“The vaccination is positive; I don’t think it’s the panacea”: A qualitative study on COVID-19 vaccine attitudes among ethnically diverse healthcare workers in the United Kingdom

  1. Mayuri Gogoi
  2. Fatimah Wobi
  3. Irtiza Qureshi
  4. Amani Al-Oraibi
  5. Osama Hassan
  6. Jonathan Chaloner
  7. Laura B. Nellums
  8. Manish Pareek
  9. on behalf of the UK-REACH Collaborative Group

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Abstract

Globally, healthcare workers (HCWs) were prioritised for receiving vaccinations against the coronavirus disease-2019 (COVID-19). Previous research has shown disparities in COVID-19 vaccination uptake among HCWs based on ethnicity, job role, sex, age, and deprivation. However, vaccine attitudes underpinning these variations and factors influencing these attitudes are yet to be fully explored.

Methods

We conducted a qualitative study with 164 HCWs from different ethnicities, sexes, job roles, migration statuses, and regions in the United Kingdom (UK). Interviews and focus groups were conducted online or telephonically, and recorded with participants’ permission. Recordings were transcribed and a two-pronged analytical approach was adopted: content analysis for categorising vaccine attitudes and thematic analysis for identifying factors influencing vaccine attitudes.

Findings

We identified four different COVID-19 vaccine attitudes among HCWs: Active Acceptance, Passive Acceptance, Passive Decline, and Active Decline. Content analysis of the transcripts showed that HCWs from ethnic minority communities and female HCWs were more likely to either decline (actively/passively) or passively accept vaccination—reflecting hesitancy. Factors influencing these attitudes included: trust; risk perception; social influences; access and equity; considerations about the future.

Interpretation

Our data show that attitudes towards COVID-19 vaccine are diverse, and elements of hesitancy may persist even after uptake. This has implications for the sustainability of the COVID-19 vaccine programme, particularly as new components (for example boosters) are being offered. We also found that vaccine attitudes differed by ethnicity, sex and job role, which calls for an intersectional and dynamic approach for improving vaccine uptake among HCWs. Trust, risk perception, social influences, access and equity and future considerations all influence vaccine attitudes and have a bearing on HCWs’ decision about accepting or declining the COVID-19 vaccine. Based on our findings, we recommend building trust, addressing structural inequities and, designing inclusive and accessible information to address hesitancy.

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  1. Version published to 10.1371/journal.pone.0273687
  2. ScreenIT

    SciScore for 10.1101/2021.09.27.21264005: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Due to restrictions on travel and social distancing, the study was conducted remotely, and all processes including, recruitment, consent, and data collection were completed online. 2.2. Recruitment: Data collection for this study was carried out between December 2020 and July 2021.
    Field Sample Permit: UK-REACH is among a collection of COVID-19 UPH studies funded by the UK Research and Innovation (UKRI) and National Institute of Health Research (NIHR), UK to provide “rapid response” research to better understand the disease and its impact, collecting real-time information to inform national policy (22).
    Sex as a biological variablenot detected.
    RandomizationIn this analysis, therefore, generation of themes was informed by data collection across all participants, and a detailed analysis of a randomly selected subset of transcripts, which were rigorously coded and analysed to generate the results presented in this paper.
    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:
    Our study has certain limitations. For example, social distancing measures meant that data collection had to be conducted remotely and using online technology. This may have affected participation from certain groups who may be less proficient in use of or have less access to digital technology. Relatedly, study promotion and invitations to join were mostly virtual, which meant that HCWs who do not routinely access virtual communication or use social media may have missed taking part. However, this study had a unique advantage of being able to collect data in real-time as the situation around COVID-19 vaccination has been unfolding in the UK, although the rapid change in scenario could also mean that some of the participants’ views may have changed from the time of data collection. Given this, we are making efforts to keep pace with the changes and bring out results rapidly, and some of our early results have already been considered by the government in their policy-making decisions (36). In conclusion, our study is one of the first to report in-depth qualitative data on attitudes of HCWs towards the COVID-19 vaccine and factors influencing vaccination decisions. While vaccine hesitancy among HCWs has been reported by other studies, our research delineates some of the reasons behind this hesitancy, such as trust and communication. Furthermore, our research strengthens knowledge around the complexity of vaccine hesitancy among this key population of HCWs, and offers a new fram...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN11811602NANA

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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

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  3. Version published to 10.1101/2021.09.27.21264005v1 on medRxiv