key: cord-0937290-nabxpyw3 authors: Bell, Sadie; Clarke, Richard; Mounier-Jack, Sandra; Walker, Jemma L; Paterson, Pauline title: Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: a multi-methods study in England date: 2020-10-19 journal: Vaccine DOI: 10.1016/j.vaccine.2020.10.027 sha: 453e154e3a9467fb645bbb87b4b1027eef49ba94 doc_id: 937290 cord_uid: nabxpyw3 Background The availability of a COVID-19 vaccine has been heralded as key to controlling the COVID-19 pandemic. COVID-19 vaccination programme success will rely on public willingness to be vaccinated. Methods We used a multi-methods approach - involving an online cross-sectional survey and semi-structured interviews - to investigate parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine. 1252 parents and guardians (aged 16+ years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey participants were interviewed. Findings Most survey participants reported they would likely accept a COVID-19 vaccine for themselves (Definitely 55.8%; Unsure but leaning towards yes 34.3%) and their child/children (Definitely 48.2%; Unsure but leaning towards yes 40.9%). Less than 4% of survey participants reported that they would definitely not accept a COVID-19 vaccine. Survey participants were more likely to accept a COVID-19 vaccine for themselves than their child/children. Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost 3 times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants. Survey participants from lower-income households were also more likely to reject a COVID-19 vaccine. In open-text survey responses and interviews, self-protection from COVID-19 was reported as the main reason for vaccine acceptance. Common concerns identified in open-text responses and interviews were around COVID-19 vaccine safety and effectiveness, mostly prompted by the newness and rapid development of the vaccine. Conclusion Information on how COVID-19 vaccines are developed and tested, including their safety and efficacy, must be communicated clearly to the public. To prevent inequalities in uptake, it is crucial to understand and address factors that may affect COVID-19 vaccine acceptability in ethnic minority and lower-income groups who are disproportionately affected by COVID-19. Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England 167 and "likely to reject" (those that answered No, definitely not or Unsure but leaning towards 168 no). 180 of interest such as underrepresented populations in the survey (e.g. participants from ethnic 181 minority groups or reporting a lower household income) and/or indicated they would likely 182 refuse a COVID-19 vaccine, for their child or themselves. We did not solely interview 183 participants who were likely to refuse a COVID-19 vaccine as we were keen to explore the 184 nuances of reasons participants had for accepting or refusing a COVID-19 vaccine. 186 Participants were emailed an information sheet, fully detailing the study objectives and 187 explaining all aspects of participation, including the right to withdraw from the research. 188 Written informed consent was obtained from each participant. Interviews lasted Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England 213 INSERT TABLE 1 HERE 214 215 43.3% of survey participants (n=530) provided their details to be contacted for a follow-on 216 interview. In total, 61 parents were contacted to participate. Of these 19 took part in 217 interviews (18 women and one man), 39 did not respond to recruitment emails, two 218 responded initially but did not follow through with an interview. The characteristics of 219 interviewees are outlined in Table 2 ). Interestingly, one interviewee (#19) that was leaning 249 towards accepting the vaccine at the time of completing the survey discussed that she was 250 leaning towards refusing the vaccination (for herself and her child) at the time of interview. 251 252 The following reasons were given for COVID-19 vaccine acceptance for self and for 253 child/children, in order of how often they were mentioned by survey participants and 254 importance to interviewees. 255 To protect self and others 256 Of survey participants expressing positive intentions to vaccinate and leaving an open-text 257 response, the most prevalent reason was to provide protection from COVID-19 to the Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England 259 protecting other people (for self: 23.7%, n=213; for child: 19.5%, n=180), including family 260 members (for self: 12.2%, n=109; for child: 5.3%, n=49). Participants also reported that they 261 would vaccinate to protect someone known to them in a risk group for COVID-19 (for self: 262 8.2%, n=74; for child: 3.1%, n=29). 5.0% (n=45) of survey participants specifically mentioned 263 that they wanted to receive the vaccine to stay healthy to look after their child/children. . This is of concern given the evidence that Black, COVID-19) vaccine became available 145 would you accept the vaccine for your child/children?". A 4-point Likert scale was used to 146 encourage participants to take a stance on the vaccine (rather than selecting a 'do not 147 know' answer). The Likert scale options were "Yes, definitely A paired samples t-test was used to compare acceptance of a COVID-19 vaccine for self and 154 for the participant's child. Two subsequent logistic regressions were then conducted to 155 determine the demographic factors associated with rejection of the COVID-19 vaccine for 156 both self-vaccination and that of the participant's child Age, household income, ethnicity, location, and employment were included as predictive 158 variables in the logistic regression models. In the logistic regression model for child 159 vaccination To perform the logistic regressions ethnicity was dichotomised into 'White' (i 000 -£84,999) and 165 "high income" (>£85,000), and the vaccine acceptance variables were dichotomised into Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England 190 around the content of the questionnaire, were used to assist the interviews. The interviews 191 included two questions related to a COVID-19 vaccination, the first focused on parents' and 192 guardians' views on receiving a new COVID-19 vaccine for themselves, should one become 193 publicly available, and the second on their views on their child of accepting a new COVID-19 194 vaccine for their child. Interview participants received a £10 gift voucher as a thank you for 195 their time and contribution. The interviews took place between 27 th April and 27 th May and Clarke [10]: data familiarisation, coding and theme 200 identification and refinement. The transcribed interviews were read and coded by SB. To 201 enhance the rigour of the analysis, coding approaches and subsequent theme generation and guardians completed the survey (see participant characteristics in Table 207 1) Of the survey participants Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England Quantitative findings -Factors associated with COVID-19 vaccine rejection for self 407 A forward stepwise logistic regression analysis was performed with a dichotomised version 408 of the self-vaccination against COVID-19 variable as the discrete variable. Age, household 409 income, ethnicity, location and employment were included as predictive variables. The final 410 model included three predictor variables (household income, employment and ethnicity) and 411 significantly predicted 'Likely to reject' (omnibus chi-square = 50.225, df = 7, p < .001) .3) as likely to reject a COVID-19 vaccine than participants with a medium 419 household income (£35,000-£84,999) Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were 2.7 424 times (95%CI: 1.27 -5.87) more likely to reject a COVID-19 vaccine than White British White Irish and White Other participants. There was also some indication that those that Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: a multimethods study in England A forward stepwise logistic regression analysis was performed with a dichotomised version 431 of the child vaccination against COVID-19 variable as the discrete variable. Age, household 432 income, ethnicity, location, employment and number of children were included as predictive 433 variables. The final model included three predictor variables (income, ethnicity and number 434 of children) and significantly predicted 'Likely to reject Age, location and employment did not significantly predict 'Likely to reject', as 436 such they were excluded from the model. The Hosmer-Lemeshow test demonstrates that 437 the model adequately fits the data chi-square = 1.502, df = 6, p = .958 Mixed or Other ethnicity were 2.74 times (95%CI: 1.35 -443 5.57) more likely to reject a COVID-19 vaccine for their child than White British, White Irish 444 and White Other participants. This finding was also found for income, with participants in 445 the lower household income bracket (<£35,000) being 1.8 times (95%CI: 1.17 -2.82) as 446 likely to reject a COVID-19 vaccine for their child than participants with a medium household 447 income (£35,000-£84,999). 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