Mistrust of the medical profession and higher disgust sensitivity predict parental vaccine hesitancy

Understanding barriers to influenza vaccination among parents is important to improve vaccine uptake among children

The COVID-19 pandemic has significantly altered public perceptions of vaccines, particularly among parents. In high-income countries like the United Kingdom (UK) and Australia, factors such as misinformation, the expedited approval process of COVID-19 vaccines and unique local challenges have contributed to vaccine hesitancy, resulting in uneven uptake across various vaccination programs. Despite efforts like school-based influenza vaccination programs in the UK and free influenza vaccines in Australia, vaccination rates continue to decline. This is especially concerning given the concurrent circulation of COVID-19 and influenza during the winter months, which places additional strain on healthcare systems. Drawing on existing evidence, this commentary examines key factors influencing childhood vaccination rates and provides preliminary policy recommendations to address these challenges. Three actionable recommendations are outlined, including strategies to counter misinformation, improve accessibility, and strengthen public trust in vaccination programs. These insights aim to guide the development of effective interventions to increase vaccination uptake.

Understanding parental choices related to infant sleep practices in the United States using a mixed methods approach

BACKGROUND

This study aimed to gather information about parental practices, knowledge, and attitudes regarding infant sleep habits and environments, among families who practice non-recommended sleep practices.

METHODS

We conducted one-on-one phone interviews with parents who had practiced non-recommended sleep methods with their infant and had or had not experienced an undesirable sleep event such as a fall. Interviews were recorded and coded with MAXQDA software. Intercoder reliability was assessed for consistency.

RESULTS

Thirty-one parents consented, and 21 interviews were conducted. Parents were aware of current American Academy of Pediatrics (AAP) sleep recommendations for infants, knew about the sleep risks of non-recommended practices and had access to a recommended sleep environment. Parents reported developing modifications to the sleep environment which they perceived made their infant's sleep safer. Many parents felt that they could not be honest with their primary care provider about utilizing a non-recommended sleep environment; many had not had a detailed conversation with their primary care provider about safe sleep.

CONCLUSIONS

Our data are consistent with previous studies which demonstrate that lack of access to a recommended sleep space or lack of knowledge about AAP sleep guidelines are not the primary reasons for practicing non-recommended sleep habits. Our data highlights the disconnect between the current AAP safe sleep recommendations and what parents feel is feasible to do on a daily basis. Evaluating the impact of a risk elimination strategy which is used in the US compared with a risk mitigation strategy which is used in other countries on parental practice and ability to communicate honestly with primary care providers is a future area of research.

Moral foundations messaging to improve vaccine attitudes: An online randomized experiment from Argentina

The uptake of routine childhood vaccinations has declined globally since the start of the COVID-19 pandemic, due in part to increased vaccine hesitancy among parents. The Moral Foundations Theory proposes six foundations which can be targeted to increase vaccine uptake. In this study, we tested whether a post by UNICEF with a purity violation message could affect vaccine attitudes among parents in Argentina, where routine immunization coverage has been declining since 2014. Using an online randomized controlled survey experiment, we included 1,511 parents with a child under 12 years in Argentina. Outcomes were measured on the Vaccine Trust Indicator (VTI). We found that the purity violation message significantly affected vaccine attitudes: 80% of the intervention group scored high on the Vaccine Trust Indicator, compared to 73% in the control group (coefficient: 0.33, 95% Confidence Interval 0.20-0.47). Vaccine messaging framed as a purity violation is a promising way to improve vaccine attitudes among parents.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

Assessment of the Prevalence and Determinants of Vaccine Hesitancy in Pakistan

Background

Global efforts were critical in controlling the COVID-19 pandemic, and the World Health Organization declared it no longer a public health emergency of international concern in May 2023. Pakistan faced six waves and used every available resource to combat the pandemic. Public knowledge, attitudes, and practices (KAP) are key to the success of preventative interventions.

Objective

The goal of this study was to examine KAP through an online study of the general population and to evaluate the prevalence and determinants of COVID-19 vaccine hesitancy in Pakistan.

Methods

Between October and December 2021, a survey of the public was undertaken in several areas across Pakistan. A questionnaire was designed with questions focused on participant`s KAP, and statistical analyses were conducted to observe the normality of the data, knowledge, attitude and practice scores and the correlation between knowledge and attitude.

Results

Out of 688 participants surveyed, 98% expressing a preference for the vaccine over contracting the disease-causing SARS-CoV-2 virus. Overall, the study respondents had a positive attitude (95%) towards preventive measures to protect against pandemic-related issues and had more interest in the vaccine if it were provided free of cost and if the vaccine could be provided at their homes (74%). For participants in this study, knowledge and attitude remained dependent and positively correlated (p < 0.05).

Conclusion

This study identified limitations in public health communication techniques used to promote the COVID-19 vaccine that prevented widespread uptake of prevention measures. Additionally, this study revealed that age, education, and gender were statistically significant determinants for vaccine hesitancy (practices) and should likely be considered while making policies for health promotion programs.

Childhood Vaccine Attitude and Refusal among Turkish Parents

We aimed to understand and resolve anti-vaccine attitudes by examining the factors associated with vaccine attitudes and exploring potential strategies to improve childhood vaccination rates. Between 2014 and 2021, a total of 628 families refused vaccination in Adiyaman. A total of 300 families accepted visits and were visited. During the visits, the families were administered a questionnaire to determine the reasons for vaccine rejection and their opinions on the matter. While providing general information about the vaccine, parents were encouraged to reconsider their decision, and at the end, parents completed the questionnaire. The questionnaire included sociodemographic questions, reasons for vaccine refusal, and a vaccine attitude scale. Among the participants in the study, 9.3% were convinced about the vaccine. The mean vaccine attitude scale score was calculated as 23.6 ± 2.5 (min = 15-max = 29). Significantly higher rates of persuasion were observed among fathers (17.3%) compared to mothers (7.7%) (p = 0.038). Participants who had received some vaccinations had a higher rate of persuasion (11.6%) compared to those who had not received any vaccinations (2.6%) (p = 0.02). Childhood vaccine refusal is a complex issue that has been the subject of numerous studies. Studies on this subject will increase awareness of vaccines.

COVID-19 vaccination and the behavioral immune system: The newcomer and the old friend get along in preventing infection

Despite its old evolutionary history and emotional relevance, the behavioral immune system is one of the less studied individual predictors of vaccine uptake. To fill the gap, we conducted a large online study (2072 participants) during the spring 2022 when the great majority of the Italian population had already received at least one dose of the COVID-19 vaccine. Hierarchical binary logistic regression showed that, after controlling for the confounding effects of demographic and personality factors, there was a significant and positive association between pathogen disgust sensitivity and COVID-19 vaccine uptake (OR, 1.68; 95% CI, 1.42-1.99). The likelihood of being vaccinated for a participant with the highest possible score on the PVD Germ Aversion scale was approximately 12 times higher than the likelihood for a participant with the lowest possible score. Public health messaging could leverage the activation of the behavioral immune system as an emotional driver of vaccine uptake.

The relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy: A nationwide survey among Japanese mothers

Background

Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy has not been fully investigated. The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy among mothers in Japan.

Method

This cross-sectional survey-based study included 4516 mothers. Using a chi-square test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID-19 vaccine hesitancy.

Results

Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID-19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine-hesitant (IRR = 0.90, 95% CI = 0.84-0.96) after adjusting for potential confounders.

Conclusion

This study suggested that having a usual source of primary care may contribute to lower parental COVID-19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.

The Role of Perceived Risk in the Relationship Between Disgust Sensitivity and COVID-19 Vaccine Hesitancy

Background

Despite widespread availability of COVID vaccines and evidence of their efficacy, vaccine hesitancy remains prevalent. Several studies have examined the relationship between disgust sensitivity and vaccine hesitancy. Although results from studies using data collected prior to the COVID pandemic indicate that higher disgust sensitivity is related to greater vaccine hesitancy, results from studies using data collected during the COVID pandemic are equivocal. The present study examined whether perceived risk of contracting COVID moderated the relationship between disgust sensitivity and vaccine hesitancy.

Methods

Participants (n = 152) completed self-report measures of disgust sensitivity, perceived risk of contracting COVID, and COVID vaccine hesitancy (defined as both vaccine confidence and vaccine complacency).

Results

Perceived risk of contracting COVID significantly moderated the relationship between disgust sensitivity and vaccine complacency, with the association strengthened at low levels of perceived risk. Perceived risk of contracting COVID also marginally moderated the relationship between disgust sensitivity and vaccine confidence, with the association strengthened at low and average levels of perceived risk.

Conclusions

Results suggest that individuals with elevated disgust sensitivity who also report low levels of perceived risk of contracting COVID are more likely to express vaccine hesitancy. Implications of these findings are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10391-8.

Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy

Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior.

Why Turkish Parents Refuse Childhood Vaccination? A Qualitative Study

BACKGROUND

Anti-vaccination is spreading among parents. In 2017, 23000 families in Turkey refused vaccinations for their children. Meanwhile an increase in infectious diseases was observed, which might be caused by vaccination rejection. The reasons why families do not vaccinate their children may be very different, such as side effects, or advocation for "healthy life" by gurus. However, the real reasons for vaccine refusal are unknown. Our aim is to determine the reasons for anti-vaccination in Turkey.

METHODS

In order to reveal the real reasons for not taking the vaccine, we planned to conduct interviews with the representatives of the vaccine rejection group using qualitative research methodology with the "grounded theory" method. We searched some anti-vaccination blogs to find candidates for interviews. Within the scope of our study, parental concerns about vaccinations were classified by analyzing the data obtained from semi-structured questions and interviews recorded with voice recorders in face-to-face interviews with 21 parents in 13 cities of Turkey.

RESULTS

The obtained findings were classified under the headings of ''mistrust'', ''vaccine efficacy-importance'', ''decision-making processes - bases'', and ''law-ethics''. Mistrust was the main theme, almost singularly, as the most important reason for vaccine rejection. The salient reasons for mistrusts were: Companies which produce vaccines especially international companies because of conspiratory beliefs; health authorities, because of the belief about non-transparency in epidemiologic data, immunization council etc. and healthcare professionals, because of their non-communicative and non-concerned attitude.

CONCLUSION

Mistrust is hard to overcome. The beliefs of the patients cannot be easily changed. As a result of our study, we made some recommendations for health authorities, healthcare professionals, companies and other related stakeholders.

Vaccine Attitudes Mediate Relationships Between Caregiver Political Ideology and Likelihood of Child Vaccination for COVID-19

INTRODUCTION

The COVID-19 vaccine has become available to children ages 5-12, yet vaccine uptake is suboptimal. Political ideology is a correlate of COVID-related beliefs and vaccine likelihood among US adults. However, since political ideology is not easily modifiable, attention to modifiable mechanisms that may explain links between political ideology and vaccine hesitancy is important in addressing this public health crisis. Caregiver attitudes around vaccine safety and efficacy have been related to vaccine uptake in other populations and warrant additional study in the context of COVID-19. The current study examined whether caregiver's attitudes regarding the safety and efficacy of the COVID-19 vaccine mediated the relationship between caregiver political ideology and likelihood of having their child vaccinated.

METHODS

144 US caregivers of children (6-12 years) completed an online survey in summer 2021 to assess political ideology, vaccine-related beliefs, and likelihood of having their child vaccinated against COVID-19.

RESULTS

Caregivers with more liberal political views reported higher likelihood of eventual child vaccination compared to caregivers who reported a more conservative views (t(81) = 6.08, BCa CI [2.97, 5.67]). Moreover, parallel mediation models indicated caregiver?s perceptions of risks (BCa CI [-.98, -.10]) and efficacy (BCa CI [-3.16, -2.15]) of the vaccine each mediated the aforementioned relationship, with perceived efficacy explaining significantly more variance than risks.

CONCLUSIONS

Findings extend knowledge by identifying social cognitive factors that impact caregiver vaccine hesitancy. Interventions to address caregiver's hesitancy to have their child vaccinated through modifying caregiver's inaccurate beliefs regarding vaccines or enhancing perceptions of vaccine efficacy is warranted.

Perception of COVID-19 vaccination among Indian Twitter users: computational approach

Vaccination has been a hot topic in the present COVID-19 context. The government, public health stakeholders and media are all concerned about how to get the people vaccinated. The study was intended to explore the perception and emotions of the Indians citizens toward COVID-19 vaccine from Twitter messages. The tweets were collected for the period of 6 months, from mid-January to June, 2021 using hash-tags and keywords specific to India. Topics and emotions from the tweets were extracted using Latent Dirichlet Allocation (LDA) method and National Research Council (NRC) Lexicon, respectively. Theme, sentiment and emotion wise engagement and reachability metrics were assessed. Hash-tag frequency of COVID-19 vaccine brands were also identified and evaluated. Information regarding 'Co-WIN app and availability of vaccine' was widely discussed and also received highest engagement and reachability among Twitter users. Among the various emotions, trust was expressed the most, which highlights the acceptance of vaccines among the Indian citizens. The hash-tags frequency of vaccine brands shows that Covishield was popular in the month of March 2021, and Covaxin in April 2021. The results from the study will help stakeholders to efficiently use social media to disseminate COVID-19 vaccine information on popular concerns. This in turn will encourage citizens to be vaccinated and achieve herd immunity. Similar methodology can be adopted in future to understand the perceptions and concerns of people in emergency situations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42001-023-00203-0.

Investigating the Reasons for Receiving the Second Booster Dose of the COVID-19 Vaccine in Adults and in People with Chronic Medical Conditions in Southern Italy

This cross-sectional survey explored the attitudes and the reasons, as well their associated factors, for receiving the second booster dose of the COVID-19 vaccine among a sample of all old adults and of people with chronic medical conditions attending two randomly selected immunization centers in Naples (Italy). A total of 438 questionnaires were collected. The majority were male (55.1%) and the median age was 71 years. A higher perception of the vaccine’s utility, measured with a 10-point Likert type scale, has been observed among males, individuals with a higher perception that COVID-19 is a severe illness, with a higher self-awareness of being at risk of infection, and with a higher trust in the information received. The most reported reasons for receiving the second booster dose included protection of themselves and of their family members from getting COVID-19, fear of acquiring the disease, and having a physician’s recommendation. Younger participants, married/cohabitant, and with a higher perception that COVID-19 is a severe illness were more likely to have indicated protecting themselves and their family members as reason for receiving the booster dose. Respondents with a chronic medical condition, with a higher perception that COVID-19 is a severe illness, with a lower trust in the information received, and informed by physicians were more likely to have received the vaccine because they perceived of being at risk of getting a severe form of the SARS-CoV-2 infection. Physicians should play a pivotal role in stressing the importance of the second booster dose and in helping individuals to make decisions.

Vaccine Hesitancy Among Canadian Mothers: Differences in Attitudes Towards a Pediatric COVID-19 Vaccine Among Women Who Experience Intimate Partner Violence

OBJECTIVES

Vaccine hesitancy (VH) in maternal decision-making is important to understand to achieve community immunity targets and optimize pediatric COVID-19 vaccine adoption. COVID-19 is exacerbating the risk of intimate partner violence (IPV) for women in abusive relationships, a known risk factor for maternal VH. This project aimed to: (1) determine if IPV impacts maternal VH in Canada; and (2) understand maternal attitudes towards routine childhood vaccines and a pediatric COVID-19 vaccine in Canada.

METHODS

As part of a cross-sectional, quantitative study, 129 women completed an online survey. IPV was assessed using the Abuse Assessment Screen and the revised, short-form Composite Abuse Scale. The Parent Attitudes about Childhood Vaccines scale evaluated maternal attitudes towards routine vaccinations and a COVID-19 vaccine. Questions informed by the World Health Organization's Increasing Vaccination Model (IVM) evaluated perceived barriers and facilitators to COVID-19 vaccination.

RESULTS

In total, 14.5% of mothers were hesitant towards routine childhood vaccines, while 97.0% were hesitant towards a COVID-19 vaccine. Experiencing IPV was significantly associated with maternal COVID-19 VH (W = 683, p < 0.05). Social processes were identified as instrumental barriers and facilitators to COVID-19 vaccination, meaning that social norms and information sharing among social networks are critical in maternal vaccination decision-making.

CONCLUSIONS FOR PRACTICE

This study provides novel evidence of maternal IPV significantly impacting VH and the presence of strong maternal VH specific to a COVID-19 vaccine in the Canadian context. Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers, especially mothers who have experienced IPV.

The relation between digital literacy, cyberchondria, and parents' attitudes to childhood vaccines

PURPOSE

This study aimed to examine the relationship between digital literacy, cyberchondria and parents' hesitancy about childhood vaccines.

DESIGN AND METHODS

The study was cross-sectional, and parents with children aged 3-5 years who had access to the questionnaire were sent online and volunteered to participate.

RESULTS

The total mean score of the Parents' Attitude to Childhood Vaccines Scale was 44.89 ± 14.99, 31.3% of the parents were hesitant about childhood vaccines. Parental hesitancy about childhood vaccinations was 3.26 times (95% CI, 1.56-6.81) for single participants and 2.77 times (95% CI, 1.33-5.74) for the participants with a high school diploma than primary school graduates, 4.69 times for the participants who did not have a healthcare professional in their family (95% CI, 2.08-10.59), 16.02 times (95% CI, 6.61-10.80) for the participants who did not have a full round of vaccines, 1.81 times higher (95% CI, 1.13-2.88) than the participants who did not have enough information about vaccines. Hesitancy increased as the cyberchondria severity score increased (95% CI, 1.02-1.09), and digital literacy decreased (95% CI, 0.34-0.87).

CONCLUSIONS

One-third of the parents had hesitations about childhood vaccines. Vaccine hesitancy is affected negatively by digital literacy and positively by cyberchondria.

PRACTICE IMPLICATION

Meeting parents' accurate and reliable vaccine information will positively affect their attitudes and behaviours. Therefore, the level of cyberchondria among parents should be reduced, and their digital literacy should be increased.

"The bottom line is that it is all about trust": Interviews with Health Services Administrators about perceived barriers and facilitators to vaccine administration in jails

Background

Compared to the general population, individuals incarcerated in jails and prisons are more vulnerable to infection and mortality from communicable diseases, such as COVID-19 and influenza. However, vaccination rates among incarcerated individuals as well as staff who work in jails and prisons remain disproportionately low. Healthcare administrators working in jails have first-hand experience about barriers to vaccine provision, but their perspectives are infrequently collected and analyzed.

Methods

We reached out to Health Services Administrators (HSAs) from all 14 Massachusetts (MA) county jails for qualitative in-depth interviews to understand how their personal and professional feelings about vaccination relate to the barriers and facilitators that surround administration of vaccines in jail.

Results

Eight people participated in the study (8/14 = 57% response rate). Key themes emerged, including 1) HSAs expressed divergent opinions on incarceration as the correct opportunity to vaccinate individuals, 2) HSAs' personal views on vaccines influenced their operationalization of vaccination in jail, and 3) opinions varied on whether their institutions' vaccine protocols needed modification.

Conclusions

Our findings highlight the critical need to leverage the feedback and influence of stakeholders such as HSAs in efforts to improve preventative healthcare delivery in carceral health systems.

The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being

Background and purpose

Recent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents.

Method

A predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire.

Results

The current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy.

Conclusion

The current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.

Parental Perceptions on Use of Artificial Intelligence in Pediatric Acute Care

BACKGROUND

Family engagement is critical in the implementation of artificial intelligence (AI)-based clinical decision support tools, which will play an increasing role in health care in the future. We sought to understand parental perceptions of computer-assisted health care of children in the emergency department (ED).

METHODS

We conducted a population-weighted household panel survey of parents with minor children in their home in a large US city to evaluate perceptions of the use of computer programs for the care of children with respiratory illness. We identified demographics associated with discomfort with AI using survey-weighted logistic regression.

RESULTS

Surveys were completed by 1620 parents (panel response rate = 49.7%). Most respondents were comfortable with the use of computer programs to determine the need for antibiotics (77.6%) or bloodwork (76.5%), and to interpret radiographs (77.5%). In multivariable analysis, Black non-Hispanic parents reported greater discomfort with AI relative to White non-Hispanic parents (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.03-2.70) as did younger parents (18-25 years) relative to parents ≥46 years (OR 2.48, 95% CI 1.31-4.67). The greatest perceived benefits of computer programs were finding something a human would miss (64.2%, 95% CI 60.9%-67.4%) and obtaining a more rapid diagnosis (59.6%; 56.2%-62.9%). Areas of greatest concern were diagnostic errors (63.0%, 95% CI 59.6%-66.4%), and recommending incorrect treatment (58.9%, 95% CI 55.5%-62.3%).

CONCLUSIONS

Parents were generally receptive to computer-assisted management of children with respiratory illnesses in the ED, though reservations emerged. Black non-Hispanic and younger parents were more likely to express discomfort about AI.

The role of generalized trust in COVID-19 vaccine acceptance

Immunization by vaccination is one of the most important tools for fighting the COVID-19 pandemic. Yet in many countries, immunization campaigns have been hampered by vaccine hesitancy within the population. Building on the idea that vaccination decisions are embedded in the broader societal context, we study the role of generalized trust-the belief that most people can generally be trusted-in vaccine acceptance. Immunization campaigns face an inherent collective action problem: As all individuals benefit collectively from high immunization rates regardless of individual contribution, especially those with a low risk of severe COVID infection have an incentive to decide against the (perceived) costs and risks of vaccination. We argue that generalized trust may help to overcome this problem by encouraging the belief that cooperation for the common good is achievable and that those who cooperate are unlikely to be exploited by others. We further argue that the positive effect of generalized trust on vaccination decisions is weaker among individuals who are at higher risk of severe outcomes from the disease, as the collective action problem is less pronounced in this group. To test our predictions, we used data from the SOEP-CoV survey, which queried a representative probability sample of Germany's population between January and February 2021 on topics connected to the pandemic. Using multiple logistic regression models, and in line with expectations, we found a positive and robust link between generalized trust and the willingness to accept vaccination as soon as offered. However, overall, our examination of heterogeneous effects does not unequivocally support the idea that the role of generalized trust varies according to individual COVID risk.

Understanding healthcare workers' knowledge and attitudes regarding the coronavirus disease 2019 (COVID-19) vaccine: Overcoming gaps to improve public health response

Vaccines serve as a major tool against the coronavirus disease 2019 (COVID-19) pandemic, but vaccine hesitancy remains a major concern in the United States. Healthcare workers (HCWs) strongly influence a patient's decision to get vaccinated. We evaluated HCW knowledge and attitudes regarding the COVID-19 vaccine.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Exploring Cultural Factors of Human Papillomavirus Vaccination Acceptance in African Americans: An Integrative Review

INTRODUCTION

Human papillomavirus (HPV) vaccine can prevent HPV-related cancers. However, African Americans (AA) have a 30% higher incidence of HPV-related cervical cancer than Whites. The purpose of this integrative review is to explore cultural factors and beliefs impacting HPV vaccine decisions in AA adults.

METHODOLOGY

The Whittemore & Knafl model guided this review. Databases searched were PubMed, CINAHL, and Embase. Key terms included "human papillomavirus," "vaccine," "cultural values," "African American," and "adult." Inclusion criteria were AAs aged 18 years and over living in the United States.

RESULTS

A total of 634 articles were identified, and 20 studies published from 2010 to 2020 were used. Common factors influencing HPV vaccine decisions included religion, knowledge, physician recommendation, social network, attitudes, mistrust, benefits, and safety.

DISCUSSION

Limitations included omission of articles lacking AA representation, limited databases searched, and one-author-evaluated studies. Future studies to discover additional cultural factors influencing HPV vaccine acceptance are critical.

COVID-19 Vaccine Hesitancy among Health Professional Students: Cross-Sectional Data from the First Wave of the HOLISTIC Cohort Study

Vaccine hesitancy has been observed around the world, but there is a paucity of data among a broad range of U.S. health professional students. The goal of this report is to present findings about COVID-19 vaccine hesitancy among a cross-section of U.S. health professional students and determine if hesitancy varies by demographic characteristics, health science college, and other factors. A cross-sectional analysis of HOLISTIC Cohort Study participants enrolled from April 14 2021 to May 5 2021 at seven health sciences colleges in the University of Illinois Chicago was used. Exploratory and confirmatory factor analysis were used to evaluate vaccine hesitancy items and identify domains. Among 555 health professional students, three domains (perceived benefit, trustworthiness, and risk) contribute to vaccine hesitancy. Significant differences were observed in the domains among students of different races as well as vaccination history. Compared to students in the College of Medicine, students in the Colleges of Applied Health Science (OR 0.43; CI [0.19–0.96]), Pharmacy (OR 0.38; CI [0.17–0.87]), Nursing (OR 0.35; CI [0.16–0.78]), and Social Work (OR 0.30; CI [0.11–0.78]) reported lower perceived benefit. Compared to students in the College of Medicine, students in the College of Applied Health Sciences (OR 0.39; CI [0.17–0.94]), Dentistry (OR 0.27; CI [0.10–0.76]), Nursing (OR 0.38; CI [0.16–0.94]), and Social work (OR 0.31; CI [0.11–0.86]) reported more trustworthiness and more concerns about risk (OR 2.80; CI [1.15–6.81] for College of Applied Health Sciences, OR 9.12; CI [2.80–29.75] for Dentistry, OR 3.77; CI [1.47–9.65] for Nursing, OR 3.14; CI [1.02–9.67] for Social Work). Our findings suggest the need for a tailored vaccination strategy among different subgroups of health professional students.

Knowledge, attitudes, and practices toward COVID-19: A cross-sectional study during normal management of the epidemic in China

Background

The COVID-19 pandemic is striking the world with serious public health and economic losses. Complying with precautionary measures is affected by knowledge, attitudes, and practices (KAP) toward COVID-19 among the general public, so it is urgent to know the public's awareness of COVID-19 as to promote the epidemic management of COVID-19 in China.

Methods

An online sample of Chinese residents was recruited. We administered a self-developed online KAP survey comprising 39 questions regarding awareness of COVID-19, transmission mode, symptoms, preventive measures, and respondents' attitudes and practices with respect to COVID-19. The total score of each item (knowledge, attitudes, and practices) adopts the ten points system, score of KAP is 30 points. Descriptive statistics, analysis of variance, and binomial logistic regression were used in the statistical analysis.

Results

Among respondents, average scores for COVID-19-related knowledge, attitudes, and practice were 8.94 ± 0.79, 5.97 ± 1.58, and 7.03 ± 3.14, respectively. 91.2% were aware that COVID-19 is an acute viral infection and 99.95% knew that wearing a mask is one way to prevent COVID-19 infection. Participants correctly identified the symptoms of COVID-19 with a high accuracy rate of over 85%.

Conclusion

Many adults in the present study had adequate knowledge, a positive attitude and engaged in correct practices against COVID-19. People in China have a high awareness of epidemic prevention and control. However, conducting KAP surveys among people with different demographic characteristics at different stages of the epidemic is important to improve public health education and implement proper COVID-19 prevention and control measures.

Understanding the Role of Psychosocial Factors in Pakistani Parents' Hesitancy to Vaccinate Their Kids: The Mediating Role of Knowledge and Mistrust of Science about the COVID-19 Vaccine

Vaccination is a vital component in the battle against outbreaks of infectious diseases. Recognizing parents' reluctance to vaccinate their children is even more critical now, given the ongoing threat of a COVID-19 pandemic. Conspiracy theories, vaccination safety concerns, parental efficacy and risk perception, and a lack of confidence in science all influence intention. To investigate how these variables interact with vaccination behavior against COVID-19, we developed a model with psychosocial factors serving as the predictor and mistrust in science and vaccine knowledge serving as the mediator. In order to validate the model, the parents' intentions regarding their children's vaccination with COVID-19 were used. The study included 454 Pakistani parents who completed an online questionnaire assessing their intention to vaccinate their children. We analyzed the data using structural equation modeling (SEM). A significant level of vaccine hesitation is due to belief in vaccine conspiracy theories, and vaccine safety concerns were investigated. A surprising correlation exists between risk perception and vaccination intentions, followed by parental self-efficacy. It is significant to note that vaccine knowledge mediated conspiracy beliefs, risk perceptions, and intentions fully but partially mediated parental self-efficacy. Conspiracy theories were mediated by a mistrust in science, while perceptions of risk and vaccine safety were partially mediated. The findings of this research were used to develop sensible policy reforms and public health campaigns to encourage vaccination against both common infections such as measles, human papillomaviruses, or pertussis, and novel diseases such as COVID-19.

Vaccine Hesitancy in Pediatrics

Vaccine hesitancy is a growing complex and multifaceted phenomenon. It encompasses a wide spectrum of context-dependent attitudes and beliefs. Multiple factors influence parental decision-making including knowledge, sources of information, risk perception, trust, and individual experiences among others. This review focuses on describing the most common reasons that contribute to vaccine hesitancy among parents. Social media and the Internet have been described as major elements that can negatively influence parental decision-making regarding vaccines. The next focus is describing effective interventions that clinical providers can apply. Nonconfrontational and open discussions along with trusting and strong relationships between parents and providers seem to create a solid foundation toward vaccine acceptance. In addition, motivational interviewing is a helpful tool that has proven to be effective during these discussions. Ultimately, an individualized approach tailored to a specific community will likely be most effective in addressing vaccine hesitancy.

The behavioral immune system in action: Psychological correlates of pathogen disgust sensitivity in healthcare professionals working in a COVID-19 hospital

The behavioral immune system includes a set of proactive mechanisms that inhibit contact with pathogens in the first place. These mechanisms offer a sort of psychological and behavioral prophylaxis against infection. The aim of this study was to assess the functionality of the behavioral immune system under conditions of strong ecological validity. Our hypothesis was that the emotional and more primitive component of the behavioral immune system (i.e. pathogen disgust sensitivity) acts as a powerful predictor of fear of infection. The sample was made up of 101 healthcare professionals working in a COVID-19 hospital when vaccination was not yet available. We conducted a hierarchical regression analysis to assess the role of germ-related disgust in modulating levels of fear. After controlling for the significant effects of depressive symptoms and exposure to people with a confirmed diagnosis of COVID-19, we found that fear of infection was more intense in those healthcare workers who reported higher levels of germ-related disgust. Fear of infection was not related to perceived infectability, an individual variable informed by more rational cognitive appraisals. These findings show that, even in healthcare workers who can take advantage of their professional knowledge and acquired skills for rational appraisals, the most primitive component of the behavioral immune system still plays a major role in eliciting fear of COVID-19. It is likely that the psychological reactions elicited by the behavioral immune system promote preventive health behaviors in modern environments as well.

Information From Same-Race/Ethnicity Experts Online Does Not Increase Vaccine Interest or Intention to Vaccinate

Policy Points Mass vaccination is essential for bringing the COVID-19 pandemic to a close, yet substantial disparities remain between whites and racial and ethnic minorities within the United States. Online messaging campaigns featuring expert endorsements are a low-cost way to increase vaccine awareness among minoritized populations, yet the efficacy of same-race/ethnicity expert messaging in increasing uptake remains unknown. Our preregistered analysis of an online vaccine endorsement campaign, which randomly varied the racial/ethnic identity of the expert, revealed no evidence that information from same race/ethnicity experts affected vaccine interest or the intention to vaccinate. Our results do not rule out the possibility that other low-cost endorsement campaigns may be more effective in increasing vaccine uptake, but do suggest that public health campaigns might profitably focus on issues of access and convenience when targeting minoritized populations in the United States.

CONTEXT

The COVID-19 pandemic in the United States has been unequally experienced across racial and ethnic groups. Mass vaccination is the most effective way to bring the pandemic to an end and to manage its public health consequences. But the racialization of public health delivery in the United States has produced a sizable racial/ethnic gap in vaccination rates. Closing this gap in vaccine uptake is therefore essential to ending the pandemic.

METHODS

We conducted a preregistered, well-powered (N = 2,117) between-subjects survey experiment, fielded March 24 to April 5, 2021, in which participants from YouGov's online panel-including oversamples of Black (n = 471), Hispanic/Latino/a (n = 430), and Asian American (n = 319) participants-were randomly assigned to see COVID-19 vaccine information endorsed by same- or different-race/ethnicity experts or to a control condition. We then measured respondents' vaccination intentions, intention to encourage others to get vaccinated, and interest in learning more information and sharing information with others.

FINDINGS

Same-race/ethnicity expert endorsements had no measurable effect on nonwhite or white respondents' willingness to get the COVID-19 vaccine, to encourage others to get the vaccine, or to learn more or share information with others.

CONCLUSIONS

Our study provides empirical evidence suggesting online endorsements from same-race/ethnicity experts do not increase vaccine interest, advocacy, or uptake, though same-race/ethnicity endorsements may be effective in other venues or mediums.

Intention to vaccinate children for COVID-19: A segmentation analysis among Medicaid parents in Florida

COVID-19 vaccines have been granted emergency use authorization for children ages 5 years and older. To understand how racially and ethnically diverse parents of young children enrolled in Medicaid feel about a prospective COVID-19 vaccine for their children, we administered an online survey that included both close-ended and open-ended items to a statewide sample in Florida (n = 1951). We used quantitative responses to conduct a statistical audience segmentation analysis that identified five distinct sub-groups that varied widely in the likelihood that they would get a COVID-19 vaccine for their child. Qualitative responses were used to illustrate differences between the groups. The youngest Black and White mothers were least likely to vaccinate their child (24%), followed by Black and White mothers in their early 30s (36%), younger Hispanic and mixed-race or other race parents (45%), older mothers (48%) and older fathers (71%). Unique challenges to building vaccine confidence emerged for each group. The youngest Black and White mothers were more likely to report their lives being worse during the COVID-19 pandemic, were far more negative and less positive about a COVID-19 vaccine, and were more concerned about paying bills than preventing COVID-19. Younger Hispanic and mixed-race parents were less negative, but more likely to use emotional language (e.g., scared, nervous, worried) talking about a COVID-19 vaccine, and more likely to report that protecting their child's health was their top concern. Recommendations are made for applying the insights gained in outreach and education efforts.

Using moral foundations in government communication to reduce vaccine hesitancy

Having a vaccine available does not necessarily imply that it will be used. Indeed, uptake rates for existing vaccines against infectious diseases have been fluctuating in recent years. Literature suggests that vaccine hesitancy may be grounded in deeply rooted intuitions or values, which can be modelled using Moral Foundations Theory (MFT). We examine the respective prominence of the MFT dimensions in government communication regarding childhood vaccinations and explore its effect on parents' vaccine hesitancy. We measure the MFT dimension loading of the vaccination information brochures from the Dutch National Institute for Public Health and the Environment (RIVM) between 2011-2019 and connect this information with the electronic national immunisation register to investigate if the use of moral foundations in government communication has a measurable effect on vaccination uptake. We find the largest positive effect for the dimensions Authority/Subversion and Liberty/Oppression and suggestive evidence in favour of a small positive effect for Purity/Degradation. Conversely, Loyalty/Betrayal actually has a negative effect on vaccination rates. For the dimension Harm/Care, we find no significant effect. While Purity/Degradation and Harm/Care appear to be the two most frequently used moral foundations by RIVM, these dimensions have in fact no or only a minor effect on parents' vaccine hesitancy. Reducing the use of these moral foundations may be the first step towards optimising government communication in this context. Instead, formulations activating the moral foundations Authority/Subversion and Liberty/Oppression appear to have positive effects on vaccination uptake.

"Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions

OBJECTIVE

The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children.

METHOD

This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children.

RESULTS

64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information.

CONCLUSION

Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.

Improving Adult Vaccination Status in the United States

Adult immunization practices leave much to be desired. Misinformation has increased mistrust. As a result, Latino and African American populations have low rates of annual flu vaccinations and, during the COVID-19 pandemic, lag behind for COVID-19 vaccination. Historically, healthcare staff have failed to adhere to adult immunization guidelines contributing to patient infections. Healthcare staff, both clinical and non-clinical, must lead by example by making “prevention primary”. Most adults may not realize they need immunizations. We recommend the following steps to increase immunization uptake: Make adult immunization a standard of patient care as we do for children. Assess immunization status at every clinical opportunity. Strongly recommend vaccinations needed. Administer needed vaccinations, multiple if warranted. Document vaccines received by your patient. Participate in your state’s immunization registry and work with community organizations that can help make adult immunization the norm.

The behavioral immune system and vaccination intentions during the coronavirus pandemic

The behavioral immune system is considered to be a psychological adaptation that decreases the risk of infection. Research suggests that, in the current environment, this system can produce attitudes with negative health consequences, such as increased vaccine hesitancy. In three studies, we investigated whether two facets of the behavioral immune system-germ aversion (i.e., aversion to potential pathogen transmission) and perceived infectability (i.e., perceived susceptibility to disease)-predicted intentions to accept COVID-19 and influenza vaccination during the pandemic. The behavioral immune system mechanisms were measured before the COVID-19 pandemic in one study, and during the pandemic in two. In contrast to previous research, those with higher germ aversion during the pandemic perceived vaccines to be safer and had higher intentions to accept vaccination. Germ aversion before the pandemic was not associated with vaccination intentions. Individuals who perceived themselves as more susceptible to disease were slightly more willing to accept vaccination. We conjecture that high disease threat reverses the relationship between the behavioral immune system response and vaccination. As the associations were weak, individual differences in germ aversion and perceived infectability are of little practical relevance for vaccine uptake.

Linking the behavioral immune system to COVID-19 vaccination intention: The mediating role of the need for cognitive closure and vaccine hesitancy

Vaccination has become one of the most effective ways of controlling the spread of COVID-19. Consequently, revealing the evolutionary and cognitive antecedents of COVID-19 vaccine hesitancy and vaccination intention has become crucial. Drawing on the theory of behavioral immune system (BIS), we investigate whether perceived vulnerability to disease (PVD) is associated with vaccination intentions through the need for cognitive closure (NCC) and vaccine hesitancy. The data was collected from 525 adults from Turkey. The structural equation modeling results indicate that of the two dimensions of PVD, germ aversion predicts COVID-19 vaccination intention through sequential mediation of NCC and vaccine hesitancy. Perceived infectability, on the other hand, is directly and positively related to vaccination intention. By showing the mediating role of NCC, our results offer an insight as to why germ aversion translates into vaccine hesitancy, and low vaccination intention. We discuss the potential benefits of considering the roles of BIS and NCC in campaigns and policies targeted at increasing COVID-19 vaccine uptake and suggest implications for such practices.

Parents' willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study

INTRODUCTION

This study aimed to evaluate the parents' willingness and attitudes concerning the COVID-19 vaccine.

METHOD

This cross-sectional study was performed using a self-administered online survey, covering parents' and their children's characteristics, parents' willingness and attitudes towards the COVID-19 vaccine. A total of 1035 parents participated.

RESULTS

Analysis showed that 36.3% of parents were willing to have their children receive the COVID-19 vaccine and that 59.9% were willing to receive it themselves. In addition, 83.9% were willing to have their children vaccinated with the COVID-19 vaccine if the mortality rates associated with COVID-19 in children increased following a mutation. After adjusting for significant variables, willingness to receive the COVID-19 vaccine (AOR = 24.91; 95% CI = 10.93-56.76), willingness for their children to participate in a COVID-19 vaccine trial (AOR = 11​.87; 95% CI = 2.41-58.40] and advising others to receive the COVID-19 vaccine [AOR = 7.82; 95% CI = 2.50-24.49] were associated with greater parents' willingness for their children to receive the COVID-19 vaccine.

CONCLUSIONS

Parents' willingness for their children to receive the COVID-19 vaccine was low. The only characteristics of either parents or children found to affect the parents' willingness for children to receive the COVID-19 vaccine was the parents being healthcare workers. Parents' willingness and positive attitudes towards the COVID-19 vaccine are factors that increase acceptance of the COVID-19 vaccine for their children.

COVID-19 vaccine acceptance: influential roles of political party and religiosity

Given recent declines in US vaccination rates and the emergence of COVID-19 vaccines, identifying sociodemographic influencers of vaccine willingness holds importance for developing effective public health campaigns aimed at enhancing nationwide COVID-19 vaccine acceptance. The present study utilized a hierarchical binary logistic regression model to assess demographic variables (age, gender, race/ethnicity, pre-existing medical conditions), political party membership, religious affiliation, level of religiosity, and fear of COVID-19 as predictors of COVID-19 vaccine acceptance ('Yes', would receive a vaccine or 'No', would not receive a vaccine) in a national sample of US adults (N = 249). Participants were recruited from Amazon's Mechanical Turk (MTurk) and completed several online questionnaires pertaining to mental health, health behaviors, and responses to the COVID-19 pandemic. Both Democratic party membership and decreased level of religiosity predicted acceptance of a COVID-19 vaccine. This investigation supports political party membership and religiosity as influencers of COVID-19 vaccine willingness and suggests that these variables could represent potential targets for public health interventions aimed at increasing vaccine adoption.

Predictors of Vaccine Hesitancy: Implications for COVID-19 Public Health Messaging

Objectives: Successful immunization programs require strategic communication to increase confidence among individuals who are vaccine-hesitant. This paper reviews research on determinants of vaccine hesitancy with the objective of informing public health responses to COVID-19. Method: A literature review was conducted using a broad search strategy. Articles were included if they were published in English and relevant to the topic of demographic and individual factors associated with vaccine hesitancy. Results and Discussion: Demographic determinants of vaccine hesitancy that emerged in the literature review were age, income, educational attainment, health literacy, rurality, and parental status. Individual difference factors included mistrust in authority, disgust sensitivity, and risk aversion. Conclusion: Meeting target immunization rates will require robust public health campaigns that speak to individuals who are vaccine-hesitant in their attitudes and behaviours. Based on the assortment of demographic and individual difference factors that contribute to vaccine hesitancy, public health communications must pursue a range of strategies to increase public confidence in available COVID-19 vaccines.

Predictors of COVID-19 vaccine intentions in the United States: the role of psychosocial health constructs and demographic factors

Background

On December 21, 2020, a study was conducted to investigate a range of psychosocial health constructs and demographic variables potentially associated with intentions toward accepting or forgoing the coronavirus (COVID-19) vaccine.

Purpose

The goal of the study was to identify predictors of forgoing COVID-19 vaccination at the time of the initial rollout.

Methods

A cross-sectional, representative online survey of 350 U.S. residents was conducted using the online crowdsourcing site Prolific to assess vaccine intentions, health attitudes, and demographic information. Variables examined included demographic factors and health constructs corresponding to each of the elements of the health belief model (perceived severity, susceptibility, benefits, barriers, and cues to action), the theory of planned behavior (attitudes, subjective norms, and perceived behavioral control), attitudes toward vaccines in general, and trust in the COVID-19 vaccine approval process.

Results

After using hierarchical linear regression to control for demographics, the health constructs uniquely associated with the likelihood to forgo vaccination were perceived barriers, general attitudes toward the COVID-19 vaccine, subjective norms, and trust in the vaccine approval process. Significant demographic predictors of vaccine reluctance included being female, politically conservative, and more religious.

Conclusions

The current research identified three demographic factors and four health constructs uniquely associated with vaccine acceptance. These findings reveal that the constructs contained within the health belief model and theory of planned behavior can be used to predict COVID-19 vaccination intentions, and can be supplemented with an assessment of general vaccine attitudes and attitudes toward the vaccine approval process.

The Long and Winding Road: Uptake, Acceptability, and Potential Influencing Factors of COVID-19 Vaccination in Austria

Acceptance of the COVID-19 vaccine will play a crucial role in combating the current pandemic. Vaccine rollouts have started in most countries. To reach the desirable vaccine coverage and to enhance its uptake, it is imperative to assess vaccine hesitancy. Methods: To assess the current vaccine acceptability in Austria and its influencing factors, an online survey was created and comprised fifteen questions segmented into a sociodemographic part and the acceptance and influencing factors of the approval of the COVID-19 vaccine. Results: In total, 70% of the 1350 respondents thought that the COVID-19 vaccine is an effective way to prevent and control the virus, while 13% disagreed and 17% were uncertain. Further, 71% approved the rapid development and rollout of the vaccine, while 55% were willing to accept the vaccine as soon as it became available, 18% did not want to get the vaccine, 17% wanted to delay, and 10% were already vaccinated. Conclusions: The results show a generally positive attitude towards the new COVID-19 vaccine. The doctor’s recommendation greatly influences the decision-making process, and tailored vaccine information can support a higher vaccine coverage.

Knowledge, Attitudes, and Practices (KAP) toward the COVID-19 Vaccine in Oman: A Pre-Campaign Cross-Sectional Study

Oman is globally acknowledged for its well-structured immunization program with high vaccination coverage. The massive spread of misinformation brought on by the COVID-19 pandemic, as well as the easy access to various media channels, may affect acceptance of a vaccine, despite the inherent trust in the local system. This cross-sectional study evaluated the knowledge, attitudes, and practice (KAP) in Oman toward COVID-19 vaccines. It included 3000 randomly selected adults answering a structured questionnaire via telephone. Participants were 66.7% Omani, 76% male, and 83.7% without comorbidities. Their mean age was 38.27 years (SD ± 10.45). Knowledge of COVID-19′s symptoms, mode of transmission, and attitudes toward the disease was adequate; 88.4% had heard of the vaccine, 59.3% would advise others to take it, 56.8% would take it themselves, and 47.5% would take a second dose. Males (CI = 2.37, OR = (2.00–2.81)) and Omani (CI = 1.956, OR = (4.595–2.397)) were more willing to be vaccinated. The history of chronic disease, source of vaccine knowledge, and education level were factors that affected the willingness to accept the vaccine. The Omani community’s willingness to take the COVID-19 vaccine can be enhanced by utilizing social media and community influencers to spread awareness about the vaccine’s safety and efficacy.

The behavioral immune system and conservatism as predictors of disease-avoidant attitudes during the COVID-19 pandemic

The COVID-19 pandemic presents a unique opportunity to explore the relationships between the behavioral immune system (BIS), Political Ideology, and disease avoidant attitudes (e.g., attitudes toward vaccination and attitudes about COVID-19). The BIS (e.g., disgust) is believed to be the first line of defense against pathogens and has been linked to socially conservative values. Ironically, however, the BIS has also been associated with anti-vaccination attitudes. In the current study, American participants (N = 139) completed an online survey with self-report measures of the BIS (e.g., disgust sensitivity and perceived infectability), political ideology, COVID-19 attitudes, and anti-vaccination attitudes. Disgust sensitivity was positively correlated with anti-vaccination attitudes but not significantly correlated with attitudes toward COVID-19. Perceived infectability, however, was negatively correlated with anti-vaccination attitudes and positively correlated with anxiety and knowledge about COVID-19. Right-wing authoritarianism and support for Trump were negatively correlated with knowledge and anxiety about COVID-19 and positively correlated with anti-vaccination attitudes.

Who Influences the Public Intention to Get a COVID-19 Vaccine and What are the Public References and Concerns? A Population Survey in Vietnam

Background

Coronavirus disease 2019 (COVID-19) vaccine acceptance is influenced by the trusted recommenders. This survey examined the public references, concerns, and trust in seven groups of recommenders regarding COVID-19 vaccine in Vietnam.

Materials and Methods

A cross-sectional survey was conducted on 1,579 participants between April 16 and July 16, 2021. Participants’ references, concerns, and responses to vaccination recommendations made by government officials, employers, physicians, nurses, pharmacists, senior family members, and religious leaders were captured using a self-administered questionnaire.

Results

Rates of trust ranged from 18.5% to 89.1%. The highest rates were attributable to government (89.1%) and physicians (85.9%). Less than half of participants would accept the vaccines if pharmacists (45.5%), nurses (44.7%), employers (42.4%), senior family members (28.1%), and religious leaders (18.4%) recommended it. Only 37.6% of participants thought that vaccines were safe for them, while 57% were unsure. Most participants would wait and see how people respond to the vaccines before getting vaccinated (91.5%), preferred to receive the vaccines at public hospitals (88.6%), and were concerned about vaccine effectiveness (86.9%) and side effects (76.4%), while 61.8% were concerned about vaccine cost.

Conclusion

Focusing on the personal benefit and relying on the government, physicians, and social role models would make the vaccine advertising campaigns more effective. If annual vaccinations were needed, providing the community with affordable vaccines would be an appropriate, long-term solution to ensure vaccination coverage in low-resource countries like Vietnam. Further studies are needed to examine reasons for the public reference of vaccination centers which may help in improving their confidence in getting the vaccine, regardless of the settings.