key: cord-0948109-7kne0syt
authors: Walsh, Jane C.; Comar, Miranda; Folan, Joy; Williams, Samantha; Kola-Palmer, Susanna
title: The psychological and behavioural correlates of COVID-19 vaccine hesitancy and resistance in Ireland and the UK
date: 2022-02-28
journal: Acta Psychol (Amst)
DOI: 10.1016/j.actpsy.2022.103550
sha: 41ebc81cfcdaea1997c4546ef7f9be75637026f4
doc_id: 948109
cord_uid: 7kne0syt

BACKGROUND: The successful control of the COVID-19 pandemic depends largely on the acceptance and uptake of a COVID-19 vaccine among the public. Thus, formative research aiming to understand and determine the causes of weak and/or positive vaccination intentions is vital in order to ensure the success of future and current vaccination programmes through the provision of effective, evidence-based health messaging. METHODS: A cross-sectional survey was completed by a sample of Irish (N = 500) and UK (N = 579) citizens using the online platform ‘Qualtrics’. Participants completed a questionnaire battery comprised of health, attitudes/beliefs, influences, and behavioural intention measures. Demographic information was also assessed. RESULTS: Results highlighted similar rates of vaccine intention among both samples; where a total of 76.8% Irish respondents, and 73.7% of UK respondents indicated that they intended to be immunized if the government advised them to take the COVID-19 vaccine. Overall, 23.2% of Irish respondents reported being vaccine hesitant or vaccine resistant, while a rate of 26.3% of UK respondents reported vaccine hesitancy or resistance. Univariate analysis highlighted that both gender and age played a significant role in vaccine intention, with women under age 30 reporting higher rate of vaccine hesitancy. Multivariate analysis revealed that significant correlates of vaccine acceptance included peer influence, GP influence, civic responsibility, perceived benefit, and positive vaccination attitudes. Those who reported vaccine resistance and hesitancy were more likely to have less positive vaccination attitudes and perceive higher vaccination risk. DISCUSSION: The current sociodemographic and psychological profiles of vaccine resistant and hesitant individuals provide a useful resource for informing health practitioners in the UK and Ireland with the means of enhancing pro-vaccine attitudes and promoting vaccination uptake. The current research shows indications of associations between distrust in the vaccine itself and vaccine hesitancy and resistance. Thus, to effectively design and deliver public health messages that ensures the success of vaccination uptake, it is likely that governments and public health officials will need to take actions to garner trust in the safety of the vaccine itself. Additionally, campaigns to decrease hesitancy and resistance in the COVID-19 vaccine may benefit in targeting altruism to increase willingness to get vaccinated against COVID-19.

It is evident from the above cited papers that substantial vaccine hesitancy and resistance exist in the global population. Vaccine hesitancy refers to delay in acceptance or refusal of a vaccine despite its availability compared with vaccine resistance is where one is absolutely against taking a vaccine. It is a complex phenomenon, and varies across time, place, and vaccines (MacDonald et al., 2015) . It is therefore very important to distinguish the psychological processes that characterise and distinguish vaccine hesitant and resistant individuals from those who are receptive to vaccines. Doing so not only helps to account for why vaccine hesitant and resistant individuals come to hold the specific beliefs that they do, but it may also provide an opportunity to tailor public health messages in ways that are consistent with these individuals' psychological dispositions. Therefore, identifying, describing, and understanding who is likely to be vaccine hesitant is of outmost importance, so that public health campaigns and interventions can be targeted for maximum efficiency.

While several studies have sought to identify factors associated with COVID-19 vaccine hesitancy, they were conducted prior to the approval of a COVID-19 vaccine. It is not known whether these factors have the same importance when the outcome is real rather than hypothetical. Data for the current study were collected during the vaccine roll-out, and therefore our participants were asked about their intention to accept a COVID vaccine which was likely to be offered soon. Additionally, we focused on psychological process variables using robust theoretical frameworks to guide our study. Further, acknowledging the multiple There is a wealth of research on factors that influence and predict intention to uptake vaccinations. Several social cognitive theories have been applied to this behaviour in previous literature. In particular, the Health Belief Model (HBM; Becker, 1974) , the Social Cognitive Theory (Bandura, 1986) , and the Theory of Planned Behaviour (TPB; Ajzen, 1991) , have shown the predictive utility of behavioural attitudes, risk perceptions, and selfefficacy towards vaccinations, including against HPV (e.g., Priest et al., 2015; Pot et al., 2017) , influenza (e.g., Wu et al., 2020; Corace et al., 2016) , and pandemic swine flu (e.g., Byrne et al., 2012; Myers & Goodwin, 2011) .

Since the start of the pandemic and before the availability of a vaccine, several studies have examined COVID-19 vaccine acceptance beliefs and attitudes. For example, Sherman et al. (2021) explored predictors of vaccine acceptance in a large sample of UK adults.

Increased likelihood of accepting a hypothetical COVID-19 vaccine was associated with older age, previous vaccination behaviour, greater COVID-19 risk perceptions, more positive vaccination beliefs and attitudes, weaker vaccine risk perception, and better health literacy.

While this study is important in understanding psychological and behavioural predictors of vaccine acceptance, it is not clear to what extent these findings can be used to understand vaccine hesitancy. A large cross-sectional survey of UK adults explored the influence of negative general vaccine attitudes and other sociodemographic and psychological variables on vaccine hesitancy and refusal (Paul et al., 2020) . Results showed that vaccine hesitancy was associated with female gender, low income, living with children, not having flu vaccine, and poor adherence to COVID government guidelines. Additionally, low trust in authorities and negative vaccine attitudes were also associated with refusal and hesitancy. While this study provides information of correlates of vaccine hesitancy and resistance, the vaccine attitude scale implemented did not ask specifically about a COVID-19 vaccine, instead it focused on general vaccine attitudes. It also did not include other psychological variables J o u r n a l P r e -p r o o f known to influence vaccine behaviour, such as HBM constructs (susceptibility, severity, risk, benefit) and TPB constructs (e.g., social norms). A survey of nationally representative samples of the general adult population in Ireland and the UK explored a range of sociodemographic and personality differences between vaccine hesitant, resistant, and accepting respondents . Results demonstrated differences with regards to levels of self-interest, trust in authorities, religious beliefs, conspiracy, and paranoid beliefs, as well as differences in thinking styles and personality traits. Likewise, as cited in a report by the International Covid-19 Behavioural Insights and Policy Group (2021); reasons for vaccine acceptance in Ireland include: trust in the efficacy and evidence of clinical testing of the vaccine and protecting oneself and others. According to a study conducted by Muldoon et al., (2021) reasons for vaccine hesitancy and resistance included: fear of side effects and conspiracy beliefs. Sub-groups with a low intention to vaccinate included women and minority groups. Key predictors of positive vaccination intentions included past vaccine uptake; perceived impact of the pandemic on one's nation or community; trust in government, science and healthcare workers; worry or fear of COVID-19; while susceptibility to misinformation was a predictor of negative intentions. Accordingly, the current study aims to incorporate previously examined variables to enhance and support findings from previous studies; as well as to bridge explorative gaps within current literature.

In particular, although the research conducted by Murphy et al., (2021) highlights the role of personality variables, it does not include the psychological variables known to influence vaccine behaviour, such as vaccine attitudes and beliefs. Consequently, the current study aims to focus on the impact of attitudes and perceptions on vaccination intention.

Additionally, the current research aims to build on the understanding around the role of civic responsibility as a predictor of intention to vaccinate. This is a contemporary addition to the field of vaccine hesitancy, which has been sparsely documented during the J o u r n a l P r e -p r o o f pandemic. Despite this, recent research studies have highlighted the importance of including it in future research (Bourgeois et al., 2020) . Research conducted by Kwok et al., (2021) explored a similar concept of 'collective responsibility', which highlighted a significant association between the variable and greater COVID-19 vaccine acceptance. However, this research was conducted on a socially unrepresentative sample of nurses, who as a professional group have been found to have higher levels of social responsibility due to taught altruism thus limiting the generalizability of results (Mahlin, 2010) . Consequently, the current study aims to build on the previous research by expanding the study population and increasing the inter-rater reliability of the findings.

Negative attitudes towards vaccinations and hesitancy or unwillingness to vaccinate are major barriers to the full population immunization against COVID-19 (Dror et al., 2020) .

Elucidating factors associated with vaccine hesitancy about receiving a COVID-19 vaccine is imperative, as individuals who are vaccine hesitant are likely to be the most realistic targets for public health interventions encouraging vaccination (Paul et al., 2020; WHO, 2020) .

The present research examines intentions to vaccinate during a declared pandemic, and at the height of the pandemic alert. This improves the validity of findings in that the crosssectional study was taken at a time when vaccination uptake was being actively advocated by government and health promotion authorities worldwide, and participants were being asked about their genuine intention to uptake vaccination.

The current study sets its focus on the four core components of the HBM model, which underscores the likelihood that a person will engage in a particular health behaviour based on their health beliefs and contains several primary concepts that predict why people will take action to prevent, to screen for, or to control illness conditions; these include perceived susceptibility to and perceived severity of disease; perceived benefits and perceived risks of preventative strategies (e.g., vaccinating) against a disease (Champion & Skinner, 2008) .

The basic framework of the model suggests that for successful behavioural change to occur, individuals must feel threatened by their current patterns of behaviour (i.e., perceived susceptibility to and perceived severity of contracting COVID-19) and believe that a specific change in behaviour will result in a valued outcome (i.e., perceived benefit of immunization against COVID-19) that outweigh the anticipated barriers to taking the action (i.e., perceived risks associated with vaccination uptake) (Ayers et al., 2007) .

The predictive utility of health belief variables (susceptibility, severity, barriers to vaccination, and benefits of prevention) were examined. The additional value of including other variables identified from previous studies of vaccine hesitancy such as attitudes, fear of Covid-19, trust in authorities, civic responsibilities, adherence to public health guidance, and external influences, were explored which are typically measured in the context of attitude behaviour models, such as the Theory of Reasoned Action (TRA) or the Theory of Planned Behaviour (TPB). Fear of Covid-19 was included as a measure of Covid-specific risk perceptions/attitudes, and is associated with adherence to public health guidance to reduce infection (Alsharawy et al., 2021) .

the UK (54%) and 500 participants from Ireland (46%). Sample size was based on guidelines for multinomial logistic regression which indicate a minimum of 10 cases per independent variable (Schwab, 2002) . Participants completed an anonymous, self-administered 15-minute online survey in self-selected locations. All procedures were reviewed and approved by the host universities' ethics committees.

Participants accessed the anonymous survey link which directed them to the Qualtrics survey platform. Informed consent was requested following the information sheet which covered the rationale behind the current research and what the survey would entail.

Confidentiality and the voluntary nature of participation was assured, and participants were informed of their right to withdraw from the survey at any time. Once completed the participants finished on a debrief sheet which included helpful links for advice surrounding COVID-19 related stress and anxiety to limit harm to participants.

The 70-item questionnaire incorporated elements of the protocol used by Byrne et al. (2012) and assessed behavioural determinants of intention to vaccinate based on components of the HBM and other relevant variables of interest, details of which are provided below.

is unnecessary for me to get vaccinated; and I can protect myself against COVID-19 without getting vaccinated with the pandemic in its current state. The response format for both items were measured on a five-point Likert scale from strongly disagree (1) to strongly agree (5).

A higher score indicates more positive attitudes toward immunization against COVID-19.

Social/External Influences (α = .59) were assessed by three items to determine the impact of others on one's vaccination intentions. Two items were examined on a 3-point Likert scale more likely, less likely, and not affected, and one on a five-point Likert scale ranging from (1) not very important to (5) very important. Social influences were measured by responding to influences of the government, the GP, and those close to you on getting vaccinated.

Trust in Authorities (α = .73) was examined using items that suggested trust in the government and in the NHS/HSE in providing "the best possible advice regarding my health". Respondents rated their level of agreement with each of the two statements on a scale from 0 to 100, and a mean of both items was calculated and utilized as a measure of 'trust'.

Adherence to COVID-19 guidelines (α = .82) was measured using thirteen items that explored respondent's participation in and general compliance to the COVID-19 guidelines recommended and implemented by the HSE. Responses were given on a five-point Likert scale ranging from never (1) to always (5). A higher score indicates more positive adherence to COVID-19 guidelines.

Civic responsibility (α = .64) investigated participants response to COVID-19 pertaining the welfare of those around them and their moral responsibility towards their external environment. Three items examined civic responsibility and included taking the COVID-19 vaccine to protect others more so than oneself; having a responsibility to one's community to vaccinate; and if one could not vaccinate, they would want others to vaccinate to help protect oneself. Responses were given on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5). In addition, participants were asked whether they believed it was their J o u r n a l P r e -p r o o f duty or their choice to follow government-mandated rules during the COVID-19 pandemic.

This variable could also be considered as a measure for civic responsibility.

Government response (Lazarus et al.,2020 ) (α = .88) was measured by examining participants opinions on the government's performance during the COVID-19 pandemic using 10-items.

Responses were given on a five-point Likert scale ranging from completely disagree (1) to completely agree (5).

Fear of COVID-19 (Ahorsu et al., 2020 ) (α = .85) measured respondents' levels of fear and anxiety surrounding the virus and the worries of contracting it. Sample items include "I am most afraid of coronavirus-19", "When watching news and stories about coronavirus-19 on social media, I become nervous or anxious". Responses were given to 7-items on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5).

Information sourcing of COVID-19 information was a further measure included for the current research as a development from Byrne et al (2012) due to the media publicity of the current pandemic the measure has been included in contemporary COVID-19 research (Oosterhoff, 2020) . Battery items examined information sourcing of COVID-19 "Do you actively seek out information regarding COVID-19" which were measured using closed question selection.

All statistical analyses were conducted using IBM SPSS for Windows (version 27).

Differences in continuous variables between the vaccine accepting, vaccine resistant and vaccine hesitant groups were analysed using Kruskal-Wallis with a Mann-Whitney U post hoc analysis. The use of non-parametric tests was employed due to violations in the criteria and assumptions of parametric tests. Associations between intention and categorical variables were analysed using chi-square. A series of multinomial logistic regression were then performed to assess the impact of the behavioural determinants on vaccination hesitancy, J o u r n a l P r e -p r o o f resistance, and acceptance. As suggested by recent research (i.e., Murphy et al., 2021) , relative to vaccine intention, national differences exist between Ireland and the UK; and thus, in addition to analysing the overall sample (N-1079), stratified analysis for both the Irish and UK samples were also conducted. Variables included in each multinomial logistic regression were chosen based on significance in prior analysis.

Data from samples from both Ireland (N=500) and the UK (N=579) were collected, revealing an overall rate of 75.2% vaccine acceptance (N=811); 10.9% vaccine resistance (N= 118); and 13.9% vaccine hesitancy (N= 150) . Results highlighted similar rates amongst both samples; where a total 76.8% Irish respondents, and 73.7% of UK respondents indicated that they intended to be immunized (vaccine acceptant) if the government advised the uptake of a COVID-19 vaccine. 9.6% of Irish respondents, and 12.1% of UK respondents did not intend to vaccinate (vaccine resistant); and 13.6% of Irish respondents, and 14.2% of UK respondents said they were unsure if they would vaccinate or not (vaccine hesitant).

Sociodemographic breakdown of the overall groups can be found in table 1.

In the overall sample, chi-square analyses revealed significant associations between intention and: gender x 2 (2)= 9.44, p = .009; ethnicity x 2 (2)= 30.70, p<.001; political orientation x 2 (4)= 10.75, p = .03; actively seeking Covid-19 information x 2 (2)= 49.54, p<.001; information source x 2 (2)= 31.01, p<.001; past flu vaccination x 2 (2)= 67.13, p<.001; present flu vaccination x 2 (4)= 172.40, p<.001; and civic responsibility (duty vs. choice) x 2 (2) = 27.45, p<.001. Further separate analysis of both samples revealed that in the Irish sample, there were significant associations between intention and: gender X 2 (2) = 7.12, p =.03; past flu vaccination X 2 (2)= 35.90, p <.001; present flu vaccination X 2 (2)= 27.45, p<.001; political 

Results from the Kruskal Wallis reported significant differences between all continuous variables and intention to vaccinate in the overall sample, and in the stratified analyses of the Irish and UK samples. A post hoc Mann-Whitney test was applied to follow up on significant variables using a Bonferroni adjusted alpha level p = 0.017 (0.05/3). The means, standard deviations, and Cronbach alpha for predictor variables can be found in Tables 5 and 6 and 7.

There was a significant difference in age depending on vaccination intention in both J o u r n a l P r e -p r o o f Relative to those who were vaccine accepting, those who were vaccine resistant 

Using the same reference category, separate multinomial logistic regressions were performed on the Irish sample (N=500) and the UK sample (N=579) to identify any population-specific J o u r n a l P r e -p r o o f 

Frequencies in data highlighted women had the highest rates of vaccine hesitancy, with between 15% and 20% of this group saying they were unsure about getting the vaccine.

Notably, multivariate analysis of the Irish sample reported a significant correlate of vaccine hesitancy among females. Results from independent non-parametric tests from both samples suggest that those who were vaccine hesitant had a significantly younger age than both the vaccine resistant and vaccine accepting groups. Distinctions in intention to vaccinate against J o u r n a l P r e -p r o o f COVID-19 based on age and gender have been seen in several other similar studies (Callaghan et al., 2021; Murphy et al., 2021) ; as well as in research examining intention to vaccinate against other infectious diseases (Pulcini et al., 2013; Flanagan et al., 2017) .

Regression modelling of the overall sample (UK and Ireland), identified that those who were vaccine hesitant had more negative attitudes towards vaccination, had an increased rate of perceived COVID-19 severity, and were less likely to be influenced by their government. These findings suggest a heightened negative emotional response among the vaccine hesitant; both regarding the disease itself and its vaccine. Much of the decrease in influence may be attributed to an erosion of trust in scientific research and vaccination effectiveness. In many cases this can be linked to both national and international media, whose coverage of the debate surrounding vaccination will frequently lead to misunderstanding and mistrust of vaccination if not adequately accompanied by appropriate health education. This could be related to the finding that a lack of confidence may predict vaccine hesitancy. These emotions can interfere with an individual's motivation and willingness to adhere with preventative health behaviours like vaccination (Morgul et al., 2020; Wang et al., 2021) ; and may also increase an individual's likelihood to embrace misinformation (MacFarlane et al., 2020) . These findings support the claims across a broad range of literature that suggest positive or negative attitudes towards vaccinations predict intention to uptake vaccination against COVID-19 (Paul et al., 2021; Sherman et al., 2021; Thunstrom et al., 2020) . These findings suggest a causal link between attitudes and behaviour and should be explored further to explain how these attitudes and beliefs become established.

Results from the stratified analysis identified that unique to the Irish sample, individuals who were vaccine hesitant had increased COVID-19 severity and more negative vaccination attitudes. Whereas in the UK sample, those who were vaccine hesitant had a lack of perceived benefit regarding the vaccine. In comparison to those who were vaccine J o u r n a l P r e -p r o o f accepting; common contributors of vaccine hesitancy in both the Irish and UK sample were:

increased perceived risk of the COVID-19 vaccine, and not having peers that viewed vaccination against COVID-19 as important. These findings may be due to concerns regarding the safety and side effects of available vaccines (Wang et al., 2021) ; or due to misinformation being spread about COVID-19 vaccination via social media platforms. The perceived safety of vaccination is identified repeatedly in the literature as a catalyst for vaccine hesitancy, with some individuals fearing that the vaccination is riskier than the virus itself (Karlsson et al., 2021; Neumann-Böhme et al., 2020) . Conspiracy theories surrounding the vaccine have claimed that the vaccine can damage DNA (Ahuja & Bhaskar, 2021), and that the vaccine contains a chip that can monitor the public (Abbas et al., 2021) . Similarly, misinformation regarding vaccination side-effects have also been prominent and may encourage vaccination hesitancy and resistance. For example, misinformation has claimed that the vaccine may cause miscarriage and infertility (Abbas et al., 2021) . While the specific reasons for vaccine hesitancy were not explored in the present study, it can be assumed that fertility concerns may be a reason for such a high rate of hesitancy amongst younger women.

Individuals who were vaccine resistant shared a similar psychological and behavioural profile to those who were vaccine hesitant. For example, regression modelling on the overall sample (UK and Ireland) identified that individuals who were vaccine resistant had increased perceived vaccine risk; had more negative vaccine attitudes; had low rates of civic responsibility; were less likely to have peers that viewed vaccination as important; and, were less likely to be influenced by their GP to vaccinate. Additionally, those who were vaccine resistant were more likely to view following public health guidelines as an act of 'choice'

rather than an act of 'duty'. This underpins the challenge of creating an environment to lead people toward the 'healthiest' choice whilst allowing them to retain a sense of personal autonomy in of the current study's findings, results from an international study conducted by Crawshaw et al. (2021) found that mistrust in governments and public health agencies was linked to lower vaccination acceptance; while social influences (e.g., peers) can encourage vaccination.

Research in the UK have supported these findings, and as a result; a digital intervention has been designed to prevent the negative effects of vaccine misinformation (Knight et al., 2021) .

This study developed a scalable digital intervention which sought to address the concerns of individuals who are vaccine hesitant with a view to enhancing their trust in COVID-19

vaccines and, in turn their uptake. Thus, these findings can be capitalized on by health promotion practitioners and other authoritative bodies to improve upon public trust in authorities, and to provide the best possible advice regarding one's health and to further enhance vaccine acceptance. Vaccine hesitancy can be shifted to vaccine acceptance if public health campaigns provide clear messages about the benefits, as well as clear information on the low risks associated with having the vaccine and promote a positive sense of civic responsibility. vaccinate-future vaccination strategies may benefit from appealing to altruism and the Given the complexity of vaccine hesitancy, vaccination campaigns require multiple messages from a variety of trusted sources, including government, health authorities, scientific experts, community and religious leaders, social media companies, and celebrities. Truthful, transparent and consistent messaging is critical, particularly where trust in authorities is low (Jennings et al., 2021) .

One of the more intriguing findings reported from this research was the correlates highlighted between adherence to public health guidelines and vaccine resistance and hesitancy in the UK sample. It can be assumed that these individuals might be managing their risk of COVID-19 behaviourally and therefore do not believe they need a vaccine to protect themselves further.

Further research is necessary to explore these findings.

The current research is one of few studies conducted in the Republic of Ireland and the UK to empirically investigate the predictive factors of vaccination intent during a time when vaccination distribution was in progress. Despite providing some significant findings in the scope of research into vaccination uptake, it is also important to acknowledge the presence of limitations within the study that should be considered for future research prospects.

The results of the current study may not be generalisable to the wider population, as a large majority of the sample were females (79%), and of white ethnicity (93%). This is not representative of the gender split within the wider population, nor is it racially representative.

Nevertheless, while the results are not representative of the general population, the reported vaccination intent (75%) is somewhat consistent with other reports of vaccination intent across the literature (Sherman et al., 2021; Chu & Liu, 2021; Malik et al., 2020) .

Additionally (1) o Professional occupations e.g STEM, health, education/teaching, busniness and public services professionals (2) o Associate professionals and technical occupations e.g STEM, health and social, media, sport, business and public services associate professional (3) o Administrative and secretarial occupations (4) o Skilled trades occupation e.g agriculture, textiles, electronics and construction (5) o Caring, leisure and other services (6) o Sales and customer services (7) o Process, plant and machine operative (including transport and delivery drivers (8 If you're considered clinically extremely vulnerable to coronavirus, you should have received a letter from the HSE. However if you're considered clinically vulnerable you may not have been contacted, but these risk factors may apply to you if you -Are 70 or older-Have a lung condition that is not severe (such as asthma, COPD, emphysema or bronchitis-Have heart disease (such as heart failure)-Have diabetes-Have chronic kidney disease-Have liver disease (such as hepatitis)-Have a condition affecting the brain or nerves (such as Parkinson's disease, motor neuron disease, multiple sclerosis or cerebral palsy)-Have a condition that means they have a high risk or getting infections-Are taking medicine that can affect the immune system (such as low doses of steroids Thank you for taking part in our research study.

If you have any questions or concerns, please contact Joy Folan or Miranda Comar at J.folan3@nuigwalway.ie / m.comar1@nuigalway.ie , or their supervisor Dr. Jane Walsh at Jane.Walsh@nuigalway.ie.

The current research was looking to predict the potential uptake of a COVID-19 vaccine among Irish adults if one was developed for distribution. Research looked at demographic information as well as vaccine beliefs and behaviours especially to expand knowledge into the involvement of civic responsibility in the prediction of vaccine uptake. What now?

J o u r n a l P r e -p r o o f

The data gathered will be used to run statistical analyses to provide results and discussion for the research aims, these will then be written up in a dissertation. The research you have participated in covered sensitive issues which may have caused stress or anxieties surrounding COVID-19 therefore there is some resources provided which can direct you to organisations or websites to ease any exacerbated worries surrounding COVID-19. https://www.citizensinformation.ie/en/covid19/community_support_during_covid1 9.html https://www2.hse.ie/services/mental-health-supports-and-services-duringcoronavirus/ Your participation in the research will remain confidential and anonymous as no traceable personal information has been collected unless otherwise consented.

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