https://orcid.org/0000-0002-1748-0413
ABSTRACT
Medical and dental professionals should continue to adhere to preventive measures after COVID-19 vaccination due to their increased risk of exposure to the virus, particularly as new variants emerge that may heighten their risk perception and susceptibility. Therefore, this study aimed to explore the effects of COVID-19 vaccination on complacency to adherence to COVID-19 preventive behavioral measures and mental health among medical and dental professionals. In this cross-sectional study 410 medical and dental professionals were recruited from different medical and dental hospitals in Islamabad, Pakistan. The data was collected using a valid and reliable questionnaire comprising of three sections (socio-demographic, information of preventive behaviors performance against COVID-19 after vaccination, mental health status). A chi-square test and ordinal logistic regression were used for analysis. Post COVID-19 vaccination there was decrease in the frequency of use of hand washing, sanitizers (70.2%), and social distancing (60.5%), however greeting with a handshake (58.8%) and use of public transport (45.9%) seen upward trend among participants. Only face mask usage post-vaccination was statistically significant (p < .05) in association with age, marital status, and years of working Experience. The greatest decrease in the usage of masks after COVID-19 vaccination was seen in age group of 10–30 (41.7%) and working experience group of 0–5 years (39.7%). All the preventive behaviors are statistically significant (p < .05) associated with the mental status of the participants except online shopping and use of public transport. These results indicate the presence of vaccination-induced complacency in adherence to COVID-19 preventive behavioral measures among healthcare professionals.
Introduction
Since the beginning of the COVID-19 pandemic, nations worldwide have developed and implemented a range of behavioral preventive measures to mitigate the spread of the virus.Citation1 These behavioral preventive measures included the use of personal protective equipment (PPE) (facemask, gloves, gowns, shoe covers, head covers, respirators, eye protection, face shields, goggles, etc.), maintaining social distance and self-quarantine and isolation.Citation1,Citation2 The efficacy of these protective behaviors in curtailing virus transmission has positioned them as central tenets of global health policies aimed at combating the pandemic. In some countries, strict measures were implemented like lockdowns and curfew to ensure compliance with these behavioral preventive measures.Citation2 However, with the development and mass vaccination of the COVID-19 vaccine, doubts started to arise about the possible changes in the behavior and attitude of people with various preventive measures. Literature has shown empirical evidence suggesting the reduction of adherence to preventive measures following the vaccine rollout of various diseases.Citation3 Following the changes in behaviors after the Lyme disease vaccine rollout, it was observed that the use of light-colored clothing and tick repellent decreased and similarly people started to interact more and in large groups after influenza vaccination.Citation4 Given the lower perceived health risks, vaccinated individuals usually tend to feel less motivated to comply with strict preventive measures. However, in COVID-19 case several factors warrant careful consideration. Firstly, the complete effectiveness of available vaccines remains to be definitively established, and immediate attainment of herd immunity is not guaranteed. Secondly, the rapid evolution of the COVID-19 virus, characterized by emerging variants and evolving clinical presentations, presents a dynamic challenge for which vaccination may not provide comprehensive immunity.Citation5
Medical and dental professionals face elevated vulnerability and heightened risk of contracting the COVID-19 virus due to their frequent and close interactions with both confirmed and suspected infected patients, leading to significant occupational exposure.Citation6,Citation7 In many countries, such as the USA and China, healthcare workers (HCWs) represented a significant proportion of COVID-19 cases during the early stages of the pandemic. For instance, in 2020, HCWs accounted for 19% of total COVID-19 infections in the USA and approximately 5% in China,Citation8–10 Studies have indicated that HCWs comprised around 10% of total COVID-19 cases during the initial phase of the pandemic.Citation9 Given their heightened risk of infection, it is imperative for HCWs to maintain adherence to behavioral preventive measures even after COVID-19 vaccination, especially considering their perceived susceptibility to emerging variants of the virus.Citation11,Citation12 Mental health significantly influences behavior, particularly in high-stress environments such as the healthcare sector during a pandemic. Research indicates that mental health concerns among healthcare workers have escalated due to the COVID-19 pandemic, affecting their well-being and their adherence to preventive behaviors.Citation12,Citation13 Given the dual role of healthcare professionals, both as recipients and administrators of the COVID-19 vaccine, their mental health status can critically influence their perception and attitudes toward vaccination. This, in turn, affects their compliance with ongoing preventive measures. A decline in mental health often manifested as increased stress or anxiety, can lead to complacency due to cognitive overload or burnout.Citation11,Citation14
Understanding changes in behavior and adherence to preventive measures alongside mental health status post-vaccination provides a holistic view of the factors influencing health policy adherence during and after the pandemic, offering insights that are critical for planning future public health strategies. However, there remains a notable dearth of studies examining compliance, mental health status and behavioral changes following COVID-19 vaccination among medical and dental professionals. Therefore, the objective of this study is to investigate how COVID-19 vaccination impacts compliance with preventive behavioral measures and mental health status of medical and dental professionals, specifically focusing on the aspect of complacency.
Methods
This cross-sectional study was carried out on medical and dental professionals in Pakistan spanning from March 10, 2022, to February 25, 2023. The ethical approval of this study was obtained from the Ethical Review Board of the Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad Pakistan (Reference no.F.116/22/SZABMU/ERB). Participation was voluntary and written consent was taken from all the participants after explaining to them the purpose of the study. The sample size calculation was conducted under the assumption that 50% of registered Medical and Dental Practitioners in Pakistan (n ≈ 274994) would not adhere to COVID-19 preventive behavioral measures post-vaccination, with a confidence level of 95% and a margin of error of 5%, showed that a total of 385 subjects were needed. To accommodate potential refusal and incomplete responses, a total of 425 subjects were recruited. For this study, medical and dental professionals were recruited using convenient sampling from different medical and dental hospitals in Islamabad, Pakistan. Those medical and dental professionals were selected who were working actively, had degrees in either Medicine or dentistry, were able to understand English, and had no medical conditions. The questionnaire used for assessing complacency to adherence to preventive behavioral measures after COVID-19 vaccination among medical and dental healthcare professionals was adopted from Yuan et al.Citation15 To ensure the questionnaire’s validation and relevance to our study objectives and population, an expert panel consisting of four members (Associate and Assistant Professors of Infectious Diseases, Assistant Professor of Epidemiology, and Assistant Professor of Public Health) reviewed the questionnaire items. Their feedback was incorporated into the final version of the questionnaire. The internal consistency reliability of the questionnaire was evaluated using Cronbach’s alpha coefficient (0.83) which indicated high internal consistency. The first section collected socio-demographic information such as age (18–30, 31–40, 41–50, >51 years), gender (Male, Female), marital status (Single/Divorced, Married), type of health care worker (Medical, Dental), years of working experience (0–5, 5–10, >10 years), place of work (Government/public-Sector, Private sector), involved in COVID-19 duties (Yes, No), current state of health (Very good, Good, Average, Poor), frequency of domestic trips (About once a month, About once every 3 months, About once every 6 months, Barely), frequency of foreign trips (At least once every 3 months, About once every 6 months, About once a year Barely). The second section with 6 items (mask usage post-vaccination, social distancing post-vaccination, use of sanitizers and frequent hand washing post-vaccination, greetings with a handshake, online shopping instead of going to crowded places like supermarkets post-vaccination, use of public transport post-vaccination) collected information related to their preventive behaviors performance against COVID-19 after vaccination. The participants responded to these questions with three response options which were ‘Lower,’ ‘No change,’ and ‘Higher.’ The third and last section with 7 items assessed the mental health status of the participants, which reflects their mood, sleep, self-reported depression, attitude toward the pandemic and its symptoms. This section was scored using a 5-point Likert scale (1=strongly disagree to 5=strongly agree), and the total score ranges from 7–35, where higher scores signified worse mental status.
After concluding the data collection phase, a meticulous review of the dataset was conducted to identify any occurrences of missing data. Any incomplete questionnaires containing missing data were excluded from the analysis for this study. The remaining data was analyzed using IBM SPSS software version 25.0 (SPSS Institute, Chicago, IL, USA). The summary statistics were obtained for all variables. A chi-square test was used to examine the association of socio-demographic characteristics and mental health status with preventive behavior performance against COVID-19 after vaccination. Given the ordinal nature of the dependent variables related to COVID-19 preventive behaviors post-vaccination, an ordinal logistic regression was performed to explore the effects of various independent variables on the likelihood of reporting changes in preventive behaviors. Mediation analysis was carried out to examine the hypothesis that adherence to COVID-19 preventive behaviors mediates the influence of socio-demographic factors on mental health status. Since there are multiple indicators for adherence to preventive behaviors, we created a composite score for adherence to COVID-19 preventive behaviors by combining multiple individual indicators into a single measure. Analyses were carried out to examine the indirect effect of each socio-demographic factors on mental health status through adherence to COVID-19 preventive behaviors (socio-demographic factors → adherence to COVID-19 preventive behaviors → mental health status) based on Model 4 of the PROCESS macro v4.2. The significance level was set at 5%.
Results
From a total of 425 respondents who were invited to participate,410 participants consented and completed the self-administrated questionnaires with a response rate of 96.4%. The mean age of the participants was 40.1 (SD = 10.1) with a high percentage of them being above 30 years of age (79.5%), female (57.1%), and married (69.5%). Moreover, a notable majority of participants were affiliated with the medical field (59.5%), possessed over five years of professional experience (65.6%), were employed in the government or public sector (56.1%), and engaged in COVID-19-related duties (57.6%). Conversely, a smaller portion of participants reported undertaking domestic trips (29.8%) ().
Table 1. Socio-demographic characteristics and mental health status of participants.
illustrates the participants’ adherence to COVID-19 preventive behaviors following vaccination. The behavior toward usage of Mask and online shopping remains the same in a higher percentage of individuals (57.8% and 60.7%) after vaccination. However, the frequency of use of hand washing and use of sanitizers decreased (70.2%), and a similar decreasing trend was reported in social distancing (60.5%) after COVID-19 vaccination. On the other hand, greeting with a handshake (58.8%) and use of public transport (45.9%) by the participants increases post COVID-19 vaccination. There was no statistically significant difference seen in preventive behaviors against COVID-19 among medical and dental professionals (p > .05).
Table 2. Adherence to preventive behaviors of participants against COVID-19 after vaccination.
The results of the association between socio-demographic characteristics and preventive behaviors performance after COVID-19 vaccination are presented in . reveals that only mask usage post-vaccination showed a statistically significant correlation (p < .05) with factors such as age, marital status, and years of working experience. Notably, the most substantial reductions in mask usage following vaccination were observed among the age group 18–30 (41.7%), those who are Single/Divorced (39.2%), and individuals with 0–5 years of working experience (39.7%).
Table 3. Association between socio-demographic characteristics and adherence to preventive behaviors after COVID-19 vaccination.
Similarly, in the second part of , only the behavior of greeting with a handshake exhibited a statistically significant correlation (p < .05) with age, marital status, and involvement in COVID-19 duties. For all other socio-demographic variables, the associations with different preventive behaviors post-COVID-19 vaccination were not statistically significant in both .
displays the findings of the association between socio-demographic factors and participants’ mental health status. Variables such as age, gender, marital status, years of working experience, current state of health, and frequency of domestic business trips are statistically significant (p < .05) in relation to mental health outcomes. Participants who are older, have more years of work experience, are female, married, rarely go on a domestic business trips and report average current health exhibit poorer mental health compared to their counterparts.
Table 4. Association between socio-demographic characteristics with mental health status.
outlines the relationship between post-COVID-19 vaccination preventive behaviors and the mental health status of participants. All preventive behaviors, except for online shopping and the use of public transport, show a statistically significant association (p < .05) with participants’ mental health status. The data indicate that individuals with poorer mental health are more likely to increase mask usage, sanitizer use, and frequency of handwashing. They also tend to maintain greater social distancing and reduce handshaking.
Table 5. Association between preventive behaviors performance after COVID-19 vaccination with mental health status.
The results of ordinal logistic regression are presented in . It reveals that the 18–30 year age group tended to be 3.96 times more likely to greetings with a handshake than > 51 age group (p < .05). When comparing married with single/divorced, it was found that single/divorced trended to be 1.9 times more likely to use sanitizers and washing hands than married. On the other hand single/divorced tended to be 0.63 times less likely to maintain social distancing post-vaccination than married ones (p < .05). Lastly, the individuals who go on domestic trips about once a month tended to be 1.89 times more likely to maintain social distancing than those who go barely on domestic trips (p < .05).
Table 6. Ordinal logistic regression analysis of factors influencing preventive behaviors post COVID-19 vaccination among healthcare professionals.
The mediation analysis tested the indirect effects of socio-demographic factors on mental health through adherence to preventive behaviors. The mediation analysis showed significant indirect effects of socio-demographic factors on mental health status, where the mediation by adherence to preventive behaviors explained 3%,17%, 4%, 7%, 35%, 19%, 31%, 6%, 7% and 8% of the relationship between the socio-demographic factors and mental health status respectively ().
Table 7. Results of the mediation analysis to examine the indirect effect of the Demographic factors on mental health status.
Discussion
This study was designed to examine the impact of COVID-19 vaccination on two critical aspects among medical and dental professionals: complacency toward adherence to COVID-19 preventive measures and changes in mental health status. The objective is to determine whether receiving the COVID-19 vaccine influences the stringency with which healthcare professionals follow established preventive behaviors and to assess any associated shifts in their mental well-being. This inquiry is crucial for understanding how vaccination might alter health behaviors and psychological conditions in a high-risk group directly involved in managing the pandemic. Literature suggests that vaccination against any infectious disease may lead to a decrease or cessation of precautionary behaviors, which poses a significant challenge in disease control.Citation16,Citation17 Such changes in behavior could substantially impact efforts to manage the disease, and to date, there is limited data exploring the potential complacency in adherence to COVID-19 preventive measures post-vaccination, especially among healthcare workers.
In this study, there have been reported changes in preventive behaviors after COVID-19 vaccination among healthcare professionals such as a reduction in the frequency of hand washing and use of sanitizers and, a decrease in social distancing. Supporting this, a previous investigation in the general Italian population revealed a broad decline in adherence to protective behaviors post-vaccination. Specifically, adherence to maintaining social distance decreased from 90.1% before vaccination to 74.7% afterward.Citation18 Similarly, research conducted in England indicated an increase in public social activities post-vaccination, such as using public transport, handshaking, eating in public spaces, and attending indoor events.Citation19 In Israel, a study found that a small fraction of individuals persisted in maintaining social distancing post-vaccination, with the majority expanding their outdoor activities and nearly 80% reporting decreased use of face masks and hand sanitizers after being vaccinated.Citation20 These findings suggest a trend of relaxed preventive behaviors in response to vaccination, which could have significant implications for public health strategies.
Another study on the lifestyle and attitude of the Bangladeshi COVID-19 vaccinated people reported social distancing as the most avoiding phenomenon as people wanted to be close and meet friends and family members.Citation21 While this increase in close contact may pose a relatively lower risk of infection for younger individuals, it could be perilous for older adults, who have been globally identified as having a higher mortality rate from COVID-19.Citation22 The observation that participants over the age of 50 are reducing adherence to COVID-19 preventive measures is particularly concerning. This trend aligns with behaviors observed in the senior population of the USA, where there has been a noted reluctance to maintain precautionary measures following vaccinations for other diseases like influenza and Lyme disease.Citation3,Citation4 Such patterns underscore the critical need for targeted public health messaging and interventions aimed at older adults to reinforce the importance of continued vigilance, especially post-vaccination. On the other hand in this study, younger participants showed less adherence to COVID-19 preventive measures after being vaccinated. These findings are in line with the results of the study by Rahamim-Cohen et al. in which younger participants were unwilling to maintain health preventive measures and behaviors post-vaccination.Citation20 This decrease in compliance may stem from a perceived reduced risk of contracting the virus after receiving the vaccine. Nonetheless, maintaining adherence to preventive measures remains crucial for controlling the spread of infection among vaccinated individuals, highlighting the need for ongoing public health education to reinforce the importance of such measures, even post-vaccination. However, there are studies with findings that contrast with those of this study. Research conducted in Germany, Japan, and Mexico showed that more than 75% of the participants continued to use face masks and maintain social distancing even after receiving the COVID-19 vaccine.Citation21,Citation23,Citation24 These results suggest variability in behavioral responses to vaccination across different cultural and regional contexts, emphasizing the need to consider local factors when interpreting data and implementing public health strategies.
The exploration of the COVID-19 vaccine’s impact on mental health, which has been significantly affected by the pandemic, is crucial.Citation25 In this study, the mental health status of participants was found to be relatively lower than findings from similar studies in China and Bangladesh.Citation15,Citation21 This discrepancy suggests that while vaccination has been hypothesized to reduce stress levels, boost confidence, and alleviate pandemic-related trauma, the actual impact might vary based on regional and local contexts.
It is also worth noting that the mental health outcomes observed in this study may be influenced by how effectively the Pakistani government managed the pandemic. The comparatively low COVID-19 mortality rate in Pakistan, relative to neighboring countries, could contribute to a more positive mental health outlook among the population.Citation26,Citation27 This aspect underscores the complex interplay between governmental response, public health outcomes, and mental health status during the pandemic, indicating that vaccination is just one of many factors that can influence overall mental well-being.
Preventive behavior adoption varies across professional groups and regions, influenced by factors like occupation-specific risk perceptions, access to healthcare information, and workplace policies. For instance, non-healthcare professionals’ adherence may depend on job flexibility, perceived virus susceptibility, and vaccination access. Regional disparities in vaccine distribution, public health messaging, and cultural norms also affect behavioral differences. Recognizing these variations is vital for tailoring interventions to promote widespread adherence and curb COVID-19 transmission.
The findings from our mediation analysis provide insights into how socio-demographic factors influence mental health status through adherence to COVID-19 preventive behaviors. By examining adherence as a mediator, we aimed to understand the indirect pathways through which socio-demographic factors impact mental health. The results support our hypothesis, demonstrating that adherence to preventive behaviors plays a significant role in mediating the effects of socio-demographic factors on mental health. For instance, the finding that adherence explained 35% of the relationship between certain socio-demographic factors and mental health underscores the importance of promoting adherence to preventive measures as a strategy to support mental health among healthcare professionals. Our results support this hypothesis, demonstrating that adherence to preventive behaviors mediates the effects of socio-demographic factors on mental health. This is consistent with the literature, which highlights the importance of health behaviors in influencing mental health outcomes.Citation28 For example, research has shown that socio-demographic factors can influence health behaviors and that these behaviors are critical determinants of mental health.Citation29 By focusing on adherence to preventive behaviors as a mediator, our study provides actionable insights that can guide interventions aimed at improving both adherence and mental health outcomes among healthcare workers.
This study presents several methodological limitations that merit consideration when interpreting the results. First, the use of a cross-sectional design restricts our ability to draw causal inferences between observed outcomes. Such designs can indicate associations but cannot definitively pinpoint cause and effect, which could mislead interpretations if temporal relationships are assumed. Secondly, the reliance on non-probability convenient sampling and the recruitment of participants exclusively from one city limits the generalizability of the findings. This approach does not guarantee that the sample is representative of all medical and dental healthcare professionals in Pakistan, as those from other cities or regions may exhibit different behaviors or attitudes due to varying local pandemic responses or cultural factors. Furthermore, the volunteer nature of participant recruitment introduces the possibility of self-selection bias. Individuals who chose to participate might have specific characteristics, motivations, or experiences that differ from those who opted out. Such differences could skew the findings, especially if these characteristics are linked to the study variables (e.g., a greater health consciousness among participants). Lastly, as with many studies relying on self-reported data, there is a risk of recall bias, memory distortion, and social desirability bias. Participants may not accurately remember past behaviors or might portray their behaviors more favorably to align with perceived social expectations. Although efforts were made to minimize these biases through transparent sampling methods and clear descriptions of the study population, the inherent limitations of self-reported data could still impact the accuracy of the findings. Recognizing these limitations is crucial for critically assessing the study’s contributions and for guiding future research. Further studies employing longitudinal designs, probabilistic sampling techniques, and multi-city recruitment, as well as those utilizing objective measures of behavior, could provide more robust data and a deeper understanding of the impacts of COVID-19 vaccination on healthcare professionals’ preventive behaviors and mental health.
Despite its limitations, this study contributes valuable insights into the behaviors, compliance, and adherence to COVID-19 preventive measures among vaccinated populations. Notably, it reveals a concerning decline in compliance with these preventive behaviors, signaling an urgent need for the development of targeted strategies and action plans to counteract this trend. The observation of increased complacency toward preventive behaviors among healthcare professionals, particularly after vaccination, is especially troubling given their frequent contact with patients. Although vaccinated, these professionals remain at risk for contracting and transmitting COVID-19 if they do not consistently adhere to recommended preventive measures.Citation7,Citation30 This finding underscores the critical need for continuous education and reinforcement of safety protocols within healthcare settings. To combat this complacency, policymakers and professional organizations must persist in their efforts, regularly revising and updating interventions to reflect the evolving dynamics of the pandemic. It is essential to ensure that compliance with preventive behaviors is maintained over time across all segments of society, not just among healthcare workers.
Furthermore, communication strategies must emphasize the importance of adhering to preventive measures regardless of vaccination status. This messaging is crucial in mitigating the spread of COVID-19 and is fundamental to the ongoing efforts to control the pandemic. By promoting a consistent and clear message about the necessity of maintaining preventive behaviors, public health authorities can help foster a culture of vigilance and sustained precaution among the vaccinated populace.
Conclusion
To the best of our knowledge, this is the first study that attempted to explore the complacency in adherence to COVID-19 preventive behavioral measures and mental health status among medical and dental professionals. It shows that COVID-19 vaccination does threaten the complacency to adherence to COVID-19 preventive behavioral measures among healthcare professionals. Though this finding cannot be extrapolated to the general population, however, there lies a possibility of the same behavioral reluctance toward COVID-19 preventive measures post-vaccination in the general population as well. Additionally, the observed changes in preventive behaviors might also reflect a broader adaptation to the pandemic lifestyle, where individuals adjust their practices in response to changing local and global pandemic dynamics. The impact of these adaptations on preventive behaviors is complex and warrants careful interpretation. However, health authorities need to continue the efforts and communicate the message of seriousness and urgency for adherence to preventive behaviors even after vaccination to healthcare professionals and the general population.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Correction Statement
This article has been corrected with minor changes. These changes do not impact the academic content of the article.
Additional information
Funding
References
- Petherick A, Goldszmidt R, Andrade EB, Furst R, Hale T, Pott A, Wood A. A worldwide assessment of changes in adherence to COVID-19 protective behaviours and hypothesized pandemic fatigue. Nat Hum Behav. 2021;5(9):1145–10. doi:10.1038/s41562-021-01181-x.
- Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, Chu DK, Akl EA, El-Harakeh A, Bognanni A, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973–87. doi:10.1016/S0140-6736(20)31142-9.
- Reiber C, Shattuck EC, Fiore S, Alperin P, Davis V, Moore J. Change in human social behavior in response to a common vaccine. Ann Epidemiol. 2010;20(10):729–33. doi:10.1016/j.annepidem.2010.06.014.
- Brewer NT, Cuite CL, Herrington JE, Weinstein ND. Risk compensation and vaccination: can getting vaccinated cause people to engage in risky behaviors? Ann Behav Med. 2007;34(1):95–9. doi:10.1007/BF02879925.
- Wright L, Steptoe A, Mak HW, Fancourt D. Do people reduce compliance with COVID-19 guidelines following vaccination? A longitudinal analysis of matched UK adults. J Epidemiol Community Health. 2022;76(2):109–15. doi:10.1136/jech-2021-217179.
- Chaudhary FA, Ahmad B, Ahmad P, Khalid MD, Butt DQ, Khan SQ. Concerns, perceived impact, and preparedness of oral healthcare workers in their working environment during COVID-19 pandemic. J Occup Health. 2020;62(1):e12168. doi:10.1002/1348-9585.12168.
- Javed MQ, Chaudhary FA, Mohsin SF, AlAttas MH, Edrees HY, Habib SR, Riaz A. Dental health care providers’ concerns, perceived impact, and preparedness during the COVID-19 pandemic in Saudi Arabia. PeerJ. 2021;9:e11584. doi:10.7717/peerj.11584.
- Zhang N, Lei H, Li L, Jin T, Liu X, Miao D, Su B, Bu Z, Fan L, Xue P, et al. COVID-19 vaccination did not change the personal protective behaviors of healthcare workers in China. Front Public Health. 2021;9:777426. doi:10.3389/fpubh.2021.777426.
- Bandyopadhyay S, Baticulon RE, Kadhum M, Alser M, Ojuka DK, Badereddin Y, Kamath A, Parepalli SA, Brown G, Iharchane S, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Glob Health. 2020;5(12):e003097. doi:10.1136/bmjgh-2020-003097.
- Chandu VC, Baddam VRR, Mupparapu M, Marella Y. Vaccination induced complacency in adherence to COVID-19 precautionary measures among oral health care professionals in India and the United States: a retrospective pretest-posttest design. Hum Vaccines & Immunother. 2021;17(12):5105–13. doi:10.1080/21645515.2021.1978794.
- Ahmad Chaudhary F, Ahmad B, Gul M, Rafiq A, Qasim Butt D, Rehman M, Ahmad P. The psychological impact of the COVID-19 pandemic on oral health care workers and its impact on their willingness to work during this pandemic. Archiv Psychiatry Res: An Int J Psychiatry Relat Sci. 2021;57(2):177–86. doi:10.20471/dec.2021.57.02.06.
- Chaudhary FA, Fazal A, Ahmad B, Khattak O, Hyder M, Javaid MM, Iqbal A, Issrani R. The impact of COVID-19 pandemic on the psychological health and dental practice of oral healthcare workers: a scoping review. Risk Manag Healthc Policy. 2022;15:1421–31. doi:10.2147/RMHP.S370125.
- Biber J, Ranes B, Lawrence S, Malpani V, Trinh TT, Cyders A, English S, Staub CL, McCausland KL, Kosinski M, et al. Mental health impact on healthcare workers due to the COVID-19 pandemic: a US cross-sectional survey study. J Patient Rep Outcomes. 2022;6(1):63. doi:10.1186/s41687-022-00467-6.
- Ruiz MS, Mv M, Latif H, Vyas A. Maintaining adherence to COVID-19 preventive practices and policies pertaining to masking and distancing in the district of Columbia and other US States: systematic observational study. JMIR Public Health Surveillance. 2023;9:e40138. doi:10.2196/40138.
- Yuan Y, Deng Z, Chen M, Yin D, Zheng J, Liu Y, Liu X, Zou H, Zhang C, Sun C, et al. Changes in mental health and preventive behaviors before and after COVID-19 vaccination: a propensity score matching (PSM) study. Nato Adv Sci Inst Se. 2021;9(9):1044. doi:10.3390/vaccines9091044.
- Bish A, Michie S. Demographic and attitudinal determinants of protective behaviours during a pandemic: a review. Br J Health Psychol. 2010;15(4):797–824. doi:10.1348/135910710X485826.
- Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict. 2021;19(5):1875–88. doi:10.1007/s11469-020-00281-5.
- Corea F, Folcarelli L, Napoli A, Del Giudice G, Angelillo I. The impact of COVID-19 vaccination in changing the adherence to preventive measures: evidence from Italy. Nato Adv Sci Inst Se. 2022;10(5):1–11. doi:10.3390/vaccines10050777.
- Desrichard O, Moussaoui L, Ofosu N. Reduction of precautionary behaviour following vaccination against COVID-19: a test on a British cohort. Nato Adv Sci Inst Se. 2022;10(6):936. doi:10.3390/vaccines10060936.
- Rahamim-Cohen D, Gazit S, Perez G, Nada B, Moshe SB, Mizrahi-Reuveni M, Azuri J, Patalon T. Survey of behaviour attitudes towards preventive measures following COVID-19 vaccination. medRxiv. 2021; 2021–2004. 2012.21255304.
- Hossain ME, Islam MS, Rana MJ, Amin MR, Rokonuzzaman M, Chakrobortty S, Saha SM. Scaling the changes in lifestyle, attitude, and behavioral patterns among COVID-19 vaccinated people: insights from Bangladesh. Hum Vaccines & Immunother. 2022;18(1):2022920. doi:10.1080/21645515.2021.2022920.
- Dhama K, Patel SK, Kumar R, Rana J, Yatoo MI, Kumar A, Tiwari R, Dhama J, Natesan S, Singh R, et al. Geriatric population during the COVID-19 pandemic: problems, considerations, exigencies, and beyond. Front Public Health. 2020;8:574198. doi:10.3389/fpubh.2020.574198.
- Kaspar K, Nordmeyer L. Personality and motivation to comply with COVID-19 protective measures in Germany. Front Psychol. 2022;13:893881. doi:10.3389/fpsyg.2022.893881.
- Brüssow H, Zuber S. Can a combination of vaccination and face mask wearing contain the COVID‐19 pandemic? Microb Biotechnol. 2022;15(3):721–37. doi:10.1111/1751-7915.13997.
- Pandey K, Thurman M, Johnson SD, Acharya A, Johnston M, Klug EA, Olwenyi OA, Rajaiah R, Byrareddy SN. Mental health issues during and after COVID-19 vaccine era. Brain Res Bull. 2021;176:161–73. doi:10.1016/j.brainresbull.2021.08.012.
- Akhtar H, Afridi M, Akhtar S, Ahmad H, Ali S, Khalid S, Awan SM, Jahangiri S, Khader YS. Pakistan’s response to COVID-19: overcoming national and international hypes to fight the pandemic. JMIR Public Health Surveillance. 2021;7(5):e28517. doi:10.2196/28517.
- Chaudhary FA, Ahmad B, Khalid MD, Fazal A, Javaid MM, Butt DQ. Factors influencing COVID-19 vaccine hesitancy and acceptance among the Pakistani population. Hum Vaccines & Immunother. 2021;17(10):3365–70. doi:10.1080/21645515.2021.1944743.
- Glanz KE, Lewis FME, Rimer BK. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass/Wiley; 2008.
- Gellert P, Ziegelmann JP, Lippke S, Schwarzer RJAo BM. Future time perspective and health behaviors: temporal framing of self-regulatory processes in physical exercise and dietary behaviors. Ann Behav Med. 2012;43(2):208–18. doi:10.1007/s12160-011-9312-y.
- Alameer A, Maslamani Y, Gosadi IM, Elamin MY, Muaddi MA, Alqassim AY, Doweri A, Namis I, Busayli F, Ahmadini H, et al. Assessing continuity of adherence to precautionary measures for COVID-19 among vaccinated people in Jazan, Saudi Arabia. Microorganisms. 2023;11(3):800. doi:10.3390/microorganisms11030800.