Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study

Healthcare provider and patient perspectives on COVID-19 vaccination among persons with HIV, hypertension, and/or Diabetes mellitus at two regional referral hospitals in Uganda

Background

People with chronic illnesses such as Human Immunodeficiency Virus (HIV), hypertension, and Diabetes Mellitus (DM) are a priority for Coronavirus disease (COVID-19) vaccination due to elevated risk of severe disease. We explored the perspectives and experiences of COVID-19 vaccination among these priority populations in Southwestern and Southcentral Uganda.

Methods

Between January and April 2023, we conducted in-depth interviews with adult (≥18 years) persons living with HIV (PLWH), hypertension and/or DM (n = 30) and key informant interviews with healthcare providers and managers (n = 12) at Mbarara and Masaka Regional Referral Hospitals. We used the Behavioral and Social Drivers model to explore the factors that influenced COVID-19 vaccination. We coded the data using Dedoose software and analyzed them using thematic deductive analysis.

Results

Motivations to take the COVID-19 vaccine included fear of COVID-19, observing the effect of COVID-19 or the vaccine on others, vulnerability from underlying illnesses, family and social support, health worker recommendation, vaccine benefits and trust in the vaccine. Fear of side effects and vaccine interactions with antiretroviral, antihypertensive or antidiabetic medications, misinformation, rapid vaccine development and rollout, inadequate sensitization, and healthcare providers' hesitancy hindered uptake. Furthermore, health system challenges like stockouts and long queues hindered uptake or dose completion.

Conclusion

Fear of COVID-19, trust in the vaccine, family and social support facilitated COVID-19 vaccination uptake. Conversely, fear of side effects, vaccine and medication interaction, misinformation and inadequate sensitization hindered vaccine uptake. Effective communication strategies involving health workers and community leaders and sustained vaccine supply are crucial to improve COVID-19 vaccine uptake.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44155-025-00199-0.

Spirituality, Conspiracy Beliefs, and Use of Complementary Medicine in Vaccine Attitudes: A Cross-Sectional Study in Northern Italy

Distinct spiritual attitudes and convictions may promote scepticism towards medical interventions, potentially influencing vaccine attitudes. This study investigated the impact of spirituality and CAM (complementary and alternative medicine) use on perceptions of vaccine harmfulness, with a focus on COVID-19 and mandatory childhood vaccinations. Additionally, it examines whether spirituality indirectly influences vaccine hesitancy through CAM use and beliefs in conspiracies. A cross-sectional probability-based survey was conducted with over 1300 participants from South Tyrol, Italy, in 2023, using the GrAw-7 (Gratitude/Awe) scale as a measure of the experiential aspect of non-religious spirituality. Statistical analysis encompassed Spearman's correlation and linear regression to assess the associations between spirituality and vaccine perceptions. A mediation model was applied to evaluate the role of spirituality in shaping attitudes towards vaccination. Higher experiential spirituality was associated with increased perceived harmfulness of COVID-19 and mandatory childhood vaccinations. Spirituality as well as perceived harmfulness of COVID-19 vaccination and mandatory childhood vaccination were correlated with age, increased CAM utilisation and conspiracy ideation, while institutional distrust was solely associated with vaccine scepticism but not with spirituality; well-being and altruism were only associated with spirituality. Mediation analysis revealed that experiential spirituality accounted for a modest but significant portion of the influence of CAM use and conspiracy thinking on vaccine perceptions. Experiential spirituality may indirectly influence vaccine perception by affecting CAM use and conspiracy thinking. Public health initiatives should incorporate spiritual beliefs and convictions into communication strategies and present vaccinations as a community responsibility. Engaging spiritual and community leaders can enhance the acceptance of vaccines among spiritually inclined groups.

COVID-19 vaccine uptake, barriers and associated factors among healthcare workers in Malawi

Background

The COVID-19 pandemic led to an urgent need for a global vaccine. Despite being a priority group, the vaccine uptake among healthcare workers (HCWs) remains low.

Aim

This article assessed the COVID-19 vaccine uptake and its associated barriers in Malawi.

Setting

A cross-sectional study was conducted among HCWs in Malawi's Blantyre, Lilongwe and Mzuzu districts from 11 April 2023 to 14 April 2023.

Methods

Proportionally distributed among various cadres, 200 participants were randomly selected. A structured questionnaire was administered, assessing HCWs' uptake, willingness, attitudes and barriers to COVID-19 vaccines. Data were managed in REDCap and analysed using STATA version 14. Frequencies and percentages were computed. Variables with p-value ≤ 0.25 were included in the multivariable modified passion model.

Results

A total of 175 (88%) participants received a single-dose vaccine, while only 11.5% received a booster. Vaccine uptake was associated with age groups 25-34 years (aPR = 2.35, 95% CI: 1.21, 4.60) and 35-44 years (aPR = 2.30, 95% CI: 1.18, 4.50), being a nurse/midwife (aPR = 0.86, CI: 0.74, 0.99) and laboratory personnel (aPR = 0.86, 95% CI: 0.74, 0.99). Unvaccinated HCWs were concerned about vaccine side effects and lacked trust in the development process.

Conclusion

Issues of vaccine safety, side effects and lack of trust in the vaccine should be addressed. Promoting awareness of vaccine development and benefits, targeting all age groups and cadres, is required among HCWs.

Contribution

The findings can be utilised to develop specific interventions on age and cadre to promote vaccine acceptance among HCWs, in countries with similar contextual settings to Malawi.

COVID-19-related stress, anxiety and vaccine hesitancy among healthcare workers in a tertiary hospital in South-Western Nigeria

COVID-19 ranks as one of the major pandemics in recent history, with healthcare workers disproportionately burdened by the disease. Vaccination emerged as the most effective measure to curb the spread and reduce COVID-19 morbidity and mortality. However, vaccine hesitancy presents a challenge to achieving optimal vaccination coverage in Nigeria. This study assessed the level of COVID-19-related stress and anxiety as well as factors associated with vaccine hesitancy among healthcare workers. A descriptive, cross-sectional study was conducted among 849 health workers of a tertiary hospital. Vaccine hesitancy, COVID-19 related stress and anxiety were assessed using the Vaccine Hesitancy Scale (VHS) and SAVE-6 scale respectively. Also, the WHO-5 index was used to assess the perceived mental wellbeing among study participants. Data analysis was conducted using SPSS 25 at univariate, bivariate and multivariate levels. There were slightly more males (479; 56.4%) than females and about four-fifth (674; 79.4%) of respondents were married. About one-quarter of health workers were vaccine hesitant, 236 (27.8%) while 96 (11.3%) had high levels of stress and anxiety. Also, 38 (4.5%) of respondents had poor mental wellbeing. Females when compared to males, had significantly higher odds (OR 1.50; 95% CI 1.10-2.10; p = 0.023) of having vaccine hesitancy while those who were married compared to their single counterparts had significantly lesser odds (OR 0.60; 95% CI 0.36-0.94; p = 0.026). However, there was no significant association between COVID-19 related anxiety and vaccine hesitancy. COVID-19 vaccine hesitancy exists even among health professionals. This study highlights that gender and marital status significantly influence vaccine hesitancy among healthcare workers. Healthcare workers need to receive vaccines to protect themselves and others. Given their role in educating patients and community members about vaccination against infectious diseases like COVID-19, targeted interventions are needed to address hesitancy and optimize vaccine acceptance among healthcare professionals.

Strategies used to improve vaccine uptake among healthcare providers: A systematic review

Background

Vaccination is one of the most effective available public health tools, preventing infectious diseases to safeguard public health and save millions of lives annually. However, in recent years vaccine hesitancy has increased among all populations, including healthcare workers. Healthcare providers are central to vaccination efforts due to their increased exposure to disease and vulnerable patients, and their role in patient confidence and decision-making. These decreasing uptake rates highlight a critical need to address specific barriers within this target group. This systematic review aims to explore the strategies used to improve vaccine uptake among healthcare providers.

Methods

A literature search was conducted in PubMed, EMBASE, and MEDLINE databases, alongside a grey literature search, to identify studies describing interventions to improve vaccine uptake among healthcare providers. This was followed by de-duplication and double-blinded screening processes using Rayyan. Data extraction and thematic analysis focused on categorising interventions and identifying frequencies of use, to develop recommendations for further interventions tailored to target regions.

Results

60 studies were identified, predominantly concerning influenza vaccination. Interventions included educational initiatives, reminders, incentives, access solutions, feedback, and policy implementation. Key strategies included targeted educational lectures, posters, and pamphlets; mobile vaccination units; extended vaccination hours; and leadership engagement. The findings underscore the importance of a multifaceted approach combining educational efforts, enhanced accessibility, and motivational incentives to improve vaccination rates within the healthcare providers, especially where mandatory vaccination is controversial.

Conclusions

This review evaluates tailored strategies to enhance vaccine confidence and uptake among healthcare providers, advocating for a holistic approach that includes educational initiatives, reminder systems, incentives, improved access, feedback mechanisms, and policy enactment to effectively address hesitancy and promote public health.

The COVID-19 Vaccine Hesitancy Among Healthcare Workers: An Exploration of Hesitancy Reasons and Suggestions to Improve Vaccination Rates

Objective

Vaccine hesitancy among healthcare workers (HCWs) represents a significant challenge and threat in pandemics. This study aims to identify the predictive factors influencing COVID-19 vaccine hesitancy among HCWs and offer strategies to increase the COVID-19 vaccination rate in healthcare settings.

Materials and Methods

This study constitutes the qualitative portion (second part) of a mixed-methods doctoral thesis employing an explanatory design. It was conducted in two distinct pandemic hospitals and involved 23 vaccine-hesitant HCWs. To conduct the interviews, the researchers developed a semi-structured interview form based on the Health Belief Model (HBM).

Results

Upon analyzing the in-depth interviews, we identified six primary reasons for vaccine hesitancy and four different sub-reasons that reinforce vaccine hesitancy. We also collected four key suggestions from vaccine-hesitant HCWs that could potentially persuade them to receive the COVID-19 vaccine.

Conclusion

This study's findings, which encompass the identification of reasons for COVID-19 vaccine hesitancy, clarification of underlying factors contributing to hesitancy towards the COVID-19 vaccines, and gathering suggestions from HCWs on how to persuade them to get vaccinated, hold significant value for guiding vaccination campaigns during potential future pandemics.

Are COVID-19 vaccination mandates for healthcare workers effective? A systematic review of the impact of mandates on increasing vaccination, alleviating staff shortages and decreasing staff illness

INTRODUCTION

The rapid development of COVID-19 vaccines is a cornerstone in the global effort to combat the pandemic. Healthcare workers (HCWs), being at the forefront of the pandemic response, have been the focus of vaccine mandate policies. This review aims to evaluate the impacts of COVID-19 vaccine mandates among HCWs, a critical step in understanding the broader implications of such policies in healthcare settings.

OBJECTIVE

The review seeks to synthesize available literature to contribute to greater understanding of the outcomes associated with COVID-19 vaccine mandates for HCWs including vaccine uptake, infection rates, and staffing.

METHODS

A systematic search of relevant literature published from March 2020 to September 2023 was conducted. The Newcastle-Ottawa scale was employed for quality assessment of the included articles. A total of 4,779 publications were identified, with 15 studies meeting the inclusion criteria for the review. A narrative synthesis approach was used to analyze these studies.

RESULTS

COVID-19 vaccine mandates for HCWs were broadly successful in increasing vaccine uptake in most settings. Although the penalties imposed on unvaccinated HCWs did not lead to major disruption of health services, less well-resourced areas may have been more impacted. Furthermore, there is insufficient literature on the impact of the vaccine mandate on reducing SARS-CoV-2 infection among HCWs.

CONCLUSION

COVID-19 vaccine mandates for HCWs have significant implications for public health policy and healthcare management. The findings underscore the need for tailored approaches in mandate policies, considering the specific contexts of healthcare settings and the diverse populations of HCWs. While mandates have shown potential in increasing vaccine uptake with minimal impacts to staffing, more work is needed to investigate the impacts of mandates across various contexts. In addition to these impacts, future research should focus on long-term effects and implications on broader public health strategies.