Parental health beliefs, intention, and strategies about covid-19 vaccine for their children: A cross-sectional analysis from five Arab countries in the Middle East

Navigating the shots: Parental willingness to immunize their children with COVID-19 vaccines in Saudi Arabia explored through a systematic review and meta-analysis

INTRODUCTION

Although COVID-19 vaccines have been recommended for children and adolescents since 2021, suboptimal vaccination uptake has been documented. No previous systematic review/meta-analysis (SRMA) investigated parents' willingness to administer COVID-19 vaccines for their children in Saudi Arabia. Accordingly, this SRMA aimed to estimate parents' willingness to immunize their children with COVID-19 vaccines in Saudi Arabia and to identify reasons and determinants influencing parents' decisions.

METHODS

This SRMA adhered to the PRISMA guidelines and the protocol was registered on PROSPERO (ID: CRD42023492760). An extensive systematic search was performed across electronic databases including Pub Med, Pub Med Central, ISI Web of science, Web of Science Core Collection, Medline, KCI-Korean Journal Database, ProQuest, and SciELO, to identify relevant studies published from January 1, 2020 to October 30, 2023. A random-effects model was utilized to estimate the pooled effects considering the expected variability across studies. Heterogeneity, risk of bias, publication bias and quality of studies were considered and evaluated by relevant appropriate tests to ensure robust results.

RESULTS

Twenty-five studies with 30,844 parents were included. The overall pooled rate of parents who intended to immunize their children with COVID-19 vaccines was 48.0% (95% CI: 41.0-54.0%) with high heterogeneity (I2 = 99.42%). The main reason for parents to vaccinate children was to protect child, family and community from COVID-19. Perceived efficacy/safety of vaccines were the most significant determinants associated with parents' willingness to vaccinate children.

CONCLUSION

This was the first SRMA from Saudi Arabia which emphasized the priority to focus on vaccine-related factors as main/key strategy of COVID-19 vaccines' drivers to convince parents in a logical way based on accurate cumulative and emerging scientific data about efficacy and safety of COVID-19 vaccines to optimize their uptake by children/adolescents. This SRMA can provide valuable insights for development of evidence-based policies to improve parental willingness to vaccinate children, which is crucial for controlling SARS-CoV-2 spread and promoting herd immunity in the community particularly if the virus continues to pose a major threat.

COVID-19 vaccine hesitancy and intentions among parents of children with mental and behavioral disorders

Parent vaccine hesitancy (PVH) remains a significant public health concern, particularly emphasized during the COVID-19 pandemic. This study investigates PVH among parents of children with various psychiatric and neurodevelopmental conditions, such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and behavioral disturbances, extending previous research focused on autism spectrum disorder (ASD). We examined PVH in children aged 5-11 years with psychiatric and behavioral disorders excluding ASD. A cross-sectional questionnaire-based analysis was conducted in Qatar, involving 244 parents of neurodiverse children and 245 parents of neurotypical children as controls. The Parent Attitudes about Childhood Vaccines (PACV) survey assessed PVH. Results indicated a significantly higher prevalence of vaccine hesitancy among parents of children with psychiatric disorders (54.1%, 95% CI [47.8%, 60.4%], n = 132) compared to controls (11.7%, 95% CI [7.5%, 16.0%], n = 26), p < .001. The PACV total score was significantly higher in parents of children with a mental disorder. Higher education among parents and lower PACV scores significantly influenced the intent to vaccinate against COVID-19. Tailored interventions by child and adolescent mental healthcare professionals, such as harnessing artificial intelligence to fight disinformation, are crucial to addressing vaccine hesitancy, enhancing acceptance, and improving outcomes for children with psychiatric disorders.

Unveiling the nexus! Understanding knowledge issues, animal contact patterns and interaction of health care providers in the context of monkeypox and COVID-19 during monkeypox outbreak 2022

BACKGROUND

A monkeypox (MPOX) outbreak occurred in May 2022. On June 3, 2022, the WHO Blueprint organized a consultation on MPOX research knowledge gaps and priority research questions because the engagement of health care providers (HCPs) in providing accurate information and the public's motivation to adapt protective behaviour were crucial. Thus, we conducted this study to explore the knowledge issues, animal patterns, and interactions of HCPs in the context of MPOX and COVID-19 during the MPOX outbreak.

METHODS

We conducted a cross-sectional web-based survey among 816 HCPs working in governmental health facilities from many countries, mainly Syria, Egypt, Saudi Arabia, and Cameroon, in September 2022.

RESULTS

Four hundred and sixty (56.37%) were aged between 18 and less than 35 years old. About 34.44% were physicians, while only 37.25% worked on the frontlines with patients. 37.99% and 5.88% received vaccinations against chickenpox and MPOX, respectively. In the meantime, 55.39% had taken courses or training programmes regarding COVID-19. Regarding knowledge-seeking behaviours (KSBs) about COVID-19, 38.73% were through passive attention, while only 28.8% got their information through active search. Most of the participants (56.86%) had a moderate level of knowledge regarding COVID-19. Only 8.82% had courses or training programmes regarding MPOX. Regarding KSB about MPOX, 50.86% were obtained through passive attention, while only 18.01% and 23.04% got their information through active and passive search, respectively. Most of the participants (57.60%) had a poor level of knowledge regarding MPOX. The regression analysis of the MPOX knowledge score revealed that individuals working on the frontlines with patients and those who had training programmes or courses were shown to have a higher score by 1.25 and 3.18 points, respectively.

CONCLUSIONS

The studied HCPs had poorer knowledge about the MPOX virus than they did about the SARS-CoV-2 virus. Training programmes and education courses had an impact on their knowledge.

Healthcare workers' perceptions and acceptance for COVID-19 vaccine for their children aged <18 years from the Region of Eastern Uttar Pradesh, India

Background

The coronavirus disease 2019 (COVID-19) vaccination program among adults in India is one of the highly successful vaccination drives globally, but the acceptance of the COVID-19 vaccine among parents for their children is largely unknown. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and acceptance for COVID-19 vaccination for children in India.

Aim

To assess parental perceptions and acceptance for COVID-19 vaccination for their children (aged <18 years).

Materials and Methods

A cross-sectional anonymous web-based survey was designed and conducted from November 1 to December 15, 2022. All the healthcare workers of a tertiary care institute in eastern Uttar Pradesh, having a child aged <18 years, constituted the study population and were invited. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Bivariate analysis was performed to determine the predictors of child vaccination acceptance among the parents.

Results

A total of 388 healthcare worker parents (HCWPs) having a child <18 years of age completed the survey. The mean age of the parents was 40.28 ± 11.34 years. The majority (96.9%) of them had already received the recommended two doses of the COVID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for children's health, whereas 89% agreed that COVID-19 vaccines are effective. A total of 356 (91.7%) parents were willing to vaccinate their children with a COVID-19 vaccine, of which 91.3% intended to do so as soon as possible. The factors significantly associated with the stated willingness for child vaccination among the participants were younger age (P = 0.008), female gender (P = 0000), currently married status (P = 0.00001), urban residence (P = 0.01), lower monthly income (P = 0.03), absence of any chronic illness (P = 0.0003), history of COVID-19 in the child (P = 0.004), and the child being up-to-date with the routine childhood vaccines (P = 0.01).

Conclusion

The HCWPs from eastern Uttar Pradesh, India, have a positive attitude and low vaccine hesitancy toward COVID-19 vaccination for children, with around 92% currently willing to vaccinate their children with COVID vaccine. Further longitudinal studies are required to assess the trend of parental acceptance of COVID vaccine.

The Social Ecology of Health Beliefs and Misinformation Framework: Examining the impact of misinformation on vaccine uptake through individual and sociological factors

BACKGROUND

Misinformation presents a critical concern for academic and public health discourse, particularly around vaccine response. Before the COVID-19 pandemic, vaccine hesitancy was responsible for decreased immunization uptake for vaccine-preventable diseases. Misinformation connected to the novel COVID-19 vaccine has further fueled vaccine hesitancy in Colorado and the United States. Our study brings together three different perspectives - physicians, public health professionals, and parents - to understand the impact of misinformation on vaccine uptake in Colorado. Our study proposes a framework for combining the Health Belief Model with the Socio-Ecological model to account for societal factors in healthcare decision making.

METHODS

Semi-structured interviews and focus groups with public health professionals, physicians, and parents (n = 31) were conducted in late spring and summer 2022. Data were coded inductively using thematic analysis. Identified themes were deductively categorized according to the Socio-Ecological Model and Health Belief Model.

RESULTS

Using a theoretical framework that combined the Health Belief Model and the Socio-Ecological Model, we identified seven factors that influenced vaccine hesitancy in Colorado. Intrapersonal factors included routine vaccine hesitancy connected to perceptions of severity and susceptibility, efficacy, and benefits and barriers to vaccine uptake; interpersonal factors included social networks; institutional factors included mass mediated platforms, portrayals of uncertainty, distrust in institutional sources of information, and political influences in vaccine decision making; and structural factors included economic barriers behind vaccine hesitancy.

CONCLUSIONS

Our study provides a unique, triangulated, post-positivist perspective on the role of misinformation in vaccine hesitancy in Colorado. The findings provide evidence that misinformation is an important barrier to vaccination uptake and can permeate multiple socio-ecological determinants/characteristics to influence vaccination behaviors including intrapersonal, interpersonal, institutional, and structural levels. We introduce the Social Ecology of Health Beliefs and Misinformation Framework to account for how misinformation may interrupt vaccine uptake.

Lessons Learned from the Pandemic in the UAE: Children COVID-19 Vaccine Hesitancy and Its Impact on the Choice of Distance versus Face-to-Face Learning Modalities: An In-Depth Analysis of a National Study

This study addresses the crucial aspect of childhood COVID-19 vaccination and its impact on parental decisions concerning learning modalities during the pandemic. This study aimed to gauge parental hesitancy towards vaccinating their children and its influence on choosing between distance and face-to-face learning options. Following STROBE guidelines for cross-sectional studies, this study surveyed 1973 parents in the United Arab Emirates using Google Forms during the COVID-19 pandemic. The results revealed that while more than half of the parents (51.6%) were willing to vaccinate their children if the COVID-19 vaccine was accessible and affordable, a significant majority (91.2%) expressed concerns about the rapid vaccine development process, which was the primary reason for vaccine rejection. Interestingly, a sizable portion (55.3%) had experienced online learning in the previous academic term, and, of those, 59.6% believed it negatively influenced their children's academic performance. Consequently, 66.4% expressed intent to shift their children back to face-to-face learning once feasible. Significantly, parents with medical backgrounds were more inclined (91.6%) to opt for face-to-face schooling compared to those without such backgrounds. Logistic regression analysis indicated associations between sociodemographic characteristics, educational level and background, and the decision to return children to face-to-face learning. Interestingly, when it comes to vaccine hesitancy, a noteworthy connection exists between the parents' reluctance to vaccinate their children and their preference for distance learning. In fact, parents who responded negatively to vaccinating their children against COVID-19, if the vaccine was available, showed a clear preference for the distance learning modality (p-value < 0.0001). This study underscores the complex interplay of factors and community perspectives shaping parental acceptance of childhood COVID-19 vaccination. The development pace of vaccines significantly influences parents' attitudes and beliefs about vaccination programs. Parents' medical backgrounds exhibit a clear correlation with their perceptions of sending children back to school safely. This highlights the potential impact of parental medical knowledge on decision making, emphasizing the need to consider parents' professional backgrounds when devising education- and vaccination-related policies.

Determinants of influenza and COVID-19 vaccine intent or uptake in Lebanon: a scoping review of the literature

BACKGROUND

Vaccination is essential to protect from influenza and recently from COVID-19, yet uptake in Lebanon is suboptimal. Several factors determine uptake including knowledge, attitude and policies. We conducted a scoping review of the literature to explore the determinants of influenza and COVID-19 vaccine intent or uptake in Lebanon.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, thirty one peer reviewed studies indexed in six databases Pub Med, EMBASE, Scopus, CINAHL, Medline, and the Cochrane Library were screened. Two students, a senior Librarian and an Associate Professor in nursing searched for eligible studies. The library search strategy followed a combination of three broad concepts (viral influenzas; vaccines; Lebanon). The search timeframe was up till December 31, 2022. Determinants of influenza and COVID-19 vaccine intent or uptake were categorized following the constructs of the Theory of Planned Behavior.

RESULTS

Nine studies investigated influenza vaccine intent or uptake among the public community, parents and healthcare workers. Twenty one studies investigated COVID-19 vaccine intent or uptake among the public community, older refugees, university students, patients with cancer, dentists, and social media users. One study investigated both types of vaccines. A conceptual model of the determinants of vaccine intent and uptake within the Lebanese context was developed. Various determinants included environmental factors, norms, knowledge, perceptions, attitudes, past experiences, behavioral control and hesitancy.

CONCLUSIONS

Research on vaccine intent and uptake in Lebanon is still in its infancy, while that of COVID-19 is on the rise. Multifaceted reasons behind the low vaccination rates were observed yet few attempts were made to target vulnerable groups. Further research studies are needed to target vulnerable groups.

Utilizing the theory of planned behavior to predict COVID-19 vaccination intention: A structural equational modeling approach

It is essential to achieve herd immunity in order to control the COVID-19 pandemic, and this requires a high level of vaccination rate. Despite the importance of vaccination, hesitancy and unwillingness in receiving the COVID-19 vaccine still exists. It is therefore crucial to comprehend the intentions of adults regarding COVID-19 vaccination, which is beneficial for establishing community immunity and an efficient future pandemic response. An online survey was administered to 2722 adults in Vietnam. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were used to test the reliability and validity of the developed scales. Then, structural equational modeling (SEM) was employed to test correlations. This study found that favorable attitudes toward COVID-19 vaccines played the most important role in shaping adults' intention to receive these vaccines, followed by perceived behavioral control, perceived benefits of COVID-19 vaccines, and subjective norms. Concurrently, all three core dimensions of the theory of planned behavior mediated the link between the perceived benefits of COVID-19 vaccines and the intention to receive them. Also, there were significant differences between males and females in the way they formed this intention. The findings of this study offer valuable guidance for practitioners on how to encourage adults to receive COVID-19 vaccinations, as well as how to limit the transmission of the COVID-19 virus.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

Knowledge and attitudes of health care workers about monkeypox virus infection in Southern Italy

Background

This present survey sought to investigate the level of knowledge and the attitudes pertaining the monkeypox (mpox) virus infection among a sample of health care workers (HCWs) in Italy, as well as the possible role of different factors on these outcomes.

Methods

The cross-sectional survey was performed from July through October, 2022 at four randomly selected hospitals located in Southern Italy.

Results

The questionnaire was completed by 421 HCWs, for an overall 59% response rate. Less than two-thirds were able to define the disease and the correct answer of the transmission mechanisms ranged from 22.8% for contact with contaminated objects to 75.8% through close contact with body fluids. Only 4% and 12.8% indicated HCWs and elderly/frail/people with underlying immune deficiencies as risk groups. The mean overall score of the knowledge assessment on mpox was 3.4 (0-9). The multivariate logistic regression analysis showed that HCWs with a lower number of years of working experience and those who had acquired information about mpox from scientific journals were more likely to have a higher level of knowledge. The average score of the perception of the severity of the disease was 6.3. A similar score with a value of 6.1 has been observed for the statement that mpox is a serious problem for the population. Regarding the level of concern about contracting mpox, the mean score was 5.1. Only 10.5% reported that they feel that this disease can be prevented, with an overall mean score of 6.5. Almost all HCWs reported that they are still living as usual, with no modification of their behavior for fear of contracting the mpox. The results of the multivariate logistic regression model showed that women, HCWs with a higher level of knowledge about mpox, and those who needed additional information about mpox were more likely to have a higher level of perception of the severity of the disease.

Conclusion

This survey has demonstrated that HCWs had an unsatisfactory level of knowledge toward mpox and only nearly half showed positive attitudes. Strategic health training programs should be made so that knowledge can be acquired.