Designing and evaluating a technology-based intervention to address deep ambivalence about COVID vaccination among people who inject drugs.

Although COVID-19 vaccines have demonstrated efficacy, there is variability in health professionals’ attitudes towards these agents. Factors associated with mental health professionals’ attitudes towards COVID-19 vaccination are not well understood. We investigated these factors by administering a newly developed measure, the COVID-19 Vaccine Attitudes Questionnaire (C-VAQ), to members of the World Health Organization’s Global Clinical Practice Network (GCPN) of mental health professionals. 1,931 GCPN members representing all world regions participated between July 28 and September 7, 2021. Mental health professionals’ attitudes towards COVID-19 vaccination were assessed in one of five languages (Chinese, English, French, Japanese, Russian, or Spanish) using the C-VAQ. Internal consistency, factor structure, and predictive validity of the C-VAQ were examined, and a multiple-linear regression model was employed to assess C-VAQ score predictors, including sociodemographic variables (age, gender, WHO region, country income level, profession, and years of professional experience) as well as country mortality rate and the stringency of each country’s response to COVID-19. The C-VAQ demonstrated good internal consistency and external validity. Items loaded on to a single factor. Having received a COVID-19 vaccine, higher country mortality rate, and higher stringency index was significantly associated with more positive vaccine attitudes. Lower age, residing in a low-and-middle income country, and living in Asia were all was significantly associated with less positive vaccine attitudes. The C-VAQ scores were negatively correlated with the number of concerns about the COVID-19 vaccination. The C-VAQ was useful in demonstrating the extent to which additional work is needed to improve mental health professionals’ attitudes towards COVID-19 vaccines globally. Relatively poorer attitudes toward vaccination among some mental health clinicians around the world suggests the need for broad, multi-pronged interventions.

Should women undergoing in vitro fertilization treatment or who are in the first trimester of pregnancy be vaccinated immediately against COVID-19

4 COVID-19 Vaccine Messaging Platforms Increase Vaccine Acceptance and Uptake in Unvaccinated Emergency Department Patients: A Cluster Randomized Controlled Trial

BackgroundThe 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. MethodsA 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. ResultsResults 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. DiscussionThe 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.

Background: Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations. Methods: Considering the study objectives, two valid questionnaires including Fear of COVID-19 Scale (FCV-19S) and attitude questionnaires were administered pre and post COVID-19 vaccination among people with MS. Results: The questionnaires were administered among 349 people with MS pre and post vaccination. The mean age of participants was 38.78 ± 8.68 (range: 19 to 64) years. They all received the first dose of COVID-19 vaccine (Sinopharm). Although about 90% of participants felt satisfied after getting vaccinated and respected the preventive actions like social distancing and wearing face mask after vaccination, about 40% of them did not recommend vaccination to other patients. None of the demographic data was predictor of attitude score in COVID-19 vaccine and the only effective factor regarding fear of COVID-19 among people with MS was gender (P = 0.001). It was found that the more a patient's fear score was, the more he/she felt satisfied after vaccination. Those patients who had got the influenza vaccine last year felt more satisfied with the vaccine and accepted the COVID-19 vaccine easier than others. Conclusion: This study revealed that there was an inverse correlation between fear of coronavirus and less trust in the vaccine in patients with MS. However, it should be mentioned that the patients felt more satisfied after COVID-19 vaccination.

BackgroundIn spring 2021, several countries, among which the Netherlands, suspended vaccinations against COVID-19 with the Vaxzevria vaccine from AstraZeneca (AZ) after reports of rare but severe adverse events (SAE). We investigated the impact of this news and the suspension on the Dutch public’s COVID-19 vaccination intentions, COVID-19 vaccination perceptions (attitudes and feelings) and their trust in the government’s COVID-19 vaccination campaign.MethodsWe conducted two surveys (N = 2628), one shortly before the AZ suspension in the Netherlands and one shortly thereafter when all vaccinations were resumed. Chi2 tests were conducted to study changes in COVID-19 vaccination perceptions, intentions and trust before and after the suspension, and differences between perceptions and intentions regarding AZ vaccines compared to COVID-19 vaccines in general. All variables were measured on a 5-point Likert scale.ResultsNo significant changes were observed in COVID-19 vaccination perceptions and intentions, but trust in the campaign declined slightly (mean diff.(ΔM)=-0.2, 95% CI=-0.3/-0.2). In addition, compared to COVID-19 vaccinations in general, respondents were less likely to vaccinate with AZ (ΔM=-0.7, 95% CI=-0.7/-0.7), reported less positive vaccine attitudes (ΔM=-0.7, 95% CI=-0.7/-0.7), and more negative feelings (ΔM=0.5, 95% CI = 0.4/0.5).ConclusionsThe news on SAE and the AZ suspension might have caused a decline in trust in the government’s COVID-19 vaccination campaign, as well as negatively impacted AZ vaccination perceptions and intentions. These results stress the need to adapt vaccination policies to anticipated public perceptions and responses following a vaccine safety scare, as well as the importance of informing citizens about the possibility of very rare SAE prior to the introduction of novel vaccines.Key messages• Trust in the COVID-19 vaccination campaign declined following the news on rare but severe adverse events (SAE) and the suspension of AstraZeneca vaccines.• While the news on SAE and the vaccination suspension did not seem to impact COVID-19 vaccination intentions in general, intentions to vaccinate with AstraZeneca were considerably lower.

BackgroundInfluenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women.MethodsPregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group (n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI.DiscussionBehavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level.Trial registrationClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.

Background & Aim: Hungary started to administer several COVID-19 vaccines; however, attitudes toward COVID-19 and vaccination are still poorly understood. This study aimed to explore how the attitudes toward COVID-19 disease are associated with the attitudes toward COVID-19 vaccination in Hungary and compare the attitudes of health and non-health workers toward COVID-19 disease and vaccination in Hungary. Methods & Materials: Using a descriptive, cross-sectional design, we recruited a sample of 1820 persons through an electronic survey. In addition to the sociodemographic questions, the attitudes towards COVID-19 disease and vaccination were assessed through self-developed, literature-based questionnaires. Principal component analysis, Spearman's correlation, linear regression, and the Mann-Whitney test were used in the data analysis. Results: The mean age for the study participants (n=1735) was 43.8 ± 6.2 years, and females were the majority (84.6%). Overall, participants showed good attitudes toward COVID-19 disease (mean score= 3.48, SD= 0.43) as compared to their attitudes toward COVID-19 vaccination (Mean score= 2.67, SD= 0.44). A positive correlation was found between the attitudes toward COVID-19 disease and attitudes toward vaccination in Hungary (r= 0.247, p< 0.01). Nurses and other health workers showed more positive attitudes toward COVID-19 vaccination than non-health workers. Conclusion: Hungarian decision-makers should intervene to improve the public's willingness to be vaccinated against COVID-19 or future pandemics. Health workers' knowledge and positive attitudes should be utilized in the media to encourage the general population to be vaccinated. The suggested questionnaires need to be validated for future pandemics' use.

PCR158 Hungarians' Attitudes Toward the COVID-19 Disease and Vaccination: An Online Survey

Recently, Altay et al. (Altay et al. 2021. J. Exp.Psychol.: Appl. (doi:10.1037/xap0000400)) showed that 5 min of interaction with a chatbot led to increases in positive COVID-19 vaccination attitudes and intentions in a French population. Here we replicate this effect in a vaccine-hesitant, UK-based population. We attempt to isolate what made the chatbot condition effective by controlling the amount of information provided, the trustworthiness of the information and the level of interactivity. Like Altay et al., our experiment allowed participants to navigate a branching dialogue by choosing questions of interest about COVID-19 vaccines. Our control condition used the same questions and answers but removed participant choice by presenting the dialogues at random. Importantly, we also targeted those who were either against or neutral towards COVID-19 vaccinations to begin with, screening-out those with already positive attitudes. Replicating Altay et al., we found a similar size increase in positive attitudes towards vaccination, and in intention to get vaccinated. Unlike Altay et al., we found no difference between our two conditions: choosing the questions did not increase vaccine attitudes or intentions any more than our control condition. These results suggest that the attitudes of the vaccine hesitant are modifiable with exposure to in-depth, trustworthy and engaging dialogues.

Anxiety before regional anesthesia and surgery is common among women undergoing cesarean section. Although perioperative education has been shown to reduce this level of anxiety, the optimal form and timing of this intervention are not known. The goal of this study was to evaluate the efficacy of an educational anesthetic video on reducing anxiety and improving maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia. Eighty patients scheduled for cesarean sectionat a tertiary-level obstetric centerwere randomized to either an interventional group (viewed an educational video onthe evening before surgery) or the control group (no educational video). Both groups received a standard preoperative assessment on the morning of surgery.Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale for anxiety (VAS-A). Maternal satisfaction was assessed using the Maternal Satisfaction Scale Score for Cesarean Section (MSSSCS). Anxiety was assessed at baseline (the evening before surgery) and immediately before surgery. Maternal satisfaction was assessed on the first postoperative day. Patients in the intervention group also had their state anxiety measured immediately after viewing the educational anesthetic video using the VAS-A. Both groups were equally matched at baseline, and a statistically significant reduction in anxiety measured using VAS-A was seen in the intervention group vs. the control group (6 vs. 4.6, p = 0.018). State-trait anxiety measured using STAI, however, was not significantly lower in the intervention vs. control group (44 vs. 46, p = 0.99). VAS-A immediately after looking at the video was also not significantly different (5 vs. 4, p = 0.323) from the control group. Maternal satisfaction was also higher in the intervention group (113 vs. 104.5, p = 0.015). The use of a simple educational anesthetic video may be associated with reduced anxiety and improved maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia.

Emergency Department Patients' Preferences for Technology-Based Behavioral Interventions

Background:It is recommended that people with immune mediated inflammatory diseases (IMIDs) who take immunosuppressive medication receive at least 3 COVID-19 vaccinations in order to generate anti-SARSCoV2 antibody levels similar to...

The global fight against the COVID-19 pandemic has underscored the critical importance of widespread vaccination to mitigate the impact of the virus on public health. The current study aimed to investigate which social influences might be most important for predicting attitudes towards COVID-19 vaccination and vaccine uptake among young students in the UK. We focused on the cultural evolution and social transmission aspects, i.e., parent-to-child versus peer-to-peer, of attitudes and vaccine uptake during the COVID-19 pandemic. A sample of 192 UK students (aged 18 to 35 years old) filled in an online survey including measures for attitudes towards COVID-19 vaccination and vaccine uptake and/or intention, age, and gender. Participants were also asked about their mother's, father's, and best friend's attitudes towards COVID-19 vaccination and vaccine uptake. Finally, they provided a subjective measure of the quality relationship with their parents. Overall, our results suggest that both parents and very close friends are important agents in understanding the students' attitudes towards COVID-19 vaccination and vaccine uptake. More specifically, our findings suggest the mother's vaccine uptake as the most salient predictor of students' attitudes towards COVID-19 vaccination and vaccine uptake, particularly when the students report having a positive relationship with their parents. In cases where students' experience negative relationship with their parents, the best friend's vaccine uptake may supersede the mother's influence. Despite these nuances, a general trend emerges from our data suggesting that vaccine uptake could be primarily guided by vertical transmission (i.e., parent to child). Our results have the potential to influence public health strategies, communication campaigns, and targeted interventions to enhance vaccination uptake. Identifying key social predictors can enable policymakers and health authorities to tailor vaccination promotion efforts towards mothers' and peers' vaccine uptake to increase overall positive attitudes and vaccine uptake among young people.

PurposeThe COVID-19 pandemic provides a novel context through which to evaluate salient factors for promoting behavioral change. We examined how attitudes, perceived community behaviors, and prior related behaviors predict intentions to (1) receive COVID-19 vaccination and (2) practice social distancing.DesignCross-sectional online survey administered through Amazon’s Mechanical Turk in September 2020.SubjectsA convenience sample of US adults (N = 1804).MeasuresCOVID-19 vaccination and social distancing intentions were measured on a 7-point Likert scale. Predictor variables included general vaccination and social distancing attitudes, perceived community mask-wearing, prior influenza vaccination, prior social distancing, and socio-demographics.AnalysisDescriptive statistics and linear regressions.ResultsThirty percent of respondents reported a strong willingness to receive COVID-19 vaccination, while 67% strongly intended to engage in social distancing. In regression analyses, vaccination intention was predicted by positive vaccine attitudes (b = .84; 95%CI: .78, .90; P < .001), prior influenza vaccination (b = −.47; 95%CI: −.63, −.32; P < .001), and perceived community mask-wearing (b = −.28; 95%CI: −.56, −.01; P=.049). Intention to practice social distancing was predicted by positive attitudes (b = .65; 95%CI: .61, .69; P < .001), prior social distancing (b = −.49; 95%CI: −.59, −.39; P < .001), and perceived community mask-wearing (b = −.28; 95%CI: −.46, −.09; P = .003).ConclusionFindings have implications for health promotion efforts. Messages that are targeted and tailored on pre-existing attitudes may be more effective. Additionally, leveraging prior behaviors and perceived community behavior may improve communication strategies.