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.