key: cord-0962151-i3mkrox1 authors: Zaitoon, Hussein; Sharkansky, Livnat; Ganaim, Loai; Chistyakov, Irina; Srugo, Isaac; Bamberger, Ellen title: Evaluation of Israeli healthcare workers knowledge and attitudes toward the COVID‐19 vaccine date: 2021-10-06 journal: Public Health Nurs DOI: 10.1111/phn.12987 sha: eb56c06c8219d686027f50204031b14ff7c248ed doc_id: 962151 cord_uid: i3mkrox1 OBJECTIVES: Healthcare workers (HCWs) are considered an important target group for the COVID‐19 vaccines. The current study assesses the knowledge and attitudes of Israeli HCWs regarding COVID‐19 immunization, and how various occupational and demographic factors may underlie COVID‐related knowledge and attitudes differences. METHODS: Following a pre‐test to validate measures, a cross‐sectional online anonymous survey was distributed to HCWs using a snowball sampling method. RESULTS: The survey was completed by 714 participants (mean age 39.9; range 18–74; 447 female), 52% doctors, 32% nurses, and the remainder by paramedical staff. Of the respondents, 553 (77.4%) answered the question are you in favor of getting the COVID‐19 vaccine, 105 (14.7%) were not sure, and 56 (7.8%) were not in favor. Doctors had higher odds of agreement as compared to both nurses (p < .025) and paramedical staff (p < .001). Multivariate logistic regression analysis revealed that increased age (OR: 1.075; 95% CI: 1.04–1.11, p < .001), profession (physician vs. nurse; OR: 2.73; 95% CI: 1.32–5.65; p < .007), and getting the current influenza vaccine (OR: 4.96; 95% CI: 2.47–9.95) were significant predictors of agreement. CONCLUSIONS: A high level of HCWs knowledge and in favor attitudes were observed. Yet negative attitudes were also noted, particularly among nurses, paramedical staff, and young employees. genetic material, with the first two employing messenger RNA (mRNA). These new techniques have proved effective in clinical studies and could lay the foundation for rapid production of a wide range of vaccine types. However, the use of novel technology could also give rise to neophobia. Healthcare workers (HCWs) are particularly exposed to transmissible diseases such as influenza and COVID-19, and can play a role in their nosocomial transmission. This makes HCWs an important target group for vaccination. Many institutions recommend that HCWs be routinely vaccinated against influenza. However, annual vaccination rates among HCWs are almost universally low, and differ between physicians and nurses (Hofmann et al., 2006; Martinello et al., 2003) . HCWs can serve as role models for the general population, thereby increasing the success of the broader vaccination campaign. Currently, however, little is known about the intention to get the new COVID-19 vaccine among HCWs (Detoc et al., 2020; Wang et al., 2020) . The current study assesses knowledge and attitudes regarding COVID-19 immunization among HCWs in Israel during the initial states of Israel vaccination campaign. Aside from identifying knowledge gaps and behavioral patterns that can serve as a basis for interventions to enhance vaccine compliance, a secondary aim of the study was to assess occupational and demographic differences in COVID-related knowledge and attitudes among HCWs in Israel. More specifically, the survey was initially distributed to 500 HCWs in Bnai Zion Medical Center through their personal email address or via a phone message. After completing the survey themselves, these participants were asked to invite other HCWs in their contact lists and from across the country to complete the survey in order to assist "a friend and colleague." Ultimately, surveys were received back from 714 HCWs. Respondents provided consent before beginning the survey. Participants were also informed that participation was voluntary, and that completion of the entire survey, while not mandatory, was preferred. The questionnaire began with a direct question regarding the willingness of the participant to receiving the COVID-19 vaccine. More specifically, participants were asked to indicate their level of agreement with the following statement: "I am in favor of getting the COVID-19 vaccine," using a five-point Likert scale (1 = fully disagree, 2 = partially disagree, 3 = uncertain, 4 = partially agree, 5 = fully agree). The demographic data and participant characteristics are presented in With respect to the direct question on willingness to receive the vaccine ("Are you in favor of getting the COVID-19 vaccine?"), 553 respondents (77.4%) were in favor (agree or partially agree), 105 (14.7%) were not sure, and 56 (7.8%) were not in favor (partially disagree or disagree). Distribution of the demographic variables and the univariate prediction of agreement are presented in Table 2 . Profession was associated with willingness to take the vaccine (p < .007); physicians had higher odds of agreement as compared to both nurses (OR: 2.09; 95% CI: 1.10-3.98; p < .025) and paramedical staff (OR: 3.40, 95% CI: 1.64-7.07; p < .001). Multivariate logistic regression analysis revealed that age, profession and getting the influenza vaccine in the current year were signifi- were not sure. The mean total attitude score was 36.5 (median 38; range 12-51). Age was positively associated with knowledge (r = .27, p < .001) and attitudes (r = .32, p < .001). In bivariate analysis, the following characteristics were significantly associated with the knowledge total score: sex, marital status, profession, chronic diseases, up to date on recommended vaccines and influenza vaccination currently and the previous year. The following characteristics were significantly associated with the attitudes total score: sex, marital status, profession, chronic diseases, up to date on recommended vaccines and influenza vaccination currently and the previous year. After adjustment for age and sex, marital status was no longer statistically significant predictor of attitude (F(2,708) = 2.55, p > .08). Our report is the first to examine the knowledge and attitudes of Israeli HCWs in relation to the newly developed COVID-19 vaccines. Such an inquiry is important in that a common perception, even among many HCWs, is that the vaccines were rapidly developed and approved, thus raising apprehension over their effectiveness and safety (Lin et al., 2020) . Indeed, these vaccines are the fastest ever developed (under 1 year), followed by the mumps vaccine, which took 4 years. The fact that the mRNA technology used in two of the vaccines has not been widely tested before in humans, along with the speed of their development, has given rise to fears about their long-term unknown effects. Israel has emerged as the world leader in administering the COVID-19 vaccine, with the world's fastest campaign per capita (Kershner, 2021) . Indeed, 20% of Israel population (9 million people), beginning with medical staff and elderly individuals, received at least one of their first two doses within a month of Israel beginning its vaccination campaign. HCWs were among the first to be vaccinated because of their greater risk of exposure (Dabholkar et al., 2020) , the concomitant risk of nosocomial transmission, and the need to set an example for the rest of the population, who may doubt the vaccine's safety and effectiveness. Given this background, we sought to better understand the COVIDrelated knowledge/beliefs and attitudes of Israeli HCWs, as well as the occupational and demographic characteristics that might underlies differences in these same knowledge/beliefs and attitudes. We found that, overall, HCWs are in favor of getting the vaccine-a response which may be explained by the physical and mental stress of the pandemic (Spoorthy et al., 2020; Vizeh et al., 2020) and the belief that only an effective vaccine can bring the pandemic to an end. Yet, we also encountered negative attitudes. In particular, unwillingness to take the vaccine was found among nurses at twice the rate of doctors, and at even greater rates among other paramedical staff. A similar trend was observed in Hong Kong (Wang et al., 2020) , Belgium and Canada (Verger et al., 2020) . In addition, we noted that nurses rely significantly less on scientific articles as a source for knowledge about vaccination for COVID-19. This was also observed with respect to the seasonal influenza vaccine (Pless et al., 2017) . Our study highlights the link between greater age and seniority and vaccine acceptance, which raises concerns regarding younger employees. False beliefs and concerns regarding side effects, and beliefs about the disease burden among the young, may lead younger HCWs to choose not to vaccinate. In addition, HCWs who are not vaccinated against influenza are most likely to refuse the COVID-19 vaccine. A similar trend regarding intention to get the COVID-19 vaccine was observed among the general population in the UK (Verger et al., 2020; Paul et al., 2020) . Interestingly, we did not find that side effects fears were a major barrier to the intention to get the vaccine. The recent studies which preceded the vaccines' approval were relatively low-scale, with small sample sizes (Baden et al., 2020; Polack et al,., 2020) , leaving some individuals concerned about serious side effects. Indeed, even though scientific papers were the most common source of knowledge in our study, most of our respondents felt that the side effects of the vaccine are not yet well-understood. Nonetheless, a majority of HCWs in our study were in favor of vaccination similar to the trends observed in Belgium and Canada (Verger et al., 2020) . An important limitation of the current analysis is that the findings are based on a sample drawn on the basis of a snowball approach. On the one hand, as this approach is non-random, we cannot be sure of the generalizability of our findings to the population of HCW in Israel. On the other hand, due to the unique circumstances at the time of data collection, it offered the best means by which to secure a sizable sample including some of the more difficult-to-reach practitioners in some of the most hard-hit areas of the country. This survey examines Knowledge and attitudes regarding uptake of the can enhance compliance and uptake of the vaccine among HCWs and the general population. None. None. The study was approved by the Bnai Zion Medical Center ethical committee/ institutional review board, approval number 0202-20-BNZ. Data available on request from the authors. WHO Coronavirus Disease (COVID-19) Dashboard, (2021) WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard. (n.d.). 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