4.1. Factors associated with the intention to be vaccinated against COVID-19
The willingness to be vaccinated does not depend on just one factor. It can be affected by the individuals’ social, cultural, and economic structures, age, gender, information from HCPs, individual or familial COVID-19 infection experiences, chronic diseases, general attitudes and beliefs toward vaccines, previous experiences of vaccine rejection, and traditional social messages [11, 15]. The current study revealed a low COVID-19 vaccine acceptance among students who were in lower classes, with low family income perception, and with previous vaccine rejection experience. Similar studies that were conducted among HCPs revealed high acceptance rates among the male gender, increasing age, education, and income level [15, 19, 25, 26].
Some studies revealed a relationship between prior seasonal influenza vaccination and intention to be vaccinated against COVID-19[13, 17, 18, 24, 26] . The current study revealed no correlation between the influenza vaccination of nursing students in the last 2 years (8.8%) and the intention to be vaccinated against COVID-19. However, previous vaccine rejection experience, either by the individual or a relative (17.1%), negatively affected one’s intention to be vaccinated against COVID-19. Individual or familial experiences of vaccine rejection is an obstacle to acquiring herd immunity through vaccination, and many countries have reported an increased incidence of vaccine-preventable diseases in recent years [18]. This may cause very serious consequences worldwide as it threatens all historical achievements in reducing the burden of infectious diseases that have been affecting humanity for centuries[7].
Some research suggests that vaccination acceptance is also affected by other motivational and psychological factors, such as anxiety, experiences, and disease risk perception [3, 27]. Many of the nursing students in the study perceived COVID-19 infection as a serious problem that would continue for a long time and two-thirds of them believed their risk of contracting infection, although the rate of individual infection is low (8.2%), whereas the rate of infection and death in the family and close environment is detected as higher. Additionally, the pandemic process has negatively affected the lives of students. An increased intention to be vaccinated was observed in students whose family members had COVID-19 infection, but no difference was observed in other factors. Nursing students in Europe also perceived contracting COVID-19 infection as a serious problem at similar rates[13], whereas a study among medical students in Egypt confirmed that 4.4% had had an infection and 51.5% in their immediate social environment had contacted the virus[9]. Among the COVID-19 vaccination motivations, the fear of being infected or the fear of infecting the family and the history of chronic disease increased the tendency to be vaccinated[9, 13, 19, 25, 26, 28]. The study of[13] revealed that the pandemic process adversely affected the mental health of nursing students and increased their depression and anxiety levels.
The current study observed that students whose primary sources of COVID-19 information were official institutions (WHO and MoH) and those who relied on the statements of HCPs had an increased intention to be vaccinated. People who rely on government sources, doctors, and public health experts’ explanations about COVID-19 information were more likely to accept the vaccine [13,19, 21, 25, 29]. Obtaining information from unreliable sources and social media increased students’ suspicions about vaccines. The presence of the anti-vaccine movement, especially on social media, may have contributed to the unwillingness to be vaccinated [15, 30].
In the current study, nursing students’ intention to be vaccinated was positively affected by vaccine effectiveness and safety, among the attitude that concerns the vaccine and its side effects, lack of information about the vaccine, whereas seeing oneself as an experiment in the vaccine administration and the thought that natural immunity preference, acquisition of COVID-19 from the vaccine, the vaccine will change the genetic structure were negative factors. The study conducted with Palestinian nurses revealed that the factors that prevent the intention to be vaccinated included preference of natural immunity, fear of long-term vaccine complications, insufficient vaccine information, fear of the vaccine, and the misrepresentation of the media about the vaccine [22]. Vaccine efficacy and safety, insufficient knowledge about the vaccine, and fear of long-term side effects are consistent with studies of [9, 10, 31]. Students may have negative cognition in vaccination. That’s why, schools should strengthen education on adverse reactions of COVID-19 vaccine, not only from knowledge, but also from psychological, physiological, so that students can have eliminate fear and enhance the willingness to vaccinate.