Parental Willingness and Factors Influencing COVID-19 Vaccination for Children in Saudi Arabia

Figures & data

Table 1 Demographic Characteristics of Participants

Variable	N	%
Gender
Female	1579	74.2
Male	548	25.8
Age of parents
18–25	286	13.4
26–35	800	37.6
36–45	759	35.7
>45	282	13.3
Nationality
Saudi	2055	96.7
Non- Saudi	72	3.3
Region
Southern region	211	9.9
Eastern Region	646	30.4
Northern region	274	12.9
Western Region	554	26.0
Central Region	442	20.8
Marital status
Married	1975	92.9
Divorced	111	5.2
Widowed	41	1.9
Level of education
Uneducated	12	0.6
Primary school graduate	12	0.6
Middle school graduate	42	2.0
High school graduate	299	14.1
Diploma	214	10.1
Bachelor’s degree	1284	60.4
Master’s or Doctoral degree	264	12.4
Family income
<3000 SR*	136	6.4
3000–5000 SR*	311	14.6
5001–12,000 SR*	708	33.3
12,001–20,000 SR*	605	28.4
>20,000 SR*	367	17.3
Are you a healthcare worker?
Yes	337	15.8
No	1790	84.2
If yes, please specify:
Physician	119	35.3
Dentist	17	5.1
Nurse	89	26.4
Pharmacist	33	9.8
Others, specify:	79	23.4

Note: *SR; Saudi Riyals (1 SAR = $0.2666)*.

Table 2 Medical History of Children

Variable	N	%
Chronic illness
Yes	478	22.5
No	1649	77.5
Specify^#
Heart conditions	57	11.9
Autoimmune conditions	50	10.5
Breathing problems	177	37.0
Behavior issues	69	14.4
Obesity	167	34.9
Diabetes	64	13.4
Cancer	16	3.3
Allergy	46	9.6
Anemia	19	4.0
Other	41	8.6
Children Taking Medications
Yes	190	8.9
No	1871	88.0
Not sure	66	3.1
Up to Date on Vaccinations
Yes	1897	89.2
No	171	8.0
Not sure	59	2.8
Parents Agree with the Imposition of Those Vaccines for the Child/Children
Yes	2045	96.1
No	82	3.9
If not, specify the reason (n=167)^#
Religious reasons	14	8.4
Personal beliefs or philosophical reasons	21	12.6
Safety concerns	69	41.3
A desire for more information from healthcare providers	63	37.7
Child Receive the Yearly Flu Vaccine
Yes	540	25.4
No	1429	67.2
Not sure	158	7.4

Note: ^#Multiple responses.

Table 3 Attitudes and Practices of Parents Regarding COVID-19 Vaccination

Variable	N	%
Parents Received the COVID-19 Vaccine
Yes	1846	86.8
No	281	13.2
Parents Planned to Receive COVID-19 Vaccine
Yes	270	96.1
No	11	3.9
Parents Accepted the Vaccine for the Child/Children
Yes	1299	61.1
No	444	20.9
Not sure	384	18.1
If yes, specify the reason#
Protect the child	1094	51.4
Protect others	921	43.3
General vaccine acceptance	872	41.0
Perceived pandemic severity	1013	47.6
Desire to return to normal life	1033	48.6
High-risk child or family members (has medical illness)	532	25.0
If no, specify the reason#
Novelty	79	3.7
Perceived child not at risk of contracting COVID-19	281	13.2
Side effects/safety concerns	477	22.4
Vaccine refusal in general	157	7.4
Efficacy concerns	210	9.9
Perceived contraindications	44	2.1
Parents Had COVID-19 infection
Yes	575	27.0
No	1484	69.8
Not sure	68	3.2
The child Had a COVID-19 infection
Yes	428	20.1
No	1603	75.4
Not sure	96	4.5
Parents Know Someone Who Had/Has COVID-19
Yes	1709	80.3
No	381	17.9
Not sure	37	1.7
Parents Know Someone Who Had/Has Been Hospitalized with COVID-19
Yes	1468	69.0
No	628	29.5
Not sure	31	1.5
“The Age of Your Children Influence Your Decision to Allow Them to Receive a COVID-19 Vaccine when Available”
Yes	840	39.5
No	909	42.7
Not sure	378	17.8
Parents Worry that the Child Will Get Sick or Have Side Effects from a COVID-19 Vaccine.
Agree	1141	53.6
Neutral	659	31.0
Disagree	327	15.4
The Development of a COVID-19 Vaccine is too Rushed to Test its Safety Properly, “and” I Am Concerned about the Side Effects of a Future COVID-19 Vaccination.
Agree	1170	55.0
Neutral	620	29.1
Disagree	337	15.8
“If the Doctor Recommends That the Child Receives the COVID-19 Vaccine, Then the Child Will be Vaccinated”.
Agree	1273	59.8
Neutral	556	26.1
Disagree	298	14.0
Parents concerned about post-vaccination safety
Agree	1189	55.9
Neutral	361	17.0
Disagree	577	27.1
COVID-19 relapse will be life-threatening
Agree	1301	61.2
Neutral	402	18.9
Disagree	424	19.9
If WHO recommends then I will vaccinate my child only
Agree	589	27.7
Neutral	900	42.3
Disagree	638	30.0
I am not aware of and concerned about vaccine efficacy
Agree	1369	64.4
Neutral	386	18.1
Disagree	372	17.5
I am not aware of potential adverse effects
Agree	1411	66.3
Neutral	386	18.1
Disagree	330	15.5
Parents’ Agreement with the Imposition of COVID-19 Vaccine for Children as a Requirement to Attend School as a Precautionary Measure for Student Safety
Agree	1077	50.6
Disagree	543	25.5
Neutral	507	23.8
I am concerned about my child and family’s data safety
Agree	1159	54.5
Disagree	534	25.1
Neutral	434	20.4
COVID-19 vaccine will be protective for my child
Agree	853	40.1
Disagree	571	26.8
Neutral	703	33.1
Children after vaccination can safely return to school in normal health status
Agree	500	23.5
Disagree	1100	51.7
Neutral	527	24.8

Note: ^#Multiple responses.

Figure 1 Analyzing medical records of children, attitudes, and awareness of parents concerning gender.

Figure 2 Analyzing medical records of children, attitudes, and awareness of parents concerning age.

Figure 3 Analyzing medical records of children, attitudes, and awareness of parents concerning level of education.

Table 4 Association of Demographic Characteristics with the Willingness to COVID-19 Vaccination for Their Children

Variable	Parents Accepting the Vaccine for the Child/Children			p-value
	No	Not Sure	Yes
Gender
Female	345	304	930	0.002*
	77.7%	79.2%	71.6%
Male	99	80	369
	22.3%	20.8%	28.4%
Age of parents
18–25	52	38	196	0.068
	11.7%	9.9%	15.1%
26–35	176	156	468
	39.6%	40.6%	36.0%
36–45	160	145	454
	36.0%	37.8%	34.9%
>45	56	45	181
	12.6%	11.7%	13.9%
Nationality
Saudi	419	370	1266	0.016*
	94.4%	96.4%	97.5%
Non- Saudi	25	14	33
	5.6%	3.6%	2.5%
Region
Southern region	29	29	153	0.0001**
	6.5%	7.6%	11.8%
Eastern Region	107	108	431
	24.1%	28.1%	33.2%
Northern region	56	42	176
	12.6%	10.9%	13.5%
Western Region	146	121	287
	32.9%	31.5%	22.1%
Central Region	106	84	252
	23.9%	21.9%	19.4%
Marital status
Married	414	353	1208	0.132
	93.2%	91.9%	93.0%
Divorced	26	25	60
	5.9%	6.5%	4.6%
Widowed	4	6	31
	0.9%	1.6%	2.4%
Level of education
Uneducated	3	2	7	0.001*
	0.7%	0.5%	0.5%
Primary school graduate	3	3	6
	0.7%	0.8%	0.5%
Middle school graduate	10	0	32
	2.3%	0.0%	2.5%
High school graduate	50	42	207
	11.3%	10.9%	15.9%
Diploma	35	51	128
	7.9%	13.3%	9.9%
Bachelor’s degree	287	237	760
	64.6%	61.7%	58.5%
Master’s or Doctoral degree	56	49	159
	12.6%	12.8%	12.2%
Family income
<3000 SR	32	23	81	0.117
	7.2%	6.0%	6.2%
3000–5000 SR	67	67	177
	15.1%	17.4%	13.6%
5001–12,000 SR	154	135	419
	34.7%	35.2%	32.3%
12,001–20,000 SR	106	103	396
	23.9%	26.8%	30.5%
>20,000 SR	85	56	226
	19.1%	14.6%	17.4%
Are you a healthcare worker?
No	385	331	1074	0.061
	86.7%	86.2%	82.7%
Yes	59	53	225
	13.3%	13.8%	17.3%

Notes: *Significant value. **Highly significant value.

Table 5 Association of Parents’ Attitudes and Practices Towards COVID-19 Vaccination with the Willingness to COVID-19 Vaccination for Their Children

Variable	Parents Accepting the Vaccine for the Child/Children			p-value
	No	Not Sure	Yes
Parents Received the COVID-19 Vaccine
No	131	65	85	0.0001**
	29.5%	16.9%	6.5%
Yes	313	319	1214
	70.5%	83.1%	93.5%
Parents Had COVID-19
Yes	106	108	361	0.388
	23.9%	28.1%	27.8%
No	322	261	901
	72.5%	68.0%	69.4%
Not sure	16	15	37
	3.6%	3.9%	2.8%
Child Had COVID-19
Yes	67	77	284	0.016*
	15.1%	20.1%	21.9%
No	358	284	961
	80.6%	74.0%	74.0%
Not sure	19	23	54
	4.3%	6.0%	4.2%
Parents Know Someone Who Has COVID-19
Yes	357	299	1053	0.400
	80.4%	77.9%	81.1%
No	81	74	226
	18.2%	19.3%	17.4%
Not sure	6	11	20
	1.4%	2.9%	1.5%
Parents Know Someone Who Has Been Hospitalized with COVID-19
Yes	281	257	930	0.0001**
	63.3%	66.9%	71.6%
No	156	113	359
	35.1%	29.4%	27.6%
Not sure	7	14	10
	1.6%	3.6%	0.8%
“The Age of Your Children Influence Your Decision to Allow Them to Receive a COVID-19 Vaccine when Available”
Yes	284	229	327	0.0001**
	64.0%	59.6%	25.2%
No	113	39	757
	25.5%	10.2%	58.3%
Not sure	47	116	215
	10.6%	30.2%	16.6%
Parents Worry that the Child Will Get Sick or Have Side Effects from a COVID-19 Vaccine.
Agree	309	267	565	0.0001**
	69.6%	69.5%	43.5%
Disagree	46	14	267
	10.4%	3.6%	20.6%
Neutral	89	103	467
	20.0%	26.8%	36.0%
The Development of a COVID-19 Vaccine is too Rushed to Test its Safety Properly, “and” I Am Concerned about the Side Effects of a Future COVID-19 Vaccination.
Agree	376	283	511	0.0001**
	84.7%	73.7%	39.3%
Disagree	25	11	301
	5.6%	2.9%	23.2%
Neutral	43	90	487
	9.7%	23.4%	37.5%
If the Doctor Recommends That the Child Receive the COVID-19 Vaccine, then the Child Will be Vaccinated.
Agree	45	142	1086	0.0001**
	10.1%	37.0%	83.6%
Disagree	239	24	35
	53.8%	6.3%	2.7%
Neutral	160	218	178
	36.0%	56.8%	13.7%
Parents’ Agreement with the Imposition of COVID-19 Vaccine for Children as a Requirement to Attend School as a Precautionary Measure for Student Safety
Agree	40	81	956	0.0001**
	9.0%	21.1%	73.6%
Disagree	316	130	97
	71.2%	33.9%	7.5%
Neutral	88	173	246
	19.8%	45.1%	18.9%

Notes: *Significant value. **Highly significant value.

Table 6 Multivariate Analysis

Effect		Value	F	Hypothesis df	Error df	Sig.	Partial Eta Squared
Gender	Pillai’s Trace	0.444	83.754b	20.000	2097.000	0.000	0.444
	Wilks’ Lambda	0.556	83.754b	20.000	2097.000	0.000	0.444
	Hotelling’s Trace	0.799	83.754b	20.000	2097.000	0.000	0.444
	Roy’s Largest Root	0.799	83.754b	20.000	2097.000	0.000	0.444
Age	Pillai’s Trace	1.997	209.031	60.000	6297.000	0.000	0.666
	Wilks’ Lambda	0.008	425.898	60.000	6257.135	0.000	0.802
	Hotelling’s Trace	22.013	768.859	60.000	6287.000	0.000	0.880
	Roy’s Largest Root	17.429	1829.222c	20.000	2099.000	0.000	0.946
Level of Education	Pillai’s Trace	1.438	33.129	120.000	12,612.000	0.000	0.240
	Wilks’ Lambda	0.122	44.446	120.000	12,126.852	0.000	0.296
	Hotelling’s Trace	3.543	61.867	120.000	12,572.000	0.000	0.371
	Roy’s Largest Root	2.556	268.686c	20.000	2102.000	0.000	0.719

Abbreviations: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; HCPs, healthcare providers; HBM, health belief model; IRB, institutional review board; SPSS, statistical package for social science; WHO, world health organization.