DOI: https://doi.org/10.14710/nmjn.v13i2.51935

Effects of Direct and Indirect Factors on Attitude toward the COVID-19 Vaccine in Pregnant Women

*Dora Samaria orcid scopus  -  Nursing Study Program, Faculty of Health Sciences, Universitas Pembangunan Nasional “Veteran” Jakarta, Indonesia
Desmawati Desmawati  -  Nursing Study Program, Faculty of Health Sciences, Universitas Pembangunan Nasional “Veteran” Jakarta, Indonesia
Lima Florensia  -  Nursing Study Program, Faculty of Health Sciences, Universitas Pembangunan Nasional “Veteran” Jakarta, Indonesia
Open Access Copyright (c) 2023 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: The administration of the COVID-19 vaccine is facing resistance from pregnant women, leading to a lower attitude toward vaccination uptake. Previous studies have explored several factors that contributed to the issue. However, no studies have investigated further the direct and indirect effects of factors that simultaneously influence attitudes toward the COVID-19 vaccine in pregnant women. 

Purpose: This study aimed to investigate the direct and indirect effects of factors that influence attitudes toward the COVID-19 vaccine (ACV) in pregnant women, particularly hesitancy, motivation, and history of COVID-19 infection (HCI), and to describe a pathway model that represents the effects.

Methods: This cross-sectional study recruited 440 pregnant women living in Bekasi and Pandeglang, Indonesia, in May–June 2022 using consecutive sampling methods. This study employed the Motivations of Vaccination Questionnaire, the Reasons for Hesitation Questionnaire, and the Attitudes toward COVID-19 Vaccine Questionnaire. A path analysis was performed to calculate the data.

Results: Hesitancy had a more indirect effect (β=-0.270; p=0.00) than the direct effect (β=-0.193; p=0.00) on ACV, whereas motivation had a more direct effect (β=0.092; p=0.04) than the indirect effect (β=0.074; p=0.00). HCI acted as the mediation variable because it could intercede with the effect of hesitancy on ACV (β=-0.449; p=0.00). It indicated that HCI in pregnant women would lead to a different approach to increasing ACV.

Conclusions: All studied factors had significant impacts on ACV, both directly and indirectly. It is recommended that interventions be adjusted according to the program’s purpose, with the aim of increasing motivation or reducing hesitancy.

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Keywords: Attitude; COVID-19 vaccine; hesitancy; motivation; pregnant women

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  1. Alamer, E., Hakami, F., Hamdi, S., Alamer, A., Awaf, M., Darraj, H., Abutalib, Y., Madkhali, E., Alamer, R., Bakri, N., Qadri, M., Algaissi, A., & Alhazmi, A. (2021). Knowledge, attitudes, and perception toward COVID-19 vaccines among adults in Jazan province, Saudi Arabia. Vaccines, 9(11), 1–12. https://doi.org/10.3390/vaccines9111259
  2. Anakpo, G., & Mishi, S. (2022). Hesitancy of COVID-19 vaccines: Rapid systematic review of the measurement, predictors, and preventive strategies. Human Vaccines & Immunotherapeutics, 18(5), e2074716. https://doi.org/10.1080/21645515.2022.2074716
  3. Baktash, M. Q., & Aziz, A. A. A. (2023). Women’s knowledge of sexually transmitted diseases in Telafer city, Iraq. Nurse Media Journal of Nursing, 13(1), 12–21. https://doi.org/10.14710/nmjn.v13i1.48924
  4. Böhm, R., Meier, N. W., Groß, M., Korn, L., & Betsch, C. (2019). The willingness to vaccinate increases when vaccination protects others who have low responsibility for not being vaccinated. Journal of Behavioral Medicine, 42(3), 381–391. https://doi.org/10.1007/s10865-018-9985-9
  5. Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest, 18(3), 149–207. https://doi.org/10.1177/1529100618760521
  6. Burger, M. N., Mayer, M., & Steimanis, I. (2022). Repeated information of benefits reduces COVID-19 vaccination hesitancy: Experimental evidence from Germany. PLoS One, 17(6), e0270666), 1–23. https://doi.org/10.1371/journal.pone.0270666
  7. Cui, Y., Binger, K., & Palatnik, A. (2022). Attitudes and beliefs associated with COVID-19 vaccination during pregnancy. JAMA Network Open, 5(4), E227430. https://doi.org/10.1001/jamanetworkopen.2022.7430
  8. Djalante, R., Lassa, J., Setiamarga, D., Sudjatma, A., Indrawan, M., Haryanto, B., Mahfud, C., Sinapoy, M. S., Djalante, S., Rafliana, I., Gunawan, L. A., Surtiarti, G. A. K., & Warsilah, H. (2020). Review and analysis of current responses to COVID-19 in Indonesia: Period of January to March 2020. Progress in Disaster Science, 6, 100091 https://doi.org/10.1016/j.pdisas.2020.100091
  9. El-Elimat, T., AbuAlSamen, M. M., Almomani, B. A., Al-Sawalha, N. A., & Alali, F. Q. (2021). Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan. PLoS One, 16(4), e0250555. https://doi.org/10.1371/journal.pone.0250555
  10. Fakari, F. R., & Simbar, M. (2020). Coronavirus pandemic and worries during pregnancy. Archives of Academic Emergency Medicine, 8(1), e21. https://doi.org/10.22037/aaem.v8i1.598
  11. Galanis, P., Vraka, I., Siskou, O., Konstantakopoulou, O., Katsiroumpa, A., & Kaitelidou, D. (2022). Uptake of COVID-19 vaccines among pregnant women: A systematic review and meta-analysis. Vaccines, 10(5), 766. https://doi.org/10.3390/vaccines10050766
  12. Geoghegan, S., Stephens, L. C., Feemster, K. A., Drew, R. J., Eogan, M., & Butler, K. M. (2021). “This choice does not just affect me.” Attitudes of pregnant women toward COVID-19 vaccines: A mixed-methods study. Human Vaccines and Immunotherapeutics, 17(10), 3371–3376. https://doi.org/10.1080/21645515.2021.1924018
  13. Ghaznavi, C., Yoneoka, D., Kawashima, T., Eguchi, A., Murakami, M., Gilmour, S., Kaneko, S., Kunishima, H., Naito, W., Sakamoto, H., Maruyama-Sakurai, K., Takahashi, A., Takayama, Y., Tanoue, Y., Yamamoto, Y., Yasutaka, T., Miyata, H., & Nomura, S. (2022). Factors associated with reversals of COVID-19 vaccination willingness: Results from two longitudinal, national surveys in Japan 2021-2022. The Lancet Regional Health - Western Pacific, 27(October), 100540. https://doi.org/10.1016/j.lanwpc.2022.100540
  14. Goncu Ayhan, S., Oluklu, D., Atalay, A., Menekse Beser, D., Tanacan, A., Moraloglu Tekin, O., & Sahin, D. (2021). COVID-19 vaccine acceptance in pregnant women. International Journal of Gynecology and Obstetrics, 154(2), 291–296. https://doi.org/10.1002/ijgo.13713
  15. Gray, J. R., Grove, S. K., & Sutherland, Suzanne. (2017). Burns and Grove’s the practice of nursing research - e-book: Appraisal, synthesis, and generation of evidence (8th ed.). Elsevier
  16. Halu, S. A. N., Dafiq, N., Banul, M. S., Laput, D. O., & Trisnawati, R. E. (2022). Factors affecting willingness to vaccinate COVID-19 in pregnant women in Manggarai regency, East Nusa Tenggara, Indonesia. Journal of Maternal and Child Health, 07(04), 446–453. https://doi.org/10.26911/thejmch.2022.07.04.08
  17. Joubert, E., Kekeh, A. C., & Amin, C. N. (2022). COVID-19 and novel mRNA vaccines in pregnancy: An updated literature review. BJOG: An International Journal of Obstetrics and Gynaecology, 129(1), 21–28. https://doi.org/10.1111/1471-0528.16973
  18. Lin, Y., Yen, C., Chang, Y., & Wang, P. (2021). Comparisons of motivation to receive COVID-19 vaccination and related factors between frontline physicians and nurses and the public in Taiwan: Applying the extended protection motivation theory. Vaccines, 9(528), 1–11. https://doi.org/10.3390/vaccines9050528
  19. Liu, S., & Liu, J. (2021). Understanding behavioral intentions toward COVID-19 vaccines: Theory-based content analysis of tweets. Journal of Medical Internet Research, 23(5),e28118. https://doi.org/10.2196/28118
  20. Lwanga, S. K., & Lemeshow, S. (1991). Sample size determination in health studies: A pratical manual. World Health Organization. https://apps.who.int/iris/handle/10665/40062
  21. Mahmud, S., Mohsin, M., Khan, I. A., Mian, A. U., & Zaman, M. A. (2021). Knowledge, beliefs, attitudes and perceived risk about COVID-19 vaccine and determinants of COVID-19 vaccine acceptance in Bangladesh. PLoS One, 16(9), e0257096. https://doi.org/10.1371/journal.pone.0257096
  22. Matenga, T. F. L., Zulu, J. M., Moonzwe Davis, L., & Chavula, M. P. (2022). Motivating factors for and barriers to the COVID-19 vaccine uptake: A review of social media data in Zambia. Cogent Public Health, 9, 2059201. https://doi.org/10.1080/27707571.2022.2059201
  23. Merkley, E., & Loewen, P. J. (2021). Assessment of communication strategies for mitigating COVID-19 vaccine-specific hesitancy in Canada. JAMA Network Open, 4(9), e2126635. https://doi.org/10.1001/jamanetworkopen.2021.26635
  24. Moore, R., Purvis, R. S., Hallgren, E., Willis, D. E., Hall, S., Reece, S., CarlLee, S., Judkins, H., & McElfish, P. A. (2022). Motivations to vaccinate among hesitant adopters of the COVID-19 vaccine. Journal of Community Health, 47(2), 237–245. https://doi.org/10.1007/s10900-021-01037-5
  25. Olanipekun, T., Abe, T., Effoe, V., Westney, G., & Snyder, R. (2021). Changes in COVID-19 vaccine acceptance rate among recovered critically Ill patients: A 12-month follow-up study. Vaccine, 39(48), 7074–7081. https://doi.org/10.1016/j.vaccine.2021.10.015
  26. Puspaningrum, N., & Samaria, D. (2023). Motivation and hesitancy towards the COVID-19 vaccine in expecting mothers. Jurnal Riset Kesehatan, 12(1), 41–49. https://doi.org/10.31983/jrk.v12i1.9565
  27. Rhatomy, S., & Prasetyo, T. E. (2020). Impact of COVID-19 on primary care visits: Lesson learnt from the early pandemic period. Journal of Community Empowerment for Health, 3(2), 108–117. https://doi.org/10.22146/jcoemph.57918
  28. Rittle, C. (2022). COVID-19 vaccine hesitancy and how to address it. Workplace Health and Safety, 70(2), 56–62. https://doi.org/10.1177/21650799211073525
  29. Samannodi, M. (2021). COVID-19 vaccine acceptability among women who are pregnant or planning for pregnancy in Saudi Arabia: A cross-sectional study. Patient Preference and Adherence, 15, 2609–2618. https://doi.org/10.2147/PPA.S338932
  30. Samaria, D., Marcelina, L. A., & Florensia, L. (2023). The COVID-19 pandemic’s impact on breastfeeding self-efficacy: A path analysis. Enfermeria Clinica, 33, S17–S21. https://doi.org/10.1016/j.enfcli.2023.01.003
  31. Simmons, L. A., Whipps, M. D. M., Phipps, J. E., Satish, N. S., & Swamy, G. K. (2022). Understanding COVID-19 vaccine uptake during pregnancy: ‘Hesitance’, knowledge, and evidence-based decision-making. Vaccine, 40(19), 2755–2760. https://doi.org/10.1016/j.vaccine.2022.03.044
  32. Skirrow, H., Barnett, S., Bell, S., Riaposova, L., Mounier-Jack, S., Kampmann, B., & Holder, B. (2022). Women’s views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: A multi-methods study in the UK. BMC Pregnancy and Childbirth, 22(1), 1–15. https://doi.org/10.1186/s12884-021-04321-3
  33. Skjefte, M., Ngirbabul, M., Akeju, O., Escudero, D., Hernandez-Diaz, S., Wyszynski, D. F., & Wu, J. W. (2021). COVID-19 vaccine acceptance among pregnant women and mothers of young children: Results of a survey in 16 countries. European Journal of Epidemiology, 36(2), 197–211. https://doi.org/10.1007/s10654-021-00728-6
  34. Tavolacci, M. P., Dechelotte, P., & Ladner, J. (2021). COVID-19 vaccine acceptance, hesitancy, and resistancy among university students in France. Vaccines, 9, 654. https://doi.org/10.3390/vaccines9060654
  35. Wang, P. W., Ahorsu, D. K., Lin, C. Y., Chen, I. H., Yen, C. F., Kuo, Y. J., Griffiths, M. D., & Pakpour, A. H. (2021). Motivation to have COVID-19 vaccination explained using an extended protection motivation theory among university students in china: The role of information sources. Vaccines, 9, 380. https://doi.org/10.3390/vaccines9040380
  36. Wirawan, G. B. S., Harjana, N. P. A., Nugrahani, N. W., & Januraga, P. P. (2022). Health beliefs and socioeconomic determinants of COVID-19 booster vaccine acceptance: An Indonesian cross-sectional study. Vaccines, 10, 724. https://doi.org/10.3390/vaccines10050724
  37. World Health Organization, & United Nations Children’s Fund. (2020). Community-based health services, including outreach and campaigns, in the context of the COVID-19 pandemic. World Health Organization. https://www.who.int/docs/default-source/searo/indonesia/covid19/who-2019-ncov-comm-health-care-2020-1-eng-indonesian-final.pdf?sfvrsn=42bf97f9_2
  38. Wu, J., Luan, S., & Raihani, N. (2022). Reward, punishment, and prosocial behavior: Recent developments and implications. Current Opinion in Psychology, 44, 117–123. https://doi.org/10.1016/j.copsyc.2021.09.003

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