What influences the intention to get vaccinated against COVID-19 in the Western Balkans?

Abstract Background Although effective vaccines against COVID-19 have been developed with the unprecedented speed, insufficient vaccine uptake suggests that many people are unwilling to get vaccinated worldwide. The aim of this study was to assess factors influencing intention to get vaccinated against COVID-19 in five Western Balkans countries. Methods Total of 700 unvaccinated respondents aged 18-75 participated in the study. Intention was assessed by a single item gauging the likelihood of getting vaccinated on a 5-points Likert scale. Multiple linear regression was used to determine whether socio-demographics (gender, age, religiousness, educational level, employment status, presence of chronic diseases) and attitudes towards vaccination predict intention to get vaccinated. Results Proportion of respondents willing to get vaccinated against COVID-19 ranged from 22.6% in Serbia to 40.4% in Montenegro. In Bosnia and Herzegovina and Albania stronger intention to get vaccinated in the future was associated with confidence in vaccine safety (β=.24, p<.01 and β=.20, p<.01 respectively) and efficacy (β=.28, p<.01 and β=.26, p<.001), higher feeling of danger of the disease (β=.21, p<.05 and β=.17, p<.05) and higher social responsibility (β=.35, p<.001 and β=.18, p<.01). Confidence in vaccine efficacy (β=.34, p<.001) and social responsibility (β=.24, p<.01), accompanied with higher sense of susceptibility to the disease (β=.13, p<.05), were significant predictors of intention in Serbia. In North Macedonia willingness to get the vaccine was significantly associated only with social responsibility (β=.09, p<.001), while in Montenegro age was the single predictor (β=-.32, p<.001); Conclusions Results of this study suggest that vaccination campaigns should focus on specific set of socio-psychological factors in each country, enhancing confidence in vaccine efficacy and appealing to collective responsibility as most prevalent determinants of vaccination intention in Western Balkans. Key messages • Specific set of socio-psychological factors influenced vaccination intention in each country. • Most prevalent factors influencing intention to get vaccinated against COVID-19 were confidence in vaccine efficacy and social responsibility.

The COVID-19 pandemic has been accompanied by an unprecedented infodemic, a key global public health challenge. Older people are more susceptible to COVID-19 and to misinformation, with WHO indicating the need for research on how people process and manage information in physical and digital environments to better understand how this phenomenon affects individuals. A qualitative study was developed in to explore the infodemic impact on elderly groups (eligible beneficiaries, aged 60-75 y, users of social services in the Heraklion Regional Unit, Crete Greece). Preliminary results indicate low trust levels for information delivered online and through media. Physicians remain the most trusted and preferred source of information, yet participants questioned their expertise level given the various issues emerging during the pandemic. Most of them report poor quality, incomplete information and point out the misleading role of media pluralism. Key topics of concern include the origin of SARS-CoV-2 and the safety and effectiveness of COVID-19 vaccines. The majority strongly believes that coronavirus is of lab origin, as they have read on the Internet. They are also susceptible to fake news and myths surrounding COVID-19 vaccines. Many of them also suffer from ''pandemic fatigue'', i.e., information overload, preferring not to further follow COVID-19 updates. Fear about their vulnerability was the major factor mentioned regarding scientific evidence, stating they prefer information to be conveyed clearly and in an understandable manner. Some exchange information with relatives and friends whilst others prefer not to discuss COVID-19, unless they consider the other person knows more than they do. Nevertheless, they all believe they make the best choices on how to protect their health, whilst having mixed feelings about the manner and content of communication received both in physical and digital environments. Key messages: COVID-19 care for the elderly should encompass infodemic management elements, incl. information presented using simple terms, from updated and regularly verified sources, ideally in printed form. Health and social care professionals' training should include media discourse, compassionate care, and motivational communication techniques rather than directional speeches of coercion and fear. In Bosnia and Herzegovina and Albania stronger intention to get vaccinated in the future was associated with confidence in vaccine safety (b = .24, p<.01 and b = .20, p<.01 respectively) and efficacy (b = .28, p<.01 and b = .26, p<.001), higher feeling of danger of the disease (b = .21, p<.05 and b = .17, p<.05) and higher social responsibility (b = .35, p<.001 and b = .18, p<.01). Confidence in vaccine efficacy (b = .34, p<.001) and social responsibility (b = .24, p<.01), accompanied with higher sense of susceptibility to the disease (b = .13, p<.05), were significant predictors of intention in Serbia. In North Macedonia willingness to get the vaccine was significantly associated only with social responsibility (b = .09, p<.001), while in Montenegro age was the single predictor (b = -.32, p<.001);

Conclusions:
Results of this study suggest that vaccination campaigns should focus on specific set of socio-psychological factors in each country, enhancing confidence in vaccine efficacy and appealing to collective responsibility as most prevalent determinants of vaccination intention in Western Balkans. Key messages: Specific set of socio-psychological factors influenced vaccination intention in each country.
Grasping the complexity of public health interventions is of increasing interest. Program evaluation may involve previously known and unknown variables; the former are best explored with quantitative, the latter with qualitative methods. As part of the impact evaluation of the Balassagyarmat Health Education Program (BEP), a near-peer education intervention targeting adolescents from a disadvantaged region of Hungary, we aimed to understand the complex effects of being an educator on medical students' knowledge about the biopsychosocial model of health. Thus, we developed a unified method that enables us to conduct an exploratory study on the effects of our intervention, then quantify and model that qualitative data. We started the method design with literature review and consultations with methodological and public health experts. We then refined the research questions based on a focus-group discussion held with 6 peer educators. After a set of pilot-interviews, we chose simulation interviewing as our knowledge elicitation procedure, then finalized the protocol with the help of additional piloting. In this unified method, simulation interviews are administered to peer educators and aligned controls, and cognitive task analysis is performed with the help of visual stimuli. Codes are developed inductively and, along with segmentation procedures, applied deductively to the entire dataset via the Reproducible Open Coding Kit.
Resulting quantified narratives are further processed with Epistemic Network Analysis. The relative frequency of code cooccurrence in each segment is modelled with networks enabling the qualitative and statistical comparison of data between subsamples. Building on the benefits of qualitative and quantitative approaches, this method offers a complex evaluation of the impact of health education interventions. By strengthening the methods of program evaluation we aim to facilitate the development of more effective interventions.

Key messages:
Qualitative and quantitative methods can be unified in program evaluation to promote a deeper understanding of the complexity in public health interventions.
Cognitive task analysis as a knowledge elicitation procedure can be used for the impact evaluation of health education programs.

Methods:
In a classroom survey among fourth graders' in North-Rhine Westphalia, Germany (07/21 -11/21), 4 items were used to assess CHL. 5 items were used to measure coronavirus knowledge, while also assessing the frequency of speaking about the coronavirus with parents. Sociodemographic characteristics were recorded, including family affluence (FAS). Bivariate correlations are reported.