key: cord-1033046-j9eht34n
authors: Kaplan, Askin Keskin; Sahin, Mustafa Kursat; Parildar, Hulya; Adadan Guvenc, Isil
title: The willingness to accept the COVID‐19 vaccine and affecting factors among healthcare professionals: A cross‐sectional study in Turkey
date: 2021-04-29
journal: Int J Clin Pract
DOI: 10.1111/ijcp.14226
sha: 28bb970efb12665387446a609bb9d97f909749db
doc_id: 1033046
cord_uid: j9eht34n

INTRODUCTION: While discussions on the effectiveness of COVID‐19 vaccines continue, healthcare professionals' attitudes and their growing fear and anxiety during the pandemic process are not yet fully known. In this study, we aimed to investigate the COVID‐19 vaccine acceptance and affecting factors in healthcare professionals. METHODS: This was a cross‐sectional online survey conducted in 1574 healthcare professionals consisting of physicians, nurses, dentists, pharmacists, and healthcare personnel in Turkey in December 2020. Demographic, attitudinal, and Fear of COVID‐19 Scale scores of healthcare professionals were investigated in this survey. RESULTS: About 84.6% of healthcare professionals declared willingness to accept the COVID‐19 vaccine whenever possible. Most physicians (90.4%) stated to receive the COVID‐19 vaccine, while 66.5% of nurses, 73.9% of healthcare personnel, also preferred to have it as soon as the vaccine was available. Factors affecting the willingness to accept the COVID‐19 vaccine were found to be advanced age, male gender, working in a primary health care center, living with family, having a child, having a chronic disease, having high Fear of COVID‐19 Scale (FC‐19S) scores. While the group with the highest vaccine rejection rate was nurses with 33.5%, FC‐19S scores were significantly higher in nurses who wanted to be vaccinated. In multivariate regression analyses, factors related to the acceptance of the COVID‐19 vaccine were identified as advanced age, routine adult vaccination, no history of COVID‐19, and recommendation of the COVID‐19 vaccine. CONCLUSION: A high proportion of healthcare professionals declared their willingness to accept the COVID‐19 vaccine, and hence, this will play a leading role in optimizing the vaccination rate of the entire population while combating the pandemic.

Although standard vaccine development is a long process, efforts have been made for a speedy organization of the available resources and knowledge from existing vaccines to fight this pandemic. For the vaccines to be effective in a pandemic, it is necessary to provide herd immunity and exceed the threshold rate by vaccinating many people. For this reason, many countries are working on developing effective strategies for the acceptability of vaccination, taking into account all the factors that determine the intention of vaccination. 1 However, many scientific studies indicate that healthcare professionals (HCPs) play a vital role in this issue and significantly affect the general public's decisions to receive the COVID-19 vaccine. 2, 3 Healthcare professionals have become a priority on vaccination programs as one out of every ten COVID-19 patients in Turkey was a healthcare professional, and a more significant proportion of HCPs have died of COVID-19 as a result of working in a very high-risk environment. Therefore, high levels of depression, anxiety, insomnia, and distress symptoms developed in HCPs during the COVID-19 pandemic associated with factors like working on the frontline and frequent testing for coronavirus. 4 While discussions on the effectiveness of COVID-19 vaccines are continuing, the opinions of HCPs, and their increasing fear and anxiety during the pandemic process,

are not yet fully known. 5 In this study, we aimed to investigate the COVID-19 vaccine acceptance and affect healthcare professionals' factors.

The present study was a cross-sectional study based on data collected between 25 ." With a total population size of 1.033.767 (N) HCW across Turkey, a margin of error of 3%, a confidence interval of 95%, an assumption percentage of willingness to accept the COVID-19 vaccine (p) 50%, the minimum sample size was calculated as 1066 participants. 

• Healthcare professionals as role models for the public have shown a high willingness to get the COVID-19 vaccine.

• Elder age, male gender, high Fear of COVID-19 scores, working in high risk are strongly related to the willingness to COVID-19 vaccination.

• Physicians are the leading group with the highest COVID-19 vaccine acceptance among healthcare professionals, whereas nurses have relatively lower acceptance rates.

• Our findings among healthcare professionals show some similarities and differences with the current literature, and these findings will be of value to local and global strategy makers for fighting against the pandemic.

Services General Directorate Scientific Research Platform (MoH: 2020-12-25T13_21_22). vaccine would end the pandemic ( Table 2 ).

The vaccination site preference was 35.3% (n = 432) primary care, 29.2% (n = 357) university, and 20.4% (n = 250) hospitals.

The FC-19S score received by those who were willing to get the COVID-19 vaccine was significantly higher, 19 ± 6.7 (Median = 18; min = 7-max = 35), than the score received by those who were not 17.7 ± 6.9 (Median = 17; min = 7-max = 35) (P = .004). FC-19S scores were significantly higher for nurses and dentists willing to accept the COVID-19 vaccine (P = .014 and P = .002 resp.) ( Figure 2 ).

Comparisons of factors affecting willingness to COVID-19 vaccine acceptance are given in Table 3 . Adult immunization practice in routine 

In our study, we found the acceptance of the COVID-19 vaccine as 84.6% among HCPs. The most important factors that increased the willingness to get the COVID-19 vaccine were identified as advanced age, recommending the vaccine to others, having other routine adult vaccines, and believing in the COVID-19 vaccine to end the pandemic.

The rate of willingness among HCPs may differ from country to country. In one study, 77% of French healthcare workers reported that they wanted to get vaccinated for COVID-19 7 while the willingness to get vaccinated was 28% among healthcare workers in

Kongo. 8 On the other hand, vaccine hesitancy seems to have an essential role in the emergence of these rates, whereas the rising rate of vaccine hesitancy among HCPs is also very bothersome. The rate of willingness to get the COVID-19 vaccine was higher for the elderly compared with younger people. 7, 10, 11 However, some other studies do not show an increase in the rate of willingness for a vaccination with age. 9, 12 The willingness to be vaccinated was lower in women than in men. 7,10-12 In a study conducted in seven countries throughout Europe, the willingness to get the COVID-19 vaccine was higher, especially in men over the age of 55. 13 There is a positive relationship between male gender and acceptance of COVID-19 vaccination. 14 Several independent reports indicate a higher risk of COVID-19

complications, infection, and death in men. 15 vaccination had also been demonstrated in a study previously conducted with 806 nurses in Hong Kong. 17 In parallel, it has been shown that influenza vaccine refusal is caused by the hesitancy of HCPs to be vaccinated in general, as a result of side effects, vaccine ineffectiveness, and misinformation or insufficient knowledge that the vaccine causes disease. 22 For this reason, it is thought that the healthcare workers in the group in our study who had regular adult vaccines, believed in the effectiveness and protection of the vaccines and perceived that the COVID-19 vaccine was an effective solution. Effective vaccination in the course of a pandemic is crucial for reaching the vaccination level that could create herd immunity. 23 Although this rate is 80% for polio, it is not yet known for COVID-19. 24 In a modeling study for the American population, the herd immunity rate required for COVID-19 eradication in the United States was reported to be at least 82.5%, with a COVID-19

vaccine at 80% effectiveness. The study showed that the herd immunity threshold could decrease to 46% if everyone regularly wore face masks in public. 25 The high rate of healthcare professionals recommending the COVID-19 vaccine in our study is also a promising finding.

Vaccine hesitations and refusals can be significant barriers to vaccine intake, especially for new pandemic vaccines. Studies showed that physicians are highly effective in encouraging vaccination and are likely to have a similar role in the COVID-19 vaccine.

However, physicians will need comprehensive and up-to-date information on COVID-19 vaccines, and pre-vaccination planning is required to equip them with the knowledge and skills to counteract anti-vaccination messages in the media. 26 In our study, considering Coronovac, BioNTech, and domestic vaccines' availability as more likely, healthcare professionals may have a higher desire to be vaccinated with these vaccines. Publications about the effects or side effects of different vaccines in different countries will cause these views to change.

Patients, healthcare colleagues, family, friends, and others will

seek doctors' advice about whether to be vaccinated. Physicians will need to discuss the benefits and risks to alleviate their hesitation about getting the vaccine. 27 Reliable and culturally informed health communication is vital in influencing positive health behaviors. 28 The main concern can be considered that vaccines, which can typically be developed in 10-15 years, are prepared in as little as one

year, bringing safety concerns. 29 Reasons for refusal and hesitation for COVID-19 vaccination included "doubts about effectiveness, efficacy, and safety," "believing it is unnecessary," and "no time to take it." 17 Concerns about side effects were a significant cause of vaccine hesitations. 11, 14, 30 Knowledge about the vaccine's safety and efficacy will be crucial to ensuring public confidence in vaccination and facilitating acceptance. In our study, the participants preferred the Family Health Centers as the primary place of vaccination. There Bbold are less than .05 and significant.

is no doubt that family medicine units that have served many years in primary care for children and adult vaccinations would be the most trusted units for COVID-19 vaccinations. Therefore, it seems inevitable that these units, which can also serve as trainers in the war with the pandemic, have an important place. 31 The widespread circulation of misleading and false information about vaccines, conspiracy theories, especially on social media, is known as some of the critical factors associated with vaccine refusal. 32, 33 After the pandemic was declared, the lack of sufficient information about COVID-19 and the Internet's dominance in numerous fake news seems to have led physicians to get information from accurate and reliable sources.

In a study involving healthcare professionals, 80% of information on COVID-19 was reached online. The self-confidence of healthcare workers, whose source of information is academic courses, was higher. No difference was seen in other sources of information. 34 It has been shown that the information on the websites of official public health organizations is more reliable. 35 It has been determined that it is more appropriate for official institutions to provide information not alone but in cooperation with other organizations and media. 36 In previous studies, physicians' importance as a stakeholder for the success of herd immunity was observed and positively affected society's acceptance of vaccines. 3, 37 However, family physicians and primary healthcare workers, who will take on an educative role in the fight against the pandemic, were more willing to be vaccinated significantly than those working at other levels. 31 We also found in our study that the main reason for HCPs' unwillingness to be vaccinated was "lack of sufficient studies." This suggests that effective communication of scientific studies on COVID-19 and scientific information on vaccines to HCPs will help overcome doubt or resistance to vaccination. 14, 22 Physicians were significantly higher in recommending the COVID-19 vaccine than nurses and other occupational groups.

These findings are also in line with the studies conducted after the H1N1 epidemic. In a study regarding the H1N1 pandemic, it was observed that although nurses had an intense relationship with patients and had a relatively higher risk, they were more reluctant to be vaccinated, which was because of misinformation about vaccines or ignoring the risk. 38 Similarly, there is a need to increase nurses' awareness of this issue in our study.

However, our study has some limitations. At first, this study was done before phase 3 results of the approved COVID-19 vaccine were announced, and respondents answered with their self-reports.

Secondly, long-time follow-up is needed to evaluate individuals' vaccination rates over time by studies with a larger sample size obtained via scanning of records. 2020-12-25T13_21_22).

Interest Statement on behalf of all the listed authors in the manuscript. The corresponding author certifies that all the information contained in this statement is accurate, correct, and agreed on by all the listed authors:

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

All authors contributed to the study conception and design. All au- Adadan Guvenc: conception, design of the work, literature review.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. 

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Adadan Guvenc I. The willingness to accept the COVID-19 vaccine and affecting factors among healthcare professionals: A cross-sectional study in Turkey