Highlights
- •Approximately 3 out of every 20 HCWs surveyed reported being vaccine hesitant.
- •Black and Republican HCWs had lower rates of COVID-19 vaccination.
- •COVID-19 vaccine uptake is influenced by colleagues who believe in vaccination.
Abstract
Background
Methods
Results
Conclusions
Key Words
BACKGROUND
Doctors and nurses want more data before championing vaccines to end the pandemic. Washington Post. Accessed September 2, 2021. https://www.washingtonpost.com/business/2020/11/21/vaccines-advocates-nurses-doctors-coronavirus/
Mar 19 P, 2021. KFF/Post survey of frontline health care workers finds nearly half remain unvaccinated. KFF. Published March 19, 2021. Accessed August 26, 2021. https://www.kff.org/coronavirus-covid-19/press-release/kff-post-survey-of-frontline-health-care-workers-finds-nearly-half-remain-unvaccinated/
Commissioner O of the. FDA approves first COVID-19 vaccine. FDA. Published August 23, 2021. Accessed September 2, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine
30% of US hospitals mandate vaccination for employment. Accessed September 2, 2021. https://www.beckershospitalreview.com/workforce/covid-19-vaccination-needed-to-work-at-30-of-us-hospitals.html
MATERIAL AND METHODS
Study participants and design
Measures
Statistical analysis
RESULTS
Participant characteristics
Characteristics | Not vaccinated / does not intend to be vaccinated (n = 289), % | Vaccinated / intends to be vaccinated (n = 1685), % |
---|---|---|
Sociodemographics | ||
Age, y | ||
18-44 | 61.2 | 54.5 |
45-64 | 37.7 | 39.2 |
≥65 | 1.0 | 6.3 |
Female sex | 90.3 | 83.3 |
Race | ||
White | 88.2 | 84.2 |
Black | 5.2 | 3.7 |
Asian | 2.4 | 9.4 |
American Indian or Alaska Native | 1.7 | 0.7 |
Native Hawaiian or other Pacific Islander | 0.3 | 0.1 |
Hispanic or Latino | 5.5 | 7.5 |
In a relationship | 86.5 | 78.2 |
Dependent children <21 y old | 51.6 | 35.3 |
Home neighborhood | ||
Urban | 17.6 | 35.7 |
Suburban | 59.2 | 56.0 |
Rural | 23.2 | 8.2 |
Formal religious belief or affiliation | 72.3 | 64.8 |
Work full- or part-time | 78.5 | 83.3 |
Work remotely | 30.0 | 31.2 |
Time spent working remotely | ||
0%-24% | 1.7 | 1.4 |
25%-49% | 1.0 | 2.6 |
50%-74% | 2.4 | 5.2 |
75%-100% | 20.8 | 22.0 |
Political partisanship | ||
Democrat (including those who leaned toward the party) | 18.7 | 63.2 |
Republican (including those who leaned toward the party) | 48.4 | 18.8 |
Other | 32.9 | 18.0 |
Institution | ||
Advocate Health Care | 78.9 | 61.8 |
Rush | 2.8 | 4.8 |
University of Illinois at Chicago | 9.3 | 29.7 |
Occupational Classification | ||
Physician or Advanced Practice Provider | 1.7 | 14.7 |
Nurse | 27.0 | 18.0 |
Allied Health Care Worker | 11.4 | 14.7 |
Administrative/Clerical | 28.0 | 23.1 |
Health Care Technicians | 16.9 | 6.1 |
Research | 2.4 | 10.9 |
Facilities and Logistics | 2.1 | 1.2 |
Student | 3.8 | 6.3 |
Other | 7.6 | 4.9 |
COVID-19 Vaccine Consideration Factors | ||
Regular contact with children | 62.3 | 51.9 |
Regular contact with elderly | 67.5 | 66.6 |
Family member with chronic illness | 40.1 | 47.3 |
Adverse events to prior vaccinations | 32.2 | 21.3 |
Seasonal influenza vaccination | 91.0 | 95.8 |
Health care worker COVID-19 vaccine attitudes scale predictors: Health belief model constructs
Perceived benefits and barriers of COVID-19 vaccination
Questionnaire items | Not vaccinated / does not intend to be vaccinated (n = 1685), % | Vaccinated / intends to be vaccinated (n = 289), % | Odds ratio (95% CI) |
---|---|---|---|
Perceived susceptibility to COVID-19 infection | |||
I am at high personal risk for getting COVID-19 | 16.6 | 44.5 | 4.00 (2.89-5.52) |
It is likely that I can infect patients with COVID-19 if I don't get vaccinated | 15.2 | 68.2 | 11.85 (8.48-16.58) |
I am likely to get COVID-19 if I do not get vaccinated | 12.8 | 62.2 | 11.13 (7.79-15.90) |
Health care workers are at greater risk than the general public of catching COVID-19 | 44.6 | 83.1 | 6.13 (4.71-7.99) |
I am at risk of catching COVID-19 from hospital patients | 24.2 | 46.4 | 2.71 (2.05-3.60) |
Perceived severity of COVID-19 infection | |||
COVID-19 infection may cause serious health problems | 77.2 | 97.7 | 13.45 (8.77-20.61) |
COVID-19 infection is dangerous for me | 28.7 | 78.4 | 9.07 (6.87-11.97) |
COVID-19 infection is dangerous for the patients in the hospital at which I work | 56.4 | 89.0 | 6.34 (4.80-8.37) |
If I were to get COVID-19, it may significantly interfere with my regular daily activities | 45.7 | 91.0 | 12.22 (9.18-16.26) |
Other health conditions that I have may become worse if I get COVID-19 | 29.1 | 60.2 | 3.68 (2.81-4.83) |
The thought of getting COVID-19 scares me | 24.6 | 74.0 | 8.75 (6.56-11.67) |
Perceived benefits of COVID-19 vaccination in preventing COVID-19 infection | |||
If I get vaccinated against COVID-19, then I will be less likely to infect patients | 22.8 | 86.9 | 22.45 (16.50-30.56) |
If I get vaccinated against COVID-19, then I will be less likely to infect family members | 26.0 | 90.5 | 27.19 (19.97-37.03) |
Getting the COVID-19 vaccine will decrease the likelihood of me getting COVID-19 | 32.9 | 93.2 | 28.22 (20.69-38.48) |
Getting the COVID-19 vaccine will decrease the spread of COVID-19 | 30.4 | 94.7 | 41.59 (29.91-57.85) |
The COVID-19 vaccine cannot cause COVID-19 | 65.1 | 95.8 | 12.52 (8.91-17.60) |
Other health care workers should be prioritized for vaccination against COVID-19, because they have a higher risk | 49.5 | 66.8 | 2.06 (1.61-2.64) |
Perceived barriers to accepting COVID-19 vaccination | |||
I am generally opposed to vaccinations | 17.0 | 1.1 | 0.06 (0.03-0.10) |
I do not have time to get the COVID-19 vaccine | 3.1 | 1.0 | 0.32 (0.14-0.74) |
I am concerned about side effects (eg, fatigue, muscle aches, mild fever) from the COVID-19 vaccine | 59.2 | 24.4 | 0.22 (0.17-0.29) |
I am concerned about severe allergic reactions after getting the COVID-19 vaccine | 54.7 | 13.5 | 0.13 (0.10-0.17) |
There is insufficient evidence for the efficacy of COVID-19 vaccination | 73.7 | 15.9 | 0.07 (0.05-0.09) |
I am currently providing breastmilk for a child and have concerns about how a vaccine against COVID-19 might negatively impact this child. | 4.2 | 0.9 | 0.21 (0.10-0.45) |
I am currently pregnant or planning to become pregnant and have concerns about how a vaccine against COVID-19 | 25.6 | 2.7 | 0.08 (0.05-0.12) |
Cues to action | |||
The recommendations in the mass media affect my decision whether to receive vaccination for COVID-19 | 11.1 | 18.5 | 1.83 (1.25-2.66) |
My personal provider's recommendations affect my decision whether to receive vaccination against COVID-19 | 18.0 | 51.1 | 4.77 (3.50-6.51) |
People close to me think it is important for me to get vaccinated against COVID-19 | 23.2 | 85.1 | 18.89 (13.94-25.59) |
My colleagues think it is important for me to get the COVID-19 vaccine | 37.4 | 83.0 | 8.24 (6.29-10.79) |
My supervisors think it is important for me to get the COVID-19 vaccine | 45.0 | 81.8 | 5.52 (4.25-7.18) |
General attitudes | |||
All health care workers should be vaccinated against COVID-19 | 12.5 | 87.4 | 48.68 (33.43-70.89) |
It is important that health care workers have freedom of choice in vaccination | 94.5 | 50.2 | 0.06 (0.04-0.10) |
I believe in immunizations | 73.4 | 98.6 | 28.24 (17.15-46.49) |
The COVID-19 vaccine is more important than other vaccines | 7.6 | 45.9 | 10.34 (6.70-15.90) |
Cues to action
Modeling factors predictive of COVID-19 vaccine uptake
Predictor variables | Base model | Base model + attitudes scale items |
---|---|---|
Odds ratio (95% CI) | Odds ratio (95% CI) | |
Demographics | ||
Age | ||
18-44 | 1 (Reference) | 1 (Reference) |
45-64 | 2.25 (1.65-3.09) | 1.11 (0.72-1.72) |
≥65 | 7.62 (2.63-32.6) | 2.62 (0.71-13.12) |
Race | ||
White | 1 (Reference) | 1 (Reference) |
Black | 0.23 (0.12-0.47) | 0.34 (0.15-0.80) |
Asian | 2.06 (0.94-5.27) | 1.40 (0.53-4.17) |
American Indian or Alaska Native | 0.45 (0.13-1.87) | 0.82 (0.14-4.16) |
Native Hawaiian or other Pacific Islander | 0.74 (0.07-16.74) | 0.14 (0.00-7.10) |
Neighborhood location | ||
Urban | 1 (Reference) | 1 (Reference) |
Suburban | 0.59 (0.39-0.87) | 0.81 (0.47-1.40) |
Rural | 0.32 (0.19-0.53) | 0.55 (0.28-1.09) |
Political Partisanship | ||
Democrat | 1 (Reference) | 1 (Reference) |
Republican | 0.13 (0.09-0.19) | 0.54 (0.31-0.91) |
Other | 0.19 (0.13-0.28) | 0.59 (0.35-1.01) |
Occupational Classification | ||
Physician or Advanced Practice Provider | 1 (Reference) | 1 (Reference) |
Nurse | 0.15 (0.04-0.38) | 0.14 (0.13-0.64) |
Allied Health Care Worker | 0.22 (0.06-0.61) | 0.12 (0.02-0.54) |
Administrative/Clerical | 0.14 (0.04-0.37) | 0.12 (0.02-0.52) |
Health Care Technicians | 0.06 (0.02-0.17) | 0.07 (0.01-0.31) |
Research | 0.52 (0.13-1.86) | 0.19 (0.03-1.09) |
Facilities and Logistics | 0.12 (0.03-0.51) | 0.12 (0.01-0.92) |
Student | 0.18 (0.05-0.57) | 0.06 (0.01-0.34) |
Other | 0.08 (0.02-0.23) | 0.05 (0.01-0.29) |
Risk Populations Exposure | ||
Do you have a family member living with chronic illness? | 1.46 (1.09-1.96) | 1.19 (0.80-1.76) |
Vaccine History | ||
Have you ever experienced side effects to the influenza vaccine or any other vaccination? | 0.67 (0.48-0.94) | 0.94 (0.59-1.53) |
Are you allergic to any vaccine components? | 0.31 (0.16-0.60) | 0.27 (0.10-0.70) |
Did you receive a 2020 seasonal influenza vaccination? | 2.56 (1.39-4.62) | 1.56 (0.70-3.41) |
COVID-19 Vaccine Attitude Scale Items | ||
I am concerned about severe allergic reactions after getting the COVID-19 vaccine | - | 0.30 (0.20-0.45) |
I am currently pregnant or planning to become pregnant and have concerns about how a vaccine against COVID-19 might negatively impact the fetus | - | 0.09 (0.04-0.16) |
People close to me think it is important for me to get vaccinated against COVID-19 | - | 5.23 (3.46-7.98) |
All health care workers should be vaccinated against COVID-19 | - | 13.94 (8.78-22.71) |
Area Under Receiver Operating Curve | 0.84 (0.82-0.86) | 0.95 (0.94-0.97) |
Discussion
Hospital survey on patient safety culture: 2016 User Comparative Database Report. Accessed August 26, 2021. https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2016-user-comparative-database-report
State efforts to ban or enforce COVID-19 vaccine mandates and passports – the National Academy for State Health Policy. Accessed September 13, 2021. https://www.nashp.org/state-lawmakers-submit-bills-to-ban-employer-vaccine-mandates/
Hospital survey on patient safety culture: 2016 User Comparative Database Report. Accessed August 26, 2021. https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2016-user-comparative-database-report
CONCLUSIONS
References
Doctors and nurses want more data before championing vaccines to end the pandemic. Washington Post. Accessed September 2, 2021. https://www.washingtonpost.com/business/2020/11/21/vaccines-advocates-nurses-doctors-coronavirus/
Mar 19 P, 2021. KFF/Post survey of frontline health care workers finds nearly half remain unvaccinated. KFF. Published March 19, 2021. Accessed August 26, 2021. https://www.kff.org/coronavirus-covid-19/press-release/kff-post-survey-of-frontline-health-care-workers-finds-nearly-half-remain-unvaccinated/
Commissioner O of the. FDA approves first COVID-19 vaccine. FDA. Published August 23, 2021. Accessed September 2, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine
30% of US hospitals mandate vaccination for employment. Accessed September 2, 2021. https://www.beckershospitalreview.com/workforce/covid-19-vaccination-needed-to-work-at-30-of-us-hospitals.html
Read “Strategies for Building Confidence in the COVID-19 Vaccines” at NAP.Edu.
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Hospital survey on patient safety culture: 2016 User Comparative Database Report. Accessed August 26, 2021. https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2016-user-comparative-database-report
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State efforts to ban or enforce COVID-19 vaccine mandates and passports – the National Academy for State Health Policy. Accessed September 13, 2021. https://www.nashp.org/state-lawmakers-submit-bills-to-ban-employer-vaccine-mandates/
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Article Info
Publication History
Footnotes
Conflicts of interest: None to report.