriers, and facilitators associated weight loss.

METHODS

Five focus group discussions were conducted with perimenopausal women (aged 40-55 y) who were recruited through convenience and snowball sampling. Discussions were conducted to understand their experiences related to weight management during the perimenopausal period. The discussions were audio-recorded and transcribed and data analysis was done using Atlas.ti software to generate codes, subthemes, and themes from the discussions.

RESULTS

A total of 23 women with a mean age of 46.6 ± 5.6 years were recruited. Several themes of risk factors of weight gain emerged like difficulty in physical activity, unhealthy eating, overeating, and religious and cultural practices. Appearance and prevention of health-related issues emerged as motivators of initiating weight loss. Barriers faced during weight loss included themes like difficulty in managing diet and activity, stress, socialization, and lack of time. Facilitators of weight loss included intrinsic motivation, experiencing early results and confidence in self-regulation.

CONCLUSION

Women during their perimenopausal phase of life encounter a range of barriers and challenges related to weight loss. An understanding of these barriers might be useful to consider while planning strategies to regulate their weight.

Evaluating COVID-19 vaccine hesitancy: A qualitative study from Vietnam

BACKGROUND AND AIMS

Vaccine hesitancy is a major threat to COVID-19 vaccination programs. This study aimed to examine the public attitudes towards COVID-19 vaccines, the variance of these attitudes, and associated determinants within a large COVID-19 outbreak in Vietnam.

METHODS

Two focus group discussions were conducted online with 20 people from different socio-economic and profession backgrounds. Purposive sampling was used to recruit participants. Discussions were recorded and transcribed verbatim. Key themes were extracted using reflexive thematic analysis method.

RESULTS

Four distinct, non-static attitudes including acceptance, conditional acceptance, hesitancy, and anti-vaccination were found. Themes identified as determinants of these attitudes were external factors, internal factors, and risk-benefit self-assessment regarding COVID-19 vaccination.

CONCLUSIONS

We found mixed, non-static COVID-19 vaccination attitudes. People's vaccination risk-benefit self-assessment greatly determines the variance of their attitudes over time. Given high public trust in the authorities, the government should take the lead to counter COVID-19 vaccine misinformation. To increase acceptance, vaccine advertising campaigns should focus on providing information about the dangers of COVID-19, the ability to manage side-effects at the vaccination centers, and updated, precise information on both the outbreak and vaccines. Future research is needed to identify the public most common COVID-19 information channels to enable effective community education.

Reported Side Effects of COVID-19 Vaccination among Adults in Saudi Arabia: A Cross-Sectional Study

Background

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, is a major international crisis. Although vaccination is the only hope to end this pandemic, adverse effects attributable to vaccines are still being reported. Active surveillance is critical for generating near-real-time, high-quality evidence for potential safety hazards, allowing us to respond quickly to vaccination

Purpose

To investigate the prevalence of side effects following COVID-19 vaccination with Oxford–AstraZeneca among adults in northwestern Riyadh Province, Saudi Arabia.

Methods

This is a cross-sectional and community-based study performed among individuals who had received any type of COVID-19 vaccination. A convenience sampling method was used to collect data using an online survey.

Results

A total of 222 individuals responded to the survey, and the majority frequently reported both localized and systemic side effects after vaccination. The most reported side effects include pain at the site of injection, myalgia, headache, and fever. Some demographic factors were significantly associated with the reported post-vaccination side effects.

Conclusion

The most prevalent side effects experienced by individuals after receiving the COVID-19 vaccine were determined in this study. Prior to the administration of a vaccination, counseling programs should be established to help people understand and deal with the possible side effects, with a special focus on demographic differences.

Community voices around COVID-19 vaccine in Chennai, India: A qualitative exploration during early phase of vaccine rollout

Background & objectives

Globally, vaccination is considered as an important public health strategy to mitigate the impact of the COVID-19 pandemic. The purpose of the current study was to conduct an in-depth inquiry to explore perceptions of community members around COVID-19 vaccines in the southern city of Chennai, Tamil Nadu. This was conducted during the early phase of the vaccine rollout programme in India.

Methods

A qualitative investigation was conducted between January-February 2021 through in-depth interviews. Healthcare workers, religious leaders, community influencers, local administrators and representatives of marginalized communities were included. The key informant interview guides and probes explored five domains; (i) vaccine availability, (ii) trust in COVID-19 vaccines, (iii) vaccine-related concerns, (iv) health/risk balance and (v) vaccine prioritization. Transcripted interviews were coded using a thematic approach and analyzed manually as well as with the help of ATLAS.ti 9 software.

Results

Eagerness to receive COVID-19 vaccines amongst some of the respondents was linked with freedom from fear, possible restoration of normalcy, protection of family and ability to travel and work abroad. Concerns around threat of emergence of new variants, damage caused by such viral mutants and trust in policymakers were other facilitatory influencers for vaccine uptake. On the other hand, doubts surrounding safety and fear of side effects of COVID-19 vaccine were the feeders to vaccine hesitancy. Lack of accurate information, sensational media reports and rumours exacerbated this fear and provoked anxiety among people. Apprehensions around COVID-19 vaccine in the wake of its rapid development and approval for use and reluctance to take it during the declining phase of the epidemic were identified as other inhibitory factors. Participants underlined the importance of having responsive communication strategies in place focussing on vaccine safety. Making vaccines available to people free of cost and ensuring wider access were other programmatic suggestions.

Interpretation & conclusions

In conclusion, our study findings suggest that it is essential to remain engaged with communities and execute evidence-based information dissemination strategy about the safety and efficacy of the vaccines. We identified that it is also imperative to sensitize and train media professionals on how to report side effects related to vaccines. Responsive communication strategies will thus have the potential to serve as a key public health approach pertaining to future pandemic preparedness as well as to manage the demands of clinical and public health issues in an ongoing pandemic situation.

Predictors and Perceptions of Healthcare Workers Regarding Vaccines Safety in the Initial Phase of COVID-19 Vaccination Drive in Western Part of India: A Regression Analysis

Background

The COVID-19 vaccination was launched in a phased manner by the government of India prioritizing healthcare workers. This study assessed the perception of healthcare workers regarding COVID-19 vaccination.

Methods

This cross-sectional study was conducted among healthcare workers vaccinated at a tertiary care center of southern Rajasthan. Logistic regression analysis was used to note the association of perception regarding vaccine safety and other variables.

Results

Out of 3,102, 56.8% were male, and the majority (73.7%) were in the age range of 20-35 years. Out of the total, 80.7% and 73.2% of subjects perceived the vaccine as safe and effective, respectively. The perception regarding the timing of rolling out of vaccine and readiness for COVID-19 appropriate behavior after vaccination was statistically significant (p<0.001). The commonest undesirable effect following vaccination was pain at the injection site. Most of the subjects did not report undesirable effects following vaccination. Logistic regression analysis showed that the involvement in the direct care of COVID-19 patients (OR: 1.58; 95% CI: 1.29, 1.94), the experience of COVID-19 infection in the past (OR: 0.68; 95% CI: 0.50, 0.91), the timing of the rollout of vaccine (OR: 3.60; 95% CI: 3.24, 4.10) showed a significant association with perception of the safety of COVID-19 vaccine.

Conclusions

The vaccine was perceived safe and effective by healthcare workers and reported minimal undesirable effects. The COVID-19 vaccine safety is also dependent on the past COVID-19 infection, involvement in patient care, and time of rollout of the vaccine.

Development and validation of comprehensive evaluation tool for weight management at menopausal transition and early menopause stage

Objective:

To develop and validate a comprehensive questionnaire to evaluate risk factors, perceptions, and practices for weight management in women at menopausal transition and early menopause stage.

Methodology:

A mixed-method study was conducted in two phases. In the first phase, the questionnaire was developed by literature review and focused group discussions with the target population and experts. In the second phase, content and face validity were established by expert evaluation and cognitive interviews with the target population. The developed questionnaire was crosssectionally administered in 215 women and responses were used to determine the construct validity by factor analysis and reliability by evaluating internal consistency.

Results:

The finalized questionnaire consisted of two sections; section A included sociodemographic characteristics, anthropometric measures, and menopausal status with symptom severity, while section B contained 32-items focusing on readiness to initiate weight loss, perceptions and practices related to lifestyle behaviors, built environment, and social support. The Cronbach's α value of the questionnaire is 0.79 with good internal consistency.

Conclusion:

The developed questionnaire is a valid and reliable tool to assess weight-related risk factors, perceptions, and practices in middle-aged women, which can potentially be used by doctors and other healthcare practitioners to customize weight management advice in women at menopausal transition and early menopause.

COVID Appropriate Behavior Compliance and Vaccine Hesitancy: Findings From a COVID-19 Health Education Campaign in a Government Tertiary Care Hospital in Delhi, India

Public health measures remain the best available approach to tackle the coronavirus disease 2019 (COVID-19) pandemic. However, little is currently known about the compliance and acceptance of these measures by people in India. The Department of Community Medicine at Vardhman Mahavir Medical College (VMMC), and Safdarjung Hospital, a tertiary care hospital in New Delhi, organized a health education campaign for raising awareness on COVID-19 in the hospital premises over a period of 15 d in May 2021. Educational and interactive sessions were conducted by medical residents, interns, and staff. Data on compliance to public health measures were collected and analyzed using SPSS 21. All quantitative variables were descriptively analyzed while qualitative data were narratively analyzed. A total of 84 (12.57%) of those observed were wearing their mask incorrectly. Social distancing was inadequate at 16 sites. Sixty-nine (10.33%) reported to have received single or both doses of vaccine. Common reasons for not getting vaccinated included doubts about vaccine efficacy, eligibility, adverse events, availability, and accessibility. Mask use was universal, but directives on correct protocol of wearing masks needs to be widely circulated. Credible information about vaccine safety, efficacy, availability, and accessibility needs to be available to the community to build confidence in COVID-19 vaccination.

A cross sectional study exploring determinants for vaccine awareness, belief and hesitancy among health care professionals regarding Covid-19 vaccine, findings from a teaching hospital based in coal capital of India

Background:

India intends to start its 1^st dose of vaccination against Covid-19 on January 16^th, 2021 prioritizing its frontline health care professionals with either of the two vaccines—Covaxin or Covishield. Whenever a new vaccine is launched, it is marred with controversy and myths. To understand the doubts and concerns better, this study was conducted on health care professionals working in a tertiary care hospital.

Materials and Methods:

Willing respondents, who are working in the institute, were administered the questionnaire asking their views on knowledge, beliefs, and reasons for hesitancy regarding Covid-19 immunization. A Likert scale was used to quantify the responses regarding participants’ knowledge, beliefs, and hesitancies regarding immunization with the available vaccines. Data were analyzed using MS office Excel sheets and JASP software was used to analyze the data thus obtained.

Results:

Out of 122 complete responses, we had 73 (60%) doctors, while 30 (24%) were nursing staff, the rest comprised of other health care workers, such as housekeeping staff, janitorial, etc., 66 (54%) respondents were unaware, while 25 (20%) respondents had hesitancy and 23 (18%) were having extremely negative views regarding vaccination. Some of the variables, such as age, role, marital status, gender, etc., were found to be possibly associated with these scores.

Conclusion:

Issues like concerns over vaccine safety, efficacy, reliability, etc., are deterrents for individuals and whole programme and vaccination drive across the nation. Time and again it has been seen that despite the vaccines’ contribution in breaking the transmission, concerns are making people either hesitant or unmotivated to get the vaccines. More dialogues from the authorities regarding the issues of concern may pave the way for more motivation to accept vaccination and increase the vaccination coverage.

Evaluation of the dose-effect association between the number of doses and duration since the last dose of COVID-19 vaccine, and its efficacy in preventing the disease and reducing disease severity: A single centre, cross-sectional analytical study from India

AIMS

To evaluate the dose-effect association between COVID-19 vaccination and probability of turning RT-PCR positive and to assess the correlation between disease severity and vaccination status.

METHODS

A single centre cross-sectional study was conducted amongst 583 individuals presenting to COVID-19 testing clinic and 55 hospitalized COVID-19 patients. Vaccination status was assessed by the number of doses and duration since the last dose. Disease severity was evaluated by the requirement of hospitalisation and ICU admission/death. The association between the vaccination status and development of disease and its severity were statistically analyzed.

RESULTS

The mean age of the population was 36.6 years and 82.6% had no comorbidities. The odds of turning RT-PCR positive was 0.17(95% CI: 0.11-0.27) among the clinical suspects who had taken both doses of the vaccine at least 14 days before (fully vaccinated). The odds of hospitalisation was 0.12(95% CI: 0.03-0.45) and ICU admission/death was 0.07(95% CI: 0.01-0.36) among fully vaccinated individuals. The protective role of vaccination was observed to start 14 days after receiving the first dose.

CONCLUSIONS

COVID-19 vaccination provides dose-dependent protection against the development of the disease. It also lowers the risk of hospitalisation and ICU admission/death in RT-PCR positive patients in a dose-dependent manner.

"The Risk Seems Too High": Thoughts and Feelings about COVID-19 Vaccination

The purpose of this study was to describe the thoughts and feelings of individuals expressing concerns about the COVID-19 vaccine. A qualitative descriptive study was conducted in order to examine the thoughts and feelings of participants who are hesitant about the COVID-19 vaccine. Data were collected from 754 participants using an online instrument. Emergent themes included a lack of knowledge about the safety of the COVID-19 vaccine; concerns over the speed of development, testing, and approval of these vaccines; reluctance to be among the first vaccinated; concerns about the motivations of government actors, pharmaceutical companies, and others involved in producing the COVID-19 vaccine; and hesitancy about vaccines generally.

Predictors of COVID-19 Vaccine Intention among the Saudi Arabian Population: A Cross-Sectional Survey

The long-term solution to managing the current COVID-19 pandemic is through mass immunization of the population. However, uncertainty or unwillingness to receive the vaccine could be a barrier in attaining sufficient vaccine coverage. Therefore, understanding the psychology of the population towards the vaccines against COVID-19 is of paramount importance. Our study was aimed at determining the predictors of COVID-19 vaccine intention in the Saudi Arabian population. A structured questionnaire guided by the 'Report of the SAGE working group on vaccine hesitancy' was administered during a span of two months among the general population from all administrative regions of Saudi Arabia, proceeding the launch of the vaccination campaign. In total, 879 out of 1600 subjects responded and completed the survey (response rate 54.9%). About 56 percent of the participants intended to be vaccinated. The predictors of a higher intention to vaccinate included those 50 years of age or older, male subjects, people suffering from systemic disease/s, subjects who were not previously infected with COVID-19, those who follow the updates about COVID-19 vaccines, and adults with a higher level of anxiety about contracting coronavirus (p < 0.05). Results from our study and other similar studies can aid policy makers and stakeholders in planning effective strategies based on the changing behavior of the population.

COVID-19 Vaccine Intention among Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey

The COVID-19 pandemic has caused largescale morbidity and mortality and a tremendous burden on the healthcare system. Healthcare workers (HCWs) require adequate protection to avoid onward transmission and minimize burden on the healthcare system. Moreover, HCWs can also influence the general public into accepting the COVID-19 vaccine. Therefore, determining COVID-19 vaccine intention among HCWs is of paramount importance to plan tailor-made public health strategies to maximize vaccine coverage. A structured questionnaire was administered in February and March 2021 among HCWs in Saudi Arabia using convenience sampling, proceeding the launch of the vaccination campaign. HCWs from all administrative regions of Saudi Arabia were included in the study. In total, 674 out of 1124 HCWs responded and completed the survey (response rate 59.9%). About 65 percent of the HCWs intended to get vaccinated. The intention to vaccinate was significantly higher among HCWs 50 years of age or older, Saudi nationals and those who followed the updates about COVID-19 vaccines (p < 0.05). The high percentage (26 percent) of those who were undecided in getting vaccinated is a positive sign. As the vaccination campaign gathers pace, the attitude is expected to change over time. Emphasis should be on planning healthcare strategies to convince the undecided HCWs into accepting the vaccine in order to achieve the coverage required to achieve herd immunity.

Ontological Analysis of COVID-19 Vaccine Roll out Strategies: A Comparison of India and the United States of America

The unprecedented outbreak of the COVID-19 pandemic has forced governments to devise national strategies to curtail its spread. The present study analyzes the national strategies of India and the United States for the COVID-19 vaccine roll out. The paper presents an ontology of COVID-19 vaccine roll out, maps the national strategies, identifies, analyzes the emphases and gaps in them, and proposes corrections to the same. The analysis shows that the national strategies are selective in their focus and siloed in their approach. They must be systematized to address the emerging challenges effectively. Thus, there is need for a systemic understanding and analysis to reinforce the effective pathways to manage vaccine roll out, reposition the ineffective ones, and engineer new ones through feedback and learning.

Development and validation of a questionnaire to assess knowledge, attitude, practices, and concerns regarding COVID-19 vaccination among the general population

BACKGROUND AND AIMS

There seems to be hesitation in the general population in accepting COVID 19 vaccine because of associated myths and/or misinformation. This study is dedicated to develop and validate a tool to interpret vaccine acceptance and/or hesitancy by assessing the knowledge, attitude, practices, and concerns regarding the COVID vaccine.

MATERIAL AND METHODS

Mixed methods study design was used. In phase 1, the questionnaire was developed through literature review, focus group discussion, expert evaluation, and pre-testing. In phase 2, the validity of the questionnaire was obtained by conducting a cross-sectional survey on 201 participants. The construct validity was established via principal component analysis. Cronbach's alpha value was used to assess the reliability of the questionnaire.

RESULTS

The 39-item questionnaire to assess the knowledge, attitude, practices, and concerns regarding the COVID-19 vaccine was developed. The Cronbach's alpha value of the questionnaire was 0.86 suggesting a good internal consistency.

CONCLUSION

The developed tool is valid to assess the knowledge, attitude, practices and concerns regarding the COVID-19 vaccine acceptance and/or hesitancy. It has the potential utility for healthcare workers and government authorities to further build vaccine literacy.