Knowledge, attitudes, and behaviors toward COVID-19 vaccination in a sample of Italian healthcare workers

Figures & data

Table 1. 5-option Likert scale used to evaluate agreement or disagreement for each specific item of the survey.

Option	Score for questions in favor of vaccination	Score for questions against vaccination
Totally agree	5	1
Partially agree	4	2
Neither agree nor disagree	3	3
Partially disagree	2	4
Totally disagree	1	5

For each question, the respondents had to choose one of 5 ordinal categories of agreeability, which was then translated into a numeric value between 1 and 5, with 1 expressing maximum disagreeability and 5 expressing maximum agreeability toward vaccination.

Table 2. Questions included in the statistical analysis as outcome variables.

Please express your opinion regarding the following statements:
General hesitancy	Q17	Vaccines are scientifically proven and are among the safest pharmaceutical products
	Q19	Vaccines represent an indispensable tool for the protection of individual and public health
	Q20	Vaccines have a negligible impact on the spread of infectious diseases
COVID-19 hesitancy	Q21	The risk of complications from COVID-19 disease is greater than the risk of serious adverse effects from COVID-19 vaccine
	Q22	It is preferable to acquire immunity against SARS-CoV-2 by contracting the infection rather than by vaccination
	Q23	There is insufficient evidence on the efficacy and safety of COVID-19 vaccines due to their rapid development
	Q25	The COVID-19 vaccine is effective in preventing COVID-19
Refusal of obligations	Q26	It is appropriate to provide for work restrictions for those who, although not presenting medical-health impediments, refuse to be vaccinated against COVID-19
	Q27	The COVID-19 vaccine should be made mandatory for healthcare professionals

Figure 1. Results of the multivariable logistic regression in form of forest plots of odds ratios with 99% confidence intervals.

* p < 0.01, ** p < 0.001

Table 3. Results of the multivariable logistic regression in form of odds ratio with 99% confidence intervals in brackets.

		General hesitancy	COVID-19 hesitancy	Refusal of obligations
Socio-demographic variables
Gender	Female	1 [1,1]	1 [1,1]	1 [1,1]
	Male	0.913 [0.623,1.337]	0.827 [0.615,1.113]	0.742 [0.507,1.088]
Age		1.011 [0.996,1.026]	1.018** [1.006,1.030]	0.994 [0.979,1.008]
Professional category	Not physician	1 [1,1]	1 [1,1]	1 [1,1]
	Physician	1.062 [0.627,1.796]	0.708 [0.477,1.052]	1.053 [0.622,1.782]
Education level	Primary or secondary	1 [1,1]	1 [1,1]	1 [1,1]
	Undergraduate	0.715 [0.311,1.647]	0.438* [0.200,0.962]	0.767 [0.318,1.850]
	Graduate	0.408* [0.172,0.967]	0.368** [0.170,0.800]	0.404 [0.161,1.010]
	Post-graduate	0.308*** [0.132,0.718]	0.361** [0.169,0.772]	0.576 [0.240,1.385]
COVID-19-related variables
Self-rated fear of COVID-19		0.945* [0.903,0.990]	0.943** [0.909,0.979]	0.883*** [0.844,0.924]
Advising COVID-19 vaccination to patients	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.300* [0.113,0.798]	0.103** [0.0314,0.341]	0.174** [0.0636,0.476]
Advising COVID-19 vaccination to relatives	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.150** [0.0561,0.400]	0.241* [0.0771,0.756]	0.102** [0.0356,0.293]
Self-rated knowledge about COVID-19 vaccines		0.914 [0.812,1.029]	0.828** [0.751,0.912]	0.917 [0.814,1.033]
Information sources about COVID-19 vaccines
Institutional sources	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.231** [0.107,0.499]	0.481 [0.223,1.036]	0.511 [0.211,1.240]
Social media	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.815 [0.278,2.389]	1.209 [0.570,2.564]	1.155 [0.443,3.006]
Colleagues	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.906 [0.615,1.335]	1.366* [1.019,1.833]	1.112 [0.760,1.626]
Health-related variables
Previous flu vaccination	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.606* [0.402,0.914]	0.579** [0.413,0.813]	0.636* [0.420,0.963]
Previous SARS-CoV-2 infection	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	0.973 [0.575,1.649]	1.004 [0.654,1.542]	1.076 [0.644,1.796]
Presence of chronic diseases	No	1 [1,1]	1 [1,1]	1 [1,1]
	Yes	1.022 [0.690,1.514]	1.150 [0.850,1.557]	1.259 [0.852,1.860]
	N	1998	1998	1998

* p < .01, ** p < .001.

Table 4. Agreement or disagreement to single questions contributing to general scores.

Score	Question	Partial or complete disagreement (percentage)	Partial or complete agreement (percentage)	Hesitancy Score
General hesitancy	Q17 Vaccines are scientifically proven and are among the safest pharmaceutical products	8.3	91.7	17.0%
	Q19 Vaccines represent an indispensable tool for the protection of individual and public health	3.0	97.0
	Q20 Vaccines have a negligible impact on the spread of infectious diseases	91.5	8.5
COVID-19 hesitancy	Q21 The risk of complications from COVID-19 disease is greater than the risk of serious adverse effects from COVID-19 vaccine	10.0	90.0	32.3%
	Q22 It is preferable to acquire immunity against SARS-CoV-2 by contracting the infection rather than by vaccination	94.4	5.6
	Q23 There is insufficient evidence on the efficacy and safety of COVID-19 vaccines due to their rapid development	89.1	10.9
	Q25 The COVID-19 vaccine is effective in preventing COVID-19	7.5	92.5
Refusal ofobligations	Q26 It is appropriate to provide for work restrictions for those who, although not presenting medical-health impediments, refuse to be vaccinated against COVID-19	16.4	83.6	18.7%
	Q27 The COVID-19 vaccine should be made mandatory for healthcare professionals	10.5	89.5
Not included in any score	Q18 Vaccines can cause serious side effects	49.3	50.7	-
	Q24 COVID-19 vaccines approved in Italy to date are comparable in terms of efficacy and safety	34.6	65.4	-

Table 5. Descriptive analysis of the sample.

Variable		Frequency
Gender	M	1,007 (47.0%)
	F	1,125 (52.5%)
	Not specified	10 (0.5%)
Age	15-25	40 (1.9%)
	26-35	327 (15.3%)
	36-45	299 (14.0%)
	46-55	399 (18.6%)
	56-65	601 (28.0%)
	66-75	436 (20.3%)
	76-85	36 (1.7%)
	86-95	4 (0.2%)
Level of education	Elementary diploma	2 (0.1%)
	Middle school diploma	6 (0.3%)
	Upper secondary education diploma	82 (3.8%)
	Bachelor’s degree	214 (10.0%)
	Master’s degree	534 (24.9%)
	Specialization or PhD	1,304 (60.9%)
Health profession	Physician	1,538 (71.8%)
	Dentist	171 (8.0%)
	Nurse	275 (12.8%)
	Chemist	3 (0.1%)
	Healthcare assistants (OSS)	19 (0.9%)
	Other	136 (6.4%)
Work setting	Hospital	692 (32.3%)
	Teaching hospital	261 (12.2%)
	Specialist outpatient clinic	146 (6.9%)
	Private activity	673 (31.4%)
	General practice	172 (8.0%)
	Public health district	200 (9.3%)
	Extended care	52 (2.4%)
	Home care	44 (2.1%)
	Outpatient first aid	22 (1.0%)
	Research institution	84 (4.0%)
	Other	266 (12.4%)
Work department (physicians)	Medicine	605 (39.3%)
	Surgery	194 (12.6%)
	Diagnosis and Therapy	190 (12.4%)
	Public health	173 (11.2%)
	General Practice	149 (9.7%)
	Other	228 (14.8%)
Work department (nurses)	Medicine	103 (37.5%)
	Surgery	30 (10.9%)
	Emergency unit	48 (17.5%)
	Primary care and public health	22 (8.0%)
	Mental Health	7 (2.5%)
	Other	65 (23.6%)
Chronic diseases	Yes	708 (33.0%)
	No	1,434 (67.0%)
Previous SARS-CoV-2 infection	Yes, asymptomatic	50 (2.3%)
	Yes, mild-moderate symptoms	197 (9.2%)
	Yes, severe symptoms and hospitalization	20 (0.9%)
	No	1,875 (87.6%)