Knowledge, attitude, and belief of health-care workers toward COVID-19 Vaccine at a tertiary care center in India

Ilesh S Kotecha; Disha Alkeshbhai Vasavada; Parveen Kumar; Lubna Mohammed Rafik Nerli; Deepak Sachidanand Tiwari; Dipesh V Parmar

doi:10.4103/shb.shb_20_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 5 | Issue : 2 | Page : 63-67

Knowledge, attitude, and belief of health-care workers toward COVID-19 Vaccine at a tertiary care center in India

Ilesh S Kotecha¹, Disha Alkeshbhai Vasavada², Parveen Kumar², Lubna Mohammed Rafik Nerli², Deepak Sachidanand Tiwari², Dipesh V Parmar¹
¹ Department of Preventive and Social Medicine, M.P. Shah Medical College, Jamnagar, Gujarat, India
² Department of Psychiatry and M.P. Shah Medical College, Jamnagar, Gujarat, India

Date of Submission	16-Apr-2021
Date of Decision	29-Aug-2021
Date of Acceptance	30-Oct-2021
Date of Web Publication	23-May-2022

Correspondence Address:
Parveen Kumar
Department of Psychiatry, M.P. Shah Medical College Jamnagar and G.G Hospital, 2^nd Floor Trauma Building, Jamnagar, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/shb.shb_20_21

Abstract

Introduction: India approved the “Covishield” vaccine for emergency use and began the first vaccination drive from January 16, 2021. As the new coronavirus disease-2019 (COVID-19) vaccine was developed within a short period, public acceptance for this new vaccine remains uncertain. Vaccine hesitancy remains an important challenge in the immunization against COVID-19. The aim of the current study was to assess different hesitancies, attitude, and beliefs about COVID-19 vaccine among health-care workers. Methods: A cross-sectional study was carried out among health-care professionals from 5^th to January 15, just before the commencement of the first vaccination drive. All the participants were requested to fill out semi-structured pro forma containing following sections: (1) demographic details and (2) attitude and belief questionnaire. Following this, a lecture of around 45–60 min was conducted by trained professionals comprising of an education module. After the educational session, participants' willingness to take the vaccine was reassessed. Results: Totally, 598 participants participated in the study. Of these, 47% participants were not willing to take the vaccine. Participants with age <35 years, experience <5 years, and working in rural areas have statistically significant unwillingness to take vaccine, on Chi-square test. Getting sick from vaccine, contracting the disease after vaccination, fear of adverse effect, uncertain efficacy, and death due to vaccine are concerns related to vaccination hesitancy. After the educational session, 82% of the participants were willing to take the vaccine. Conclusion: Inadequate knowledge about vaccine contributed significantly to denial for vaccination. Educational program was effective in addressing the concerns of participants about vaccination, improving vaccine usage and hence control of the COVID-19 pandemic.

Keywords: Attitude, coronavirus disease-2019, health-care worker, hesitancy, knowledge, severe acute respiratory syndrome coronavirus-2, vaccine

How to cite this article:
Kotecha IS, Vasavada DA, Kumar P, Nerli LM, Tiwari DS, Parmar DV. Knowledge, attitude, and belief of health-care workers toward COVID-19 Vaccine at a tertiary care center in India. Asian J Soc Health Behav 2022;5:63-7

How to cite this URL:
Kotecha IS, Vasavada DA, Kumar P, Nerli LM, Tiwari DS, Parmar DV. Knowledge, attitude, and belief of health-care workers toward COVID-19 Vaccine at a tertiary care center in India. Asian J Soc Health Behav [serial online] 2022 [cited 2023 Sep 23];5:63-7. Available from: http://www.healthandbehavior.com/text.asp?2022/5/2/63/345815

Introduction

Severe acute respiratory syndrome coronavirus-2 is the novel virus responsible for coronavirus disease-2019 (COVID-19). As there is no specific antiviral medication for COVID-19 till now, we are following the World Health Organization guidelines in prevention, i.e. COVID appropriate behavior; early diagnosis by means of tracing, testing, and treatment. Preventive measure in the form of vaccine is also one of the strategies to prevent transmission of COVID-19 and curb the ongoing pandemic. Besides stopping transmission, developing vaccine can also provide clinical and socioeconomic benefits.^[1] Normally, developing a successful vaccine would take years and would require passing different stages for potency, efficacy, and safety in normal people as well as high-risk individuals, namely elderly, pregnant women, people with comorbidities, and health-care workers (HCWs). There are numbers of vaccines that are in clinical or preclinical evaluation stages currently.^[2]

India approved the “Covishield” vaccine for emergency use and began the first vaccination drive from January 16, 2021, in which HCWs were given priority.^[3] As the new COVID-19 vaccine was developed within a short period, public acceptance for this new vaccine remains uncertain, and thus, vaccine hesitancy remains an important challenge in the immunization against COVID-19 as reported in previous studies.^[4] To flatten the epidemic curve, high vaccine coverage is needed. Vaccine hesitancy is reported as one of the major threats to global health.^[5] It affects the individual who is hesitant to take the vaccine as well as the whole community, leading to difficulty in reaching the threshold to confer herd immunity.^[6] Vaccine hesitancy is a worldwide phenomenon not only spreading among citizens but also among HCWs and general population.^[7]

There are certain beliefs and barriers regarding vaccination among the HCWs. Factors such as peoples' behavior, geography, and time alter vaccine coverage and its acceptance. There are also some other factors which determine acceptance of vaccines such as severity of the disease, previous vaccination history, lack of belief in health-care services, route of administration of vaccine, economic and educational status of the individuals, recommendations from doctors, and cost of vaccine.^[8] Similar concerns were also observed during 2009 H1N1 pandemic.^[9],[10]

To overcome this hesitancy and build trust, understanding of various attitudes and developing heterogeneous approach to assess vaccine refusal among different groups is necessary for controlling or ending the pandemic.^[11] Multiple factors which influenced confidence in other vaccines such as confidence in efficacy of the vaccine and fear of side effects are likely contributors to the low level of confidence in COVID-19 vaccine.^[12] Despite the new law about compulsory vaccination, there is no obligatory vaccination for HCWs in Italy, and vaccination coverage among HCWs is estimated to be very low, although there is a lack of complete data.^[13] Kukreti et al. (2021) observed 23.4% in Taiwan,^[7] and Shekhar et al. (2021) observed 36% acceptance of COVID-19 vaccine among HCWs at the United States.^[14]

Vaccine acceptance and vaccine coverage rate can be improved by understanding about the common barriers and facilitators among the general population.^[15] Different strategies for improving opinions about vaccines among vaccine-hesitant HCWs were explored. These focused on the physical, social, and emotional impacts of the diseases, either by having interviews from someone who had suffered from a vaccine-preventable disease, or by conducting an informational course with particular focus on vaccine-preventable diseases.^[16] It was also observed that access to health information was a positive predictor for receiving vaccines.^[17] Therefore, the current study was aimed to assess different hesitancies, knowledge, attitudes, and beliefs about COVID-19 vaccine among HCWs working at a tertiary care hospital.

Methods

Design and participants

A cross-sectional study was carried out among medical, dental, and nursing health-care professionals working at a tertiary care center at Jamnagar, Gujarat, from 5^th to January 15, just before the commencement of the first vaccination drive. Date and time of the educational program were discussed beforehand to attain maximum attendance and to conduct the study with proper social distancing norms. All the participants were approached and requested to complete a semistructured pro forma containing following sections: (1) demographic details and (2) knowledge, attitude, and belief questionnaire. Following this, a lecture of around 45–60 min was conducted by trained professionals comprising of an educational module. Education module about COVID-19 vaccine contained information about different types of vaccines available, nature of the vaccine, adverse/side effect of the vaccine, safety and efficacy of vaccine, risk of contracting disease, risk of death, effectiveness of alternative measures with vaccine, requirement of vaccine, benefits of vaccine, who can take the vaccine and order of preference for vaccination. In the end, an interactive session was carried out and queries of health professionals were answered. After the educational session, participants' willingness to take vaccine was reassessed by asking “are you willing to take the vaccine?” question. Participants who consented were included in the study.

Measures

Demographic details

Demographic details include parameters such as age, gender, profession, working area, marital status, living with family or not, and family education.

Knowledge, attitude, and belief questionnaire

A 20-item knowledge, attitude, and belief questionnaire was developed on the basis of following factors: importance of vaccine, concerns regarding safety of vaccine, concerns regarding side effects of vaccine, risk of death due to vaccine, need of vaccine, chances of contracting disease from vaccine, and religious beliefs. Attitudinal statements were scored on a 5point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = do not know, 4 = agree, and 5 = strongly agree. The questionnaire was pretested on 25 participants, 15 male and 10 female in age group 18–62 years from the same medical college affiliated tertiary care setup; difficulties faced by them in some of the items were rephrased. This scale showed adequate reliability with a Cronbach's alpha internal consistency coefficient of 0.78 for the current sample.

Sample size calculation

Sample size required for the current study was calculated using EpiInfo software. Sample size for the current study was estimated to be 460 by 95% confidence interval, 5% absolute precision, and considering 20% of nonresponse rate.

Ethical consideration

Ethical approval for the present study was taken from the Institutional Ethics Committee of M P Shah Government Medical College and Guru Gobindsingh Hospital, Jamnagar (Ref. No. IEC/Certi/232/06/2020).

Statistical analysis

All the collected data were tabulated in Microsoft Excel and analyzed by statistical software “International business machines, Armonk, New York, United States.” Frequencies and percentages were computed for the sociodemographic and social media usage variables. Chi-square test was used for categorical data. The data not following a normal distribution were assessed by Kolmogorov–Smirnov test. Mann–Whitney U-test was applied to compare the attitude of participants “willing to take vaccine” and “not willing to take vaccine.” P < 0.05 was considered as statistically significant.

Results

In total, 598 participants participated in the study. Age of the participants ranged from 18 to 62 years with mean age 28.72 ± 11.35 years. Of these, 282 (47.16%) participants were unwilling, while 316 (52.84%) were willing to take the vaccine.

[Table 1] shows that participants with age <35 years, experience <5 years, working in rural area, and resident doctors have statistically significant unwillingness for vaccination, which was denoted by Chi-square test.

Table 1: Relationship of different variables of participants with willingness to take vaccine (n=598)

Click here to view

[Table 2] shows that participants who were “unwilling to take vaccine” have more concerns regarding getting sick from vaccine, contracting disease after vaccine, adverse effects, death due to vaccine, doubtful efficacy of vaccine, vaccine doing more harm than good, using alternative measures such as hand washing and mask and concern about safety of the vaccine. Both participants, those who were willing and those unwilling to take the vaccine believed that God protects his children from the virus, vaccine companies are motivated by profit, and vaccine weakens immune system. Participants willing to take the vaccine believed that the vaccine is a prerequisite for HCWs and is important for reducing/eliminating the disease. This is denoted by Mann–Whitney U-test and found to be statistically significant.

Table 2: Comparison of willingness to take vaccine with knowledge, attitudes, and beliefs toward vaccine (n=598)

Click here to view

[Table 3] shows that educational session had statistically significant impact on changing attitude toward willingness for vaccination, as denoted by Wilcoxon signed-rank test (Z = ‒12.584, P < 0.001).

Table 3: Effect of education on willingness toward vaccine (n=598)

Click here to view

Discussion

The current study observed that 47% participants were not ready for vaccination. However, 53% of the participants willing to take the vaccine also have several concerns about the vaccine. It was observed that participants with age <35 years, experience <5 years, working in rural areas, and resident doctors were less willing to take the vaccine. Pogue et al. (2020) observed that approximately 68% of all participants were supportive of being vaccinated for COVID-19 but did have concerns about side effects, efficacy, and length of testing.^[18]

Concern related to unwillingness is mainly due to the fear of getting sick, contracting the disease after vaccination, adverse effects, death due to vaccine, doubtful efficacy, and the belief that vaccine does more harm than good. Beliefs that vaccine companies are motivated by profit and vaccine weakens immune system were reported by participants willing as well as those unwilling for vaccination. As per Pogue et al. (2020), participants were concerned that side effects of the vaccine are likely to be worse than COVID-19 itself. Safety, side effects, and effectiveness were another major area of concern. Islam et al. (2021) Bangladesh observed that only a quarter of participants thought that the COVID-19 vaccine available in Bangladesh is safe, and 60% of the population was willing for vaccination, while almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.^[19]

Verger et al. (2021) in a survey conducted among HCWs at France and French-speaking parts of Belgium and Canada observed that 48.6% showed high acceptance, 23.0% moderate acceptance, and 28.4% hesitancy/reluctance concerning vaccination. Safety concerns are the main factors leading to hesitancy toward vaccination and must be addressed before/during upcoming vaccination campaigns. Initiating health education programs before mass vaccination schedule seem to be a viable option to improve knowledge and acceptance for vaccination.^[20]

The current study observed that education program was effective in addressing the concern of participants about vaccination. Therefore, public education programs are necessary for improving knowledge and changing attitudes toward a potential COVID-19 vaccine. Public outreach efforts will likely improve vaccine usage and contribute to control of the COVID-19 pandemic.

Limitations

The current study addresses many concerns about vaccination. However, the study is limited by cross-sectional design. The study contains self-reported data that might affect the accuracy of statistical relationship. There was no control group in this study which is required to compare effectiveness.

Conclusion

HCWs were concerned about contracting disease after vaccination, adverse effects, death due to vaccine, doubtful efficacy, and safety. Inadequate knowledge about these factors contributed significantly to denial for vaccination. Education programs were effective in addressing the concern of participants about vaccination, improving vaccine usage, and hence, controlling the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sharun K, Tiwari R, Iqbal Yatoo M, Patel SK, Natesan S, Dhama J, et al. Antibody-based immunotherapeutics and use of convalescent plasma to counter COVID-19: Advances and prospects. Expert Opin Biol Ther 2020;20:1033-46.
2.	Lurie N, Saville M, Hatchett R, Halton J. Developing Covid-19 vaccines at pandemic speed. N Engl J Med 2020;382:1969-73.
3.	India Today. Covid Vaccination Drive in India to begin from January 16, Healthcare Workers to get Priority. Delhi January 9 HMN, January 10, 2021 Updated; 2021. Available from: https://www.indiatoday.in/coronavirus-outbreak/story/coronavirus-vaccination-drive-india-begin-from-january-16-healthcare-workers-priority-1757458-2021-01-09. [Last accessed on 2021 Apr 13].
4.	Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: A critical review. Soc Sci Med 2014;112:1-11.
5.	Al-Mohaithef M, Padhi BK. Determinants of COVID-19 vaccine acceptance in Saudi Arabia: A web-based national survey. J Multidiscip Healthc 2020;13:1657-63.
6.	Adebisi YA, Alaran AJ, Bolarinwa OA, Akande-Sholabi W, Lucero-Prisno DE. When it is available, will we take it? Social media users' perception of hypothetical COVID-19 vaccine in Nigeria. Pan Afr Med J 2021;38:230. doi: 10.11604/pamj.2021.38.230.27325.
7.	Kukreti S, Lu MY, Lin YH, Strong C, Lin CY, Ko NY, et al. Willingness of Taiwan's healthcare workers and outpatients to vaccinate against COVID-19 during a period without community outbreaks. Vaccines (Basel) 2021;9:246.
8.	Nguyen T, Henningsen KH, Brehaut JC, Hoe E, Wilson K. Acceptance of a pandemic influenza vaccine: A systematic review of surveys of the general public. Infect Drug Resist 2011;4:197-207.
9.	Eastwood K, Durrheim DN, Jones A, Butler M. Acceptance of pandemic (H1N1) 2009 influenza vaccination by the Australian public. Med J Aust 2010;192:33-6.
10.	Maurer J, Uscher-Pines L, Harris KM. Perceived seriousness of seasonal and A (H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S. adults: Does the source of information matter? Prev Med 2010;51:185-7.
11.	Bish A, Michie S. Demographic and attitudinal determinants of protective behaviours during a pandemic: A review. Br J Health Psychol 2010;15:797-824.
12.	Williams L, Gallant AJ, Rasmussen S, Brown Nicholls LA, Cogan N, Deakin K, et al. Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: Outlining evidence-based and theoretically informed future intervention content. Br J Health Psychol 2020;25:1039-54.
13.	Bertoncello C, Ferro A, Fonzo M, Zanovello S, Napoletano G, Russo F, et al. Socioeconomic determinants in vaccine hesitancy and vaccine refusal in Italy. Vaccines (Basel) 2020;8:276.
14.	Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines (Basel) 2021;9:119. doi: 10.3390/vaccines9020119.
15.	Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: A modelling impact assessment. Lancet 2020;395:1382-93.
16.	Johnson DK, Mello EJ, Walker TD, Hood SJ, Jensen JL, Poole BD. Combating vaccine hesitancy with vaccine-preventable disease familiarization: An interview and curriculum intervention for college students. Vaccines (Basel) 2019;7:39.
17.	Gatwood J, Shuvo S, Hohmeier KC, Hagemann T, Chiu CY, Tong R, et al. Pneumococcal vaccination in older adults: An initial analysis of social determinants of health and vaccine uptake. Vaccine 2020;38:5607-17.
18.	Pogue K, Jensen JL, Stancil CK, Ferguson DG, Hughes SJ, Mello EJ, et al. Influences on Attitudes regarding potential COVID-19 vaccination in the United States. Vaccines (Basel) 2020;8:582.
19.	Islam MS, Siddique AB, Akter R, Tasnim R, Sujan MS, Ward PR, et al. Knowledge, attitudes and perceptions towards COVID 19 vaccinations: A cross sectional community survey in Bangladesh. medRxiv 2021. [Preprint]. doi: 10.1101/2021.02.16.21251802.
20.	Verger P, Scronias D, Dauby N, Adedzi KA, Gobert C, Bergeat M, et al. Attitudes of healthcare workers towards COVID-19 vaccination: A survey in France and French-speaking parts of Belgium and Canada, 2020. Euro Surveill 2021;26:2002047.