COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK: A mixed-methods study

  1. Sadie Bell
  2. Richard M. Clarke
  3. Sharif A. Ismail
  4. Oyinkansola Ojo-Aromokudu
  5. Habib Naqvi
  6. Yvonne Coghill
  7. Helen Donovan
  8. Louise Letley
  9. Pauline Paterson
  10. Sandra Mounier-Jack

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Abstract

The UK began delivering its COVID-19 vaccination programme on 8 December 2020, with health and social care workers (H&SCWs) given high priority for vaccination. Despite well-documented occupational exposure risks, however, there is evidence of lower uptake among some H&SCW groups.

Methods

We used a mixed-methods approach—involving an online cross-sectional survey and semi-structured interviews–to gain insight into COVID-19 vaccination beliefs, attitudes, and behaviours amongst H&SCWs in the UK by socio-demographic and employment variables. 1917 people were surveyed– 1656 healthcare workers (HCWs) and 261 social care workers (SCWs). Twenty participants were interviewed.

Findings

Workplace factors contributed to vaccination access and uptake. SCWs were more likely to not be offered COVID-19 vaccination than HCWs (OR:1.453, 95%CI: 1.244–1.696). SCWs specifically reported uncertainties around how to access COVID-19 vaccination. Participants who indicated stronger agreement with the statement ‘I would recommend my organisation as a place to work’ were more likely to have been offered COVID-19 vaccination (OR:1.285, 95%CI: 1.056–1.563). Those who agreed more strongly with the statement ‘ I feel/felt under pressure from my employer to get a COVID-19 vaccine ’ were more likely to have declined vaccination (OR:1.751, 95%CI: 1.271–2.413). Interviewees that experienced employer pressure to get vaccinated felt this exacerbated their vaccine concerns and increased distrust. In comparison to White British and White Irish participants, Black African and Mixed Black African participants were more likely to not be offered (OR:2.011, 95%CI: 1.026–3.943) and more likely to have declined COVID-19 vaccination (OR:5.550, 95%CI: 2.294–13.428). Reasons for declining vaccination among Black African participants included distrust in COVID-19 vaccination, healthcare providers, and policymakers.

Conclusion

H&SCW employers are in a pivotal position to facilitate COVID-19 vaccination access, by ensuring staff are aware of how to get vaccinated and promoting a workplace environment in which vaccination decisions are informed and voluntary.

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  1. Version published to 10.1371/journal.pone.0260949
  2. ScreenIT

    SciScore for 10.1101/2021.04.23.21255971: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This is the first study to consider the role of beliefs, attitudes and other factors in COVID-19 vaccination uptake among H&SCWs. By using a mixed-methods approach, our study explored not only the association between demographic characteristics – as other studies have done (29) - but also attitudinal, organisational and cultural influences on COVID-19 vaccination that have not been examined in UK H&SCWs. Our recruitment strategy achieved a high number of H&SCW responses from across a range of job roles, and intentionally high representation across broad ethnic categories. On reflection, we consider that this was possible due to diverse representation among the study researchers. Future research should concentrate on exploring the heterogeneity within broad ethnic groups. While ethnic minority representation was good across our sample, some categories used within the regression analysis still had less than ideal numbers of participants. For instance, there were 66 Black or Black British Caribbean or Mixed Black Caribbean participants, 15 of whom declined the COVID-19 vaccine. With such numbers, it is possible that recruitment bias and other general limitations to conducting survey research may limit the representativeness of the findings. In our sample, Asian participants were overrepresented within highly medical roles (54% in our sample vs 26% in the NHS workforce (20)), suggesting that our higher uptake findings for Asian participants should be in...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.04.23.21255971v1 on medRxiv