key: cord-0871339-0e4sdnme authors: Sano, S.; Sato, S.; Ohmagari, N.; Takahashi, O. title: A Qualitative Study Regarding Messages of the COVID-19 Vaccine from Vaccinated Healthcare Providers and Healthy Adults date: 2022-03-25 journal: nan DOI: 10.1101/2022.03.24.22272878 sha: eb5014522bcfcb5b46cbb4a9f428701a6b246066 doc_id: 871339 cord_uid: 0e4sdnme Background : To promote the vaccination against COVID-19, person-to-person communication from vaccinated people will play an important role. The objectives of this study are to identify what messages were shared by vaccinated people, and the relationship between these messages and their background. Methods : This study was an exploratory and prospective basis with individual interviews. The participants were healthcare providers and healthy adults who were recruited at a vaccination site in Chuo-City, Tokyo. The online interviews were conducted using a semi-structured interview. Based on the Health Belief Model (HBM), the participants were asked about their perspectives on vaccines and what they talked about after their vaccination. The interviews were categorized into each item of the HBM and analyzed using NVivo software. Results : During August to October 2021, five healthcare providers and seven healthy adults were enrolled in the study. One healthy adult could not be contacted resulting in a total of 11 participants interviewed. Both the healthcare providers and the healthy adults mainly talked about side effects after their vaccination, and to ease the other persons concerns based on their experience. Meanwhile, there were differences in the recommendations for vaccination between the two groups. The healthcare providers were strongly aware of the severity of COVID-19 infection and recommended vaccination to others as a useful measure to suppress becoming severely ill. On the other hand, the healthy adults recommended the vaccine with varying degree depending on their expectations and concerns about the vaccine and external factors such as living with a family member. Conclusion : Both the healthcare providers and healthy adults shared similar messages to ease the vaccination concerns of others. However, their vaccine recommendation level was varied, which may be influenced not only by expectations and concerns toward the vaccine, but also by external factors such as family members living together. 112 individually between August and November 2021. As the purpose of this research was to 113 interview participants about their conversations with close persons after their vaccination, the 114 online interview was scheduled to take place at least two weeks after the second vaccination. 115 The study was approved by the is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint Between August and October 2021, five healthcare providers who were engaged in 171 vaccination and seven healthy adults who were vaccinated at the site were enrolled in the 172 study (Fig 1) . One of the healthy adults was not included due to scheduling difficulties and 173 loss of contact. Individual interviews were conducted with a total of 11 participants, 5 with 174 males and 6 with females (Table 1) . Participant ages included two in their 20s, two in their 175 30s, five in their 40s, and two in their 50s. The mean period between the second vaccination 176 and the interview was 114 days for health care providers and 21 days for healthy adults. 177 Healthcare providers received the COVID-19 vaccine as a priority, therefore the mean period 178 to interview was longer than with the healthy adults (Fig 2) is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; https://doi.org/10.1101/2022.03.24.22272878 doi: medRxiv preprint 201 respectively (coding-condensation), and by categorizing the codes matching the HBM, 59 categories and 68 categories were created, respectively 202 (categorizing). Finally, the generalizability of the categories was 26 and 27 in healthcare providers and healthy adults, respectively 203 (generalizing). The categories for vaccination recommendations were 3 and 6, and the categories for messages after vaccination were 3 and 7 for 204 healthcare providers and healthy adults, respectively. Each category and main comments are listed (S1 and S2 Table) . and S2 Table. Also, 205 summary of the results is indicated (Fig 3) . The healthcare providers were aware of the possibility that they might be infected with 213 COVID-19 at their hospital, even if they were not directly involved in the treatment because 214 the hospital where they worked treated COVID-19 infected patients. On the other hand, the 215 healthy adults began to be aware that they might also be infected when the number of 216 infections rapidly expanded in Tokyo (Fig 2) [24], or when they saw or heard that there were 217 infected people nearby. However, when there were no infected people in their immediate 218 vicinity, the sense of reality was weakened, leading them to think that they might not be 219 infected weakening their perceived susceptibility. 220 The healthcare providers realized that the severe cases of COVID-19 increased in their 222 daily practice and that most of the severe cases were unvaccinated patients. Furthermore, 223 even when discharged from the hospital, some patients still suffered from sequelae, and this 224 made them aware of the COVID-19 threat. In addition, some participants realized that not getting vaccinated may affect their 226 interpersonal relationships; for example, by wearing a mask when meeting unvaccinated 227 people. The healthy adult #12 has had similar experiences about relationships with others and 228 realized that the conversation atmosphere deteriorated when she mentioned to others that she 229 had no intention to vaccinate. The healthy adults were concerned that not vaccinating may 230 lead to discrimination and prejudice. On the other hand, the healthy adult #8 commented that 231 since there were more people infected with the COVID-19 in Tokyo than in rural areas, she 232 did not face discrimination or prejudice from others even when she was infected. It is 233 possible that whether the number of infected people is high or low in the surrounding area 234 may influence the tendencies for discrimination and prejudice. . CC-BY 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; https://doi.org/10.1101/2022.03.24.22272878 doi: medRxiv preprint 260 Also, the COVID-19 vaccines were a novel type with a different development process 261 than the conventional ones, and people felt anxious about the novelty itself. Because of the 262 lack of sufficient long term clinical data, they were concerned about unexpected side effects 263 and sequelae in the future. As it was a novel type of vaccine, there was a lot of uncertain 264 information on social networking sites and the Internet, such as "the COVID-19 vaccine will 265 lead to infertility" and "the COVID-19 vaccine will affect immunity and eventually cause 266 death". These questionable information had led to a sense of barrier to vaccination. The unique perception of the healthy adults was that they recognized that Spikevax™ is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The participants recognized the importance of providing correct information, as they 286 sometimes saw or heard ambiguous information. The healthcare providers were aware from 287 their vaccination work that many people had concerns about vaccines, and believed that it 288 was necessary to have a point of contact for these people to feel free to talk about various 289 concerns and worries about the COVID-19 vaccines. 290 291 4.2.6. Self-efficacy 292 The healthcare providers had made the decision to vaccinate because of their sense of 293 responsibility. As healthcare providers, they tried to give correct information to their family 294 and friends, as they were often asked about vaccinations. To enhance self-efficacy, they 295 believed it is important to know about the COVID-19 vaccines first. Both the healthcare providers and the healthy adults found that their concerns before 297 vaccination were alleviated by talking with others who had been vaccinated, and they felt 298 more secure after vaccination. On the other hand, those who did not originally intend to be 299 vaccinated did not have a high sense of self-efficacy even after receiving the vaccine. 300 301 Both the healthcare providers and the healthy adults were motivated to get vaccinated by 303 recommendations from specialists of infection disease and physicians, and by the fact that the 304 people around them had also been vaccinated. Even though they were not forced to be vaccinated, they felt the atmosphere in their 306 workplace that they should be vaccinated. The ease of making reservations for vaccination 307 was also a trigger for vaccination, as the healthy adults had to make their own reservations. . CC-BY 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; 310 The healthcare providers were very eager to have as many people as possible vaccinated. 311 As the COVID-19 vaccines were the most promising way to reduce the risk of getting severe 312 infection, and realizing how devastating it can be, they believed that vaccines have more 313 benefits than risks. On the other hand, recommendations from the healthy adults for vaccination of others 315 were varied. Some recommended vaccination to close family members, but did not actively 316 recommend vaccination to others. This is because they recognize that not getting the vaccine 317 is an option and should not be forced. Therefore, they would like to respect the unvaccinated 318 people's opinions. Differences in vaccine recommendations were found between the 319 healthcare providers and the healthy adults. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; https://doi.org/10.1101/2022.03.24.22272878 doi: medRxiv preprint 357 much as possible. According to the perceived severity, we found that the healthcare providers 358 strongly recognized the severity of COVID-19, such as the fact that unvaccinated patients 359 with COVID-19 infection could become severely ill, the sequelae of COVID-19 infection 360 could persist, and the sense that the number of the severe cases was increasing. Vaccination 361 has been recognized as a useful measure to reduce the risk of getting severely ill. The reason 362 why they recommend vaccination was not only because of its advantage, but also because of 363 the downside of not being vaccinated which would change the hospital's acceptance of an 364 infected patient who becomes severely ill. Of course, they were concerned about side effects 365 of the vaccine and the lack of long-term clinical data. However, based on the current data and 366 their experiences and those of their colleagues, few serious side effects occurred, and they 367 believed that the benefits of vaccination outweigh the risks at this point in time. The interviews also clarified that the healthcare providers felt strongly about their 369 responsibility. In the initial phase of the vaccination in Japan, when the experience of 370 COVID-19 vaccination was still minimal, their sense of responsibility as healthcare providers 371 promoted vaccination. And in the conversation with their close persons after the vaccination, 372 healthcare providers mainly talked about side effects based on their own experiences, but 373 they also emphasized that there was no need to be afraid of side effects. This was because 374 many people were worried about side effects of the vaccines, so they were trying to alleviate 375 the concerns by explaining that side effects were milder than they had expected. In addition, 376 they told the others that the vaccination gave them a sense of security because it reduced the 377 risk of getting severe illness even if infected with the COVID-19. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; 381 some healthy adults were willing to recommend vaccination to close family members, others 382 were not actively recommending it to others. This may be affected by how much expectation 383 they had for the vaccine in advance. Those who recommended vaccination were more likely 384 to have been living with family members, and as a perceived threat, they were worried about 385 transmitting COVID-19 to others if they had been infected. The recommendation to vaccinate 386 might have been based on their desire to protect the family. In contrast, those who responded 387 that they would not actively recommend the vaccine did not live with their families, but were 388 considering getting the vaccine when the number of infected people significantly increases in 389 Tokyo (Fig 2) . This tendency was observed among younger people who, besides being 390 concerned about side effects from the vaccine, were also concerned about the fact that it was 391 a novel type of vaccine. Especially for non-regular employees, they were worried about loss 392 of income if they had to take a leave due to side effects of the vaccine, which suggests that 393 their expectations of the vaccine were relatively low. Not only the expectation and insecurity 394 toward the vaccine, but also environmental factors such as living with family members and 395 employment status may affect the level of recommendation after vaccination. In conversations after vaccination, the healthy adults mainly talked about side effects, 397 based on their own experiences, to close persons and people who were worried about getting 398 vaccinated, but told them that there was no need to worry. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted March 25, 2022. ; https://doi.org/10.1101/2022.03.24.22272878 doi: medRxiv preprint healthcare providers and healthy adults shared similar messages to ease the vaccination 479 concerns of others regarding side effects. 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