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Understanding the impact of chronic diseases on COVID‐19 vaccine hesitancy using propensity score matching: Internet‐based cross‐sectional study

Abstract

Aims and Objectives

To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases.

Background

Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death.

Methods

From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases.

Results

Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases.

Conclusions

Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system.

Relevance to Clinical Practice

Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice.

Patient or Public Contribution

Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.

Changes in parental anxiety and intention to demand antibiotics: A longitudinal study among parents during the COVID‐19 pandemic

Abstract

Aims

Assessing the effects of the COVID-19 pandemic on parental anxiety and preferences for antibiotic treatment can help inform antibiotic stewardship strategies. Therefore, this study aimed to examine COVID-19 pandemic-related changes in parental anxiety levels, their intentions to demand antibiotics and frequencies of practising preventative behaviours.

Design

This longitudinal quantitative study compared two groups of parents, those from Victoria and Western Australia, who experienced high and low COVID-19 risk, respectively.

Methods

Participants were recruited through an online panel to complete three waves of surveys between October 2020 and August 2021. Anxiety scores and frequency of preventative behaviours were analysed using mixed-effects tobit regression, considering time, state, and their interaction as fixed effects predictors. Intention to demand antibiotics was modelled using multinomial logistic regression, with time, state, and their interaction as the predictors.

Results

The final longitudinal sample comprised 50 participants from Victoria and 51 from Western Australia. Parental anxiety did not significantly change over time for either state. Intention to demand antibiotics was also stable over time within each state; however, participants from Victoria exhibited stronger intentions to demand antibiotics compared to those from Western Australia. Frequencies of parental preventative behaviours declined from Wave 1 to Wave 2 before increasing again in Wave 3, but only for Western Australia.

Conclusion

This longitudinal study among Australian parents found stable parental anxiety and intention to demand antibiotics within each state. However, the intention to demand antibiotics and preventative behaviours varied between states as per the COVID-19 risk. Thus, viral pandemics may not affect judicious antibiotic use, though the intention to demand antibiotics may increase in states with high COVID-19 risk.

Impact

Though parental anxiety may not impact antibiotic stewardship during viral respiratory illness outbreaks, tailored messaging to maintain appropriate antibiotic use may be necessary, especially when the disease risk is high.

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