Cognitive Barriers to COVID-19 Vaccine Uptake Among Older Adults

Effectiveness of stage-of-change (SOC)-tailored interventions in increasing uptake of any type of vaccination: A systematic review and meta-analysis

Vaccine hesitancy remains a significant public health challenge globally, requiring innovative, evidence-based approaches to improve uptake. This systematic review and meta-analysis evaluated the effectiveness of stage-of-change (SOC)-tailored interventions, the customized strategies based on an individual's readiness for behavioral changes, in promoting vaccination uptake. Data were synthesized from randomized controlled trials (RCTs), quasi-experimental, and non-experimental studies identified through MEDLINE, PubMed, Web of Science, Embase, Global Health, and APA PsycInfo databases. Five eligible studies published between 2004 and 2023 were included, with three RCTs and one quasi-experimental study contributing to the meta-analysis. The pooled standard mean difference (SMD) for vaccination uptake was 0.54 (95% confidence interval [CI]: 0.49, 0.59, p < .001), indicating a significant medium effect size with no heterogeneity (I2 = 0%, p = .88). Subgroup analyses showed SOC-tailored interventions were particularly effective for older adults (SMD = 0.57, 95% CI: 0.22 to 0.92, p = .03) and for parents or caregivers to increase children's vaccination uptake (SMD = 0.53, 95% CI: 0.32 to 0.74, p = .02). These findings provided preliminary evidence on the effectiveness of SOC-tailored interventions in addressing vaccine hesitancy. Future research should explore geographically diverse settings and cost-effective delivery methods to maximize the impact.

COVID-19 vaccination refusal among the anti-vaccinationists in a Chinese society: a critical medical anthropology study of the vaccination barriers

Introduction

This study investigated the reasons for COVID-19 vaccination refusal among some Hong Kong residents who were anti-vaccinationists, despite the implementation of a vaccine incentive policy called the Vaccine Pass. The health belief model and the theory of planned behavior have been widely employed to analyze the determinants of COVID-19 vaccination. However, these two theories focus on the micro individual factors, which do not provide a sufficiently comprehensive analysis.

Study design

A qualitative descriptive approach with a critical medical anthropology framework.

Methods

This study adopts a critical medical anthropology framework that provides a micro and macro analysis at four social levels. A qualitative approach with individual, semi-structured, in-depth interviews was conducted from September 2022 to March 2023 with 30 individuals aged 20-59 years who did not receive COVID-19 vaccination in Hong Kong. The participants were recruited through purposive sampling and snowball sampling. A thematic analysis of data was implemented.

Results

The reasons for COVID-19 vaccination refusal involved intertwining relationships among factors in the four social levels of the critical medical anthropology framework. The participants' doubts about the safety of COVID-19 vaccines at the individual level were interacting with: (1) their ethnocultural beliefs and the perceived profit-oriented nature of vaccine production and distribution at the macro-social level, (2) their interpretation of the inconsistent advice of medical doctors at the micro-social level, and (3) their distrust in the government's vaccination policies at the intermediate-social level.

Conclusion

The participants' refusal of COVID-19 vaccines was correlated with perceived profit motives related to the vaccine, perceived conflict of interest of health-care providers, and the distrust of government.

Latent profile of personality traits for American older adults and its transition during the COVID-19 pandemic

Background

The impact of COVID-19 on older adults' personality development is essential for emergency management but under-researched. This study seeks to explore the personality profiles of older adults living in the United States and how these profiles transitioned during the pandemic.

Methods

Longitudinal data were collected from 3,550 adults aged 60 and older who participated in both the 2016 and 2020 waves of the Health and Retirement Survey (61.18% female, mean age 65.85 in 2016). Personality traits were assessed using the Midlife Development Inventory. COVID-19-related experiences including pandemic concerns, restricted healthcare access, financial instability, work challenges, disrupted social connections, and mutual aid behaviors. Latent Profile Analysis and Transition Analysis were used for analysis.

Results

Three distinct personality profiles were identified: Well-adjusted, Moderate-adjusted, and Poor-adjusted. About 42% of respondents experienced personality changes during the pandemic. Higher levels of COVID-19 concern were linked to an increased likelihood of transitioning to Poor-adjusted from Moderate (OR=1.06, p<0.05) or Well-adjusted (OR=1.05, p<0.01). Challenges such as healthcare delays and financial hardships hindered transitions from Poor- to Moderate-adjusted (Healthcare delay: OR=0.39, p<0.05; Financial hardships: OR=0.67, p<0.05) but increased the likelihood of Moderate-adjusted individuals transitioning to Poor-adjusted (Healthcare delay: OR=1.46, p<0.05; Financial hardships: OR=1.51, p<0.05). However, Poor-adjusted individuals who provided help to others were more likely to transition to Moderate-adjusted (OR=2.71, p<0.01).

Conclusions

Personality transitions during crisis are significant among older adults. Future interventions should focus on addressing traumatic concerns, encouraging helping behaviors, and mitigating healthcare and financial challenges to support older adults' personality development during crisis.

Belief in vaccine myths and vaccine uptake in Utah during the COVID-19 pandemic

Introduction

Since its emergence in December 2019, COVID-19 has caused millions of deaths worldwide. While vaccines are largely available in most places, including the United States (U.S.), vaccine uptake is lower than is desirable from a public health perspective.

Objective

The objective of this paper is to examine belief in vaccine myths, including what individual and place characteristics underpin such beliefs, and uptake of vaccines - as well as the role of belief in myths in obtaining the COVID-19 vaccine.

Methods

We use weighted survey data from an online panel of 529 Utah adult residents.

Results

Sixty-nine percent of our sample was fully vaccinated at the time of taking the survey. We find that belief in vaccine myths varies among Utahns, with the highest percentage seeing the vaccines as unsafe because of their rapid development. Those who are older, are more religious (including members of The Church of Jesus Christ of Latter-day Saints), have less formal education, and are more conservative were more likely to have medium and/or higher levels of belief in vaccine myths. We find that belief in vaccine myths is associated with lower COVID-19 vaccine uptake, even when controlling for other factors.

Conclusion

Understanding what drives vaccination uptake, including the role of belief in emerging vaccine myths, is important for public health measures in this and future outbreaks.

Cohort Profile: Real-Time Insights of COVID-19 in India (RTI COVID-India)

BACKGROUND

The coronavirus disease (COVID) pandemic caused disruption globally and was particularly distressing in low- and middle-income countries such as India. This study aimed to provide population representative estimates of COVID-related outcomes in India over time and characterize how COVID-related changes and impacts differ by key socioeconomic groups across the life course.

METHODS

The sample was leveraged from an existing nationally representative study on cognition and dementia in India: Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). The wave-1 of LASI-DAD enrolled 4096 older adults aged 60 years and older in 3316 households from 18 states and union territories of India. Out of the 3316 LASI-DAD households, 2704 with valid phone numbers were contacted and invited to participate in the Real-Time Insights COVID-19 in India (RTI COVID-India) study. RTI COVID-India was a bi-monthly phone survey that provided insight into the individual's knowledge, attitudes, and behaviour towards COVID-19 and changes in the household's economic and health conditions throughout the pandemic. The survey was started in May 2020 and 9 rounds of data have been collected.

FINDINGS TILL DATE

Out of the 2704 LASI-DAD households with valid phone numbers, 1766 households participated in the RTI COVID-India survey at least once. Participants were in the age range of 18-102 years, 49% were female, 66% resided in rural area. Across all rounds, there was a higher report of infection among respondents aged 60-69 years. There was a greater prevalence of COVID-19 diagnosis reported in urban (23.0%) compared to rural areas (9.8%). Respondents with higher education had a greater prevalence of COVID-19 diagnosis compared to those with lower or no formal education. Highest prevalence of COVID-19 diagnosis was reported from high economic status compared to middle and low economic status households. Comparing education gradients in experiencing COVID-19 symptoms and being diagnosed, we observe an opposite pattern: respondents with no formal schooling reported the highest level of experiencing COVID-19 symptoms, whereas the greatest proportion of the respondents with secondary school or higher education reported being diagnosed with COVID-19.

FUTURE PLANS

The study group will analyse the data collected showing the real-time changes throughout the pandemic and will make the data widely available for researchers to conduct further studies.

Understanding COVID-19 vaccine hesitancy: A cross-sectional study in Malang District, Indonesia

Introduction

Vaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia.

Methods

Data come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined.

Results and discussion

The results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195-1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026-1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027-1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998-1.040), need for chaos (OR = 1.044, 95% CI = 1.022-1.067), and populist views (OR = 1.028, 95% CI = 1.00-1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle "infodemics" are needed to address hesitancy during a new vaccine introduction program.

Greater knowledge about COVID-19, more negative emotions. Research in adult Poles after 2nd and 5th waves of the pandemic

Introduction: The study investigated the dynamics of cognitive and emotional representation of COVID-19 in adult Poles, following the second (2021) and the fifth (2022) wave of the pandemic. Material and methods: The study involved a total of 303 subjects (N = 198 in Survey 1 in 2021, and N = 105 in Survey 2 in 2022). The following measures were used: a questionnaire covering demographic data and general opinions about COVID-19 as well as the Revised Illness Perception Questionnaire (IPQ-R). Results: After the fifth wave, significantly more respondents were convinced that COVID-19 was a real and dangerous disease. Cognitive deficits were more commonly recognised among symptoms of the viremia. Vaccination against COVID-19 was recognised as an essential preventive measure. Both surveys showed that COVID-19 representation was characterised by negative emotions and low sense of illness coherence. However, there was increased belief that the disease can be controlled through medical interventions. The age of the respondents in Survey 1 and Survey 2 was differently related to beliefs about COVID-19. Conclusions: 1. After 2.5 years of the pandemic, the awareness of Poles about the causes, symptoms and methods of preventing the disease has increased. 2. Failure to vaccinate against COVID-19 has been identified as a significant cause of viremia. 3. Negative emotions and a sense of serious consequences were predominant in both Surveys, but after the fifth wave of the pandemic the scores reflect increased perception of the chronic nature of the disease and belief that the illness can be treated with medication, whereas the sense of personal control was found to decrease. 4. After the fifth wave of the pandemic, older age corresponded to increased belief in the relevance of some preventive measures, and to greater awareness of the viral origin, increased belief in the feasibility of controlling the disease through one's behaviours and a greater sense of illness coherence. 5. The intensification of negative emotions related to the pandemic can be treated as a predictor of the increase in adjustment disorders and risk of mental health deterioration among adult Poles in the following years. Keywords: cognitive and emotional representation of illness, COVID-19 pandemic, Polish adults

Factors Influencing the Choice to Advise for or against COVID-19 Vaccination in the Physicians and Dentists of an Italian Region

Healthcare workers (HCWs), particularly physicians, are a relevant and trusted source of information for patients, especially when health-related choices such as vaccination are concerned. Between July and November 2022, we administered a web-based survey to physicians and dentists living in the Latio region of Italy to explore whether their background might affect their willingness to recommend the COVID-19 vaccination to their patients (RCVtoPat) and their relatives (RCVtoRel). We performed a multivariable logistic regression to study the association between the two outcomes (RCVtoPat and RCVtoRel) and their potential determinants in our sample (n = 1464). We found that being a dentist, an increasing fear of COVID-19, and having been previously vaccinated against flu are positively associated with both RCVtoPat and RCVtoRel, while a better self-rated knowledge of COVID-19 vaccines is associated only with RCVtoRel. No role was found for age, sex, civil status, education level, information sources, previous SARS-CoV-2 infection, and chronic diseases. A sub-group analysis of physicians alone (n = 1305) demonstrated a positive association with RCVtoRel of being specialized in diagnostic/therapeutic services and a negative effect on RCVtoPat of being trained in general practice. We provide useful insights about the factors that should be addressed to ensure HCWs exert a positive influence on their patients and communities.

Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: A qualitative study

Although COVID-19 vaccines are available, evidence suggests that several factors hinder or facilitate their use. Several studies have found gender differences in COVID-19 vaccine uptake, with women less likely to vaccinate than men in many countries, including Ghana. These studies, however, have primarily been quantitative. This study used a qualitative approach to examine the facilitators and barriers to vaccine uptake among women in Ghana. Using a cross-sectional descriptive qualitative research design, 30 women in the Greater Accra and Ashanti regions of Ghana were conveniently sampled and interviewed using a semi-structured interview guide. Fifteen (15) interviews were conducted in each region. The data were transcribed verbatim and analysed thematically using QSR NVivo version 10 software. Among the key factors that facilitate COVID-19 vaccination are the desire to protect oneself and family against COVID-19, education about COVID-19 vaccines, seeing others receive the COVID-19 vaccine, and vaccine being cost-free. On the other hand, long queues at the vaccination centres, fear of side effects, misconceptions about the vaccines, and shortage of vaccines were the main barriers against COVID-19 vaccination. The study results show that individual, institutional, and vaccine-related factors facilitate or hinder COVID-19 vaccination among women. Addressing these factors need continuous comprehensive health education, and ensuring vaccine availability at vaccination sites will improve women’s uptake of the COVID-19 vaccines.

COVID-19 vaccine uptake among physicians during the second wave of COVID-19 pandemic: Attitude, intentions, and determinants: A cross-sectional study

Background

Developed within a short period of time, the COVID-19 vaccine is not yet widely accepted among the public despite its availability, including by physicians, who are considered a vulnerable group.

Methodology

A descriptive cross-sectional study selected 436 governmental physicians from different specializations, representing four random administrative regions in Egypt. The data were collected through a self-administrated online questionnaire and analyzed using suitable tests.

Results

Out of the studied 436 physicians, 229 (52.2%) [aged 20-30, 284 (65.1%)] were women, 270 (61.9%) were residents, 219 (50.2%) were married, 398 (91.3%) were non-smokers, and 263 (60.3%) were non-frontline caregivers. The majority of the physicians, 227 (52.1%) of them, hesitated to take the vaccine, 236 (54.1%) had not decided on the preferred type of vaccine, and 101 (23.2%) were neutrally confident in the Egyptian healthcare system; 302 (96.3%) had no history of drug or food hypersensitivity. There was no statistically significant (p < 0.05) relationship between the physicians' attitude toward COVID-19 vaccine uptake and the studied demographic variables. There was a statistically significant connection between all of the doctors' intentions to get the COVID-19 vaccine and all of the four attitude domains that were looked at.

Conclusion

The study concluded that a low level of willingness among Egyptian physicians to take the COVID-19 vaccine is a prevalent problem. COVID-19 vaccination hesitancy and non-acceptance were linked to negative attitudes about natural immunity, mistrust of vaccine benefits, and concerns about commercial profiteering.

I Think I Should Get Vaccinated, I Feel I Should Not. Individual Differences in Information Processing and Vaccination Behavior (COVID-19)

Following the outbreak of the COVID-19 pandemic, the scientific community responded promptly by developing effective vaccines. Still, even though effective vaccines against COVID-19 became available, many people did not seem to be in a rush to become immunized. Community protection can be enhanced if more people decide to vaccinate, and thus it is necessary to identify relevant factors involved in vaccination behavior to find better ways of encouraging it. Vaccination behavior is the result of a decision process that might vary according to individual differences in information processing. We investigated the role of cognitive reflection ability and thinking styles in predicting self-reported vaccination behavior against COVID-19. A sample of 274 Romanian participants was surveyed for the present study, out of which 217 (M_age = 24.58, SD = 8.31; 53% female) declared they had the possibility to become vaccinated. Results showed that a higher level of cognitive reflection ability significantly increased the odds of becoming vaccinated. A rational thinking style was not linked to vaccination behavior. However, an experiential thinking style indirectly predicted vaccination behavior by means of attitudes towards vaccination. Since individual differences in information processing are, to a certain extent, linked to vaccination behavior, the design of vaccination campaigns could consider that people have specific information needs and address them as such.

Ready for Vaccination? COVID-19 Vaccination Willingness of Older People in Austria

In spite of findings highlighting higher health risk from infection compared to younger people, a certain percentage of older people in Austria still lack a valid vaccination certificate. The current gaps in vaccination coverage in countries such as Austria are likely to be in large part due to vaccination refusal and pose or will pose problems for the health system and consequently for all of society should the initial findings on Omicron coronavirus infectivity prove true. Surprisingly, only a few studies around the globe explicitly address older people's COVID-19 vaccination willingness. The present work therefore intends to contribute to this field by identifying factors associated with the decision for or against a vaccination among the older population in Austria. Data collected between late 2020 and early 2021 via the cross-national panel study Survey of Health, Aging and Retirement in Europe (SHARE) are used to perform multinomial logistic regression to analyse differences between COVID-19 vaccination supporters, undecided persons and rejectors. The results show that persons exhibiting a low risk assessment toward COVID-19, less health protection behaviors, lower education and belonging to households with financial burdens are significantly more likely to refuse vaccination or be ambivalent. Although multimorbidity reduces risk of vaccination refusal, poor subjective health was significantly related to a higher risk of refusing vaccination. The results point to the importance of addressing the factors related to refusal. Only by understanding these factors will it be possible to increase vaccination rates and thus minimize other restrictive measures.