|Year : 2022 | Volume
| Issue : 1 | Page : 37-45
A study on acceptance of COVID-19 vaccination among health-care workers in a tertiary care hospital in Eastern India
Mausumi Basu, Vineeta Shukla, Vanlaldiki Chhakchhuak, Prince Kerketta, Ratul Kumar Bysack, Anamitra Chakraborty
Department of Community Medicine, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
|Date of Submission||10-Jul-2021|
|Date of Decision||06-Oct-2021|
|Date of Acceptance||01-Jan-2022|
|Date of Web Publication||23-May-2022|
Dr. Vineeta Shukla
Department of Community Medicine, IPGME&R, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background and Objectives: Vaccination is perhaps the only modality for providing specific protection to the general population against the ongoing coronavirus disease-19 (COVID-19) pandemic. This study was conducted among the health-care workers of a tertiary care hospital in Kolkata with objectives to estimate the proportion of the acceptance of vaccination against COVID-19 as well as to find the factors associated with vaccine acceptance.
Methodology: A cross-sectional observational study was conducted among 350 health-care workers of a tertiary care hospital in Kolkata using a predesigned, pretested, structured schedule by face-to-face interview method. Data were analyzed using SPSS 25.0. Pearson's Chi-square test and multivariable binary logistic regression were performed to find the factors associated with vaccine acceptance.
Results: The proportion of vaccine acceptance was 88.7%. Education above secondary level, occupation—doctor, and living with family and friends had higher odds of vaccine acceptance. Age above 55 years and residing in rented house/flat were significantly associated with vaccine denial.
Conclusion: There was a high proportion of vaccine acceptance in our study. However, concerns about vaccine safety are prevalent and this may affect vaccine uptake in the future.
Keywords: COVID-19 pandemic, health-care workers, vaccination, vaccine
|How to cite this article:|
Basu M, Shukla V, Chhakchhuak V, Kerketta P, Bysack RK, Chakraborty A. A study on acceptance of COVID-19 vaccination among health-care workers in a tertiary care hospital in Eastern India. J NTR Univ Health Sci 2022;11:37-45
|How to cite this URL:|
Basu M, Shukla V, Chhakchhuak V, Kerketta P, Bysack RK, Chakraborty A. A study on acceptance of COVID-19 vaccination among health-care workers in a tertiary care hospital in Eastern India. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Dec 10];11:37-45. Available from: https://www.jdrntruhs.org/text.asp?2022/11/1/37/345813
| Introduction|| |
The coronavirus disease-19 (COVID-19) pandemic, which started last year, is still expected to continue its course and impose vast burden of morbidity and mortality including disturbing economies globally. Also, there is no specific antiviral treatment for the disease at present. A vaccine is perhaps the only modality for providing specific protection to the general population including first-line warriors such as health-care personnel, policemen, and so on. Ever since the pandemic was announced, several countries in collaboration with various pharmaceutical companies had started the mammoth task of preparing an appropriate and highly effective vaccine for the same.
India, too, entered the global quest for a safe and effective vaccine and has approved two vaccines so far, ChAdOx1 nCoV-19/AZD1222 (by University of Oxford, AstraZeneca, and the Serum Institute of India) marketed by the name “Covishield” and “Covaxin,” which is India's indigenous vaccine prepared by Bharat Biotech International Limited developed in collaboration with the Indian Council of Medical Research and National Institute of Virology, India. Indian started the vaccination drive from January 16 which is still ongoing.
Vaccine acceptance represents a spectrum of behaviors from rejection to active support of immunization recommendations. Vaccine hesitancy lies within this spectrum. Vaccine hesitancy is defined as a “delay in acceptance or refusal of vaccination despite availability of vaccination services,” which can vary in form and intensity based on when and where it occurs and what vaccine is involved. The World Health Organization identified vaccine hesitancy as one of the top 10 global health threats in 2019.
Despite great progress, one of the challenges we have to face is the uncertainty about the acceptance of vaccine against COVID-19. Vaccine acceptance reflects the overall perception of disease risk, vaccine attitudes, and demand within the general population, which is critical for high vaccination coverage, especially for newly emerging diseases like the COVID-19.
Existing studies regarding COVID-19 vaccine uptake suggest that a considerable proportion of people are reluctant to get vaccinated. A global survey of COVID-19 vaccine acceptance in 19 countries by Lazarus et al. reported that 71.5% of the participants would be very or somewhat likely to take a COVID-19 vaccine. A systematic review on acceptance of a COVID-19 vaccine based on surveys in 20 nations suggests that the vaccine acceptance rate in most of the nations would not reach the 67% necessary for achieving population immunity.
Knowledge and understanding of the factors of vaccine acceptance and identifying common barriers are important as these help in designing of effective strategies. This will subsequently help to improve the vaccine coverage rate among the general population. A recent study published in January 2021 reported that vaccine acceptance is low among health-care workers in the USA. This is a matter of serious concern as this segment of society is especially entrusted with the responsibility of communicating reliable information about such preventive measures to the general population. Moreover, their participation in such programs motivates the community at large. With this background and rationale, this study was conducted among the health-care workers of a tertiary care teaching hospital in Kolkata with the objectives to estimate the proportion of acceptance of vaccination against COVID-19 as well as to find the factors associated with vaccine acceptance.
| Materials and Methods|| |
An observational study, cross-sectional in design, was conducted at a tertiary care teaching hospital in Kolkata, for a period of 12 weeks (December 2020 to February 2021).
The study population were the health-care workers registered to be vaccinated at that hospital. Inclusion criteria were all health-care workers who gave informed written consent to participate in the study. Health-care workers who were ill and could not be contacted after three consecutive attempts were excluded.
Taking proportion (p) of vaccine acceptance from a global survey as 0.715, q = 1 − P = 0.285, type I error α = 0.05, confidence interval 95% with Z1−α = Z0.95 = 1.96 and absolute precision L = 5%, sample size was calculated using Cochran's formula:
N = Zα2pq/(L)2
= [(1.96)2 × 0.715 × 0.285]/[(0.05)2]
After multiplying by 1.5 for design effect due to stratified random sampling and adding 10% nonresponse, final sample size was calculated to be 519. Thus, rounding off, a total of 520 health-care workers were included for the study.
The sampling technique was stratified random sampling [Figure 1].
The study tool was a predesigned, pretested, structured schedule which was designed by a team of three experts including one professor of community medicine, one public health expert, and one epidemiologist. It was prepared in English and later translated into Bengali and Hindi. The schedule was then pretested among 20 randomly selected health-care workers of the same institution for its validity and reliability. Those selected for pretesting were not included in the final study population.
- Dependent variable: Vaccine acceptance
- Independent variables: Sociodemographic characteristics, history of COVID-19 infection, history of COVID-19 infection among family members, and so on
Study technique and data collection
For data collection, the selected health-care workers were approached either by phone call or by visiting them at their respective departments. A brief outline of the study was narrated to them including nature and purpose of the study. Then, data were collected by face-to-face interview method after taking informed written consent and ensuring them about their anonymity and confidentiality. All the responses were recorded in the schedule.
All of the 520 responses were included in the analysis. Data were tabulated in Microsoft Excel 2019 (Microsoft Corp, Redmond, WA, USA) and then imported to Statistical Package for the Social Sciences (SPSS for Windows, version 25.0, SPSS Inc., Chicago, IL, USA) for interpretation and analysis. Descriptive statistics were used to summarize the data. Pearson's Chi-square test was performed to find association between vaccine acceptance and sociodemographic profile. We also performed univariate binary logistic regression to ascertain relationship between dependent and independent variables. All independent variables having P value < 0.20 were considered biologically plausible to be included in the multivariable binary logistic regression model. Data were checked for multicollinearity (Variance inflation factor (VIF) <10) and variables with P value < 0.05 were considered statistically significant.
All people engaged in actions whose primary intent is to enhance health such as doctors, nurses, medical technologist, medical, paramedical and nursing students, housekeeping staff, security personnel, kitchen staff, and administrative staff.
Institutional Ethics Committee permission was obtained prior to start of the study (IPGME&R/IEC/2021/129 dated 06.02.2021). Informed written consent was obtained before each interview and all ethical principles were strictly adhered throughout the course of the study.
| Results|| |
About 36.5% were nurses and 25.8% were doctors. About 51% of the study population belonged to age group of 26–55 years and about 54% were females. Concerning education, about 57.5% had completed their graduation and higher degrees. Nearly 80% of them were residing outside institution premises. About 56.2% of the study population were married, 87.5% were staying with their family, and 61.7% belonged to nuclear families. About 81% of the study population belonged to Class I (upper class) as per Modified BG Prasad Scale 2020 [Table 1].
The proportion of vaccine acceptance was 88.7% [Figure 2]. About 98.3% of the study population were aware of the new vaccine. Most common sources of knowledge were news and updates on social media (90.3%) followed by other health-care workers (88%).
|Figure 2: Pie chart showing distribution of study population according to vaccine acceptance (n = 520)|
Click here to view
Most common reason was fear of getting infected (76.3%) followed by fear of family members getting infected (49.2%). Most common reason for not willing to take the vaccine was lack of proven efficacy (86.4%) followed by fear of side effects (52.5%) and lack of proven safety (44.1%) [Figure 3] and [Figure 4].
|Figure 3: Reasons reported by study population for willing to take vaccine (n = 461)*. #Others include prevention better than cure, I want to play my part in stopping the pandemic, vaccine will help me fight if I get infected by any means.|
Click here to view
|Figure 4: Reasons reported by the study population for not willing to take vaccine (n = 59)*. *Multiple response; #Others include: not interested and scared of injection|
Click here to view
Pearson's chi square was performed to obtain factors associated with acceptance of vaccination against COVID-19 [Table 2]. Age group, gender, level of education, occupation, current residence, residence type, marital status, residing with family/friends, type of family, socio-economic status and previous history of COVID-19 infection were categories that were significantly associated with vaccine acceptance.
|Table 2: Factors Associated With Acceptance of Vaccination Against COVID-19 (N=520)|
Click here to view
On performing multivariable binary logistic regression, we found that education above secondary level, occupation—doctor, and living with family and friends had higher odds of vaccine acceptance. Age above 55 years and residing in rented house/flat were significantly associated with vaccine denial [Table 3].
|Table 3: Multivariable Binary Logistic Regression Showing Predictors of Vaccine Acceptance (N=520)|
Click here to view
| Discussion|| |
Vaccines are one of the most significant public health achievements in history of medical revolution, resulting in remarkable decrease in the prevalence of many preventable diseases. For COVID-19 pandemic also, a vaccine is like a light at the end of a long dark tunnel.
The proportion of vaccine acceptance found in our study was 88.7% which was slightly less than findings by Wang et al. in China (91.3%) and Harapan et al. in Indonesia (93.3), both among adult population. However, it was higher than most other studies. A study on beliefs and practices associated with vaccination among general population in India by Khan et al. reported that 86.3% of the study population were planning to get COVID-19 vaccination, whereas 13.7% admitted hesitancy. Proportion of vaccine acceptance was 80% among adult Australian population in a study by Seale et al., 79% in study by Bhartiya et al. among slum residents in Mumbai India, 71.5% in global survey conducted over 19 countries by Lazarus et al., 71.2% among working-age group population in France by Schwarzinger et al., 67% among adult population of United States in a study by Malik et al., 64.7% in a study by Al-Mohaithef in Saudi Arabia, and 60.6% in a study among college students in South Carolina by Qiao et al.
Some studies reported low proportion of vaccine acceptance. Only 28.7% of the study population said a definite yes to take vaccine in an online study conducted among Chinese population by Lin et al., 37.4% in a study from Jordan by El-Elimat et al., 43% in Egypt in a global study by Abdul et al., 53.1% among general population of Kuwait by Alqudeimat et al., and 53.6% in Uganda study by Echoru et al.
Concerning sources of information on the vaccine, we found that the most common source of knowledge was social media. Other studies that have been conducted over general adult population have reported that they trust their government and don't believe in viral news over social media as they may carry misinformation.,, But in our study, such a finding can be explained by the fact that the study population were health-care workers and they themselves are a potential source of information. So, they receive knowledge from various social media groups of which they are a part of.
Coming to reason for vaccine acceptance, our study found that the most common reason was fear of getting infected amongst the health-care workers. This was in contrast to study by Khan et al. where the respondents said that they would take the vaccine only if its safety and efficacy is confirmed by further studies.
Similar to our finding of association of higher age group with vaccine denial, age more than 35 years was associated with denial of vaccination in Jordan. In contrast, Lazarus et al. in his global survey reported that people aged 55–64 and greater than 63 were more likely to accept the vaccine. Older adults in the United States and Australia also favored vaccination more than younger population.,
Gender was significantly associated with vaccine acceptance in our study. In univariate logistic regression, females had higher odds of vaccine acceptance. Similarly, Australia study and global survey study also reported females having more acceptance of vaccination., In contrast, males were associated with vaccine acceptance in China, the United States, Jordan, Kuwait, and Uganda.,,,,
Our study reported association of vaccine acceptance with higher level of education which was similar to findings by Lazarus et al. globally, Malik et al. in the United States, Alqudeimat et al. in Kuwait, and Echoru et al. in Uganda.,,, We also found that being a doctor was significantly associated with vaccine acceptance which was in line with the study by Alqudeimat et al. from Kuwait. Although this is a predictable finding, it could be attributed to inclusion of a large number of physicians in our study.
Residing outside institution premises was associated with vaccine acceptance. This could be probably because nearly 80% of our study population resided outside institution premises. Similar explanation could be attributed to type of residence as well. Residence in rented house/flat and hostel/quarter were found to be associated with unwillingness to take the vaccine as nearly 70% of the study population resided in their own homes. Also, many students residing in hostels were reluctant to take the vaccine as they had university examinations coming up. Housekeeping staff residing in quarters were hesitant to take vaccine because they were scared of side effects such as fever and flu which could result in them being absent from duty.
We found that being married was significantly associated with vaccine acceptance. This was also reported from China study and Saudi Arabia study., Residing with family and friends and no previous history of COVID-19 infection were associated with vaccine acceptance. This could be justified with the reasons reported for willingness to take the vaccine such as fear of getting infected and fear of infecting family members.
Strengths of the study
Strengths of our study include large sample size and stratified random sampling technique. Our study population was diverse with representation from different gender, age groups, other sociodemographic characteristics, and roles in health care.
Limitations of the study
Unfortunately, we encountered some limitations during the course of the study. First, this study was conducted in only one tertiary health-care institution in Eastern India, so results cannot be generalized to other institutes or all health-care workers as a whole. Second, due to reporting and social desirability bias, some of study population may have given socially favorable responses.
| Conclusion and Recommendations|| |
There was a high level of acceptance of COVID-19 vaccination among the health-care workers. However, concerns about vaccine safety are prevalent and this may affect vaccine uptake in the future. Factors relating to low vaccine acceptance need to be urgently addressed by public health strategies. Strategies need to be made to address the widespread misinformation and fake news surrounding COVID-19 vaccines. Also, Information, education and communication (IEC) about vaccine effectiveness and safety should be continued to be provided as it will contribute to increasing public trust in COVID-19 vaccination program.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al
. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 2021;27:225-8.
Thiagarajan K. Covid-19: India is at centre of global vaccine manufacturing, but opacity threatens public trust. BMJ 2021;372:n196.
Feemster KA. Overview: Special focus vaccine acceptance. Hum Vaccin Immunother 2013;9:1752-4.
Sallam M. COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines (Basel) 2021;9:160.
Ozawa S, Stack ML. Public trust and vaccine acceptance-international perspectives. Hum Vaccin Immunother 2013;9:1774-8.
Feleszko W, Lewulis P, Czarnecki A, Waszkiewicz P. Flattening the curve of COVID-19 vaccine rejection—An international overview. Vaccines (Basel) 2021;9:44.
Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al
. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines (Basel) 2021;9:119.
The World Health Report 2006. Health Workers: A Global Profile. World Health Organization. Geneva; 2006. p. 1-17.
Debnath DJ. Kakkar R. Modified BG Prasad socio-economic classification, updated – 2020. Indian J Community Health 2020;32:124-5.
Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al
. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines (Basel) 2020;8:482.
Harapan H, Wagner AL, Yufika A, Winardi W, Anwar S, Gan AK, et al
. Acceptance of a COVID-19 vaccine in Southeast Asia: A cross-sectional study in Indonesia. Front Public Health 2020;8:381.
Khan S, Rahman CKF, Haritha CV, Jose B, Tiwari R, Dhama K. COVID-19 vaccine acceptance: Beliefs and barriers associated with vaccination among the general population in India. J Exp Biol Agric Sci 2020;8:S210-8.
Seale H, Heywood AE, Leask J, Sheel M, Durrheim DN, Bolsewicz K, et al
. Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine. BMC Infect Dis 2021;21:120.
Bhartiya S, Kumar N, Singh T, Murugan S, Rajavel S, Wadhwani M. Knowledge, attitude and practice towards COVID-19 vaccination acceptance in West India. Int J Community Med Public Health 2021;8:1170-6.
Schwarzinger M, Watson V, Arwidson P, Alla F, Luchini S. COVID-19 vaccine hesitancy in a representative working-age population in France: A survey experiment based on vaccine characteristics. Lancet Public Health 2021;6:e210-21.
Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine 2020;26:100495.
Al-Mohaithef M, Padhi BK. Determinants of COVID-19 vaccine acceptance in Saudi Arabia: A web-based national survey. J Multidiscip Healthc 2020;13:1657-63.
Qiao S, Friedman DB, Tam CC, Zeng C, Li X. Vaccine acceptance among college students in South Carolina: Do information sources and trust in information make a difference? medRxiv 2020;2020.12.02.20242982.
Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China. PLoS Negl Trop Dis 2020;14:e0008961.
El-Elimat T, AbuAlSamen MM, Almomani BA, Al-Sawalha NA, Alali FQ. Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan. PLoS One 2021;16:e0250555.
Kazi Abdul M, Khandaker Mursheda F. Knowledge, attitude and acceptance of a COVID-19 vaccine: A global cross-sectional study. Available from: https://mpra.ub.uni-muenchen.de/105236/
. [Last accessed on 2021 Jun 07].
Alqudeimat Y, Alenezi D, AlHajri B, Alfouzan H, Almokhaizeem Z, Altamimi S, et al
. Acceptance of a COVID-19 vaccine and its related determinants among the general adult population in Kuwait. Med Princ Pract 2021;30:262-71.
Acceptance and Risk Perception of COVID-19 Vaccine in Uganda: A Cross Sectional Study in Western Uganda [Internet]. Available from: https://www.researchsquare.com
. [Last accessed on 2021 Jun 07].
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]