Keywords
vaccine hesitancy
COVID-19
psychological wellbeing
Abstract
Objectives. The present study aimed to identify factors that affect healthcare workers’ (HCWs) vaccine hesitancy and the subsequent changes in psychological well-being.
Study design. 800 employees (207 M; 14 aged ≤ 25; 145 aged 26-35; 381 aged 36-55; 260 aged > 55 years) were recruited from the San Martino Hospital during the first months 2021.
Methods. HCWs were asked to fill in an online survey assessing (a) demographics, (b) having contracted COVID-19 infection, (c) vaccination history (against COVID-19 and influenza), (d) expected changes in psychological well-being, (e) vaccine hesitancy and (f) factors leading to a decision about the vaccine (Information Trust, Information Seeking, Fear for the Self, and Sense of Responsibility).
Results. We found that, in vaccinated HCW, years of employment and adherence to the influenza vaccine indirectly affected vaccine hesitancy. These effects were mediated by HCWs’ sense of responsibility and information trust. Moreover, while information trust promoted positive changes in psychological well-being, vaccine hesitancy negatively affected it.
Conclusions. The present study consistently points to the crucial role of trusting information and having a sense of responsibility on vaccine hesitancy and, consequently, on psychological well-being. We discuss the practical implications for public health of these findings. In the conclusions, we suggest short-term and long-term strategies for improving vaccine adherence.
References
Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Human Vaccines & Immunotherapeutics 2013; 9(8):1763-1773. doi: 10.4161/hv.24657
Sallam, M. COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines 2021. 9(2):160.
Brown KF, Long SJ, Ramsay M, Hudson MJ, Green J, Vincent CA, Simon Kroll J, Fraser G, Sevdalis N. UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis. Vaccine 2012; 30(10):1855-1864. doi: 10.1016/j.vaccine.2011.12.127
Sticchi L, Taramasso L, Di Biagio A, Olobardi D, Icardi G, Bassetti M. Will vaccine hesitancy compromise our efforts to face the next SARS-CoV-2 epidemic wave? Human Vaccines & Immunotherapeutics 2021; 17(6):1664-1665. doi: 10.1080/21645515.2020.1829413
de Miguel-Arribas A, Aleta A, Moreno Y. Impact of vaccine hesitancy on secondary COVID-19 outbreaks in the US: an age-structured SIR model. BMC Infectious Diseases 2022; 22(1): 511. doi: 10.1186/s12879-022-07486-0
Barrière J, Vanjak D, Kriegel I, Otto J, Peyrade F, Estève M, Chamorey E. Acceptance of the 2009 A(H1N1) influenza vaccine among hospital workers in two French cancer centers. Vaccine 2010; 28(43):7030-7034. doi: 10.1016/j.vaccine.2010.08.021
Dini G, Toletone A, Sticchi L, Orsi A, Bragazzi N L, Durando P. Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Human Vaccines & Immunotherapeutics 2018; 14(3):772-789. doi: 10.1080/21645515.2017.1348442
Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, Raude J, Pulcini C, Peretti-Watel P. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. eBioMedicine 2015; 2(8):891-897. doi: 10.1016/j.ebiom.2015.06.018
McCready JL, Nichol B, Steen M, Unsworth J, Comparcini D, Tomietto M. Understanding the barriers and facilitators of vaccine hesitancy towards the COVID-19 vaccine in healthcare workers and healthcare students worldwide: An Umbrella Review. PLOS ONE 2023; 18(4):e0280439. doi: 10.1371/journal.pone.0280439
Asad H, Johnston C, Blyth I, Holborow A, Bone A, Porter L, Tidswell P, Healy B. Health Care Workers and Patients as Trojan Horses: a COVID19 ward outbreak. Infection Prevention in Practice 2020; 2(3):100073. doi: 10.1016/j.infpip.2020.100073
Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Annals of Internal Medicine 2020; 173(2):120-136. doi: 10.7326/m20-1632 %m 32369541
Grochowska M, Ratajczak A, Zdunek G, Adamiec A, Waszkiewicz P, Feleszko W. A Comparison of the Level of Acceptance and Hesitancy towards the Influenza Vaccine and the Forthcoming COVID-19 Vaccine in the Medical Community. Vaccines 2021; 9(5):475.
Papini F, Mazzilli S, Paganini D, Rago L, Arzilli G, Pan A, Goglio A, Tuvo B, Privitera G, Casini B. Healthcare Workers Attitudes, Practices and Sources of Information for COVID-19 Vaccination: An Italian National Survey. International Journal of Environmental Research and Public Health 2022; 19(2):733.
Reiter PL, Pennell ML, Katz ML, Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine 2020; 38(42):6500-6507. doi: 10.1016/j.vaccine.2020.08.043
Tomietto M, Simonetti V, Comparcini D, Stefanizzi P, Cicolini G. A large cross-sectional survey of COVID-19 vaccination willingness amongst healthcare students and professionals: Reveals generational patterns. Journal of Advanced Nursing 2022; 78(9):2894-2903. doi: 10.1111/jan.15222
Bertoncello C, Ferro A, Fonzo M, Zanovello S, Napoletano G, Russo F, Baldo V, Cocchio S. Socioeconomic Determinants in Vaccine Hesitancy and Vaccine Refusal in Italy. Vaccines 2020; 8(2):276.
Giuliani M, Ichino A, Bonomi A, Martoni R, Cammino S, Gorini A. Who Is Willing to Get Vaccinated? A Study into the Psychological, Socio-Demographic, and Cultural Determinants of COVID-19 Vaccination Intentions. Vaccines 2021; 9(8):810.
Perrone C, Fiabane E, Maffoni M, Pierobon A, Setti I, Sommovigo V, Gabanelli P. Vaccination hesitancy: To be vaccinated, or not to be vaccinated, that is the question in the era of COVID-19. Public Health Nursing 2023; 40(1):90-96. doi: 10.1111/phn.13134
Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health 2021; 194:245-251. doi: 10.1016/j.puhe.2021.02.025
Ann S, Baumann O. Psychological mechanisms and interventions directed at vaccination attitudes. Front Sociol 2023; 8:1076015. doi:10.3389/fsoc.2023.1076015
Belingheri M, Roncalli M, Riva MA, Paladino ME, Teruzzi CM. COVID-19 vaccine hesitancy and reasons for or against adherence among dentists. The Journal of the American Dental Association 2021; 152(9):740-746. doi: 10.1016/j.adaj.2021.04.020
Di Gennaro F, Murri R, Segala FV, Cerruti L, Abdulle A, Saracino A, Bavaro DF, Fantoni M. Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy. Viruses 2021; 13(3):371.
Ledda C, Costantino C, Cuccia M, Maltezou HC, Rapisarda V. Attitudes of Healthcare Personnel towards Vaccinations before and during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health 2021; 18(5):2703.
Regazzi L, Marziali E, Lontano A, Villani L, Paladini A, Calabrò GE, Laurenti P, Ricciardi W, Cadeddu C. Knowledge, attitudes, and behaviors toward COVID-19 vaccination in a sample of Italian healthcare workers. Human Vaccines & Immunotherapeutics 2022; 18(6):2116206. doi: 10.1080/21645515.2022.2116206
Chaudhuri K, Howley P. The impact of COVID-19 vaccination for mental well-being. European Economic Review 2022; 150:104293. doi: 10.1016/j.euroecorev.2022.104293
Koltai J, Raifman J, Bor J, McKee M, Stuckler D. COVID-19 Vaccination and Mental Health: A Difference-In-Difference Analysis of the Understanding America Study. American Journal of Preventive Medicine 2022; 62(5):679-687. doi: 10.1016/j.amepre.2021.11.006
Zhou Y, Li R, Shen L. Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies. Vaccine X 2023; 13:100279. doi:10.1016/j.jvacx.2023.100279
Brown TA. Confirmatory factor analysis for applied research. Guilford publications, 2015.
Frati P, La Russa R, Di Fazio N, Del Fante Z, Delogu G, Fineschi V. Compulsory Vaccination for Healthcare Workers in Italy for the Prevention of SARS-CoV-2 Infection. Vaccines 2021; 9(9):966.
Di Pumpo M, Vetrugno G, Pascucci D, Carini E, Beccia V, Sguera A, Zega M, Pani M, Cambieri A, Nurchis MC, D’Ambrosio F, Damiani G, Laurenti P. Is COVID-19 a Real Incentive for Flu Vaccination? Let the Numbers Speak for Themselves. Vaccines 2021; 9(3):276.
Ogliastro M, Borghesi R, Costa E, Fiorano A, Massaro E, Sticchi L, Tisa V, Durando P, Icardi G, Orsi A. Monitoring influenza vaccination coverage among healthcare workers during the COVID-19 pandemic: a three-year survey in a large university hospital in North-Western Italy. J Prev Med Hyg 2022; 63(3):E405-e414. doi: 10.15167/2421-4248/jpmh2022.63.3.2700
Kahneman D. Thinking, fast and slow. New York, NY, US: Farrar, Straus and Giroux; 2011
Berthet V. The Impact of Cognitive Biases on Professionals' Decision-Making: A Review of Four Occupational Areas. Front Psychol 2021; 12:802439. doi: 10.3389/fpsyg.2021.802439
Park T, Ju I, Ohs JE, Hinsley A. Optimistic bias and preventive behavioral engagement in the context of COVID-19. Research in Social and Administrative Pharmacy 2021; 17(1):1859-1866. doi: 10.1016/j.sapharm.2020.06.004
Gambetta D, Morisi D. COVID-19 infection induces higher trust in strangers. Proceedings of the National Academy of Sciences 2022; 119(32):e2116818119. doi:10.1073/pnas.2116818119
Sapienza A, Falcone R. The Role of Trust in COVID-19 Vaccine Acceptance: Considerations from a Systematic Review. International Journal of Environmental Research and Public Health 2023; 20(1):665.
Fiske A, Schönweitz F, Eichinger J, Zimmermann B, Hangel N, Sierawska A, McLennan S, Buyx A. The COVID-19 Vaccine: Trust, doubt, and hope for a future beyond the pandemic in Germany. PLOS ONE 2022; 17(4):e0266659. doi: 10.1371/journal.pone.0266659
Rahmani A, Dini G, Orsi A, Sticchi L, Bruzzone B, Montecucco A, Pellegrini L, Manca A, Domnich A, Battistini A, Kusznir Vitturi B, Zacconi S, Debarbieri N, Icardi G, Durando P. Reactogenicity of BNT162b2 mRNA COVID-19 Vaccine in a Young Working Age Population: A Survey among Medical School Residents, within a Mass Vaccination Campaign, in a Regional Reference Teaching Hospital in Italy. Vaccines (Basel) 2021; 9(11):1269. doi: 10.3390/vaccines9111269.
Rahmani A, Dini G, Montecucco A, Orsi A, Sticchi L, Domnich A, Bruzzone B, Pellegrini L, Manca A, Ogliastro M, Kusznir Vitturi B, Zacconi S, Debarbieri N, Icardi G, Durando P. Adverse Reactions after the Third Dose of the BNT162b2 mRNA COVID-19 Vaccine among Medical School Residents in a Regional Reference University Hospital in Italy. Vaccines (Basel); 2022. 10(11):1779. doi: 10.3390/vaccines10111779.
Voglino G, Barbara A, Dallagiacoma G, Santangelo OE, Provenzano S, Gianfredi V. Do Degree Programs Affect Health Profession Students' Attitudes and Opinions Toward Vaccinations? An Italian Multicenter Study. Safety and Health at Work 2022; 13(1):59-65. doi: 10.1016/j.shaw.2021.10.005
Scardina G, Ceccarelli L, Casigliani V, Mazzilli S, Napoletano M, Padovan M, Petillo A, Sironi D, Brilli C, Gattini V, Tavoschi L, Foddis R, Guglielmi G, Privitera GP, Baggiani A. Evaluation of Flu Vaccination Coverage among Healthcare Workers during a 3 Years’ Study Period and Attitude towards Influenza and Potential COVID-19 Vaccination in the Context of the Pandemic. Vaccines 2021; 9(7):769.
Cadeddu C, Sapienza M, Castagna C, Regazzi L, Paladini A, Ricciardi W, Rosano A. Vaccine Hesitancy and Trust in the Scientific Community in Italy: Comparative Analysis from Two Recent Surveys. Vaccines 2021; 9(10):1206.
Fell L. Trust and COVID-19: Implications for Interpersonal, Workplace, Institutional, and Information-Based Trust. Digit Gov: Res Pract 2020; 2(1): 1-5. doi: 10.1145/3428472
Korn L, Böhm R, Meier NW, Betsch C. Vaccination as a social contract. Proceedings of the National Academy of Sciences 2020; 117(26):14890-14899. doi:10.1073/pnas.1919666117
Ellena AM, Aresi G, Marta E, Pozzi M. Post-traumatic Growth Dimensions Differently Mediate the Relationship Between National Identity and Interpersonal Trust Among Young Adults: A Study on COVID-19 Crisis in Italy. Frontiers in Psychology 2021; 11. doi: 10.3389/fpsyg.2020.576610
Hong S-A. COVID-19 vaccine communication and advocacy strategy: a social marketing campaign for increasing COVID-19 vaccine uptake in South Korea. Humanities and Social Sciences Communications 2023; 10(1):109. doi: 10.1057/s41599-023-01593-2
Ceccarini F, Capuozzo P, Colpizzi I, Caudek C. Breaking (Fake) News: No Personal Relevance Effect on Misinformation Vulnerability. Behavioral Sciences 2023; 13(11):896. doi:10.3390/bs13110896
Cannito L, Ceccato I, Bortolotti A, Di Crosta A, La Malva P, Palumbo R, Di Domenico A, Palumbo R. Exploring vaccine hesitancy: the twofold role of critical thinking. Current Psychology 2022; doi: 10.1007/s12144-022-04165-w
Ali K, Li C, Zain-ul-abdin K, Muqtadir SA. The effects of emotions, individual attitudes towards vaccination, and social endorsements on perceived fake news credibility and sharing motivations. Computers in Human Behavior 2022; 134:107307. doi: 10.1016/j.chb.2022.107307
Hoffman BL, Felter EM, Chu KH, Shensa A, Hermann C, Wolynn T, Williams D, Primack BA. It’s not all about autism: The emerging landscape of anti-vaccination sentiment on Facebook. Vaccine 2019; 37(16):2216-2223. doi: 10.1016/j.vaccine.2019.03.003
Bago B, Rand DG, Pennycook G. Fake news, fast and slow: Deliberation reduces belief in false (but not true) news headlines. Journal of Experimental Psychology: General 2020; 149(8):1608-1613. doi: 10.1037/xge0000729