Knowledge, attitudes and behaviors of Inonu University faculty members regarding childhood vaccine refusal

ABSTRACT

Introduction

Although there is a lot of scientific evidence that the benefits of vaccines outweigh their risks, hesitancy about the safety of vaccines can occur in every segment of the community. In this study, we aimed to determine the knowledge, attitudes, and associated factors of vaccine hesitancy among Inonu University faculty members regarding childhood vaccinations.

Method

This is a cross-sectional study, and 258 faculty members were included in the study. The questionnaire used in the study explored the sociodemographic characteristics of the faculty members and their knowledge, attitudes and behaviors regarding childhood vaccination. A chi-square test and a fisher exact test were used for statistical analysis.

Results

Of the faculty members, 31.8% were hesitant about childhood vaccines, 51.9% stated that there were studies reporting the side effects of vaccines, 48.1% did not agree with giving booster doses of vaccines, 35.7% stated that vaccines could cause autism due to the chemicals contained in the vaccines. The most important information sources of university faculty regarding childhood vaccines members are scientific publications and health professionals.

Conclusions

Faculty members level of hesitancy about vaccines was high and since health professionals and scientific articles are the most important information sources of faculty members, misinformation here may affect their knowledge, attitudes and behaviors about vaccination.

KEYWORDS:

• Vaccine
• vaccination refusal
• knowledge
• faculty member
• hesitancy

Introduction

Vaccination is an important public health intervention. It aims to reduce mortality and morbidity by preventing the emergence of vaccine-preventable diseases in communities. The World Health Organization (WHO) considers vaccination services one of the most important. It is cost-effective interventions for the prevention of vaccine-preventable diseases and related deaths.¹ In addition to the individual immunity obtained by vaccination, herd immunity is another objective.²

Despite the gains made with vaccines, the concepts of ‘vaccine hesitancy and refusal’ have emerged over time in the world Vaccination refusal is a situation where an individual does not accept any vaccine voluntarily. Vaccine hesitancy is a behavior in which individuals accept some vaccines while rejecting or delaying others.³ As a result of the decrease in vaccination rates worldwide, the annual measles incidence, which was decreasing during the 2000–2016 period, entered an increasing trend in the 2017–2019 period. In 2019, the number of measles cases reported worldwide reached the highest level in the last 23 years.⁴ Vaccine hesitancy and refusal have increased over the years in Turkey in parallel with their situation in the rest of the world. According to the 2018 Turkey Demographic and Health Survey, the rate of children vaccinated according to their age is 67%.⁵

In a comprehensive study on the causes of increasing hesitancy toward childhood vaccinations in Turkey and possible solutions, researchers determined that to reduce vaccine refusal in society, academics and those working in public institutions and organizations related to the subject should organize social awareness trainings through various means such as social media and mass media.³ There is no study in the literature examining the knowledge, attitudes and behaviors of university faculty members regarding childhood vaccinations. University faculty members can be considered thought leaders who are respected in society and who can be taken as examples with their knowledge, attitudes and behaviors. For these reasons, it is important to determine the knowledge, attitudes and behaviors of faculty members about vaccine hesitancy and refusal, as they are the cornerstone of higher education, have respectable places in society and guide future generations.

The aim of this study is to determine the knowledge, attitudes, vaccine hesitancy and associated factors of vaccine hesitancy among Inonu University faculty members regarding childhood vaccination.

Materials and methods

This study was designed as a descriptive cross-sectional study and carried out between July and August 2019. Written permission was obtained from the Rectorate of Inonu University and the Scientific Research and Publication Ethics Committee of Inonu University (2019/250).

There were 799 faculty members working at Inonu University at the time of the research. When the ‘yes’ answer to the question “I do not trust the vaccine producing companies” of the pilot study was taken as 56% with a 95% confidence interval and 80% power, the sample size was calculated as 258.⁶ A stratified sampling method was used according to the type of department where the faculty members worked. There were 258 people working as faculty members at Inonu University, who agreed to participate in the study and filled out the questionnaires completely.

A questionnaire form consisting of 26 questions that was created by the researchers based on a literature review was distributed to be filled out by the university faculty members.^7–15 The first part of the questionnaire included questions on the sociodemographic characteristics of the faculty members, and the second part included questions determining the knowledge, attitudes and behaviors of faculty members regarding childhood vaccine refusal. Triple Likert-type (Agree- Disagree- Undecided) questions were used to determine their knowledge, attitudes and behaviors regarding childhood vaccines. In addition, in this study, vaccination hesitancy behavior of faculty members was tried to be determined with the question “Do you have any hesitancy about childhood vaccinations?” The independent variables of the study were sociodemographic characteristics of the faculty members and their children as well as the answers given to the questions about their knowledge and behaviors regarding childhood vaccinations, whereas the dependent variable was the hesitancy status of faculty members about childhood vaccinations.

The data of the study were analyzed with the SPSS 22.0 package program. Number (n) and percentage (%) were used to present descriptive data. A chi-square, a fisher exact test were used for statistical analysis. A result of p < .05 was considered significant in all evaluations.

Results

As shown in Table 1 68.9% of the faculty members participating in the research were male, 85.3% were married. Of the faculty members participating in the study, 44.6% worked in health sciences department, 19.8% worked in science department, and 35.6% worked in social sciences department.

Table 1. Distribution of sociodemographic characteristics of faculty members participating in the study

Sociodemographic characteristics	n	%
Age
≤34	31	13.1
35–44	94	39.8
45–54	80	34.0
≥55	31	13.1
Faculty
Health Sciences	115	44.6
Science	51	19.8
Social Sciences	92	35.6
Gender
Female	80	31.1
Male	177	68.9
Title
Professor	83	32.7
Associate professor	64	25.2
Doctor Lecturer	107	42.1
Has a child
Yes	216	84.0
No	41	16.0

31.8% of the faculty members participating in the study stated that they were hesitant about childhood vaccinations, 42.6% had not read any scientific publications on the subject of vaccination and 99.1% stated that their children had received all infancy/childhood vaccinations.

When faculty members were asked about sources of information about vaccines, 49.4% stated scientific articles, 46.7% stated family physicians, 31.5% stated the internet, 31.5% stated school education, 31.1% stated family and friends, 21.8% stated television, and 19.8% stated books.

As shown in Table 2 51.9% of the faculty members stated that there are studies reporting the side effects of vaccines, and 24.9% stated that they do not trust companies that produce vaccines. In addition, 48.1% stated that they should not give booster doses of vaccines, 35.7% stated that vaccines could cause autism due to the chemicals contained in vaccines, and 31.4% were undecided about vaccines causing infertility.

Table 2. Distribution of the answers given to the questions for knowledge, attitudes and behavior of faculty members participating in the study regarding childhood vaccines

Knowledge, attitudes and behavior	Agree		Disagree		Undecided
	n	%	n	%	n	%
Knowledge
There are studies reporting side effects of vaccines.	134	51.9	32	12.4	92	35.7
There are no studies proving the reliability of vaccines.	39	15.1	143	55.4	76	29.5
Complementary and alternative medicine is more effective and has fewer side effects.	30	11.8	164	64.6	60	23.6
Vaccines cause infertility.	5	1.9	172	66.7	81	31.4
Children’s immune systems are not yet fully developed and vaccinations damage the immune system.	13	5.1	178	69.5	65	25.4
Behavior
I do not trust companies that produce vaccines.	64	24.9	107	41.6	86	33.5
Attitude
Booster doses should not be given.	23	8.9	111	43.0	124	48.1

In Table 3 can see that the hesitancy status of faculty members working in health sciences was significantly lower than the hesitancy status of faculty members working in science and social sciences (p = .001). The hesitancy status of the faculty members who wanted to wait when a new vaccine came out and see others have it done (34.2%) was significantly higher compared to those who thought that there was no need to wait and instead would get the vaccination first (17.1%) (p < .05).

Table 3. Comparison of hesitancy status of faculty members participating in the study according to various variables

	Vaccine hesitant		Vaccine acceptance		p
	n	%	n	%
Faculty					0.001
Health Sciences^a	23	20.0	92	80.0
Science	18	36.0	32	64.0
Social Sciences	40	44.4	50	55.6
Reading Scientific Publications on Vaccination(Behavior)					<0.001
Yes	34	23.0	114	77.0
No	47	43.9	60	56.1
Getting Vaccinated First When a New Vaccine Is Available(Behavior)					0.044
Yes	6	17.1	29	82.9
No	75	34.2	144	65.8

^aDifferent from Science and Social Sciences.

As shown in Table 4, those who thought that the chemicals in vaccines caused autism and those who were undecided were found to be significantly more worried about childhood vaccines than those who did not believe vaccines caused autism and were undecided compared to those who did not trust the drug producing companies and those who were undecided compared to those who thought that there were not enough studies on the safety of vaccines and those who were undecided (p < .05).

Table 4. Comparison of faculty members’ knowledge, attitudes and behaviors regarding childhood vaccinations and their hesitancy status

	Vaccine hesitant		Vaccine acceptance
	n	%	n	%	p
Chemicals in vaccines cause autism.
Agree	13	68.4	6	31.6	<0.001
Disagree^a	19	13.0	127	87.0
Undecided	49	54.4	41	45.6
I don’t trust companies that produce vaccines
Agree	41	65.1	22	34.9	<0.001
Disagree^a	14	13.2	92	86.8
Undecided	26	30.6	59	69.4
Children’s immune systems are not yet fully developed and vaccinations damage the immune system.
Agree	10	76.9	3	23.1	<0.001
Disagree^a	32	18.0	146	82.0
Undecided	39	62.9	23	37.1
Studies proving the safety of vaccines are insufficient
Agree	21	56.8	16	43.2	<0.001
Disagree^a	24	16.8	119	83.2
Undecided	36	48.0	39	15.3
A booster dose should not be given in vaccination
Agree	9	39.1	14	60.9	<0.001
Disagree^a	16	14.5	94	85.5
Undecided	56	45.9	66	54.1

^aDiffer from each other.

Discussion

The childhood vaccination rate in Turkey is over 95%.¹⁶ Consistent with the literature, almost all the faculty members participating in our study stated that their children had all childhood vaccinations. In a study conducted with Finnish healthcare workers, a large number of the participants (95.9%) stated that they accepted all childhood vaccinations.¹⁷ In another study conducted with individuals over the age of 18, the acceptance rate of recommended vaccines was found to be lower (72.7%).¹⁸ Vaccine acceptance rate was also high among university faculty members, just like with health workers, since they were more educated on vaccination.

In the present study, 31.8% of the faculty members in the present study stated that they were hesitant about childhood vaccines. The hesitancy status of faculty members working in health sciences was significantly lower. In another study, 25.6% of pediatric health professionals in the Barcelona public primary care centers expressed concern about at least one vaccine in the vaccination calendar.⁶ In a survey of Finnish healthcare workers, 13% were concerned about child vaccinations.¹⁷ In a study conducted in Turkey at a university hospital, 10.5% of physicians were hesitant about the vaccines recommended by the Expanded Program on Immunization.¹⁹ Health workers believe more in the usefulness and safety of vaccination.²⁰ Furthermore, another study found that trust is associated with high education level.^21,22 It is thought-provoking that university faculty members have a higher rate of childhood vaccination hesitancy than other groups. Hesitancy can be relieved by adopting scientific publications that provide evidence-based information and are the main sources of information on vaccines, since faculty members represent both the professional and intellectual parts of society.

In a study conducted on parents in Turkey, it was found that majority of the participants believed that alternative/complementary medicine could replace vaccination.²³ Similarly, in the present study, the hesitancy status of faculty members who applied alternative and complementary medicine methods to their children was found to be significantly higher than those who did not. In a study conducted on parents in Australia, it was observed that those who refused vaccination resorted to alternative medicine methods more frequently, and individuals stated that complementary medicine methods were more natural and reliable methods without chemicals and side effects, and without the monetary concern of drug companies.²⁴ For these reasons, it should not be forgotten that alternative and complementary medicine may have a place in the treatment of some diseases, but primary prevention methods should be the basis of treatment in infectious diseases.

In many studies, it has been determined that the parents’ sources of information about vaccines are healthcare professionals, the internet and television/radio programs.^18,25–27 The participants were asked about their information sources regarding vaccines and we found that the internet/television programs were among these sources. However, academic publications and books should be the most important source of information for academicians advancing in the field of science. In addition, nearly half of the faculty members stated that they had not read any scientific publications on vaccines. The media and the internet were sources that gave more weight to personal opinions, often not based on scientific knowledge, compared to scientific studies proving the safety and efficacy of vaccines. Such misinformation can cause hesitancy in parents. According to a study conducted in Turkey, the number of newspaper articles with negative content about vaccines has increased over the years, and social media has become a platform for anti-vaccination campaigns.³ For this reason, faculty members should use the right sources of information about vaccines to reduce vaccine hesitancy.

Prior study has been shown that the beliefs of healthcare professionals regarding the benefits and safety of vaccines is proportional to the duration of the medical education they received.⁸ A study conducted in Poland showed, that individuals with a higher education level exhibited a more pro-vaccine attitude.²⁸ In the present study, the hesitancy status of faculty members working in the field of health sciences and faculty members whose sources of information were scientific articles, school education and family doctors was lower. It was expected that the status of hesitancy would be lower since the faculty members working in the field of health could distinguish the correct information in their own branches.

A study on pediatric doctors and nurses regarding childhood vaccines found that participants were more likely to trust vaccines used for a longer time than newer vaccines.⁶ This result is consistent with the present study. To reduce the lack of trust that may occur against new vaccines, the results of studies on the safety of vaccines should be presented accurately and clearly by sources trusted by the society.

In the present study, we observed that faculty members who thought that the chemicals in vaccines caused autism were significantly more hesitant about childhood vaccines. Due to the increase in the number of autism diagnoses over the years, many factors have been investigated, and claims were raised that this increase was caused by vaccines. However, there is no study in the literature positively linking a vaccine with autism. As a result of these concerns, it was emphasized again that the measles, rubella and mumps vaccines did not cause autism.^29,30

In the present study, participants who did not trust the companies producing vaccines were found to be significantly more hesitant about childhood vaccines. In a similar study examining parental attitudes, beliefs, behaviors and concerns about child vaccinations in Australia, individuals who did not trust vaccines were found to be seven times more hesitant.²⁶ Concerns that have arisen as a result of this distrust toward vaccines may lead to a decrease in vaccination rates.

An increase in vaccination and a decrease in vaccine refusal can be achieved more easily with the cooperation of different sectors. In order to combat communicable diseases nationally and globally, vaccine hesitancy and refusal, the biggest obstacle to vaccination, must be eliminated. Stakeholders such as the health sector, universities and other educational institutions, and the media can work together on this issue to prevent vaccine hesitancy and refusal caused by misinformation. In addition, preventing the spread of distrust in the pharmaceutical industry and false information about the content of drugs can also be achieved through this joint effort. We found that the most important information sources of university faculty members are scientific publications and health professionals. For this reason, health professionals and scientific articles have a significant impact on the knowledge, attitudes, and behaviors of faculty members regarding vaccination.

However, it is necessary to reduce the anxiety level of faculty members about childhood vaccinations, to be informed correctly and to ensure that their attitudes are more positive.

This study has several limitations: First, the study was conducted in only one university. Secondly, the health science department would be expected to have more knowledge on the subject of vaccines compared to those in social science. Thirdly, the questionnaire form used in the study did not have a certain validity and reliability.

Acknowledgments

We would like to thank all of the faculty members who participated in this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.