Behavior of nurses and nurse aides toward influenza vaccine: the impact of the perception of occupational working conditions

Intention, Motivation, and Empowerment: Factors Associated with Seasonal Influenza Vaccination among Healthcare Workers (HCWs)

BACKGROUND

Vaccination against seasonal influenza has proven effective in preventing nosocomial influenza outbreaks among hospital patients and healthcare workers (HCWs). This study aims to explore the intention, motivation, and empowerment toward vaccination and vaccination advocacy as contributing factors for seasonal influenza vaccination in HCWs.

METHODS

A cross-sectional study in eight secondary hospitals in Greece was conducted from March to May 2022. An anonymous questionnaire was enclosed in an envelope and distributed to all participants, including questions on vaccine behavior and the MoVac-flu and MoVad scales.

RESULTS

A total of 296 participants completed the questionnaire. In multivariate logistic regression models adjusted for potential confounders, increased age, intention score, MoVac-flu scale score, and the presence of chronic diseases were significant predictors of influenza vaccination this year, while increased age, intention score, and presence of chronic diseases were predictors of vaccination every year.

CONCLUSION

Vaccination uptake is simultaneously affected by logical cognitive processes (intention), together with factors related to motivation and empowerment in distinct self-regulatory domains such as value, impact, knowledge, and autonomy. Interventions focused on these identified predictors may be used as a guide to increase HCWs' vaccination rates.

Partisan self-identification predicts attitudes of South Dakota nurses toward COVID-19 vaccine mandate for healthcare workers

Objectives

Nurses are at greater risk of infection from COVID-19. However, mistrust of the vaccine exists even among this group. In the United States, the government implemented a vaccine mandate for health care workers to increase vaccination rates. This study investigated the drivers of nurses' attitudes toward the mandate.

Methods

We fielded a survey to study the attitudes of nurses toward COVID-19 vaccine mandate for HCWs. We contacted nurses in South Dakota, United States, based on the information from the South Dakota Board of Nursing. The survey was open in June and July 2022. We conducted a multivariate regression analysis to identify the factors that predict attitudes toward this regulation.

Results

We received 1,084 responses. Results of regression analysis showed statistically significant relationships between partisan self-identification, evangelical identity, gender, and COVID-19 vaccination status and support for COVID-19 vaccine mandate for healthcare workers. Age, time with patients, positive COIVD-19 test in the last year, education, and nurse classification variables were not statistically significant.

Conclusions

The same factors that drive people's attitudes toward COVID-19 mitigation policies also explain nurses' attitudes toward a vaccine mandate for healthcare workers. The politicization of the COVID-19 pandemic is present also among nurses. Health care officials should be mindful of the influence of these biases as they evaluate the vaccine mandate and develop new regulations.

Views and Challenges of COVID-19 Vaccination in the Primary Health Care Sector. A Qualitative Study

COVID-19 has affected the global community as it has severely raised population mortality and morbidity rates. Vaccination was seen as a mechanism against the spread of the pandemic. Yet, there are still several reservations about its adoption. Professionals in the field of health care have a crucial frontline role. The present study uses a qualitative research approach to examine Greek health professionals' views on vaccination acceptance. According to the key findings, health professionals largely accept vaccination. The main reasons cited were scientific knowledge, a sense of obligation to society, and protection from disease. However, there are still numerous restrictions to adhering to it. This is due to the lack of knowledge of certain scientific disciplines or to misinformation, as well as to religious or political convictions. The issue of trust is central to the acceptance of vaccinations. According to our research, the most adequate strategy to enhance immunization and ensure that it is widely accepted is to promote health educational interventions for professionals working in primary care settings.

Social conformism and confidence in systems as additional psychological antecedents of vaccination: a survey to explain intention for COVID-19 vaccination among healthcare and welfare sector workers, France, December 2020 to February 2021

Background

The start of the COVID-19 vaccination campaign among French healthcare and welfare sector workers in January 2021 offered an opportunity to study psychological antecedents of vaccination in this group.

Aim

We explored whether knowledge and attitude items related to social conformism and confidence in systems contributed to explaining intention for COVID-19 vaccination.

Methods

We developed a knowledge and attitude questionnaire with 30 items related to five established and two hypothetical psychological antecedents of vaccination (KA-7C). The online questionnaire was distributed from 18 December 2020 to 1 February 2021 through chain-referral via professional networks, yielding a convenience sample. We used multivariable logistic regression to explore the associations of individual and grouped KA-7C items with COVID-19 vaccine intention.

Results

Among 5,234 participants, the vaccine intention model fit (pseudo R-squared values) increased slightly but significantly from 0.62 to 0.65 when adding social conformism and confidence in systems items. Intention to vaccinate was associated with the majority opinion among family and friends (OR: 11.57; 95% confidence interval (CI): 4.51–29.67) and a positive perception of employer’s encouragement to get vaccinated (vs negative; OR: 6.41; 95% CI: 3.36–12.22). The strongest association of a knowledge item was identifying the statement ‘Some stages of vaccine development (testing) have been skipped because of the epidemic emergency.’ as false (OR: 2.36; 95% CI: 1.73–3.22).

Conclusion

The results suggest that social conformism and confidence in systems are distinct antecedents of vaccination among healthcare and welfare workers, which should be taken into account in vaccine promotion.

Vaccine hesitancy in health-care providers in Western countries: a narrative review

INTRODUCTION

Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant.

AREAS COVERED

This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience.

EXPERT OPINION

Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.

Meta-analysis of whether influenza vaccination attenuates symptom severity in vaccinated influenza patients

BACKGROUND

Influenza vaccination has been associated with decreased risk of influenza-related infections. However, associations between influenza vaccination and the severity of influenza cases have not been systematically summarized. We conducted a meta-analysis to evaluate whether influenza vaccination could attenuate symptom severity in vaccinated influenza patients.

METHODS

A systematic literature search was performed using the PubMed, Web of Science, EMBASE, and Scopus databases. A quantitative synthesis of the data was conducted using a fixed/random effects model in the meta-analysis.

RESULTS

A total of seven studies, involving 6342 vaccinated and 7036 non-vaccinated patients were included. Compared with non-vaccinated, vaccinated patients were significantly less likely to develop a fever (OR = 0.66, 95% CI: 0.43-0.89), be admitted to the ICU (OR = 0.79, 95% CI: 0.64-0.97), suffer mortality (OR = 0.55, 95% CI: 0.34-0.89), stay in the ICU (WMD = -1.37, 95% CI: -2.15 to -0.60) or stay in the hospital (WMD = -0.32, 95% CI: -0.61 to -0.04).

CONCLUSION

Those benefits that could be highlighted in the communication material to enhance the uptake of influenza vaccination among both the public health nurses and the community as a whole.

Perceptions of COVID-19 vaccines among healthcare assistants: A national survey

Background

Limited COVID‐19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID‐19 infections. Our study objective was to evaluate the perceptions of COVID‐19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity.

Methods

An online survey was conducted from December 2020 to January 2021 through national e‐mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27‐item survey asked questions about experiences and perceptions of COVID‐19 vaccines, including how confident they were that COVID‐19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID‐19 vaccines.

Results

We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID‐19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non‐white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID‐19 vaccines.

Conclusion

Frontline HCAs reported low confidence in COVID‐19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID‐19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.

Vaccine hesitancy among hospital staff physicians: A cross-sectional survey in France in 2019

BACKGROUND

Healthcare professionals, because they recommend vaccines to their patients, answer their questions, and vaccinate them, are the cornerstone of vaccination in France. They can nonetheless be affected by vaccine hesitancy (VH).

AIMS

We sought to study the opinions, practices, and perceptions of French hospital staff physicians (HSPs) toward vaccination and the prevalence and correlates of VH among them.

METHODS

We conducted a cross-sectional survey in 14 public hospitals in France from September 2018 to October 2019. HSPs completed a standardized questionnaire -most of the time face-to-face - about their vaccine-related attitudes and practices. Data were weighted for age and sex. An agglomerative hierarchical cluster analysis of the HSPs' perceptions and opinions toward vaccination allowed us to identify vaccine-hesitant HSPs, and multiple Poisson regression with robust standard errors let us study the factors associated with VH.

RESULTS

The study included 1,795 HSPs (participation rate: 86%). Almost all (93.7%) were strongly favorable to vaccination, even though 42.2% (95CI = 39.8-44.6) showed moderate VH. VH prevalence was lowest among infectious disease specialists (12.3%; 95CI = 6.7-21.3) and pediatricians (27.7%; 95CI = 21.4-35.2). Hesitant HSPs were less trustful of vaccination information sources and doubted the safety of vaccines more often than HSPs with almost no VH. Compared with non-hesitant HSPs, those with higher VH had less often taken a medical course about vaccination and were less likely to be vaccinated against seasonal influenza, to recommend vaccines to their patients and to try to convince vaccine-hesitant patients to be vaccinated.

CONCLUSIONS

Strong favorability to vaccination does not prevent VH, which was observed in most specialties. Interventions are required to help hesitant HSPs to adopt more proactive vaccination practices.

Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin

Background: In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (Gamma) variant of concern (VOC), mRNA vaccines have been made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimed to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. Methods: A cross-sectional survey was conducted from January 22 to March 26, 2021 among a sample of HCWs in French Guiana. They were asked about their willingness to get vaccinated against COVID-19 and vaccine hesitancy, vaccine uptake and vaccines attitudes. Factors associated with willingness to get vaccinated have been analyzed with ordinal logistic regression, using Stata software. Results: A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. HCWs were more willing to get vaccine if they were older, were worried about COVID-19 and were confident in the management of epidemic. Conversely, participants were less likely to have been vaccinated or willing to if they were nurses or of another non-medical profession, born in French Guiana, feared adverse effects, or if they did not trust pharmaceutical companies and management of the epidemic by authorities. Conclusion: Negative attitudes towards vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with Gamma VOC. General vaccine hesitancy and concerns about future side effects in particular represent important barriers. Low confidence in government and science are significant in COVID-19 vaccine refusal among non-medical staffs. Public health messaging with information on vaccine safety should be tailored to address these concerns. The specific challenges of HCWs from French Guiana must be taken into account.

Vaccination perception and coverage among healthcare students in France in 2019

BACKGROUND

Vaccine hesitancy in healthcare workers has been increasing especially in France while they are the cornerstone of vaccination programs. Greater understanding of healthcare students (HCS) vaccine knowledge, attitudes and beliefs is necessary to provide an adequate vaccination education to better equip them to promote vaccination in their future careers. The aim of this study was to assess vaccination perception (VP) (perception of benefits and risks of vaccines) and its impact on vaccination coverage (VC) for mandatory and recommended vaccines among HCS.

METHODS

A standardized, anonymous self-reporting electronic questionnaire was prospectively sent to HCS (medicine, nursing, pharmacy, midwifery, physiotherapy students and 1st year of health sciences students) of Normandy University in France between 18/03/2019 and 8/04/2019. VP was evaluated with questions regarding vaccination hesitancy, safety of vaccine and the benefit/risk balance of vaccination. Global VC (GVC) was defined as being vaccinated according to the mandatory and/or recommended vaccination schedule by national French law in 2018.

RESULTS

542 HCS took part in this survey. VC was high for mandatory (diphtheriae, poliomyelitis, tetanus 93.5%, hepatitis B virus 88.6%) and even most of recommended vaccinations (measles 95%, pertussis 88.2%). Global VC (40.4%) was not statistically different between HCS except for 1st year health sciences students who were less vaccinated (25.6%). Regarding VP, 97.8% of HCS thought that vaccine are effective. When vaccine safety and level of vaccine hesitancy were assessed (on a 0-10 scale, 0: not safe or not hesitant and 10: completely safe and strongly hesitant for vaccine), 91% of respondents stated that vaccine safety is ≥7 and in 80% the vaccine hesitancy was < 3. There was no difference among student categories. 80.6% of HCS recommended all vaccines but only 52% agreed that flu vaccination should be mandatory for HCS. In the multivariate analysis, being a 1st year health care sciences student was associated with a lower GVC (OR 95% CI = 2 [1.2-3.3], p = 0.004) than being a medical student.

CONCLUSION

HCS perceived vaccine as effective and secure. Despite the good perception of vaccines, less than half HCS are well vaccinated.