2.4. Ethical considerations
Ethical permission to carry out the research was obtained from Ege
University Health Sciences Scientific Research and Publication Ethics
Committee (Approval number: 2021/982). Written informed consent was
obtained from all students who participated in the study.
RESULTS
The mean age of 498 nursing students between the ages of 18–29 years
who participated in the study was 21.06 ± 1.74 and the majority (85.1%)
were female. The introductory characteristics of the students are
presented in Table 1. The majority of nursing students (81.3%) think
that the COVID-19 pandemic will continue for a long time, they view
having COVID-19 infection as a moderate and very serious problem
(90.6%), and 63.3% of them have the risk of contracting COVID-19
infection. COVID-19 infection was experienced by 8.2% of nursing
students and the pandemic process affected the lives of many of them
badly or very badly (87%). Most students (87.8%) follow the news about
COVID-19 at a moderate and advanced level, and the primary sources of
information (75.9%) are the WHO/ Ministry of Health (MoH) Scientific
Committee and social media (72.7%). However, 57.6% stated their trust
in the explanations of HCPs (Table 2).
COVID-19 vaccine attitudes and concerns, willingness to get
vaccinated and barriers
Nursing students reported that the information about the current
COVID-19 vaccine was insufficient (65.7%), the vaccine side effects
(50.8%), the vaccine was effective (41.2%), and the vaccine was safe
(45.8%) (Figure 1). While 64.5% of students were willing to be
vaccinated against COVID-19, 35.5% are unwilling (6.2%) and hesitant
(29.3%). The reasons for their included insufficient trust in the
vaccine efficacy (84%) due to COVID-19 virus mutation (Figure 2).
A significant difference was found between nursing students’ intentions
to get COVID-19 vaccine, class, family income perception, previous
vaccination rejection, family members having COVID-19 infection, the
WHO/ MoH Scientific Committee as primary sources of COVID-19 information
and relying on HCP COVID-19 statements (p < 0.05),
(Table 1, 2). Attitudes and concerns towards the COVID-19 vaccine
positively or negatively affected nursing students’ intention to be
vaccinated (p < 0.05), (Table 3).
DISCUSSION
HCPs are considered the most reliable source of information on vaccines,
and their recommendations play a major role in patients’ vaccination
decisions. Hence, vaccine acceptance by HCPs would increase vaccine
uptake by the public. Frontline HCPs, including nurses, are susceptible
to acquiring the virus due to a variety of factors, including exposure,
inadequate supply of personal protective equipment, and inadequate
infection control. Therefore, being vaccinated will not only protect
them and their families but will also allow them to advise their
communities to get vaccinated against COVID-19. A universal vaccination
program is an important measure to control the pandemic and achieve herd
immunity. Vaccine hesitancy is a limiting step in global attempts to
control the current pandemic with adverse health and socioeconomic
consequences [9,10, 19].
The current study revealed that two-thirds (64.5%) of the nursing
students were willing to get the vaccine. Our findings are consistent
with the intention of the nurses working in our country to be
vaccinated. While the willingness of the students to
be vaccinated against COVID-19 was low in the United States and across
seven European countries (45%; 44 %, respectively)[ 3,13] , it was higher among Chinese students
(83.3%). In other studies conducted on medical
students revealed that 73% intended to be vaccinated in the USA[21], whereas 35% in Egypt[9]. A rapid systematic review of 13 studies that
assess the attitudes toward COVID-19 vaccination among the HCPs
concluded that vaccine acceptance varied widely and ranged from 27.7%
to 77.3% [19]. However, these studies also
revealed that the intention to be vaccinated differed between nursing
students and HCPs. Our study also showed that younger students and those
with milder viral exposure are more likely not to accept the vaccine
compared to older students. Differences between various studies are
attributed to the sample difference, data collection time, morbidity and
mortality rate in countries, vaccine information sources, types of
approved vaccines between countries, and rapid and changing flow of
country-specific information about the disease or vaccines[9,11,13,15].
Our findings also indicated that their willingness to receive the
vaccine was not without concerns and/or hesitation. The current study
revealed that the students’ attitudes and concerns on COVID-19 vaccine
mostly included the inadequacy of vaccine information, its side effects,
effectiveness, and safety, the thought that they were used as
experiments for COVID-19 vaccine application, and the thought of
preferring natural immunity rather than being vaccinated. Several
studies that assess the attitudes and concerns toward the COVID-19
vaccine revealed that participants commonly expressed their concerns
toward the vaccine effectiveness and side effects, insufficient vaccine
information, distrust of the supplied vaccine and the supplier company,
negative effects of the media, thoughts that there should be no vaccine
according to their sources, thoughts that the COVID-19 vaccine will
infect the virus or change their genetic structure, and thought that
they are used as experiments in the COVID-19 vaccine application[7, 9, 13,15, 22]. These expressed concerns about
vaccine efficacy are not surprising, as vaccine development can take
10–15 years [11]. However, other concerns, such
as the vaccine will change their genetic structure, the vaccine will
infect COVID-19, and that they are used as experiments in vaccine
application, arise. Vaccine misinformation and insufficient advanced
vaccine information can increase anxiety and lead to an overestimation
of potential side effects. Many hesitant individuals are anticipated to
accept the vaccine if they were reassured on vaccine safety and
effectiveness and if reliable information is provided[21].
University students and HCPs use various resources through social media
and personal networks to acquire COVID-19 infection and vaccine
information [9]. A study conducted among medical
and health students revealed that social media was used as an important
source of information about the virus [23].
Another study involving students from a large public university in New
Jersey stated that the most reliable sources of COVID-19 vaccine
information were official health institutions (78.1%) and medical
professionals (63.2%), respectively [24]. In the
current study, official health institutions (WHO and MoH) were reported
to be the primary sources of information among the students, whereas
social media (72.7%) came second. Vaccine concerns and hesitancy are
heightened by social media, conspiracy theories, and misinformation[9,11]. Infodemia, as characterized as the spread
of misleading and false information by the WHO, must be tackled[23] to eliminate the lack of information and
misinformation about the COVID-19 vaccine, thus providing training on
this subject in the curriculum is necessary.
The current study revealed that the most common reasons for not wanting
to be vaccinated were distrust in vaccine effectiveness due to the
mutation of the virus, vaccines side effects, distrust of the current
vaccine and the company, and the negative effects of news in the media.
Similar results were obtained in previously conducted studies, wherein
most of the reasons for the unwillingness to be vaccinated against
COVID-19 include constantly mutating severe acute respiratory syndrome
coronavirus 2 virus, vaccine ineffectiveness, serious long-term side
effects, insufficient vaccine information, rapid vaccine production,
preference for natural immunity, the thought that COVID-19 vaccines
would change the DNA structure, fear that the vaccines would cause
infertility, fear of high financial costs if the vaccine is not free,
and media misrepresentation of the vaccine [9, 10,
13, 21].