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].