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

Positivity, daily time use, mood, and functioning in patients with schizophrenia spectrum disorders: Results from the diapason multicentric study

BACKGROUND

Positivity (POS) indicates the proclivity to see life and experiences in a positive light. There is limited research on its effects on individuals with Schizophrenia Spectrum Disorders (SSD). Very little is known about the relationship between POS and daily activities in people with SSD.

AIM

The study aims to compare the POS rated by patients with SSD with those obtained in an Italian normative sample matched by age and sex and to use the Ecological Momentary Assessment (EMA) to investigate the association between POS and daily time use (i.e. productive activities, leisure activities), functioning and mood in individuals with SSD.

METHOD

620 SSD patients were recruited from mental health services in Italy as part of the DiAPAson project. POS, symptom severity, functioning, and quality of life (QoL) were assessed. POS scores were compared to a normative sample of 5,002 Italian citizens. Additionally, a subset of 102 patients underwent 7-day assessments using mobile EMA.

RESULTS

People with SSD did not significantly differ from the Italian normative sample in POS levels (0.035, p = .190). POS showed a significant inverse association with support network (-0.586, p = .036) and symptomatology (BPRS -0.101; 95% p < .001; BNSS B = -0.113, p < .001). A significant direct association was found between POS and QoL (B = 0.310, p < .001) and functioning (B = 0.058, p < .001). In the subsample using EMA, POS ratings showed significant associations with Positive Emotions (B = 0.167, p < .001) and Negative Emotions (B = -0.201, p < .001).

CONCLUSION

People with SSD exhibited comparable levels of POS to the normative sample. Higher POS was linked to better functioning, QoL, fewer severe symptoms, and increased positive emotions. However, it did not relate to increased productivity or engagement in leisure activities. Further research is needed to understand the relationship between POS and time use in individuals with SSD.

The intention to get COVID-19 booster vaccination and its association with cognitive and emotional factors: A survey of Chinese COVID-19 infected people in Hong Kong

BACKGROUND

Although the pandemic has ended officially, COVID-19 remains impactful. Booster COVID-19 vaccination is still needed to protect individuals against COVID-19 and the disease's harmful consequences. This study investigated the prevalence of the intention to get booster COVID-19 vaccination after receiving the COVID-19 diagnosis and its associated factors among people reporting prior COVID-19.

METHODS

A population-based anonymous telephone survey was conducted in Hong Kong, China from June to August 2022 among Chinese people reporting prior COVID-1 between February and August 2022 and having taken up ≥2 doses of COVID-19 vaccines prior to COVID-19 diagnosis.

RESULTS

The prevalence of the intention to get booster vaccination was 59.2 %. Older age (>60 years), being currently married, not employed full-time, and having chronic diseases were positively associated with the intention to get booster vaccination. Adjusted for the background factors, higher levels of the cognitive factors of perceived susceptibility to COVID-19, perceived acquired moderate-to-strong immunity against COVID-19, and perceived adequate knowledge of COVID-19 were positively associated with the intention to get booster vaccination; stronger perceived severity of prior infection despite vaccination was negatively associated with the intention outcome. In contrast, stronger mental distress due to COVID-19, illness concern, and emotional representation were positively associated with the intention. Self-perceived long COVID status was not a significant factor.

DISCUSSION

The prevalence of the intention to get booster COVID-19 vaccination was limited, especially among younger people reporting prior COVID-19. Health promotion is still required among people reporting prior COVID-19 and may emphasize the significant cognitive factors positively associated with the intention. Future studies are needed to confirm the findings, clarify the role of emotional factors on booster vaccination, and explore other factors of the intention to get booster vaccination among people reporting prior COVID-19.

To vaccinate or not to vaccinate? The interplay between pro- and against- vaccination reasons

BACKGROUND

By mid 2023, European countries reached 75% of vaccine coverage for COVID-19 and although vaccination rates are quite high, many people are still hesitant. A plethora of studies have investigated factors associated with COVID-19 vaccine hesitancy, however, insufficient attention has been paid to the reasons why people get vaccinated against COVID-19. Our work aims to investigate the role of reasons in the decision to get vaccinated against COVID-19 in a representative sample of 1,689 adult Italians (March-April 2021) balanced in terms of age, gender, educational level and area of residence.

METHODS

Through an online questionnaire, we asked participants to freely report up to three reasons for and against COVID-19 vaccination, and the weight each had in the decision to get vaccinated. We first investigated the role of emotional competence and COVID-19 risk perception in the generation of both reasons using regression models. Next, we studied the role that the different reasons had in the vaccination decision, considering both the intention to vaccinate (using a beta regression model) and the decision made by the participants who already had the opportunity to get vaccinated (using a logistic regression model). Finally, two different classification tree analyses were carried out to characterize profiles with a low or high willingness to get vaccinated or with a low or high probability to accept/book the vaccine.

RESULTS

High emotional competence positively influences the generation of both reasons (ORs > 1.5), whereas high risk perception increases the generation of positive reasons (ORs > 1.4) while decreasing reasons against vaccination (OR = 0.64). As pro-reasons increase, vaccination acceptance increases, while the opposite happens as against-reasons increase (all p < 0.001). One strong reason in favor of vaccines is enough to unbalance the decision toward acceptance of vaccination, even when reasons against it are also present (p < 0.001). Protection and absence of distrust are the reasons that mostly drive willingness to be vaccinated and acceptance of an offered vaccine.

CONCLUSIONS

Knowing the reasons that drive people's decision about such an important choice can suggest new communication insights to reduce possible negative reactions toward vaccination and people's hesitancy. Results are discussed considering results of other national and international studies.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy

Introduction

Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy.

Methods

This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures.

Results

In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures.

Discussion

Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.

Social network, political climate, income inequality, and Americans uptake of monovalent COVID-19 booster

The COVID-19 pandemic has posed an unprecedented impact on Americans for over three years. To control the damage, a booster shot becomes increasingly necessary because the efficacy of the initial vaccine is waning and new variants of the virus are emerging. This study aims to understand factors at both individual and state levels that influence one's decision to take the monovalent booster. We merged data from a national survey administered in the Spring of 2022 with state-level indicators of the political climate, income inequality, and public health conditions. Multilevel logistic regression is adopted for statistical estimation. Findings show contrasting effects of the social network. More vaccinated people in one's network promote booster uptake, while more family members and close friends who contracted the virus in one's network inhibit booster uptake. In addition, residents of states with more votes for the Democratic candidate in the 2020 general election are more likely to take the booster. Meanwhile, residents from states with high income inequality are less likely to become boosted. This study identified multilevel determinants of the individual decision to receive the monovalent COVID-19 booster. The results imply the need to leverage the social network, weaken partisanship salience, and reduce income inequality to encourage booster uptake.

Vaccination, time lost from work, and COVID-19 infections: a Canadian healthcare worker retrospective cohort study

The COVID-19 pandemic highlighted hurdles for healthcare delivery and personnel globally. Vaccination has been an important tool for preventing severe illness and death in healthcare workers (HCWs) as well as the public at large. However, vaccination has resulted in some HCWs requiring time off work post-vaccination to recover from adverse events. We aimed to understand which HCWs needed to take time off work post-vaccination, for which vaccine types and sequence, and how post-vaccination absence impacted uptake of booster doses in a cohort of 26,267 Canadian HCWs. By March 31, 2022, more than 98% had received at least two doses of the approved COVID-19 vaccines, following a two-dose mandate. We found that recent vaccination and longer intervals between doses were associated with significantly higher odds of time-loss, whereas being a medical resident and receiving the BNT162b2 vaccine were associated with lower odds. A history of lab-confirmed SARS-CoV-2 infection was associated with lower odds of receiving a booster dose compared with no documented infection, aOR 0.61 (95% CI: 0.55, 0.68). Similarly, taking sick time following the first or second dose was associated with lower odds of receiving a booster dose, aOR 0.83 (95% CI: 0.75, 0.90). As SARS-CoV-2 becomes endemic, the number and timing of additional doses for HCWs requires consideration of prevention of illness as well as service disruption from post-vaccination time-loss. Care should be taken to ensure adequate staffing if many HCWs are being vaccinated, especially for coverage for those who are more likely to need time off to recover.

The Interplay of Perceived Risks and Benefits in Deciding to Become Vaccinated against COVID-19 While Pregnant or Breastfeeding: A Cross-Sectional Study in Italy

The present study examined the role of the perception of risks and benefits for the mother and her babies in deciding about the COVID-19 vaccination. In this cross-sectional study, five hypotheses were tested using data from a convenience sample of Italian pregnant and/or breastfeeding women (N = 1104, July-September 2021). A logistic regression model estimated the influence of the predictors on the reported behavior, and a beta regression model was used to evaluate which factors influenced the willingness to become vaccinated among unvaccinated women. The COVID-19 vaccination overall risks/benefits tradeoff was highly predictive of both behavior and intention. Ceteris paribus, an increase in the perception of risks for the baby weighed more against vaccination than a similar increase in the perception of risks for the mother. Additionally, pregnant women resulted in being less likely (or willing) to be vaccinated in their status than breastfeeding women, but they were equally accepting of vaccination if they were not pregnant. COVID-19 risk perception predicted intention to become vaccinated, but not behavior. In conclusion, the overall risks/benefits tradeoff is key in predicting vaccination behavior and intention, but the concerns for the baby weigh more than those for the mother in the decision, shedding light on this previously neglected aspect.

Openness buffers the impact of Belief in Conspiracy Theories on COVID-19 vaccine hesitancy: Evidence from a large, representative Italian sample

As COVID-19 continues to incur enormous personal and societal costs, widespread vaccination against the virus remains the most effective strategy to end the pandemic. However, vaccine hesitancy is rampant and has been steadily rising for decades. Seeking to remedy this, personality psychologists have begun to explore psychological drivers of vaccine hesitancy, including the Big Five. Openness to Experience presents itself as a vexing case as previous attempts to study its association with vaccine hesitancy have yielded mixed findings. In this preregistered study, we hypothesise that the impact of Openness to Experience on Vaccine Hesitancy depends on its interplay with other factors, namely conspiracy beliefs. To test this, we apply logistic regressions, simple slopes analyses, and propensity score matching to a nationally representative sample of 2500 Italian citizens, collected in May 2021. Contrary to our original hypothesis (i.e., Openness will have a positive association with Vaccine Hesitancy at high – and a negative at low – levels of Conspiracy Beliefs) we find that high Openness diminishes the impact of Belief in Conspiracy Theories on Vaccine Hesitancy. Consistent with previous research, we propose that Openness serves as a buffer against extreme positions by allowing individuals to be exposed to a greater diversity of information.

Risk communication and risk perception along with its influencing factors in Covid-19 disease: Focusing on the Extended Parallel Process Model

INTRODUCTION

Following the global spread of the Covid-19 infection, the Iranian government adopted measures to control the spread of the disease, but they were not applicable without the acceptance and interaction of the general population. This study used the Extended Parallel Process Model (EPPM) components to attempt to determine risk communication and risk perception along with its influencing factors in Covid-19 disease among the population of northwestern Iran.

METHOD

This cross-sectional study was conducted among the general population of the province. Demographic characteristics and extended parallel process model questionnaires were used to collect data, which was then analyzed based on descriptive (frequency, mean, standard deviation) and inferential statistics (t-test, analysis of variance, regression, chi-square) in SPSS-25 software.

RESULTS

This study showed that 63.8% of the participants continually followed Covid-19 news, and 34% of participants used social media to get the news and warnings related to the Covid-19 pandemic. Among the domains of participants' risk perception for Covid-19 disease, the three domains of self-efficacy, response effectiveness and intention had the highest means compared with other domains. Significant correlations were found between risk perception and the dimensions of age, gender, marriage status, number of family members, place of residence, underlying disease, history of Covid-19, and family history of Covid-19 disease (p < 0.05). Multivariate linear regression analysis revealed that perceived sensitivity, perceived severity, self-efficacy, fear, defensive avoidance, intention, and behaviors were independent predictors of response efficacy (p < 0.001).

CONCLUSION

More than two years after the onset of the spread of Covid-19 disease, the risk perception of the disease among the study population was still insufficient in many areas. Risk of communication refers to the point of interaction between the government and the people, and the need to improve public trust in this issue is strongly felt.

A cross-national study of multilevel determinants on public fully vaccination against COVID-19

The pandemic caused by SARS-CoV-2 (COVID-19) has impacted the world for close to three years and led to substantial costs to public well-being. To mitigate the pandemic's damage, the most effective approach lies in the vaccine. This study aims to investigate multilevel predictors of the public decision to become fully vaccinated against COVID-19. Data from a cross-national survey on representative samples are merged with country-level indicators. Multilevel logistic regression models are estimated on populations from 15 countries. Findings show that people who agree the government handles the pandemic well, believe the health officials would provide an effective vaccine, perceive the virus's danger, and are older are more likely to get fully vaccinated than their counterparts. Meanwhile, the national case rate and vaccination rate also affect one's decision to become fully vaccinated. Furthermore, there are significant cross-level interactions as people are more inclined to become fully vaccinated if they agree with the government's performance, perceive the virus's danger, and also reside in countries with higher case and vaccination rates. This study shows cross-national evidence regarding multilevel determinants of public vaccine uptake. Knowing the profiles among populations who have become fully vaccinated or not helps public health experts leverage factors and maximize vaccination.

Are psychological status and trust in information related to vaccine hesitancy during COVID-19 pandemic? A latent class and mediation analyses in Italy

Despite the recognized benefits of the COVID-19 vaccination, vaccine hesitancy (VH) remains one of the biggest challenges of the mass vaccination campaign. Most studies investigating VH determinants focused on socio-demographics and direct relationships. In this study, we aimed at: 1) identifying subgroups of people differently affected by the pandemic, in terms of psychological status; 2) investigating the role of psychological status and trust in information as possible mediators of the relationship between individual characteristics and VH. To this purpose, a latent class analysis (LCA) followed by a mediation analysis were carried out on data from a survey conducted in January 2021 on 1011 Italian citizens. LCA identified four different subgroups characterized by a differential psychological impact of the pandemic: the extremely affected (21.1%), the highly affected (49.1%), the moderately affected (21.8%) and the slightly affected (8%). We found that VH decreased with the increase of psychological impact (from 59.3% to 23.9%). In the mediation analysis, past vaccination refusal, age 45-54 years and lower-than-average income, were all indirectly related to higher VH through mistrust in COVID-19 information. Differently, the psychological impact counteracted the greater VH in females, the negative effect of social media among youngest (<35 years) and the negative effect of mistrust in the lower-than-average-income subgroup. Knowledge of psychological profile of hesitant individuals, their level of trust and the sources of information they access, together with their sociodemographic characteristics provides a more comprehensive picture of VH determinants that can be used by public health stakeholders to effectively design and adapt communication campaigns.

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic’s vast impact. Data were collected using a questionnaire designed according to the “survey tool and guidance” provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities’ recommendations, being informed by HCWs or formal information sources, care for others, concern about the country’s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.

Main Predictors of COVID-19 Vaccination Uptake among Italian Healthcare Workers in Relation to Variable Degrees of Hesitancy: Result from a Cross-Sectional Online Survey

Background: Hesitancy remains one of the major hurdles to vaccination, regardless of the fact that vaccines are indisputable preventive measures against many infectious diseases. Nevertheless, vaccine hesitancy or refusal is a growing phenomenon in the general population as well as among healthcare workers (HCWs). Many different factors can contribute to hesitancy to COVID-19 vaccination in the HCWs population, including socio-demographic characteristics (female gender, low socio-economical status, lower age), individual beliefs regarding vaccine efficacy and safety, as well as other factors (occupation, knowledge about COVID-19, etc.). Understanding the determinants of accepting or refusing the COVID-19 vaccination is crucial to plan specific interventions in order to increase the rate of vaccine coverage among health care workers. Methods: We conducted a cross-sectional online survey on HCWs in seventeen Italian regions, between 30 June and 4 July 2021, in order to collect information about potential factors related to vaccine acceptance and hesitancy. Results: We found an overall vaccine uptake rate of 96.4% in our sample. Acceptance was significantly related to job task, with physicians showing the highest rate of uptake compared to other occupations. At univariate analysis, the HCWs population’s vaccine hesitancy was significantly positively associated with fear of vaccination side effects (p < 0.01), and negatively related to confidence in the safety and efficacy of the vaccine (p < 0.01). Through multivariate analysis, we found that only the fear of possible vaccination side effects (OR: 4.631, p < 0.01) and the confidence in vaccine safety and effectiveness (OR: 0.35 p < 0.05) remained significantly associated with hesitancy. Conclusion: Action to improve operator confidence in the efficacy and safety of the vaccine should improve the acceptance rate among operators.

People's perspectives about COVID-19 vaccination certificate: Findings from a representative Italian sample

In Italy, like in other countries, issues still exist regarding how to reach high vaccine coverage and several countries have considered policies to increase vaccine uptake. In the present study, we focused on people who have a favorable attitude towards vaccination. In March-April 2021, we asked a representative sample of Italian participants (N = 1,530) to assess to what extent they would support the adoption of a COVID-19 vaccination certificate, excluding unvaccinated people from participating in public and cultural events. Furthermore, as the vaccination coverage increases, severe forms of COVID-19 requiring hospitalization more likely involve unvaccinated individuals, who might be perceived as those who don't contribute to ending the pandemic and who constitute a significant health cost for society. We then asked participants to assess to what extent they would favor the idea of requiring people who refuse the vaccine to pay for their own medical expenses in case of hospitalization. We hypothesized that support for the adoption of the vaccination certificate would be predicted by the COVID-19 vaccination status (received, booked, high-, medium-, low-willingness to be vaccinated, or refused) and by the same factors that are known to affect the willingness to get vaccinated. These factors were also tested in a model aimed at investigating if a vaccinated person would favor a measure requiring the unvaccinated individuals to pay for medical expenses. Results confirmed that the support towards the vaccination certificate policy was strongly predicted by the vaccination status and by factors known to affect the willingness to get vaccinated. Interestingly (and surprisingly), a similar pattern was observed for the support of the policy about medical expenses. In conclusion, support for a COVID-19 vaccination certificate was high among the Italian population in the early phases of the vaccination rollout. The findings are discussed considering potential policies to tackle the pandemic.

Multilevel determinants on COVID-19 booster intention among Americans

The pandemic has disrupted public health and social well-being for more than two years. With the vaccine efficacy waning over time and the spread of new variants, a booster becomes increasingly imperative. This study investigates predictors of the American public's COVID-19 booster intention. A national survey was conducted from September 23rd to October 31st, 2021, on a representative sample. The survey data is merged with state-level indicators of vaccination rate, case rate, political context, and economic recovery. Multilevel regression modeling is adopted for statistical estimation. Results show that a higher proportion of vaccinated people in the network is positively related to one's chance of getting the booster (β = 0.593, p = 0.000). In comparison, a higher proportion of infected people in the network is negatively related to one's intention to become boosted (β = -0.240, p = 0.039). Additionally, the higher educated (β = 0.080, p = 0.001) and older (β = 0.004, p = 0.013) were more likely to say they would get the booster than their counterparts. Meanwhile, the odds of people taking the COVID-19 booster decrease by 3.541 points (p = 0.002) for each unit increase in the case rate at the state level. This study articulates that individual intention to take the booster is a function of their personal characteristics and is also rooted in social networks. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who intend to take/refuse the booster provides essential information to leverage certain factors and maximize booster uptake to mitigate the pandemic's devastating impact.

Psychological well-being during the COVID-19 pandemic in Italy assessed in a four-waves survey

COVID-19 pandemic had a negative impact on the mental health and well-being (WB) of citizens. This cross-sectional study included 4 waves of data collection aimed at identifying profiles of individuals with different levels of WB. The study included a representative stratified sample of 10,013 respondents in Italy. The WHO 5-item well-being scale (WHO-5) was used for the assessment of WB. Different supervised machine learning approaches (multinomial logistic regression, partial least-square discriminant analysis-PLS-DA-, classification tree-CT-) were applied to identify individual characteristics with different WB scores, first in waves 1-2 and, subsequently, in waves 3 and 4. Forty-one percent of participants reported "Good WB", 30% "Poor WB", and 28% "Depression". Findings carried out using multinomial logistic regression show that Resilience was the most important variable able for discriminating the WB across all waves. Through the PLS-DA, Increased Unhealthy Behaviours proved to be the more important feature in the first two waves, while Financial Situation gained most relevance in the last two. COVID-19 Perceived Risk was relevant, but less than the other variables, across all waves. Interestingly, using the CT we were able to establish a cut-off for Resilience (equal to 4.5) that discriminated good WB with a probability of 65% in wave 4. Concluding, we found that COVID-19 had negative implications for WB. Governments should support evidence-based strategies considering factors that influence WB (i.e., Resilience, Perceived Risk, Healthy Behaviours, and Financial Situation).

Vaccine Hesitancy during the Coronavirus Pandemic in South Tyrol, Italy: Linguistic Correlates in a Representative Cross-Sectional Survey

Background: German is a minority language in Italy and is spoken by the majority of the inhabitants of the Autonomous Province of Bolzano, South Tyrol. Linguistic group membership in South Tyrol is an established determinant of health information-seeking behavior. Because the COVID-19 incidence and vaccination coverage in the second year of the pandemic in Italy was the worst in South Tyrol, we investigated whether linguistic group membership is related to COVID-19 vaccine hesitancy. Methods: A cross-sectional survey was conducted on a probability-based sample of 1425 citizens from South Tyrol in March 2021. The questionnaire collected information on socio-demographics, including linguistic group membership, comorbidities, COVID-19-related experiences, conspiracy thinking, well-being, altruism, and likelihood of accepting the national vaccination plan. Multiple logistic regression analyses were performed to identify the significant predictors of vaccine hesitancy. Results: Overall, 15.6 percent of the sample reported vaccine hesitancy, which was significantly higher among German speakers than among other linguistic groups. Increased hesitancy was mostly observed in young age, the absence of chronic disease, rural residence, a worsened economic situation, mistrust in institutions, and conspiracy thinking. In the multiple logistic regression analyses, linguistic group membership was not an independent predictor of vaccine hesitancy. Conclusion: Although German is a minority language in Italy and COVID-19 vaccine hesitancy was higher in the German native language group than in the Italian, linguistic group membership was not an independent predictor of hesitancy in the autonomous province. Known predictors of vaccine hesitancy are distributed unevenly across language groups. Whether language group-specific intervention strategies to promote vaccine hesitancy are useful requires further study.

COVID-19 VACCINATION: AN OVERVIEW OF THE ITALIAN NATIONAL HEALTH SYSTEM ONLINE COMMUNICATION FROM A CITIZEN PERSPECTIVE

COVID-19 vaccine hesitancy is still widespread. During the pandemic, the internet has been the preferred channel for health-related information, especially for less-educated citizens who tend to be the most hesitant about vaccination. A well-structured web communication strategy could help both to overcome vaccine hesitancy and to ensure equity in healthcare service access. This study investigated how the various regional and local health authorities in Italy used their institutional websites to inform users about COVID-19 vaccinations between March and April 2021. We browsed 129 institutional websites, checking the availability, quality and quantity, actionability and readability of information using a literature-based common grid. Descriptive statistics and statistical tests were performed. The online public dissemination of COVID-19 vaccination information in Italy was fragmented, both across and within regions. The side effects of vaccinations, were often not reported on the websites, thus missing an opportunity to enhance vaccination uptake. More focus should also be placed on readability, since readability indexes showed that they were difficult to understand. Our research revealed that several actions could be implemented to enhance online communication on COVID-19 vaccination. For instance, simplifying texts can make them more understandable and the information reported actionable.

COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination

Background

The hesitancy in taking the COVID-19 vaccine is a global challenge. The need to identify predictors of COVID-19 vaccine reluctance is critical. Our objectives were to evaluate sociodemographic, psychological, and behavioral factors, as well as attitudes and beliefs that influence COVID-19 vaccination hesitancy in the general population of Italy.

Methods

A total of 2,015 people were assessed in two waves (March, April and May, 2021). Participants were divided into three groups: (1) individuals who accepted the vaccination (“accepters”); (2) individuals who refused the vaccination (“rejecters”); and (3) individuals who were uncertain about their attitudes toward the vaccination (“fence sitters”). Group comparisons were performed using ANOVA, the Kruskal-Wallis test and chi-square tests. The strength of the association between the groups and the participants' characteristics was analyzed using a series of multinomial logistic regression models with bootstrap internal validation (one for each factor).

Results

The “fence sitters” group, when compared to the others, included individuals of younger age, lower educational level, and worsening economic situation in the previous 3 months. After controlling for sociodemographic factors, the following features emerged as the main risk factors for being “fence sitters” (compared with vaccine “accepters”): reporting lower levels of protective behaviors, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and higher conspirative mentality. Higher levels of COVID-19 perceived risk, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and protective behaviors were associated with a higher likelihood of becoming “fence sitters” rather than vaccine “rejecters.”

Conclusions

The “fence sitters” profile revealed by this study is intriguing and should be the focus of public programmes aimed at improving adherence to the COVID-19 vaccination campaign.

"Would You Get Vaccinated against COVID-19?" The Picture Emerging from a Study on the Prevalence of SARS-CoV-2 Infection in the General Population of the Veneto Region

COVID-19 disease, caused by the SARS-CoV-2 virus, continues to cause high hospitalization and death rates. Vaccination campaigns have been key to controlling the pandemic, but vaccine hesitancy is on the rise. This study investigated the general population’s attitude to vaccination in Veneto (northeast Italy) in January 2021 as part of a study on the prevalence of SARS-CoV-2 infection. An ad hoc questionnaire collected 4467 respondents’ sociodemographic data and propensity to be vaccinated, and findings were analyzed using logistic multivariable regression. The 48.9% of respondents were male, and the mean age was 46.8 ± 16.0 years. Asked whether they would get vaccinated against COVID-19, 84.3% said yes, 5.0% were uncertain, and 10.7% said no. Vaccine acceptance was higher in males than in females (85.8% vs. 82.8%), in people 70+ years old (92.3%), and among people with more than 14 years of schooling (89.6%). Multivariable analysis with adjOR (95% CI) showed a significantly greater vaccine reluctance in females (0.68 (0.57−0.81)), people 30−49 or 50−69 years old (0.69 (0.54−0.87)), and (0.76 (0.58−0.99)); and those with <9 or 9−13 years of schooling (0.62 (0.46−0.82)), and (0.72 (0.57−0.91)). As people refusing vaccination undeniably hinder efforts to control the pandemic, specific strategies are needed to overcome their doubts.