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Kalatzi P, Travlos AK, Geladas N, Iliadou M, Tzavara C, Chryssanthopoulos C, Mihopoulos A, Tziaferi S. Vaccination coverage of primary care providers against seasonal influenza, tetanus, pneumococcal pneumonia and herpes zoster: A cross-sectional study in Greece. AIMS Public Health 2023; 10:952-963. [PMID: 38187900 PMCID: PMC10764975 DOI: 10.3934/publichealth.2023061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs. Methods A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05. Results In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14-0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31-0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37-0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40-49 vs. 19-39; OR = 0.42; 95% CI = 0.28-0.63, over 50 years old vs. 19-39; OR = 0.54; 95% CI = 0.36-0.79). Conclusions The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.
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Affiliation(s)
- Panagiota Kalatzi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Antonios K. Travlos
- Department of Sports Organization and Management, University of Peloponnese, Sparti, Greece
| | - Nickos Geladas
- Department of Physical Education & Sport Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Chara Tzavara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Alexandros Mihopoulos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
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Rzymski P, Pokorska-Śpiewak M, Jackowska T, Kuchar E, Nitsch-Osuch A, Pawłowska M, Babicki M, Jaroszewicz J, Szenborn L, Wysocki J, Flisiak R. Key Considerations during the Transition from the Acute Phase of the COVID-19 Pandemic: A Narrative Review. Vaccines (Basel) 2023; 11:1502. [PMID: 37766178 PMCID: PMC10537111 DOI: 10.3390/vaccines11091502] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The COVID-19 pandemic has been met with an unprecedented response from the scientific community, leading to the development, investigation, and authorization of vaccines and antivirals, ultimately reducing the impact of SARS-CoV-2 on global public health. However, SARS-CoV-2 is far from being eradicated, continues to evolve, and causes substantial health and economic burdens. In this narrative review, we posit essential points on SARS-CoV-2 and its responsible management during the transition from the acute phase of the COVID-19 pandemic. As discussed, despite Omicron (sub)variant(s) causing clinically milder infections, SARS-CoV-2 is far from being a negligible pathogen. It requires continued genomic surveillance, particularly if one considers that its future (sub)lineages do not necessarily have to be milder. Antivirals and vaccines remain the essential elements in COVID-19 management. However, the former could benefit from further development and improvements in dosing, while the seasonal administration of the latter requires simplification to increase interest and tackle vaccine hesitancy. It is also essential to ensure the accessibility of COVID-19 pharmaceuticals and vaccines in low-income countries and improve the understanding of their use in the context of the long-term goals of SARS-CoV-2 management. Regardless of location, the primary role of COVID-19 awareness and education must be played by healthcare workers, who directly communicate with patients and serve as role models for healthy behaviors.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Teresa Jackowska
- Department of Pediatrics, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland;
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wrocław Medical University, 50-367 Wroclaw, Poland;
| | - Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Bialystok, Poland;
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Avakian I, Dadouli K, Anagnostopoulos L, Fotiadis K, Lianos A, Mina P, Hadjichristodoulou C, Mouchtouri VA. Nationwide Survey on Seasonal Influenza Vaccination among Health Care Workers during the COVID-19 Pandemic in Greece: Determinants, Barriers and Peculiarities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6247. [PMID: 37444095 PMCID: PMC10341827 DOI: 10.3390/ijerph20136247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Seasonal influenza vaccination (SIV) of health care workers (HCWs) is critical in protecting patients' and HCWs' health. Our objective was to examine HCW SIV coverage and related determinants. METHODS AND MATERIALS A nationwide cross-sectional questionnaire survey was conducted among HCWs during the first half of 2021. The questionnaire (online or paper-based) included knowledge, attitude and practice questions regarding SIV, COVID-19 vaccines and vaccination. RESULTS Out of 6500 questionnaires administered, 2592 were completed (response rate: 39.9%). SIV coverage reached 69.4% (95% CI: 67.6-71.2%) based on self-reported vaccine uptake. Nurses and administrative staff were found to be more skeptical and have lower vaccine acceptance in comparison with physicians (aOR = 0.66 and aQR = 0.59, respectively). Other SIV hesitancy risk factors included working in secondary health care (aOR = 0.59) and working in northern Greece (aQR = 0.66). Determinants for SIV acceptance included being or living with high-risk people due to medical history (aOR = 1.84 and aOR = 1.46, respectively), positive attitudes towards routine vaccinations (aOR: 1.86), knowledge about COVID-19 vaccines (aOR = 1.53) and COVID-19 vaccine uptake (aOR = 3.45). The primary reason for SIV refusal was low risk perception (58.7%). CONCLUSIONS SIV coverage (2020/2021) was relatively high, but remained far from formal recommendations. Specific occupational groups were skeptical and low-risk perception was the main reason for vaccine refusal. Targeted policies should be developed and enforced.
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Affiliation(s)
- Ioanna Avakian
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | - Lemonia Anagnostopoulos
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | | | - Athanasios Lianos
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | - Paraskevi Mina
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | - Christos Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
| | - Varvara A. Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 12 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (K.D.); (L.A.); (A.L.); (C.H.)
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4
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Politis M, Sotiriou S, Doxani C, Stefanidis I, Zintzaras E, Rachiotis G. Healthcare Workers' Attitudes towards Mandatory COVID-19 Vaccination: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11040880. [PMID: 37112791 PMCID: PMC10142794 DOI: 10.3390/vaccines11040880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND COVID-19 vaccine mandates are considered a controversial public health policy both in public debate and among healthcare workers (HCWs). Thus, the objective of this systematic review is to give a deep insight into HCWs' views and attitudes towards COVID-19 vaccination mandates amid the ongoing COVID-19 pandemic. METHODS A systematic literature search of five databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) was conducted between July 2022 and November 2022. Original quantitative studies that addressed the attitudes of HCWs regarding COVID-19 vaccine mandates were considered eligible for this systematic review. All the included studies (n = 57) were critically appraised and assessed for risk of systematic bias. Meta-analyses were performed, providing a pooled estimate of HCWs' acceptance towards COVID-19 vaccine mandates for: 1. HCWs and 2. the general population. RESULTS In total, 64% (95% CI: 55%, 72%) of HCWs favored COVID-19 vaccine mandates for HCWs, while 50% (95% CI: 38%, 61%) supported mandating COVID-19 vaccines for the general population. CONCLUSIONS Our findings indicate that mandatory vaccination against COVID-19 is a highly controversial issue among HCWs. The present study provides stakeholders and policy makers with useful evidence related to the compulsory or non-compulsory nature of COVID-19 vaccinations for HCWs and the general population. Other: The protocol used in this review is registered on PROSPERO with the ID number: CRD42022350275.
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Affiliation(s)
- Marios Politis
- Department of Biomathematics, School of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Sotiris Sotiriou
- Department of Pathology, Faculty of Medicine, Aristotle University, 54124 Thessaloniki, Greece
| | - Chrysoula Doxani
- Department of Biomathematics, School of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Ioannis Stefanidis
- Department of Nephrology, School of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Elias Zintzaras
- Department of Biomathematics, School of Medicine, University of Thessaly, 41222 Larissa, Greece
- Center for Clinical Evidence Synthesis, Tufts University School of Medicine, Boston, MA 02111, USA
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, School of Medicine, University of Thessaly, 41110 Larissa, Greece
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5
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Ibrahim AM, Hamayoun M, Farid M, Al-Umra U, Shube M, Sumaili K, Shamalla L, Malik SMMR. COVID-19 Vaccine Acceptance and Hesitancy in Health Care Workers in Somalia: Findings from a Fragile Country with No Previous Experience of Mass Adult Immunization. Vaccines (Basel) 2023; 11:858. [PMID: 37112770 PMCID: PMC10144151 DOI: 10.3390/vaccines11040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia's federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15-4.90) or a nurse (aOR = 2.12, 95% CI: 1.05-4.25); having a master's degree (aOR = 5.32, 95% CI: 1.28-22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68-6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15-3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02-2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public's willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.
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Affiliation(s)
| | | | | | - Umar Al-Umra
- World Health Organization, Mogadishu 63565, Somalia
| | - Mukhtar Shube
- Federal Ministry of Health and Human Services, Mogadishu P.O. Box 22, Somalia
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Sciurti A, Baccolini V, Renzi E, De Blasiis MR, Siena LM, Isonne C, Migliara G, Massimi A, De Vito C, Marzuillo C, Villari P. Attitudes of University Students towards Mandatory COVID-19 Vaccination Policies: A Cross-Sectional Survey in Rome, Italy. Vaccines (Basel) 2023; 11:vaccines11040721. [PMID: 37112633 PMCID: PMC10141490 DOI: 10.3390/vaccines11040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Mandatory vaccination (MV) against COVID-19 is a contentious topic. In this study, we used logistic regression models to identify attitudes among Sapienza University students towards MV for COVID-19. We considered three different scenarios: mandatory COVID-19 vaccination (MCV) for healthcare workers (HCWs) (Model 1), for all people aged ≥ 12 years (Model 2), and for admission to schools and universities (Model 3). We collected 5287 questionnaires over a six-month period and divided these into three groups (September-October 2021, November-December 2021, and January-February 2022). MCV for HCWs was the most strongly supported policy (69.8% in favour), followed by MCV for admission to schools and universities (58.3%), and MCV for the general population (54.6%). In a multivariable analysis, the models showed both similarities and differences. There was no association of socio-demographic characteristics with the outcomes, apart from being enrolled in non-healthcare courses, which negatively affected Models 2 and 3. A greater COVID-19 risk perception was generally associated with a more positive attitude towards MCV, although heterogeneously across models. Vaccination status was a predictor of being in favour of MCV for HCWs, whereas being surveyed in November-February 2022 favoured MCV for admission to schools and universities. Attitudes towards MCV were variable across policies; thus, to avoid unintended consequences, these aspects should be carefully considered by policymakers.
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Affiliation(s)
- Antonio Sciurti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Erika Renzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Roberta De Blasiis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Leonardo Maria Siena
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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7
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Ugarte D, Young S. Effects of an Online Community Peer-support Intervention on COVID-19 Vaccine Misinformation Among Essential Workers: Mixed-methods Analysis. West J Emerg Med 2023; 24:264-268. [PMID: 36976597 PMCID: PMC10047750 DOI: 10.5811/westjem.2023.1.57253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/09/2023] [Indexed: 03/22/2023] Open
Abstract
Introduction: Public health efforts to reduce the spread of coronavirus disease 2019 (COVID-19) have been plagued by vaccine hesitancy and misinformation. Social media has contributed to spreading misinformation by creating online environments where people find information or opinions that reinforce their own. Combating misinformation online will be essential to prevent and manage the spread of COVID-19. It is of particular urgency to understand and address misinformation and vaccine hesitancy among essential workers, such as healthcare workers, because of their frequent interactions with and influence upon the general population. Using data from an online community pilot randomized controlled trial designed to increase requests for COVID-19 vaccine information among frontline essential workers, we explored the topics discussed on the online community related to COVID-19 and COVID-19 vaccination to better understand current misinformation and vaccine hesitancy.
Methods: For the trial, 120 participants and 12 peer leaders were recruited through online advertisements to join a private, hidden Facebook group. The study consisted of an intervention and control arm, each with two groups of 30 randomized participants each. Peer leaders were only randomized into one of the intervention-arm groups. Peer leaders were tasked with engaging the participants throughout the study. Posts and comments of only participants were coded manually by the research team. Chi-squared tests assessed differences in the frequency and content of posts between intervention and control arms.
Results: We found significant differences in the numbers of posts and comments focused on topics of general community, misinformation, and social support between intervention and control arms (6.88% vs 19.05% focused on misinformation, respectively, (P <0.001); 11.88% vs 1.90% focused on social support, respectively, (P <0.001); and 46.88% vs 62.86% focused on general community (P <0.001)).
Conclusion: Results suggest that peer-led online community groups may help to reduce the spread of misinformation and aid public health efforts in our fight against COVID-19.
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Affiliation(s)
- Dominic Ugarte
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Sean Young
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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8
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Ghare F, Meckawy R, Moore M, Lomazzi M. Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals: A Review. Vaccines (Basel) 2023; 11:311. [PMID: 36851189 PMCID: PMC9961323 DOI: 10.3390/vaccines11020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.
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Affiliation(s)
- Fathema Ghare
- World Federation of Public Health Associations (WFPHA), Institute of Global Health, University of Geneva, Campus Biotech—G6, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Rehab Meckawy
- World Federation of Public Health Associations (WFPHA), Institute of Global Health, University of Geneva, Campus Biotech—G6, Chemin des Mines 9, 1202 Geneva, Switzerland
- Public Health and Community Medicine Department, Alexandria Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria 21321, Egypt
| | - Michael Moore
- World Federation of Public Health Associations (WFPHA), Institute of Global Health, University of Geneva, Campus Biotech—G6, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Marta Lomazzi
- World Federation of Public Health Associations (WFPHA), Institute of Global Health, University of Geneva, Campus Biotech—G6, Chemin des Mines 9, 1202 Geneva, Switzerland
- Institute of Global Health, University of Geneva, Campus Biotech—G6, Chemin des Mines 9, 1202 Geneva, Switzerland
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9
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The Impact of the COVID-19 Pandemic on Mental Health and Quality of Life in COVID-19 Department Healthcare Workers in Central Greece. J Pers Med 2023; 13:jpm13020250. [PMID: 36836484 PMCID: PMC9967900 DOI: 10.3390/jpm13020250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The pandemic crisis created conditions of insecurity and threat and brought about changes in social contacts and everyday life. Frontline healthcare workers (HCW) were mostly affected. We aimed to evaluate the quality of life and negative emotions in COVID-19 HCW and searched for factors influencing the above. METHODS The present study was conducted among three different academic hospitals in central Greece (04/2020-03/2021). Demographics, attitude towards COVID-19, quality of life, depression, anxiety, stress (using the WHOQOL-BREF and DASS21 questionnaire) and the fear of COVID-19 were assessed. Factors affecting the reported quality of life were also assessed. RESULTS The study involved 170 HCW in COVID-19 dedicated departments. Moderate levels of quality of life (62.4%), satisfaction with social relations (42.4%), working environment (55.9%) and mental health (59.4%) were reported. Stress was present in 30.6% of HCW; 20.6% reported fear for COVID-19, depression (10.6%) and anxiety (8.2%). HCW in the tertiary hospital were more satisfied with social relations and working environment and had less anxiety. Personal Protective Equipment (PPE) availability affected the quality of life, satisfaction in the work environment and the presence of anxiety and stress. Feeling safe during work influenced social relations and fear of COVID-19 Conclusion: The HCW quality of life is affected in the pandemic. Feelings of safety during work related to the reported quality of life.
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Prezerakos P, Dadouli K, Agapidaki E, Kravvari CM, Avakian I, Peristeri AM, Anagnostopoulos L, Mouchtouri VA, Fountoulakis KN, Koupidis S, Hadjichristodoulou C. Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:216. [PMID: 36612538 PMCID: PMC9819918 DOI: 10.3390/ijerph20010216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic’s vast impact. Data were collected using a questionnaire designed according to the “survey tool and guidance” provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities’ recommendations, being informed by HCWs or formal information sources, care for others, concern about the country’s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.
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Affiliation(s)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Eirini Agapidaki
- Secretary General of Public Health, Ministry of Health, 10433 Athens, Greece
| | | | - Ioanna Avakian
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Athanasia-Marina Peristeri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Lemonia Anagnostopoulos
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Varvara A. Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece
| | - Konstantinos N. Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sotirios Koupidis
- Occupational and Environmental Health Sector, Public Health Policy Department, School of Public Health, University of West Attica, 11521 Athens, Greece
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11
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Kipourgos G, Kourtis G, Papatheodorou M, Elesnitsalis G, Filtiseniou P, Albani E, Tzenalis A. When the first vaccine arrived: An investigation of factors that influenced the intention of health care workers in the national health system of Greece to be vaccinated against the SARS COV-2 virus during the first trimester of vaccine arrival. Nurs Forum 2022; 57:1080-1095. [PMID: 36053028 PMCID: PMC9538693 DOI: 10.1111/nuf.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 vaccination started in Greece in the last days of December 2020. Health care workers (HCWs) of the public national health system (NHS) were on the frontline and they would be role models for all the citizens. AIM Investigation of the intention and hesitation of HCWs (doctors, nurses, and nursing assistants) of the NHS of Greece, regarding the vaccine against SARS COV-2 virus and the factors that affect them, during the first trimester of the availability of vaccines, in the country. METHODS A multicenter cross-sectional study was conducted in Greece among health professionals (n = 2484) of the NHS. Data were collected with the use of an online questionnaire through snowballing sampling. RESULTS Acceptance of a safe and effective COVID- 19 vaccines was higher among doctors (85.6%), followed by nurses (66.3%), and nursing assistants (64.1%). This study confirms pre-existing research on the interaction of gender, age, quality of personal information, educational level, training by the employer, and cognitive background regarding viruses and vaccines. CONCLUSION In conclusion, our study showed that once a vaccine was available, most HCWs were willing to be vaccinated. These findings could be used in the future to tailor communication and promotion campaigns, using anthropocentric strategies.
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Affiliation(s)
| | | | | | | | | | - Eleni Albani
- Nursing DepartmentUniversity of PatrasPatrasGreece
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12
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Shui X, Wang F, Li L, Liang Q. COVID-19 vaccine acceptance among healthcare workers in China: A systematic review and meta-analysis. PLoS One 2022; 17:e0273112. [PMID: 35960730 PMCID: PMC9374244 DOI: 10.1371/journal.pone.0273112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background Since the successful development of Coronavirus Disease (COVID-19) vaccine, COVID-19 vaccination has been actively advocated all over the world. As the key population for COVID-19 vaccination, the acceptance of Healthcare Workers (HCWs) is not only related to their risk of contracting COVID-19 infection at work, but also affects the decision of the general population on COVID-19 vaccination. Currently, a series of observational studies have been conducted on the acceptance of COVID-19 vaccines among HCWs in China, but there are presently no all-inclusive reviews. Therefore, this paper reviewed to identify a reliable estimate of acceptance rate of COVID-19 vaccine among HCWs in China. Methods We conducted a search on PubMed, EMbase, The Cochrane Library, Web of Science, CNKI (Chinese National Knowledge Infrastructure), Wanfang Database, CBM (Chinese Biomedical Literature Database) and VIP database (Chinese Scientific Journal Database) from January 2020 to June 2022. The quality of included articles was estimated using the Newcastle-Ottawa Quality Assessment tool suitable for cross-sectional studies and STATA 16 was used for analysis, A random-effects model was used to calculate acceptance rate for COVID-19 vaccine, as well as subgroup analysis and sensitivity analysis. Result This review included 18 studies involving 45,760 subjects, all of which were of medium or high quality. Meta-analysis results represented that, the pooled estimated acceptance rate of COVID-19 vaccine among HCWs in China was 78% (95%CI: 73–83%), and the pooled acceptance rate in 2021 (82%, 95%CI: 78–86%) was significantly higher than that in 2020 (73%, 95%CI: 65%-81%). Subgroup analysis showed different acceptance rates for COVID-19 vaccine among HCWs with different characteristics. Conclusion The result revealed that HCWs in China generally have a high acceptance rate of COVID-19 vaccines, but the acceptance rate varies with different characteristics of the population. Therefore, corresponding training should be carried out for HCWs with different characteristics, and they should play an exemplary and leading role in COVID-19 vaccination, so as to improve the vaccination rate of the whole population and form an immune barrier at an early date.
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Affiliation(s)
- Xiaoling Shui
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Fang Wang
- Nursing Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- * E-mail:
| | - Ling Li
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qian Liang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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13
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Peruch M, Toscani P, Grassi N, Zamagni G, Monasta L, Radaelli D, Livieri T, Manfredi A, D'Errico S. Did Italy Really Need Compulsory Vaccination against COVID-19 for Healthcare Workers? Results of a Survey in a Centre for Maternal and Child Health. Vaccines (Basel) 2022; 10:1293. [PMID: 36016179 PMCID: PMC9414650 DOI: 10.3390/vaccines10081293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/29/2022] [Accepted: 08/06/2022] [Indexed: 12/16/2022] Open
Abstract
Since its early spread, the COVID-19 pandemic has become a health threat globally. Due to their crucial role in the pandemic, Italy declared compulsory vaccination for healthcare workers. Vaccine hesitancy was observed among the healthcare workers and an ethical debate arose about Italian legal statement D.L. n. 44/2021. In this article, we present the results of a survey performed in an Italian center for maternal and infant care and assess the attitudes towards the COVID-19 pandemic and the mandatory COVID-19 vaccination of healthcare workers. Since March 2022, 91.5% of healthcare workers have been vaccinated with an additional dose. Only 2.3% of the respondents refused to take vaccination: the reasons behind this refusal were distrust, doubts over safety, and lack of information. Despite the high rate of response to vaccination, 17.7% of HCWs did not agree with its mandatory nature. In addition, 5.4% stated that they agreed to be vaccinated exclusively because of the sanctions provided for by the legislation. In conclusion, adequate vaccination coverage has been achieved in the hospital under consideration. However, it is still very important to continue to persuade HCWs of vaccine efficacy and safety, considering their social role.
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Affiliation(s)
- Michela Peruch
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Paola Toscani
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Nicoletta Grassi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Giulia Zamagni
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Davide Radaelli
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Tommaso Livieri
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Alessandro Manfredi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Stefano D'Errico
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
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14
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Sociodemographic and Occupational Factors Associated with Low Early Uptake of COVID-19 Vaccine in Hospital-Based Healthcare Workers, Georgia, March-July 2021. Vaccines (Basel) 2022; 10:vaccines10081197. [PMID: 36016084 PMCID: PMC9415840 DOI: 10.3390/vaccines10081197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
In Georgia, an upper-middle income European country, the COVID-19 vaccine rollout began on 15 March 2021 with health workers (HWs), a priority group for vaccination. We assessed the factors associated with COVID-19 vaccination among HWs at six large hospitals in the early stages of the vaccine rollout (March−July 2021). Among 1533 HWs, 274 (17.9%) had received one dose of the COVID-19 vaccine. Strong independent predictors of early vaccine uptake were age > 40 years, especially 50−59 years old (aOR 2.40, 95% CI 1.50−3.88), considering the vaccine as “somewhat effective” or “very effective” rather than “not effective” (aOR 6.33, 95% CI 2.29−26.3 and aOR 10.9, 95% CI 3.88−45.70, respectively), and previous vaccination against seasonal influenza (aOR 2.98, 95% CI 2.19−4.08). Previous SARS-CoV-2 infection was negatively associated with receiving the vaccine (aOR 0.6, 95% CI 0.40−0.80). Compared to physicians, nurses/midwives (aOR 0.22, 95% CI 0.15−0.32), administrative staff (aOR 0.36, 95% CI 0.22−0.56), and ancillary staff (aOR 0.07, 95% CI 0.04−0.15) were less likely to have received the COVID-19 vaccine. Tailoring the COVID-19 vaccine communications campaign to younger and non-physician HWs, and emphasizing the benefits of the COVID-19 vaccine, could help further increase vaccine coverage among HWs in Georgia.
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15
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Susło R, Pobrotyn P, Mierzecki A, Drobnik J. Fear of Illness and Convenient Access to Vaccines Appear to Be the Missing Keys to Successful Vaccination Campaigns: Analysis of the Factors Influencing the Decisions of Hospital Staff in Poland concerning Vaccination against Influenza and COVID-19. Vaccines (Basel) 2022; 10:vaccines10071026. [PMID: 35891190 PMCID: PMC9318872 DOI: 10.3390/vaccines10071026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
The COVID-19 pandemic has lasted for two years as of 2022, and it is common knowledge that vaccines are an essential tool to mitigate the health, economic, and social fallout. Unfortunately, vaccine hesitancy is still a serious global problem, both in the general population and among healthcare workers. The authors used an original questionnaire to conduct an anonymous survey study in the University Clinical Hospital in Wrocław, Poland, in April and May of 2021 after acquiring consent from the Medical University of Wrocław, Poland Bioethical Committee. The study results demonstrate that, to a significant extent, the decisions concerning vaccinations are based on factors that are difficult to change with rational argumentation, including people’s personal opinions or beliefs concerning vaccinations and their earlier experiences with vaccinations. The study results suggest that the impregnating effect of one’s own opinions, beliefs, and experiences can be surmounted if vaccines are dispensed free and conveniently while the pathogen is irrationally and emotionally perceived as untamed and possibly severe and life threatening. It makes a significant difference as in such cases that the percentage of participants whose decisions concerning vaccination are influenced by the risks to life or health of one’s own or others rises by about 27 and 36 percent points, respectively. Therefore, in order to succeed, campaigns for vaccinations need to include strong subjective and emotional communication, appealing to negative emotions and exploiting the public’s fear of the unknown while stressing tangible and personal threats possibly resulting from acquiring a vaccine-preventable infectious disease.
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Affiliation(s)
- Robert Susło
- Epidemiology and Medical Education Unit, Population Health Department, Health Sciences Faculty, Wrocław Medical University, 50-556 Wrocław, Poland;
- Correspondence:
| | | | - Artur Mierzecki
- Family Medicine Department, General Medicine and Dentistry Faculty, Medical University in Szczecin, 70-203 Szczecin, Poland;
| | - Jarosław Drobnik
- Epidemiology and Medical Education Unit, Population Health Department, Health Sciences Faculty, Wrocław Medical University, 50-556 Wrocław, Poland;
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16
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Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116762. [PMID: 35682345 PMCID: PMC9180025 DOI: 10.3390/ijerph19116762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 02/06/2023]
Abstract
In this research, we examined how COVID-19 impacts employee decision-making and performance, knowing that this virus has negatively affected public health, crippled economies, and transformed social and business environments across the globe. To quantitatively test our specific hypotheses regarding the effects of employees’ perceived risk of COVID-19 and psychological distress on negative performance outcomes, we surveyed 443 healthcare workers who were employed by a group of private hospitals in Zimbabwe. These essential workers were delivering day-to-day frontline services with high exposure to COVID-19 during the pandemic. We find that employees’ perceived risk of COVID-19 increases their disengagement, turnover intention, burnout, and low morale at a p < 0.05 significance level. These latter relationships are mediated by employees’ psychological distress at a p < 0.05 significance level. Our findings shed light on how the COVID-19 pandemic is affecting the cognitions and behaviors of the frontline workers who are vulnerable to this contagious disease. Turnover intentions are amplified among healthcare employees, due to their perceived risk of COVID-19 and the resulting psychological distress. Similarly, burnout becomes predominant as these workers worry about contracting the coronavirus due to the poor working conditions they face. As such, our research confirms that the pandemic has intensified the precariousness of work and challenge of managing employee performance, especially for frontline healthcare workers.
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17
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Avakian I, Anagnostopoulos L, Rachiotis G, Fotiadis K, Mariolis A, Koureas M, Dadouli K, Papadopoulos C, Speletas M, Bakola M, Vardaka P, Zoubounelli S, Tatsios E, Niavi F, Pouliou A, Hadjichristodoulou C, Mouchtouri VA. Prevalence and Predictors of COVID-19 Vaccination Acceptance among Greek Health Care Workers and Administrative Officers of Primary Health Care Centers: A Nationwide Study Indicating Aspects for a Role Model. Vaccines (Basel) 2022; 10:vaccines10050765. [PMID: 35632522 PMCID: PMC9142949 DOI: 10.3390/vaccines10050765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Τhe study aims to identify factors associated with COVID-19 vaccine acceptance and to investigate knowledge and perceptions of Primary Health Care Centers (PHCC) personnel, who acted as pioneers in the national COVID-19 vaccination strategy. Methods and Materials: A nationwide cross-sectional survey was conducted by distributing an online anonymous questionnaire comprising 25 questions during the first semester of 2021. Results: Approximately 85.3% of the 1136 respondents (response rate 28.4%) were vaccinated or intended to be. The acceptance of seasonal flu vaccine (aOR: 3.29, 95%CI: 2.08−5.20), correct COVID-19 vaccine knowledge (aOR: 8.37, 95%CI: 4.81−14.59) and lack of concern regarding vaccine novelty (aOR: 6.18, 95%CI: 3.91−9.77) were positively correlated with vaccine acceptance. Vaccinated respondents were more likely to be physicians (aOR: 2.29, 95%CI: 1.03−5.09) or administrative staff (aOR: 2.65, 95%CI: 1.18−5.97) compared to nursing stuff. Reasons for vaccine hesitancy included inadequate information (37.8%) and vaccine safety (31.9%). Vaccine acceptance was strongly correlated (Spearman’s correlation coefficient r = 0.991, p < 0.001) between PHCC personnel and the general population of each health district. Conclusions: COVID-19 vaccine acceptance among PHCC personnel in Greece was comparably high, but specific groups (nurses) were hesitant. As the survey’s target population could serve as a role model for the community, efforts should be made to improve COVID-19 vaccine acceptance.
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Affiliation(s)
- Ioanna Avakian
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | - Lemonia Anagnostopoulos
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | - George Rachiotis
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | | | | | - Michalis Koureas
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | | | - Matthaios Speletas
- Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, 45110 Ioannina, Greece;
| | - Panagiota Vardaka
- Department of General Practice, University Hospital of Larissa, 41334 Larissa, Greece; (P.V.); (S.Z.); (E.T.); (A.P.)
| | - Stamatia Zoubounelli
- Department of General Practice, University Hospital of Larissa, 41334 Larissa, Greece; (P.V.); (S.Z.); (E.T.); (A.P.)
| | - Evangelos Tatsios
- Department of General Practice, University Hospital of Larissa, 41334 Larissa, Greece; (P.V.); (S.Z.); (E.T.); (A.P.)
| | - Fevronia Niavi
- Primary Health Care Center of Palama, 43200 Palamas, Greece;
| | - Apostolia Pouliou
- Department of General Practice, University Hospital of Larissa, 41334 Larissa, Greece; (P.V.); (S.Z.); (E.T.); (A.P.)
| | - Christos Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
| | - Varvara A. Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Street, 41222 Larissa, Greece; (I.A.); (L.A.); (G.R.); (M.K.); (K.D.); (C.H.)
- Correspondence: ; Tel.: +30-2410-565009
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Cadeddu C, Regazzi L, Bonaccorsi G, Rosano A, Unim B, Griebler R, Link T, De Castro P, D’Elia R, Mastrilli V, Palmieri L. The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084429. [PMID: 35457297 PMCID: PMC9029177 DOI: 10.3390/ijerph19084429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/06/2023]
Abstract
Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a “good” (47.5%) or “sufficient” (20.1%) level of VL, 32.4% had “limited” VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities.
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Affiliation(s)
- Chiara Cadeddu
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (L.R.)
| | - Luca Regazzi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (L.R.)
| | | | - Aldo Rosano
- National Institute for the Analysis of Public Policy, 00198 Rome, Italy;
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00162 Rome, Italy;
| | - Robert Griebler
- Competence Centre Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria; (R.G.); (T.L.)
| | - Thomas Link
- Competence Centre Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria; (R.G.); (T.L.)
| | - Paola De Castro
- Scientific Communication Unit, Italian National Institute of Health, 00161 Rome, Italy;
| | - Roberto D’Elia
- Ministry of Health, Viale Giorgio Ribotta, 5, 00144 Rome, Italy; (R.D.); (V.M.)
| | - Valeria Mastrilli
- Ministry of Health, Viale Giorgio Ribotta, 5, 00144 Rome, Italy; (R.D.); (V.M.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00162 Rome, Italy;
- Correspondence:
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19
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Woolf K, Gogoi M, Martin CA, Papineni P, Lagrata S, Nellums LB, McManus I, Guyatt AL, Melbourne C, Bryant L, Gupta A, John C, Carr S, Tobin MD, Simpson S, Gregary B, Aujayeb A, Zingwe S, Reza R, Gray LJ, Khunti K, Pareek M. Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study. EClinicalMedicine 2022; 46:101346. [PMID: 35308309 PMCID: PMC8923694 DOI: 10.1016/j.eclinm.2022.101346] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several countries now have mandatory SARS-CoV-2 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Using data from the nationwide UK-REACH study we aimed to understand UK HCW's views on improving SARS-CoV-2 vaccination coverage, including mandatory vaccination. Methods Between 21st April and 26th June 2021, we administered an online questionnaire via email to 17 891 UK HCWs recruited as part of a longitudinal cohort from across the UK who had previously responded to a baseline questionnaire (primarily recruited through email) as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question "What should society do if people do not get vaccinated against COVID-19?" using qualitative content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not, using logistic regression to calculate its demographic predictors, and its occupational, health, and attitudinal predictors adjusted for demographics. Findings Of 5633 questionnaire respondents, 3235 answered the free text question. Median age of free text responders was 47 years (IQR 36-56) and 2705 (74.3%) were female. 18% (n = 578) favoured mandatory vaccination (201 [6%] participants for HCWs and others working with vulnerable populations; 377 [12%] for the general population), but the most frequent suggestion was education (32%, n = 1047). Older HCWs (OR 1.84; 95% CI 1.44-2.34 [≥55 years vs 16 years to <40 years]), HCWs vaccinated against influenza (OR 1.49; 95% CI 1.11-2.01 [2 vaccines vs none]), and with more positive vaccination attitudes generally (OR 1.10; 95% CI 1.06-1.15) were more likely to favour mandatory vaccination, whereas female HCWs (OR= 0.79, 95% CI 0.63-0.96, vs male HCWs) and Black HCWs (OR=0.46, 95% CI 0.25-0.85, vs white HCWs) were less likely to. Interpretation Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating, and supporting HCWs who are hesitant about vaccination may be more acceptable, effective, and equitable. Funding MRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care (DHSC) via the National Institute for Health Research (NIHR). Core funding was also provided by NIHR Biomedical Research Centres.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, University College London Medical School, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - Padmasayee Papineni
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
| | - Susie Lagrata
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura B. Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - I.Chris McManus
- Research Department of Medical Education, University College London Medical School, UK
| | - Anna L. Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
| | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
| | - Rubina Reza
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - UK-REACH Study Collaborative Group
- Research Department of Medical Education, University College London Medical School, UK
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Oxford University Hospitals NHS Foundation Trust, UK
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
- Nottinghamshire Healthcare NHS Foundation Trust, UK
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
- Diabetes Research Centre, University of Leicester, UK
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20
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Prevalence and Predictors of COVID-19 Vaccine Hesitancy among Health Care Workers in Tertiary Health Care Institutions in a Developing Country: A Cross-Sectional Analytical Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/7299092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. The coronavirus disease 2019 (COVID-19) pandemic highlighted the challenges and impact of vaccine hesitancy and the role of health care institutions in mounting an effective pandemic response. The study objective was to determine the prevalence and predictors of COVID-19 vaccine hesitancy among health care workers in tertiary health care institutions in Nigeria. Methods. A cross-sectional analytical design that used convenience and snowballing techniques to enroll 347 health care workers from tertiary health care institutions in Imo State, Nigeria, from September 28 to October 14, 2021. Data was collected using a structured online questionnaire and bivariate and multivariate analyses were done using SPSS at a level of significance set at
. Result. The prevalence of vaccine hesitancy was 35.4%. HCWs of the Pentecostal faith (aOR: 2.52) and males (aOR: 2.72) were significantly more likely to be COVID-19 vaccine hesitant. About 30% of the respondents reported that they trusted information from the Internet and social media relating to COVID-19 and its vaccine. However, respondents who felt there was enough information about the vaccine and its safety were more than two and a half times more likely to be vaccine-hesitant (aOR: 2.77). About 20% and 31% of the respondents, respectively, stated that the government has an ulterior motive and that they did not trust the vaccine manufacturers. However, respondents who do not trust the government were more than two and a half times more likely to be COVID-19 vaccine hesitant (aOR: 2.69). Conclusion. The issues of vaccine hesitancy among health care workers in a developing country appear to be fundamental and very challenging to resolve. Therefore, the approach of instituting government vaccine uptake mandates for health care workers may be the solution for tackling vaccine hesitancy in health care institutions.
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21
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Miskulin M, Mujkic A, Miskulin I, Makaric ZL, Kovacevic E, Pintaric L, Pavic Z. Vaccination Attitudes and Experiences of Medical Doctors in Croatia amid the COVID-19 Pandemic: A Social Roles Conflict? Vaccines (Basel) 2022; 10:vaccines10030399. [PMID: 35335031 PMCID: PMC8954650 DOI: 10.3390/vaccines10030399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
The study aimed to investigate the range of experiences and attitudes of Croatian medical doctors (MDs) related to vaccination and vaccine hesitancy. In January 2021 three asynchronous online focus groups were held using MRQual, a web-based platform, which included 46 MDs from all three levels of the healthcare system in Croatia. NVivo, a qualitative data analysis software package, was used for the thematic analysis of collected data. The participants expressed a high level of support for the Croatian immunization program and vaccines in general. However, some skepticism was expressed regarding new vaccines and the regulatory processes of their approval. A significant number of participants raised concerns over the approval of COVID-19 vaccines, especially given their rapid development. The results also revealed that the process of communication with patients is often based on the very elaborate categorizations of patients based on previous experience, which leads to prioritizing and a communication breakup when dealing with “problematic patients”. MDs find themselves in a delicate situation where a fine balance between time-consuming communication with patients and the demands for maintaining satisfying vaccination uptake is needed. The situation arises from a social roles conflict that is embedded in wider social values and expectations, since communication problems do not arise in the doctor’s office, and therefore cannot be solved without addressing the social forces that cause trust deficiencies. To achieve better immunization results public health leaders need to better understand the social contexts and constraints of MDs vaccine-related behaviors.
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Affiliation(s)
- Maja Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Aida Mujkic
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Ivan Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Correspondence: ; Tel.: +385-912241500
| | - Zvjezdana Lovric Makaric
- Division for Epidemiology of Communicable Diseases, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Emma Kovacevic
- Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (E.K.); (L.P.); (Z.P.)
| | - Ljiljana Pintaric
- Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (E.K.); (L.P.); (Z.P.)
| | - Zeljko Pavic
- Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (E.K.); (L.P.); (Z.P.)
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22
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Gomes IA, Soares P, Rocha JV, Gama A, Laires PA, Moniz M, Pedro AR, Dias S, Goes AR, Leite A, Nunes C. Factors Associated with COVID-19 Vaccine Hesitancy after Implementation of a Mass Vaccination Campaign. Vaccines (Basel) 2022; 10:vaccines10020281. [PMID: 35214739 PMCID: PMC8879669 DOI: 10.3390/vaccines10020281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 01/27/2023] Open
Abstract
An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September–November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, “COVID-19 Barometer: Social Opinion”. Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.
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Affiliation(s)
- Inês Afonso Gomes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
- Laboratórios Pfizer Lda., Lagoas Park, 2740-271 Porto Salvo, Portugal
- Correspondence:
| | - Patricia Soares
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Gama
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Pedro Almeida Laires
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Marta Moniz
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Pedro
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sónia Dias
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Goes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Andreia Leite
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
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