Hesitancy toward Childhood and Influenza Vaccines: Experiences from Highly Educated Jordanian Parents
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Sample Size
2.3. Questionnaire Design
2.4. Ethical Approval
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Abu-Rish, E.Y.; Elayeh, E.R.; Mousa, L.A.; Butanji, Y.K.; Albsoul-Younes, A.M. Knowledge, awareness and practices towards seasonal influenza and its vaccine: Implications for future vaccination campaigns in Jordan. Fam. Pract. 2016, 33, 690–697. [Google Scholar] [CrossRef]
- Fan, J.; Ye, C.; Wang, Y.; Qi, H.; Li, D.; Mao, J.; Xu, H.; Shi, X.; Zhu, W.; Zhou, Y. Parental Seasonal Influenza Vaccine Hesitancy and Associated Factors in Shanghai, China, during the COVID-19 Pandemic: A Cross-Sectional Study. Vaccines 2022, 10, 2109. [Google Scholar] [CrossRef]
- Somes, M.P.; Turner, R.M.; Dwyer, L.J.; Newall, A.T. Estimating the annual attack rate of seasonal influenza among unvaccinated individuals: A systematic review and meta-analysis. Vaccine 2018, 36, 3199–3207. [Google Scholar] [CrossRef] [PubMed]
- Wang, X.; Li, Y.; O’Brien, K.L.; Madhi, S.A.; Widdowson, M.-A.; Byass, P.; Omer, S.B.; Abbas, Q.; Ali, A.; Amu, A.; et al. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: A systematic review and modelling study. Lancet Glob. Health 2020, 8, e497–e510. [Google Scholar] [CrossRef]
- Influenza. Available online: https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccines-quality/influenza (accessed on 20 May 2024).
- Andre, F.E.; Booy, R.; Bock, H.L.; Clemens, J.; Datta, S.K.; John, T.J.; Lee, B.W.; Lolekha, S.; Peltola, H.; Ruff, T.A.; et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull. World Health Organ. 2008, 86, 140–146. [Google Scholar] [CrossRef] [PubMed]
- Assaf, A.M.; Hammad, E.A.; Haddadin, R.N. Influenza Vaccination Coverage Rates, Knowledge, Attitudes, and Beliefs in Jordan: A Comprehensive Study. Viral Immunol. 2016, 29, 516–525. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Vaccines against influenza: WHO position paper—May 2022. Wkly. Epidemiol. Rec. 2022, 97, 185–208. [Google Scholar]
- MacDonald, N.E.; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef]
- Romani, M.H.; Musharrafieh, U.M.; Lakkis, N.A.; Hamadeh, G.N. Family physicians beliefs and attitudes regarding adult pneumococcal and influenza immunization in Lebanon. Fam. Pract. 2011, 28, 632–637. [Google Scholar] [CrossRef]
- ETF Jordan: Education, Training and Employment Developments 2021; European Training Foundation: Torino, Italy, 2021; Available online: https://www.etf.europa.eu/sites/default/files/document/CFI_Jordan_2021.pdf (accessed on 10 June 2024).
- Masadeh, M.M.; Alzoubi, K.H.; Al-Azzam, S.I.; Al-Agedi, H.S.; Abu Rashid, B.E.; Mukattash, T.L. Public awareness regarding children vaccination in Jordan. Hum. Vaccines Immunother. 2014, 10, 1762–1766. [Google Scholar] [CrossRef]
- Ababneh, M.; Jaber, M.; Rababa’h, A.; Ababneh, F. Seasonal influenza vaccination among older adults in Jordan: Prevalence, knowledge, and attitudes. Hum. Vaccines Immunother. 2020, 16, 2252–2256. [Google Scholar] [CrossRef]
- Zein, S.; Abdallah, S.B.; Al-Smadi, A.; Gammoh, O.; Al-Awaida, W.J.; Al-Zein, H.J. Factors associated with the unwillingness of Jordanians, Palestinians and Syrians to be vaccinated against COVID-19. PLoS Negl. Trop. Dis. 2021, 15, e0009957. [Google Scholar] [CrossRef]
- Alsuwaidi, A.R.; Elbarazi, I.; Al-Hamad, S.; Aldhaheri, R.; Sheek-Hussein, M.; Narchi, H. Vaccine hesitancy and its determinants among Arab parents: A cross-sectional survey in the United Arab Emirates. Hum. Vaccines Immunother. 2020, 16, 3163–3169. [Google Scholar] [CrossRef] [PubMed]
- Opel, D.J.; Mangione-Smith, R.; Taylor, J.A.; Korfiatis, C.; Wiese, C.; Catz, S.; Martin, D.P. Development of a survey to identify vaccine-hesitant parents. Hum. Vaccin. 2011, 7, 419–425. [Google Scholar] [CrossRef] [PubMed]
- AlOmran, H.I.; Al-Dosary, A.S.; AlGhamdi, F.M.; Alshahrani, Z.M.; Altayar, N.S. Exploring parents’ knowledge and attitudes towards the influenza vaccine in a rural community of Saudi Arabia. J. Public Health Afr. 2022, 13, 2207. [Google Scholar] [CrossRef] [PubMed]
- Raof, A.M. Parental Attitude and Beliefs towards Child Vaccination: Identifying Vaccine Hesitant Groups in a Family Health Center, Erbil City, Iraq. World Fam. Med. J. Inc. Middle East J. Fam. Med. 2018, 99, 1–10. [Google Scholar] [CrossRef]
- Napolitano, F.; D’Alessandro, A.; Angelillo, I.F. Investigating Italian parents’ vaccine hesitancy: A cross-sectional survey. Hum. Vaccines Immunother. 2018, 14, 1558–1565. [Google Scholar] [CrossRef]
- Tran, B.X.; Boggiano, V.L.; Nguyen, L.H.; Latkin, C.A.; Nguyen, H.L.T.; Tran, T.T.; Le, H.T.; Vu, T.T.M.; Ho, C.S.; Ho, R.C. Media representation of vaccine side effects and its impact on utilization of vaccination services in Vietnam. Patient Prefer. Adherence 2018, 12, 1717–1728. [Google Scholar] [CrossRef]
- Nickerson, R.S. Confirmation Bias: A Ubiquitous Phenomenon in Many Guises. Rev. Gen. Psychol. 1998, 2, 175–220. [Google Scholar] [CrossRef]
- Al-Sabbagh, M.Q.; Al-Ani, A.; Mafrachi, B.; Siyam, A.; Isleem, U.; Massad, F.I.; Alsabbagh, Q.; Abufaraj, M. Predictors of adherence with home quarantine during COVID-19 crisis: The case of health belief model. Psychol. Health Med. 2021, 27, 215–227. [Google Scholar] [CrossRef]
- Al-Ani, A.; Hammouri, M.; Sultan, H.; Al-Huneidy, L.; Mansour, A.; Al-Hussaini, M. Factors affecting cervical screening using the health belief model during the last decade: A systematic review and meta-analysis. Psychooncology 2024, 33, e6275. [Google Scholar] [CrossRef] [PubMed]
- Truong, B.Q.Q.; Ong, K.I.C.; Shibanuma, A.; Kiriya, J.; Jimba, M. Adaptation and application of the Parent Attitudes About Childhood Vaccines survey tool in the Vietnamese language: A cross-sectional study. BMC Public Health 2024, 24, 946. [Google Scholar] [CrossRef]
- Gualano, M.R.; Bert, F.; Voglino, G.; Buttinelli, E.; D’Errico, M.M.; De Waure, C.; Di Giovanni, P.; Fantini, M.P.; Giuliani, A.R.; Marranzano, M.; et al. Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study. Vaccine 2018, 36, 3368–3374. [Google Scholar] [CrossRef]
- Anderson, J. The impact of family structure on the health of children: Effects of divorce. Linacre Q. 2014, 81, 378–387. [Google Scholar] [CrossRef] [PubMed]
- Gaith, B. Jordan Ranks 3rd in Divorce Rates in Arab World—Report. Available online: https://jordantimes.com/news/local/jordan-ranks-3rd-divorce-rates-arab-world-%E2%80%94-report (accessed on 25 April 2024).
- Lataifeh, L.; Al-Ani, A.; Lataifeh, I.; Ammar, K.; AlOmary, A.; Al-hammouri, F.; Al-Hussaini, M. Knowledge, Attitudes, and Practices of Healthcare Workers in Jordan towards the COVID-19 Vaccination. Vaccines 2022, 10, 263. [Google Scholar] [CrossRef]
- ElSayed, D.A.; Bou Raad, E.; Bekhit, S.A.; Sallam, M.; Ibrahim, N.M.; Soliman, S.; Abdullah, R.; Farag, S.; Ghazy, R.M. Validation and Cultural Adaptation of the Parent Attitudes about Childhood Vaccines (PACV) Questionnaire in Arabic Language Widely Spoken in a Region with a High Prevalence of COVID-19 Vaccine Hesitancy. Trop. Med. Infect. Dis. 2022, 7, 234. [Google Scholar] [CrossRef]
- Equils, O.; Bakaj Berishaj, A.; Stice, E.; da Costa, C. COVID-19 risk perception, cognitive dissonance, and vaccine hesitancy. Hum. Vaccines Immunother. 2023, 19, 2180217. [Google Scholar] [CrossRef]
- Harmon-Jones, E.; Harmon-Jones, C. Cognitive Dissonance Theory after 50 Years of Development. Z. Für Sozialpsychologie 2007, 38, 7–16. [Google Scholar] [CrossRef]
- Walkowiak, M.P.; Walkowiak, D. Predictors of COVID-19 Vaccination Campaign Success: Lessons Learnt from the Pandemic So Far. A Case Study from Poland. Vaccines 2021, 9, 1153. [Google Scholar] [CrossRef]
- Walkowiak, M.P.; Walkowiak, J.B.; Walkowiak, D. COVID-19 Passport as a Factor Determining the Success of National Vaccination Campaigns: Does It Work? The Case of Lithuania vs. Poland. Vaccines 2021, 9, 1498. [Google Scholar] [CrossRef]
Non-Hesitant | Hesitant | ||||
---|---|---|---|---|---|
Variable | Category | N (%) | N (%) | p-Value | Odds Ratio (95% CI) |
Parent | Father | 583 (20.0%) | 78 (26.1%) | 0.014 | 1.408 (1.071–1.851) |
Mother | 2326 (80.0%) | 221 (73.9%) | |||
Age group | 20–30 | 550 (18.9%) | 69 (23.1%) | 0.193 | REF |
30–40 | 1014 (34.9%) | 103 (34.4%) | 0.810 (0.587–1.117) | ||
>40 | 1345 (46.2%) | 127 (42.5%) | 0.753 (0.552–1.026) | ||
Marital status | Married | 2732 (93.9%) | 269 (90.0%) | 0.029 | REF |
Divorced | 90 (3.1%) | 16 (5.4%) | 1.806 (1.046–3.118) | ||
Widow | 87 (3.0%) | 14 (4.7%) | 1.634 (0.917–2.913) | ||
Educational level | None | 35 (1.2%) | 5 (1.7%) | 0.013 | NA |
Primary | 41 (1.4%) | 10 (3.3%) | NA | ||
Foundational | 90 (3.1%) | 16 (5.4%) | NA | ||
High school | 629 (21.6%) | 69 (23.1%) | NA | ||
University | 2114 (72.7%) | 199 (66.6%) | NA | ||
Occupation | Does not work | 1363 (46.9%) | 151 (50.5%) | 0.229 | 0.864 (0.681–1.096) |
Works | 1546 (53.1%) | 148 (49.5%) | |||
Income level | <500 | 980 (33.7%) | 125 (41.8%) | 0.017 | REF |
500–1000 | 1222 (42.0%) | 114 (38.1%) | 0.731 (0.560–0.956) | ||
>1000 | 707 (24.3%) | 60 (20.1%) | 0.665 (0.482–0.919) | ||
Parent works in healthcare | No | 2304 (79.8%) | 251 (84.8%) | 0.039 | 0.707 (0.508–0.984) |
Yes | 584 (20.2%) | 45 (15.2%) | |||
Number of children | 1 | 470 (16.2%) | 48 (16.1%) | NA | NA |
2–4 | 1727 (59.4%) | 162 (54.2%) | NA | ||
5–7 | 629 (21.6%) | 72 (24.1%) | NA | ||
>8 | 83 (2.9%) | 17 (5.7%) | NA | ||
Does the child have a chronic disease | No | 2685 (92.3%) | 269 (90.0%) | 0.155 | 1.337 (0.895–1.997) |
Yes | 224 (7.7%) | 30 (10.0%) | |||
Compliance with national vaccine | No | 32 (1.1%) | 28 (9.4%) | <0.001 | REF |
Yes | 2523 (86.7%) | 164 (54.8%) | 0.074 (0.044–0.126) | ||
Some | 354 (12.2%) | 107 (35.8%) | 0.345 (0.199–0.600) | ||
Compliance with COVID-19 vaccine | No | 2464 (84.7%) | 247 (82.6%) | 0.341 | 1.166 (0.850–1.598) |
Yes | 445 (15.3%) | 52 (17.4%) | |||
PACV score | 21.1 ± 12.5 | 56.1 ± 6.5 | <0.001 | NA |
Question | Responses | N | % |
---|---|---|---|
Have you ever delayed having your child get a shot for reasons other than illness or allergy | Yes | 2597 | 84.8% |
No | 467 | 15.2% | |
Have you ever decided not to have your child get a shot for reasons other than illness or allergy | Yes | 2816 | 90.3% |
No | 304 | 9.7% | |
If you had another infant today, would you want him/her to get all the recommended shots | Yes | 2707 | 84.4% |
IDK | 246 | 7.7% | |
No | 255 | 7.9% | |
How sure are you that following the recommended shot schedule is a good idea for your child | 8–10 | 2300 | 71.7% |
6–7 | 360 | 11.2% | |
0–5 | 548 | 17.1% | |
Children get more shots than are good for them | Disagree | 1496 | 46.6% |
Not Sure | 1073 | 33.4% | |
Agree | 639 | 19.9% | |
I believe that many of the illnesses shots prevent are severe | Agree | 2482 | 77.4% |
Not Sure | 530 | 16.5% | |
Disagree | 196 | 6.1% | |
It is better for my child to develop immunity by getting sick than to get a shot | Disagree | 3208 | 100.0% |
Not Sure | 0 | 0.0% | |
Agree | 0 | 0.0% | |
It is better for children to get fewer vaccines at the same time | Disagree | 3208 | 100.0% |
Not Sure | 0 | 0.0% | |
Agree | 0 | 0.0% | |
How concerned are you that your child might have a serious side effect from a shot | Not Concerned | 876 | 27.3% |
Not Sure | 461 | 14.4% | |
Concerned | 1871 | 58.3% | |
How concerned are you that any one of the childhood shots might not be safe | Not Concerned | 1032 | 32.2% |
Not Sure | 649 | 20.2% | |
Concerned | 1527 | 47.6% | |
How concerned are you that a shot might not prevent the disease | Not Concerned | 1054 | 32.9% |
Not Sure | 1027 | 32.0% | |
Concerned | 1127 | 35.1% | |
Overall, how hesitant about childhood shots would you consider yourself to be | Not Hesitant | 2355 | 73.4% |
Not Sure | 317 | 9.9% | |
Hesitant | 536 | 16.7% | |
I trust the information I receive about shots | Agree | 2299 | 71.7% |
Not Sure | 649 | 20.2% | |
Disagree | 260 | 8.1% | |
I am able to openly discuss my concerns about shots with my child’s doctor | Agree | 2528 | 78.8% |
Not Sure | 513 | 16.0% | |
Disagree | 167 | 5.2% | |
All things considered, how much do you trust your child’s doctor | 8–10 | 1993 | 62.1% |
6–7 | 613 | 19.1% | |
0–5 | 602 | 18.8% |
Question | No | Yes | I Don’t Know |
---|---|---|---|
Do you think influenza can lead to serious complications (e.g., Hospitalization or death) | 608 (19.0%) | 2221 (69.2%) | 379 (11.8%) |
Do you think influenza is a highly contagious disease? | 98 (3.1%) | 3042 (94.8%) | 68 (2.1%) |
Do you know influenza is transmitted primarily by coughing and sneezing? | 81 (2.5%) | 3048 (95.0%) | 79 (2.5%) |
Do you think the influenza vaccine is effective in preventing the flu? | 969 (30.2%) | 1516 (47.3%) | 723 (22.5%) |
Do you think the influenza vaccine is safe? | 671 (20.9%) | 1443 (45.0%) | 1094 (34.1%) |
Do you think the influenza vaccine is necessary for children? | 1184 (36.9%) | 1227 (38.2%) | 797 (24.8%) |
Do you know the influenza vaccine is recommended for all children 6 months of age or older? | 1000 (31.2%) | 1223 (38.1%) | 985 (30.7%) |
The influenza vaccine will cause influenza | 902 (28.1%) | 1059 (33.0%) | 1247 (38.9%) |
The influenza vaccine should be given every year | 913 (28.5%) | 1243 (38.7%) | 1052 (32.8%) |
Antibiotics cannot treat a viral infection | 618 (19.3%) | 1950 (60.8%) | 640 (20.0%) |
p-Value | OR | L95% CI | U95% CI | ||
---|---|---|---|---|---|
Parent | Parent (Father) | 0.203 | 1.214 | 0.901 | 1.636 |
Age of parent | 20–30 | 0.963 | REF | ||
30–40 | 0.964 | 1.008 | 0.721 | 1.408 | |
>40 | 0.809 | 1.043 | 0.740 | 1.470 | |
Marital status | Married | 0.478 | |||
Divorced | 0.231 | 1.416 | 0.801 | 2.502 | |
Widowed | 0.781 | 1.091 | 0.591 | 2.014 | |
Educational level | None | 0.915 | REF | ||
Primary | 0.812 | 1.166 | 0.330 | 4.122 | |
Foundational | 0.833 | 1.132 | 0.357 | 3.587 | |
High school | 0.819 | 0.885 | 0.311 | 2.517 | |
University | 0.959 | 0.973 | 0.345 | 2.742 | |
Occupation | Occupation (Working) | 0.413 | 0.892 | 0.678 | 1.173 |
Income level | <500 | 0.243 | REF | ||
500–1000 | 0.097 | 0.773 | 0.571 | 1.047 | |
>1000 | 0.263 | 0.814 | 0.569 | 1.166 | |
Working in healthcare | Healthcare (Works) | 0.006 | 0.623 | 0.444 | 0.874 |
Number of children | 1 | 0.387 | REF | ||
2–4 | 0.483 | 1.132 | 0.801 | 1.598 | |
5–7 | 0.247 | 1.273 | 0.846 | 1.916 | |
>8 | 0.110 | 1.711 | 0.885 | 3.310 | |
A child with a chronic disease | Chronic Disease (True) | 0.697 | 1.086 | 0.717 | 1.645 |
Given vaccines per national program | No | 0.000 | REF | ||
Yes | 0.000 | 0.078 | 0.046 | 0.131 | |
Some | 0.000 | 0.375 | 0.218 | 0.643 | |
Given COVID-19 vaccine | COVID-19 Vaccine (True) | 0.468 | 1.129 | 0.814 | 1.565 |
Knowledge of influenza and vaccines | 0.000 | 0.795 | 0.751 | 0.841 |
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Al-Iede, M.; Aljahalin, M.; Fashho, E.; Sweis, S.; Mesmeh, R.; Hamad, L.B.; Abuzaid, L.; Sa’ed, J.A.; Elbetar, Y.; Alabdali, A.Y.M.; et al. Hesitancy toward Childhood and Influenza Vaccines: Experiences from Highly Educated Jordanian Parents. Vaccines 2024, 12, 945. https://doi.org/10.3390/vaccines12080945
Al-Iede M, Aljahalin M, Fashho E, Sweis S, Mesmeh R, Hamad LB, Abuzaid L, Sa’ed JA, Elbetar Y, Alabdali AYM, et al. Hesitancy toward Childhood and Influenza Vaccines: Experiences from Highly Educated Jordanian Parents. Vaccines. 2024; 12(8):945. https://doi.org/10.3390/vaccines12080945
Chicago/Turabian StyleAl-Iede, Montaha, Mohammad Aljahalin, Eva Fashho, Sami Sweis, Rahaf Mesmeh, Loai Bani Hamad, Leen Abuzaid, Jana Al Sa’ed, Yasmeen Elbetar, Aya Yaseen Mahmood Alabdali, and et al. 2024. "Hesitancy toward Childhood and Influenza Vaccines: Experiences from Highly Educated Jordanian Parents" Vaccines 12, no. 8: 945. https://doi.org/10.3390/vaccines12080945