| BackgroundCoronavirus Disease 2019(COVID-19)is an infectious disease caused by the SARS-CoV2 virus.The main mode of transmission is through respiratory droplets and close contact.Prevention and mitigation of transmission is achieved through personal protective measures and vaccination.Jinan authority carried out basic immunization with the COVID-19 vaccine in the general population aged 18 years and above from March 2021 and booster immunization with the COVID-19 vaccine from October 2021.The government has been promoting vaccination.However,over time,vaccine efficacy waned and breakthrough infections and clusters of outbreaks occurred in many areas.These complex changes in information may lead to changes in public knowledge,attitudes,protective practice,and vaccine hesitancy.Leshan community has complex socio-demographic characteristics and is located in the heart of Jinan.It is a representative community,so we selected Leshan community as a survey site and conducted surveys in the basic and booster immunization phases,respectively.To investigate whether there is a change in COVID-19 KAP and vaccine hesitation among Jinan residents.ObjectivesTo understand the COVID-19 KAP and vaccine hesitation of Jinan residents during the basic and booster immunization phases,and to investigate the possible factors affecting vaccine hesitation.To investigate whether the KAP and vaccine hesitation status of COVID-19 and vaccine in Jinan residents change at different vaccination stages.Methods1.SubjectsAccording to the cross-sectional study sample size calculation formula and considering the multi-stage sampling design effect,the sample size of this study was calculated to be 330 people.Two consecutive surveys were conducted among residents of the Leshan community in Jinan from May to June,2021(basic dose vaccination phase)and from December,2021 to January,2022(booster vaccination phase).First,10 buildings were randomly selected within 59 residential buildings by the whole-group sampling method,and then 50 residents were randomly selected within each building.500 questionnaires were distributed for each survey.This research plan has been approved by the Public Health Ethics Committee of Shandong University(LL20211201).2.ContentsAfter multiple rounds of expert group discussions,the survey questionnaire was determined,and then a combination of paper and electronic questionnaires was used to conduct the survey.A closed Q&A method was used for anonymous filling.The main survey subjects were social demographic characteristics,access to information,COVID-19 knowledge,belief and practice,COVID-19 vaccination and hesitation,adverse reactions and reasons related to vaccination.3.Statistical analysisDescriptive statistical analysis was used to describe general demographic characteristics,COVID-19 KAP and vaccine hesitation of Jinan residents at two stages.The χ2test was used to compare whether there was a difference in COVID-19 KAP and vaccine hesitation between the two stages.The χ2 test was used to analyze whether there were differences in vaccine hesitancy among respondents with different characteristics.Factors with P<0.2 were included in the multi-factor logistic regression to analyze the factors affecting vaccine hesitancy,and the nomogram was constructed.Results1.Social demographic characteristics of adult residentsIn the basic immunization phase,459 questionnaires were collected,of which 423 were valid,with an efficiency rate of 92.2%.In the booster immunization phase,477 questionnaires were collected,of which 470 were valid,with an efficiency rate of 98.5%.During the basic immunization stage,female residents accounted for 59.3%,married residents accounted for 87.2%,residents with a college degree or above accounted for 58.8%,and residents with occupations such as enterprise employees,students,and retirees accounted for 82.5%;During the booster immunization phase,61.3%of female residents were vaccinated,84.7%were married,57.2%were residents with a college degree or above,and 78.5%were residents with occupations such as enterprise employees,students,and retirees.There were no significant differences between the two surveys in terms of gender,age,marital status,occupation,education level,presence of chronic diseases,and physical condition of the residents.2.Access to informationIn both surveys,the main ways for residents to obtain information about COVID-19 were TV and WeChat,followed by community outreach and news websites,while the least number of residents get information through family and friend exchanges,newspapers and magazines,radio and microblogs.With the increase of age,the number of residents who obtain information through WeChat(basic phase:trend X2=63.955,P<0.0015 r=-0.348;booster phase:trendχ2=70.419,P<0.001,r=-0.354)and microblog(basic phase:trendχ2=63.955,P<0.001,r=-0.348;booster phase:trend χ2=112.849,P<0.001,r=-0.445)gradually decreases.Residents who access information through Television(basic phase:trend χ2=12.012,P=0.017,r=0.120)gradually increase with age.3.COVID-19 knowledge,attitude,and practiceDuring the basic and booster immunization phases,51.8%and 67.2%residents had excellent COVID-19 cognition,and 48.2%and 32.8%had fair or poor COVID-19 cognition,respectively.Compared with the basic immunization phase,community residents had better knowledge of COVID-19 during the booster phase(67.2%vs.51.8%,P<0.001).At the stage of basic immunization,66.7%of the residents had positive attitude toward the government’s prevention and control measures;33.3%had an average or poor attitude.At the stage of booster immunization,80.6%of the residents had positive attitude toward the government’s prevention and control measures,while 19.4%were average or poor.Compared to the basic immunization phase,residents had more positive attitude toward government prevention and control measures during the booster immunization phase(80.6%vs.66.7%,P<0.001).At the stage of basic immunization,74.0%of the residents had excellent protective behaviors;26.0%were average or poor.At the stage of booster immunization,76.8%had excellent protective behaviors during the COVID-19,while 23.2%of them had average or poor protective behaviors.There was no statistically significant difference in daily protective behaviors between residents in the two stages(74.0%vs.76.8%,P=0.329).4.Vaccination and adverse reactionsDuring the basic immunization phase,73.3%of residents have received the first dose of vaccine.During the booster immunization phase,94.3%of residents have received the COVID19 vaccine and 50.1%have received the booster dose.During the basic immunization phase,33.5%of residents presented adverse reactions,with muscle aches(17.1%),weakness(16.1%),drowsiness(14.8%)and redness,hardness and pain at the vaccination site(10.3%)were the most common.During the booster immunization phase,31.4%of residents presented with adverse reactions,of which muscle aches(13.5%),redness,swelling,hard nodes and pain at the vaccination site(13.5%)were the most common.The incidence of malaise(16.1%vs.8.6%,P=0.010)and drowsiness(14.8%vs.8.5%,P=0.028)was significantly greater during the basic immunization phase compared with the booster phase,and there was no statistical difference in any other general adverse reactions.5.Influencing factors of COVID-19 Vaccination hesitancyDuring the basic and booster immunization phases,26.7%and 25.5%residents were hesitant to receive the vaccine.There was no statistically significant difference in vaccination hesitancy between residents in the two stages(26.7%vs.25.5%,P=0.329).Both phases of the survey showed that marital status and attitude toward COVID-19 vaccine were influential factors in vaccine hesitation.Unmarried or divorced residents were more likely to be vaccine hesitant than those who were married(basic phase:OR=2.352,95%CI:1.163-4.757;booster phase:OR=2.482,95%CI:1.424-4.325);residents with negative attitudes toward COVID-19 vaccine were more likely to be vaccine hesitant than residents with positive attitudes(basic phase:OR=2.486,95%CI:1.250-4.943;booster phase:OR=1.695,95%CI:1.075-2.674).In addition,COVID-19 vaccine hesitation in the basic immunization phase was also related to education,self-perception of physical condition,and chronic disease;the hesitation of vaccine in the booster immunization phase was also related to occupation,attitude toward government measures,and daily protective behavior.During the basic immunization phase,residents with high school or less(OR=0.461,95%Cl:0.232-0.928),college or bachelor’s degree(OR=0.283,95%CI:0.148-0.539),master’s and above(OR=0.104,95%CI:0.022-0.488)were less hesitant about vaccine than those with junior high school or less education.Residents in fair or poor health(OR=4.1 14,95%CI:1.849-9.154)were more hesitant to vaccinate than residents in very good health;residents with chronic diseases(OR=2.359,95%CI:1.359-3.990)were more hesitant to vaccinate than residents without chronic diseases.During the booster immunization phase,teachers and public service residents(OR=0.461,95%CI:0.234-0.910)were less vaccine hesitant than students and retirees;residents with fair or poor attitudes toward government protective measures(OR=1.758,95%CI:1.048-2.949)were more vaccine hesitant than residents with better attitudes;residents with fair or poor behaviors(OR=1.982,95%CI:1.210-3.247)were more hesitant than residents with better daily protective behaviors.ConclusionsCompared with the basic immunization phase,residents’ knowledge of COVID-19 increased during the booster immunization phase,and their attitude toward government control measures were more positive.The residents did not change in their daily protective behaviors or in their hesitation for the COVID-19 vaccine.Both phases of the survey showed that marital status and attitude towards the new crown vaccine were the factors affecting vaccine hesitancy;In addition,the hesitancy of the COVID-19 vaccine in the basic immunization stage is also related to the level of education,physical condition self-perception,and chronic disease status;Vaccine hesitancy during the booster immunization phase is also related to occupation,attitude towards government control measures,and daily protective behavior. |
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