INTRODUCTION
As
the global pushback against the SARS-CoV-2 virus remains the top priority in
the health sector, the ultimate goal is to bring the COVID-19 pandemic under
control, by attaining considerable global herd immunity.(1) A major milestone
during the pandemic has been the rollout of vaccines to combat the infection.
In the US, during the first quarter of 2021, three vaccines (two mRNA vaccines,
produced by both Pfizer and Moderna, and one viral
vector vaccine, produced by Johnson & Johnson’s Janssen) had been approved and
recommended for administering to the adult population in all communities,
having met Safety and Effectiveness requirements to obtain FDA’s Emergency Use
Authorization for the prevention of COVID-19.(2-4) In response to this
campaign, there have been observed sentiments among the public, which
ultimately have resulted in various attitudes towards the rollout and
administering of these vaccines. Some research studies carried out within
certain regions and communities have identified some of these sentiments and
possible factors associated with them which have resulted in some of the
perceived attitudes towards the rollout and administering of the vaccines. (2,5)
Although the study on the patients of the
Good News Clinic hopes to identify the general perceived attitude among this
patient population.(3) towards the vaccines, explore possible factors
associated with these attitudes, and thus shed light on those unique factors
and influences about the attitudes of this patient population. We also hope to
establish the connections between this patient population and that of the
greater community of which it is a part of. Thus, based on certain similarities
observed, solutions addressing the issues and concerns within this patient
community can also be projected onto the greater Gainesville community. Thus,
the findings could be relevant for the use by the community healthcare
policymakers to strategically address issues specific to the uniqueness of the
community in hopes of solving problems of the community healthcare system and
with regards to the pandemic, causing a positive impact on herd immunity to the
COVID 19 infection.
AIMS AND OBJECTIVES
This
study aims at
1.
Exploring
the general sentiment revolving around the perceived attitude of the patient
cohort towards the COVID-19 vaccine roll-out.
2.
Establish
the general attitude displayed by the patient cohort towards the COVID-19
VACCINE.
3.
Identify
various factors and influences that attribute to the perceived attitude towards
the COVID-19 vaccine roll-out.
4.
Identify
which of the factors are of significance in causing the perceived attitude
towards the vaccine and establish which are of relevance to the Gainesville
community.
Based
on the above findings, proffer solutions that may address issues and concerns
of the cohort and hence the community, to encourage attitudes that arise from
well-informed decision-making by community members.
METHODS
This
was a cross-sectional study that collected data from adult patients (n=200)
receiving care at the Good News Clinic, Gainesville.
A structured questionnaire was used to
collect information over five weeks from July 5th through August 6th,
2021, by way of Convenience Sampling. All questions answered were assessed as a
valid questionnaire. Approval of the study was granted by the board of the
clinic.
Information collected and used in this study
included socio-demographics, pre-existing medical conditions, knowledge and
awareness of COVID-19, and COVID-19 vaccination.
The first question on the survey asked about
knowledge of COVID-19: “How well informed are you about the COVID-19 virus” The
response options were: high/well informed, average, low/not well informed, and
unsure. Next, we asked two questions to assess the impact of COVID-19. First
“How would you rank the impact the COVID-19 virus has had on you” with response
option: High, average, low, unsure. Second, “Has the COVID-19 virus affected
you in any of the following ways” with response options: Illness, illness of a
loved one, death of a loved one, unsure. A final set of questions asked about
COVID-19 vaccination.(6) “Have you received a COVID-19
vaccine” with options for yes or no. We also investigated the reasons for
COVID-19 vaccine hesitancy. All respondents who answered “no” were presented
with follow-up questions asking whether they have been busy, but intend to take
the vaccine eventually, are waiting to see the outcome of the vaccine within
the community, are concerned about the effects of the vaccine, or do not
believe in the benefits of the vaccine.
Data were analyzed using SPSS 21 (IBM Corp).
We computed descriptive statistics to describe the demographic characteristics
of the study participants.
Next, knowledge and awareness of covid-19
were computed across groups and crosstabs. Responses were compared for various sociodemographic characteristics.
Study Location
Our
study, took us to a particular setting in the Gainesville community of Georgia state. The Good News Clinic. This
clinic is a religious-affiliated nonprofit organization with the mission to
provide free medical and dental care to patients of the community, who are
unable to afford the purchase of health care services. The Gainesville community
itself had witnessed several impacts, especially during the early stages of the
pandemic, that had placed a burden on its healthcare
system. A scenic illustration of this burden was the propping up of
make-shift-pods and tents, set up by the Northeast Georgia Medical Center, to
accommodate the overflow from the in-patient facilities, due to the
overwhelming number of patients that had been admitted to the center, during
this time frame. Also, scores of deaths that had resulted from complications of
the COVID-19 pandemic, had been reported at the same
time. Such observances thus prompted this Study as it would be interesting to
note the attitudes within the community towards the COVID-19 vaccines as they
were made available to the public.
The
Outstanding Attribute of this Population
The
demographic profile which reflects the predominance of the Latino ethnicity
stands out during the analysis. Making up 45.00% of the respondents, the
general response to survey questions tends to shift towards the responses made
by this group.
RESULTS
Table
1.Racial/Ethnic Group Distribution of Patient Cohort Presenting to the Goodnews Clinic
|
Race/Ethnic group
|
Frequency
|
Percentage
|
|
Asian
|
13
|
6.50
|
|
Black/African American
|
16
|
8.00
|
|
Hispanic
|
90
|
45.00
|
|
White/Caucasian
|
76
|
38.00
|
|
Unaccounted group
|
5
|
2.50
|
|
Total
|
200
|
100
|
Table1;
Showing in percentage, the racial/ethnic distribution of patients. With the Hispanic community reflecting a predominance at 45%.
Table
2.Racial/Ethnic Group Distribution from Gainesville, Georgia (April 2020)
|
Race/Ethnic group
|
Percentage
|
|
Asian
|
2.70%
|
|
Black/African American
|
16.30%
|
|
White/Caucasian
|
40.20%
|
|
Native Hawaiian and
other Pacific Islander
|
0.00%
|
|
Hispanic
|
38.10%
|
|
Multiracial
|
12.30
|
|
American Indian/Alaska
Native
|
0.50%
|
Table
2; The table shows extracts from the April 2020 census
according to the US census bureau. It reflects a 38.10% representation of
Hispanics in the Gainesville community of Georgia. Being the second most represented
group according to the chart, one can argue a semblance with the represented
patient cohort of the Good News Clinic, Gainesville.
Table
3.Vaccination Status of Patient Cohort of the Good News Clinic, Gainesville
|
Vaccine status
|
Frequency
|
Percentage
|
|
Unvaccinated
|
75
|
37.50
|
|
Vaccinated
|
115
|
57.50
|
|
Unaccounted group
|
10
|
5.00
|
|
Total
|
200
|
100
|
Table
3; Shows the numbers and percentages of the vaccinated and unvaccinated patient
cohorts at 57.50% and 37.50% respectively. The 5% unaccounted forthe cohort were those who did not respond to this
question, though participated in the study.
Table
4.Vaccinated Population Based on Racial/Ethnic Distribution
|
Race/Ethnic group
|
Frequency
|
Percentage
|
|
Asian
|
5
|
4.35
|
|
Black/African American
|
8
|
6.96
|
|
Hispanic
|
57
|
49.56
|
|
White/Caucasian
|
45
|
39.13
|
|
Total
|
115
|
100
|
Table
4; Of the 115 patients who were vaccinated, 49.56% were of Hispanic ethnicity,
showing the relevance in terms of the representative count of this patient
group in this study.
Table
5.Unvaccinated Population Based on Racial/Ethnic Distribution
|
Race/Ethnic group
|
Frequency
|
Percentage
|
|
Asian
|
8
|
10.67
|
|
Black/African American
|
8
|
10.67
|
|
Hispanic
|
29
|
38.67
|
|
White/Caucasian
|
30
|
40.00
|
|
Total
|
75
|
100
|
Table
5; the numbers reveal that the Caucasian race was mostly represented in this
category with 40.00% of the unvaccinated. We can argue that the Hispanic
ethnicity still holds a significant representation with 38.67%. This highlights
their relevance in impacting the trends of observed attributes in the clinic
(and hence the community).
Table
6.Unvaccinated Population Based on Educational Status
|
Educational status
|
Frequency
|
Percent
|
|
High school or less
|
56
|
74.66
|
|
College
|
10
|
13.33
|
|
Postgraduate
|
5
|
6.67
|
|
None
|
4
|
5.33
|
|
Total
|
75
|
100
|
Table
6; Showing the “Highschool and Below”
category under educational status, recorded the most observed in the group of
unvaccinated patients with a percentage representation of 74.66%.
Table
7.A Focus on the Race/Ethnicity of Patients with High School and Below
Educational Status
|
Race/Ethnic group
|
Frequency
|
Percentage
|
|
Asian
|
7
|
5.11
|
|
Black/African American
|
10
|
7.30
|
|
Hispanic
|
69
|
50.36
|
|
White/Caucasian
|
51
|
37.23
|
|
Total
|
137
|
100
|
Table
7; This table highlights the Hispanic ethnicity as the
most represented under the category of the “Highschool
and Below” demographic, with a representation of 50.36%.
Table
8; This table reveals a major limitation of this study
as the unaccounted group comprised 44%. The unaccounted group means this
question was not filled in. However, for those that responded, the most
identified concern was in the category of “Health reasons” with a percentage of
43.50% (87).
DISCUSSION
A hint of the attitudes towards the rollout
of the various vaccines against the sars-cov-2 virus, globally, was sensed by
the various sentiments that were expressed concerning the vaccines. Amongst
these sentiments, were that of enthusiasm, especially for those who felt highly
impacted by the pandemic, perhaps through experiencing personal illness, or the
illness of a loved one, or even, the death of a loved one, however, on the
other end, was the feeling of concern and mistrust about the safety and efficacy
of the vaccine, with the sense that not much time had been invested in the development
of the vaccines.(7) With such sentiments arose the attitudes that currently
plague the pandemic, the attitudes of acceptance and hesitancy. These attitudes
are being encountered on a global scale. Our study has ascribed to the attitude
of acceptance, enthusiasm, and ready willingness to take the vaccine while
hesitancy is ascribed to the display of unenthusiasm,
manifesting as delay, indecisiveness, and unwillingness in receiving the
vaccines.(23) It should be noted that for 8. the purpose of this study, the terms denoting attitudes of
acceptance and hesitancy, are limited to the description above, indeed, the
term hesitancy, has been noted to embrace a spectrum of attitudes from full
acceptance to complete refusal, in some other studies. Thus, for this study, the attitude of
acceptance will be excluded from the spectrum and emphasizes the response of
having been vaccinated. In encountering the attitudes of acceptance and
hesitancy displayed among the patients of the GNC, our quest in this discussion
is to provide an insight into the attributes of this patient community, causing
these attitudes and the perception towards the vaccines that bears
responsibility for the perceived attitude.
So far, on the global scale, several factors
have been identified as having an impact on the sentiments that yield these
attitudes. Some studies demonstrate how demographic factors such as age, sex,
racial/ethnic group, education, and socio-economic, have influences on these
attitudes and how these factors at times could show variations in different
geographic settings.(19) Although our study did not
establish a significant P value, when factors were analyzed, there is arguably
a relevance to the findings highlighted in the results, as this discussion
would reveal. The trends that have been observed in this study,
are 9. necessary as they help healthcare
investors/policymakers strategically proffer solutions that address issues such
as cultural norms, language barriers, mistrust in healthcare systems
experienced by some minority groups and the list goes on. The data analysis from our survey brings to
light the unique qualities/ attributes of this patient population that will
enable a specific approach in addressing their concerns and perhaps in areas
where these approaches could be projected unto the community, due to the
semblance between the clinic and the community in which it is a member of, such
recommendations can be made.
Of the 115 respondents that acknowledged they
were vaccinated, the Hispanic community made up 49.56%, that is, almost half of
the vaccinated respondents! The influence is seen the other way as well, in the
hesitant category, although the data analysis reveals within each 10.
racial/ethnic subcategory, the Asian representation has the highest display of
hesitancy of 61.53%, however, this only accounts for 10.6% of all the
unvaccinated, being surpassed by the Latino ethnic which bear 38.67% of all
unvaccinated and the Caucasian race displaying the most unvaccinated, bearing
40% of unvaccinated.
This observation highlights the possible
impact and influence of the Hispanic community not just within the clinic, but
the Gainesville community, where they make up 38.10% of the ethnicity,
according to the US census bureau, April 2020. This does not assume any less
significance, nor does it undermine the needs of other identified groups
including minorities within this community. However, it emphasizes a possible
shift in paradigm that could be achieved by strategically targeting messages
that address the concerns of this group, especially those that will yield
socio-economic and health benefits, perhaps towards increasing herd immunity
regarding the pandemic.
Another unique finding is the number of
respondents identifying in the category of high-school and below in highest
attainment of education. These comprised 74.66% of the unvaccinated
respondents. It might also be important to note that 50.36% in this category
identified as Hispanic. Perhaps, when considering educational status as an
indicator of socioeconomic status and, low socioeconomic status as one of the
criteria for admission into the clinic, this finding is not surprising.
However, unlike in the previously highlighted category, the high numbers of
respondents are not a reflection of the demographic profile for the education of
the Gainesville community.(8-12) Nevertheless,
addressing the concerns of this demography can go a long way in impacting the
general well-being and with regards to the pandemic, boosting the impact on
herd immunity. In bringing to observation, the probable influence of the
Hispanics in this category, perhaps campaigns geared at addressing the language
barrier with a simplistic approach, could go a long way to proffer solutions
addressing concerns in this category.
Aside from demographic attributes, the study
sheds some light on possible influences on attitudes that could arise from the
concept of perception, i.e., perception of personal impact brought upon by the
virus. An important finding was the possible influence on the health status of
the individuals. Of respondents that specifically identified influences on
“health”, “religion” and “news/media”, 77.67% of these acknowledge, health as
the most reason influencing the choice of their vaccination status. A possible
inference that could be made from this, is the
importance of personal health on choices that affect individual well-being.
This highlights the role and importance of media campaigns in the dissemination
of health information and perhaps the tunneling of messages that not only focus
on the safety and efficacy of vaccines, nor place emphasis on several
sicknesses and deaths, but perhaps an emphasis on transparency on the impact
vaccines have had on individuals especially those with pre-existing medical
conditions. The objective here is not to coerce subjects who are hesitant, into
receiving the vaccines, but to allow them to make well-informed decisions about
their health, about their choices on vaccines.
The above observations and recommendations
have been stated based on findings as at the time of the conduct of this
survey, August 2021. With evolving
trends in the prevalence of virus variants, vaccine regimen recommendations,
and vaccine mandates imposed by some groups, organizations, and governments, it
will be correct to assume there also would be the observation of an evolving
change in the trend of theattitudes. Hence, ongoing
studies will continue to be recommended. Studies like these, though conducted
on a local scale, could serve as a reference for other ongoing studies, to
observe for changes and advocate for more recommendations.
Limitations
The
design of the questionnaire was deliberately truncated and aimed to;
1.
Engage
patients during their wait time, before their encounter with their primary care
provider.
2.
Researchers
were as brief as possible, to encourage more participation, hence straight to
the point. For this reason, questions were limited to only asking if any
vaccine had been taken. It did not probe further on which vaccines and several
doses.
3.
There
were English and Hispanic versions, some respondents of the Hispanic version
expressed difficulties in fully comprehending the questions and thus did not
fully engage in their questionnaires, this results in
a category of “unaccounted” under some variables, in our results.
Overall,
the results of the above-mentioned limit us to interpreting Acceptance as
respondents who had taken the vaccine and Hesitancy 14. as
respondents who had not taken the vaccine. It should be pointed out here that
several other studies would class those who had not fully been vaccinated with
a second dose (as at the time of this study) as hesitant. Thus, the description
of attitudes assigned to respondents of this survey is strictly for this
survey. Secondly, although there were considerable numbers of Hispanic
respondents that were subjected to the survey, due to the lack of an
interpreter, a considerable data information was left
out due to Hispanic respondents not fully understanding questions and how to
put them in writing. Finally, at the time at which the survey was conducted,
some possible respondents opted out of and avoided participation purely on
discovering the survey involved the subject of COVID - 19 vaccines, this might
have been due to pre-conceived misinformation, these non-respondents, I would
describe as a “silent category”, most likely would have identified as hesitant
and their concerns would have been interesting to know but were never expressed.
Another limitation, aside from the
aforementioned variables, is that several others will have implications on
perceived attitude towards the rollout of the vaccines, e.g., financial
implications, peer 15. influences, political
affiliations, etc. that were not explored. Thus, limiting our
projections and recommendations to ideas that were only expressed in the
survey.
A recommendation, therefore, is for a more
elaborate questionnaire designed to accommodate specifically an audience whose
subjects mostly have a language barrier and thus require aids for
interpretation and also have questions that throw more light on vaccination
status and introduce more variables that might pertain to the time, e.g.,
reflecting on policies involving mandates, etc.
Conflict of Interest:
Authors
have declared that there was no conflict of interest.
Grant:
The
researchers received no grant for the study.
Ethical
Consideration:
Subjects
for the research consented to the study in accordance with Hensinki
declaration (revised 13th edition)
Acknowledgement/Appreciation
Note
First
of all, we would acknowledge the provision of the Almighty Creator, who put the
team together and made it happen.
Thanks to Liz Coates, the Executive Director
of the Good News Clinic, Gainesville, and its entire staff, for the support
shown during the period of the survey at the clinic.
Our appreciation also
for the support from The Mother and Baby Care Global Foundation and Dr. Eli Sukarime, the Executive Director.
And thanks to Courage Osagie
for the assistance given to support the project.
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