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

Dora Samaria; Desmawati Desmawati; Lima Florensia

doi:10.14710/nmjn.v13i2.51935

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

- 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

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{NMJN51935,
    author = {Dora Samaria and Desmawati Desmawati and Lima Florensia},
    title = {Effects of Direct and Indirect Factors on Attitude toward the COVID-19 Vaccine in Pregnant Women},
    journal = {Nurse Media Journal of Nursing},
  volume = {13},
    number = {2},
    year = {2023},
    keywords = {Attitude; COVID-19 vaccine; hesitancy; motivation; pregnant women},
    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.   Conclusion  s  :  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.     },
   issn = {2406-8799},   pages = {226--235}  doi = {10.14710/nmjn.v13i2.51935},
    url = {https://ejournal.undip.ac.id/index.php/medianers/article/view/51935}
}

Citation Format:

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.

Fulltext View|Download

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

Article Metrics:

Article Info

Section: Articles

Language : EN

In Vol 13, No 2 (2023): (August 2023)

Recent articles

Women and Family Members’ Views Regarding Early Decisions about Breast Cancer Treatment: A Qualitative Study Chemotherapy-Induced Nausea and Vomiting (CINV) Based on Blood Types among Cancer Patients in Yogyakarta, Indonesia Barriers and Support for Family Caregivers in Caring for Older Adults with Dementia: A Qualitative Study in Indonesia Editorial Back Matter Editorial Front Matter More recent articles

Most cited articles

BSE Practice and BSE Self-Efficacy among Nursing Students in Aceh, Indonesia Mental Distress in Rural Areas of Indonesia Development of a Community-Based Spiritual Life Review Program for Promoting Resilience of Elders Residing in Disaster-Prone Areas Teaching Pain Management to Student Nurses: A Literature Review Ethical Values in the Nursing Profession as Perceived by Head Nurses and Staff Nurses in Public Hospitals, Banda Aceh, Indonesia: A comparison Study More cited articles

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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

Last update:

No citation recorded.

Last update: 2024-12-21 19:05:32

No citation recorded.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Journal Author(s) Rights

In order for the Department of Nursing, Faculty of Medicine, Universitas Diponegoro to publish and disseminate research articles, we need non-exclusive publishing rights (transferred from the author(s) to the publisher). This is determined by a publishing agreement between the author(s) and the Department of Nursing, Faculty of Medicine, Universitas Diponegoro. This agreement involves the transfer or licensing of the copyright for publishing to the publisher, while authors still retain significant rights to use and share their own published articles. The Department of Nursing, Faculty of Medicine, Universitas Diponegoro supports the need for authors to share, disseminate, and maximize the impact of their research through these rights in any databases.

As the author(s), you have rights to a wide range of uses of your article, including use by your employing institution or company. These author rights can be exercised without the need to obtain specific permission. Authors publishing in the Nurse Media Journal of Nursing have extensive rights to use their works for teaching and scholarly purposes without needing to seek permission, including:

use for classroom teaching by the author or the author’s institution and presentation at a meeting or conference, including distributing copies to attendees;
use for internal training by the author’s company;
distribution to colleagues for their research use;
use in a subsequent compilation of the author’s works;
inclusion in a thesis or dissertation;
reuse of portions or extracts from the article in other works (with full acknowledgment of the final article);
preparation of derivative works (other than for commercial purposes) (with full acknowledgment of the final article);
voluntary posting on open websites operated by the author or the author’s institution for scholarly purposes;

following the open access license of the Creative Commons CC BY-SA License.

Authors, readers, and third parties can copy and redistribute the material in any medium or format, as well as remix, transform, and build upon the material for any purpose, even commercially, but they must give appropriate credit (including the name of the creator and attribution parties, detailed information about the authors, a copyright notice, an open access license notice, a disclaimer notice, and a link to the material), provide a link to the license, and indicate if changes were made. The publisher will indicate any modification of the material (if any) and retain an indication of previous modifications using a CrossMark Policy and information about Erratum-Corrigendum notifications.

Authors, readers, and third parties can read, print, and download, redistribute or republish the article (e.g., display it in a repository), translate the article, download it for text and data mining purposes, reuse portions or extracts from the article in other works, sell or reuse it for commercial purposes, remix, transform, or build upon the material. They must distribute their contributions under the same license as the original Creative Commons Attribution-ShareAlike (CC BY-SA).

Copyright Transfer Agreement for Publishing (Publishing Right)

The Authors submitting a manuscript do so on the understanding that if accepted for publication, non-exclusive right for publishing (publishing right) of the article shall be assigned/transferred to Publisher of the Nurse Media Journal of Nursing (Department of Nursing, Faculty of Medicine, Universitas Diponegoro).

Upon acceptance of an article, authors will be asked to complete a 'Copyright Transfer Agreement for Publishing (CTAP)'. An e-mail will be sent to the Corresponding Author confirming receipt of the manuscript together with a 'Copyright Transfer Agreement for Publishing' form by online version of this agreement.

Nurse Media Journal of Nursing and Department of Nursing, Faculty of Medicine, Universitas Diponegoro, the Editors and the Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the Nurse Media Journal of Nursing are sole and exclusive responsibility of their respective authors and advertisers.

Please note that even though we ask for a transfer of copyright for publishing (CTAP), our journal Author(s) retain (or are granted back) significant scholarly rights as mentioned before.

The Copyright Transfer Agreement for Publishing (CTAP) Form can be downloaded here: [Copyright Transfer Agreement for Publishing (CTAP) Form NMJN 2024]

The copyright form should be signed electronically and send to the Editorial Office in the form of original e-mail below:

Dr. Meira Erawati (Editor-in-Chief)
Editorial Office of Nurse Media Journal of Nursing
Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Jl. Prof. Soedarto, Tembalang, Semarang, Central Java, Indonesia 50275
Telp.: +62-24-76480919; Fax.: +62-24-76486849
E-mail: media_ners@live.undip.ac.id

(This policy statements has been updated at 24th January 2024)

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

Journal Author(s) Rights

Copyright Transfer Agreement for Publishing (Publishing Right)

OFFICE INFORMATION