Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2020) – 1.2
JCI – 0.22
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

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Dental and Medical Problems

2022, vol. 59, nr 1, January-March, p. 21–26

doi: 10.17219/dmp/145491

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Qabool H, Hamid F, Sukhia RH. Acceptance of SARS-CoV-2 vaccination and the associated factors among dental health care professionals: A cross-sectional survey. Dent Med Probl. 2022;59(1):21–26. doi:10.17219/dmp/145491

Acceptance of SARS-CoV-2 vaccination and the associated factors among dental health care professionals: A cross-sectional survey

Hafsa Qabool1,A,B,C,D,E,F, Fatima Hamid1,A,B,C,F, Rashna Hoshang Sukhia1,A,C,E,F

1 Section of Dentistry (Orthodontics), Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan

Abstract

Background. One of the greatest inventions of the 21st century is the development of vaccines against the life-threatening pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Whenever a new medication or treatment modality is introduced globally, it is accompanied by anxiety in the general public and among health care professionals.

Objectives. The aim of the study was to explore factors that may influence the acceptance of COVID-19 vaccination among dental health care professionals, as they are the first subgroup in the population to receive the vaccine.

Material and methods. A survey-based cross-sectional study was conducted on 164 health care professionals (general dentists, dental specialists with 2 years of experience after graduation and dental assistants). Data was collected by sending a URL link to the hard- and soft-copy questionnaire on Google Forms through all social media platforms. The questionnaire had 2 sections – the 1st part concerned the demographic details and the 2nd part was designed to assess the acceptance of SARS-CoV-2 vaccination among dental health care professionals and the related factors. The normality of the data was assessed with the Shapiro–Wilk test. The Cox regression algorithm was applied to evaluate the factors associated with the acceptance of SARS-CoV-2 vaccination.

Results. Out of 164 participants, 85.37% showed a positive attitude toward vaccination and only 7.32% of dental health care professionals were not willing to get vaccinated; out of them, 5 were males and 7 were females. Those who refused to get vaccinated included 3.6% of general dentists, 21.1% of dental specialists and 11.7% of dental assistants. The complications of major concern were fever, myalgia and the lethargic condition immediately after vaccination.

Conclusions. A small percentage of health care professionals declined to get vaccinated against COVID-19 and the main reason was uncertainty about the associated side effects. The respondents were mostly concerned about such side effects as fever, myalgia and the lethargic condition immediately after vaccination.

Keywords: SARS-CoV-2, dentist, vaccine, acceptance, health care professional

Introduction

December 2019 brought along a global humanitarian crisis due to the rapid spread of a disease caused by different variants of coronavirus – coronavirus disease 2019 (COVID-19) – with 87% chances of cross-infection and a 4% mortality rate.1 Policy-making organizations and health care setups declared an emergency situation to avoid the spread of the infection.2 Every country imposed strict guidelines and protocols to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Wearing a face mask and social distancing were made elemental protocols worldwide to minimize the rate of spread of the coronavirus through air-borne droplets.3 Despite all these preventive measures, SARS-CoV-2 spread rapidly in 2020 and policy-making organizations were worried about halting this viral web.4 Hence, the development and deployment of COVID-19 vaccines was considered to be the most promising health care fortification step to mitigate the rapid spread of the SARS-CoV-2 infection.5

One of the greatest inventions of the 21st century is the development of vaccination against life-threatening COVID-19.6 Current research is focused mainly on the trials of the newly developed vaccines against this deadly virus and their effects on the overall human health.7 Whenever a new medication or treatment modality is introduced globally, it is accompanied by anxiety in the general public and among health care professionals.8 The situation is quite challenging in the case of SARS-CoV-2 vaccines due to an already heightened level of stress and apprehension.9 This anxiety is associated with the alarming spread of the infection and a gradual increase in the mortality rate associated with the disease. At the end of December 2020, a mass vaccination program was initiated. The World Health Organization (WHO) collaborated with different companies worldwide to complete the critical steps of manufacturing safe and efficacious vaccines.10 One of the factors that greatly influenced the attitude of the general population toward COVID-19 vaccines was the misinformation being spread by anti-vaccination activists.11 Approximately 7% of the population of Saudi Arabia did not get vaccinated against influenza due to the fear of getting sick.6 This rate of acceptance was attributed to a multitude of factors, including location, the educational status and social behaviors.6

A survey conducted by Thunström et al. to explore the acceptance of vaccination revealed that around 20% of the population in the USA declined a COVID-19 vaccine.12 The most valid reasons for this non-acceptance were the possible side effects and vaccine ineffectiveness against the disease. Thus, it is imperative to explore factors that may influence the acceptance of vaccination among dental health care professionals, as they are highly exposed to SARS-CoV-2, working close to the oral cavity. Also, health care professionals along with the elderly population are among the initial subsets of the population to receive the vaccine allocated by the WHO.10

Therefore, this study aimed to assess the rate of acceptance of COVID-19 vaccination and the factors affecting the acceptance among dental health care professionals.

Material and methods

An analytical survey-based cross-sectional study was conducted after obtaining an approval from the institutional Research Ethics Committee (No. of approval: 2021-6233-17837). Data was collected by sending a URL link to the questionnaire on Google Forms through all the approachable social media platforms (e-mail, WhatsApp and Facebook Messenger). A modified version of the validated questionnaire of Posse et al.13 was used in this study. It comprised 2 sections. The 1st section was based on informed consent and concerned the demographic information about the study participants. The 2nd section was framed to assess the acceptance of COVID-19 vaccination among dental health care professionals along with its associated factors. The questionnaire was then assessed by 3 dental health care professionals for its face validity.

The sample size of the study was calculated with the OpenEpi software, v. 3.01 (https://www.openepi.com/Menu/OE_Menu.htm). Since, according to the findings of Wang et al.,11 the anticipated proportion of the acceptance of vaccination among dental health care professionals was kept at 89.5%, and a level of significance was set at 5%, precision at 5% and a design effect at 1, a sample size of 160 dental health care professionals was required for this study with an inflation of 10%.

The study questionnaire was sent to general dentists, dental specialists with 2 years of experience after graduation and dental assistants. Five reminders were sent to the non-responders before excluding them from the study. Moreover, the participants were asked to forward the Google form link to other dental health care professionals; in this way, data was collected by means of a simplified snowball sampling technique.

Statistical analysis

The data was analyzed using the statistical software for data science Stata®, v. 12.0 (StataCorp, College Station, USA). Descriptive statistics for continuous variables were reported as mean and standard deviation (M ±SD), as the data was normally distributed. Nominal data was reported as percentage frequency or as number and percentage (n (%)). The unadjusted and adjusted prevalence ratios of the factors influencing the acceptance of vaccination were assessed using the Cox regression algorithm with a 95% confidence interval (CI).

Results

Demographics

A summary of the descriptive analysis with the percentage frequencies of the participants’ responses is shown in Table 1. Our sample included 81 males and 83 females, with 28 gene­ral dentists, 76 dental specialists and 60 dental assistants. Among a total of 164 participants, 85.37% showed a positive attitude toward vaccination. Only 7.32% of dental health care professionals were not willing to get vaccinated; out of them, 5 were males and 7 were females. Among health care professionals, we found that 3.6% of general dentists, 21.1% of dental specialsts and 11.7% of dental assistants refused vaccination (Table 2). Overall, 32.5% of the participants were concerned about fever, myalgia and lethargy, 28.0% were anxious about an allergic reaction to SARS-CoV-2 vaccination, 26.5% were worried about headaches and neurological complications, and the remaining 13.0% of the respondents were worried about respiratory complications (Table 1).

Acceptance of SARS-CoV-2 vaccination

Using the Cox regression algorithm, we found a statistically non-significant difference in the acceptance of vaccination between general dentists, dental specialists and dental assistants. As many as 96.4% of general dentists, 78.9% of dental specialists and 88.3% of dental assistants were willing to receive the vaccine. However, 3.6% of general dentists, 21.1% of dental specialists and 11.7% of dental assistants refused to be vaccinated. Among those who refused to get vaccinated, 50.0% were not sure if the vaccination was safe and 33.3% had doubts as to the development of vaccines; they were not sure if the regulatory bodies had approved the vaccine after the required research trials, as shown in Table 3. We found that there was a statistically non-significant difference in the acceptance of vaccination between genders (Table 3).

Discussion

Since the outbreak of COVID-19, efforts have been constantly made to control the pandemic and curb the rapid spread of coronavirus,12, 13, 14 and since the advent of vaccines against SARS-CoV-2 to limit cross-infection, many surveys have been performed to assess the acceptance of vaccination.15 The majority of those surveys focused on the general population.16, 17 On the Asian continent, the vaccine was first introduced to the subset of health care professionals. Hence, health care professionals can be an authentic source of evidence regarding factors that influence the acceptance of SARS-CoV-2 vaccination.18 Therefore, a survey like this may provide essential information to policy-making organizations and institutions to target the apprehension and motivate the rest of the population for vaccination.

In this survey, we found that only 7.32% of the participants were not willing to get vaccinated, 7.31% were hesitant about getting vaccinated, while as many as 85.37% of the participants accepted the vaccine. The present results are in contrast to a survey-based study conducted by Murhekar et al. in the USA, where 33.3% of the participants refused SARS-CoV-2 vaccination.19 The initial survey conducted in May 2020 reported a 47% rate of vaccination refusal.19 This gradual decrease in the percentage of health care professionals refusing SARS-CoV-2 vaccination may be due to the fact that awareness is increasing. The decreasing percentage also reflects the motivation of health care professionals to play a role in limiting the spread of cross-infection.20 Hesitation about getting vaccinated was found to be multifactorial. The cultural fears, side effects and general myths related to this disease make people uncertain about vaccination. According to the findings of Cascini et al., attitudes toward vaccination were also closely related to the initiatives taken by the government and the awareness campaigns conducted by the doctors.21 Health care professionals base their decisions on scientific evidence and the results of trials. These long-term trials have increased trust in the safety and effectiveness of vaccination.21

It is perceived that the acceptance of SARS-CoV-2 vaccination increases along with the level of experience and designation, as specialists were more willing to get vaccinated as compared to dental assistants.22 This may be due to the fact that dental assistants and dental staff with less experience lack valid information on vaccination.22 However, it is undeniable that overall, health care professionals faced a wave of uncertainty in this pandemic, which may have led them to spread rumors and myths regarding SARS-CoV-2 vaccination.

This survey found that almost 73% of the participants gained awareness with regard to SARS-CoV-2 vaccination via electronic and social media. Hence, electronic and social media may also be helpful in disseminating authentic information on SARS-CoV-2 vaccination. The WHO has taken an important initiative to address the myths regarding vaccination by answering the most commonly asked queries of the general population and uploading them on its website.23 We suggest that policy-making organizations should make use of electronic and social media, and take key steps to clear up misinformation among the popu­lation. This would increase the number of vaccinated people and eventually limit the spread of cross-infection.

Limitations

The limitations of this study are a survey-based cross-sectional study design with a non-probability snowball sampling technique and a small sample size. However, we believe that a long-term study should be conducted.

Conclusions

There was a small percentage of health care professionals refusing SARS-CoV-2 vaccination. The main reason was uncertainty about side effects, the most expected being fever, myalgia and lethargy following vaccination.

Ethics approval and consent to participate

The ethical approval was obtained from the institutional Research Ethics Committee (No. of approval: 2021-6233-17837). The respondents provided informed consent prior to completing the questionnaire.

Data availability

All data generated and/or analyzed during this study is included in this published article.

Consent for publication

The subjects understood that their names and initials would not be published, and due efforts would be made to conceal their identity, but anonymity could not be gua­ranteed.

Tables


Table 1. Acceptance of vaccination among 3 groups of dental health care professionals (N = 164)

Factors influencing the acceptance of SARS-CoV-2 vaccination

Dental health care professionals

general dentists

dental specialists

dental assistants

Q.1

Do you want to receive the vaccine as soon as it becomes available?

yes

96.4

78.9

88.3

no

3.6

21.1

11.7

Q.2

If not, what is your reason for not getting vaccinated?

not an effective option

21.1

10.3

8.6

unsafe

31.6

30.8

8.6

vaccine created in rush

31.6

43.6

40.0

immunity will develop

15.8

0.0

34.3

other

0.0

15.4

8.6

Q.3

Where did you get information on SARS-CoV-2 vaccination?

electronic/social media

85.7

73.7

70.3

publications/conferences/seminars

10.7

21.0

29.7

people/relatives

3.6

5.3

0.0

Q.4

How would you rate your knowledge about the COVID-19 pandemic?

good

7.1

61.8

55.0

moderate

35.7

36.8

43.3

poor

57.2

1.3

1.7

Q.5

How much has this pandemic affected
your daily routine?

significantly

92.9

82.5

91.7

insignificantly

7.1

17.5

8.3

Q.7

Do you think you will get infected with
the virus after getting vaccinated?

yes

46.4

59.2

56.7

no

3.6

9.2

8.3

not sure

50.0

31.6

35.0

Q.8

Did you ever refuse any vaccination
in the past?

yes

0.0

7.9

6.7

no

100.0

92.1

93.3

Q.9

Do you think SARS-CoV 2 vaccination will be an effective way to minimize and control
this infection?

yes

46.4

59.2

56.7

no

3.6

9.2

8.3

not sure

50.0

31.6

35.0

Q.10

Is the price of the vaccine an important factor in deciding whether to get vaccinated or not?

yes

50.0

28.9

35.0

no

50.0

63.2

53.3

not sure

0.0

7.9

11.7

Q.11

Is the vaccination schedule an essential factor in making a decision regarding
getting vaccinated?

yes

50.0

52.6

65.0

no

50.0

42.1

16.7

not sure

0.0

5.3

18.3

Q.12

Do you think the SARS-CoV 2 vaccine will have specific side effects?

yes

96.4

68.3

68.4

no

3.6

13.3

10.5

not sure

0.0

18.3

21.1

Q.13

Which side effects are you particularly worried about?

allergic reaction

21.4

38.2

18.3

neurological disturbances

14.3

22.4

10.0

respiratory disturbances

28.6

13.0

6.7

fever/myalgia/lethargy

35.7

26.4

65.0

Data presented as percentage values. SARS-CoV-2 – severe acute respiratory syndrome coronavirus 2; COVID-19 – coronavirus disease 2019.
Table 2. Descriptive statistics (N = 164)

Dental health care professionals

Gender
n (%)

Age
[years]
(M ±SD)

Experience
[years]
(M ±SD)

Percentage of acceptance
[%]

Percentage of unacceptance
[%]

male

female

General dentists

9 (32.1)

19 (67.9)

31.05 ±6.56

4.87 ±3.34

96.4

3.6

Dental specialists

37 (48.7)

39 (51.3)

36.09 ±8.14

8.48 ±6.31

78.9

21.1

Dental assistants

35 (58.3)

25 (41.7)

31.32 ±4.87

8.47 ±5.65

88.3

11.7

M = 81; F = 83; M – males; F – females; n – number; M – mean; SD – standard deviation.
Table 3. Factors influencing the acceptance of vaccination among dental health care professionals (N = 164)

Variable

Hazard ratio

95% CI

p-value

R2

Male gender

1.05

0.75, 1.46

0.750

0.75

Designation (general dentists as reference)

dental specialists

0.80

0.54, 1.19

0.290

0.57

dental assistants

0.86

0.55, 1.34

0.510

If you don’t want to receive the vaccine, what is
the reason?

not an effective option

1.26

0.85, 1.88

0.230

0.68

unsafe

1.26

0.66, 2.43

0.470

vaccine created in rush

0.90

0.51, 1.61

0.730

immunity will develop

1.01

0.57, 1.77

0.950

Where did you get information on SARS-CoV-2 vaccination?

electronic/social media

1.41

0.57, 3.46

0.440

0.67

publications/conferences/seminars

1.28

0.49, 3.31

0.610

How would you rate your knowledge about
the COVID-19 pandemic?

moderate

0.82

0.29, 2.28

0.710

0.16

poor

0.86

0.31, 2.35

0.770

How much has this pandemic affected your daily routine?

insignificantly

1.08

1.02, 1.20

0.050*

1.08

Do you think you will get infected with the virus after getting vaccinated?

no

1.02

0.71, 1.45

0.910

0.35

not sure

1.20

0.65, 2.21

0.550

Did you ever refuse any vaccination in the past?

no

1.06

0.53, 2.07

0.870

0.03

Do you think SARS-CoV 2 vaccination will be an effective way to minimize and control this infection?

no

1.13

0.67, 1.91

0.630

0.30

not sure

1.31

0.38, 4.50

0.660

Is the price of the vaccine an important factor in deciding whether to get vaccinated or not?

no

1.79

0.81, 0.71

0.140

0.27

Is the vaccination schedule an essential factor in making a decision regarding getting vaccinated?

no

1.08

0.59, 1.99

0.780

0.10

Do you think the SARS-CoV 2 vaccine will have specific side effects?

no

0.82

0.54, 1.25

0.360

0.66

Which side effects are you particularly worried about?

allergic reaction

1.05

0.61, 0.51

0.850

0.79

neurological disturbances

0.93

0.51, 1.71

0.830

respiratory disturbances

0.88

0.46, 1.69

0.720

fever/myalgia/lethargy

1.99

0.57, 2.05

0.790

Cox regression algorithm model; CI – confidence interval; * statistically significant (p ≤ 0.05).

References (23)

  1. Kaur H, Kochhar AS, Gupta H, Singh G, Kubavat A. Appropriate orthodontic appliances during the COVID-19 pandemic: A scoping review. J Oral Biol Craniofac Res. 2020;10(4):782–787. doi:10.1016/j.jobcr.2020.10.014
  2. Lee TVN, Fowler PV, Williams JC, Ellis P, Atack NE, Ireland AJ. Orthodontics at times of national emergency: Past and current crises Part 2. COVID-19: Implications for clinical practice. Orthod Update. 2020;13(3):108–116. doi:10.12968/ortu.2020.13.3.108
  3. Dalewski B, Palka L, Kiczmer P, Sobolewska E. The impact of SARS-CoV-2 outbreak on the Polish dental community’s standards of care – a six-month retrospective survey-based study. Int J Environ Res Public Health. 2021;18(3):1281–1284. doi:10.3390/ijerph18031281
  4. Marshall S, Duryea M, Huang G, et al. COVID-19: What do we know? Am J Orthod Dentofacial Orthop. 2020;158(5):e53–e62. doi:10.1016/j.ajodo.2020.08.010
  5. Adly AS, Adly AS, Adly MS. Approaches based on artificial intelligence and the Internet of intelligent things to prevent the spread of COVID-19: Scoping review. J Med Internet Res. 2020;22(8):e19104. doi:10.2196/19104
  6. Perillo L, Nucci L, Yitschaky O, Carrino G, Carrino R, Chaushu S. Returning to the orthodontic practice amid COVID-19 crisis. Stoma Edu J. 2020;7(3):209–215. doi:10.25241/stomaeduj.2020.7(3).art.7
  7. Zahran S, Wright N. A review of COVID-19 and the implications for orthodontic provision in England. Orthod Update. 2020;13(3):117–124. doi:10.12968/ortu.2020.13.3.117
  8. Hegde MN, Parmar G, Logani A, et al. Dental practice management during COVID‐19 times – now and beyond. Int J Clin Pract. 2021;75(9):e14251. doi:10.1111/ijcp.14251
  9. Bakaeen LG, Masri R, AlTarawneh S, et al. Dentists’ knowledge, attitudes, and professional behavior toward the COVID-19 pandemic: A multisite survey of dentists’ perspectives. J Am Dent Assoc. 2021;152(1):16–24. doi:10.1016/j.adaj.2020.09.022
  10. World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed September 15, 2021.
  11. Wang J, Jing R, Lai X, et al. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines (Basel). 2020;8(3):482. doi:10.3390/vaccines8030482
  12. Thunström L, Ashworth M, Finnoff D, Newbold SC. Hesitancy towards a COVID-19 vaccine. Ecohealth. 2021;18(1):44–60. doi:10.1007/s10393-021-01524-0
  13. Posse JL, van Harten MT, Mac Giolla Phadraig C, et al. The impact of the first wave of the COVID-19 pandemic on providing special care dentistry: A survey for dentists. Int J Environ Res Public Health. 2021;18(6):2970. doi:10.3390/ijerph18062970
  14. Day CJ, Price R, Sandy JR, Ireland AJ. Inhalation of aerosols produced during the removal of fixed orthodontic appliances: A comparison of 4 enamel cleanup methods. Am J Orthod Dentofacial Orthop. 2008;133(1):11–17. doi:10.1016/j.ajodo.2006.01.049
  15. Renukaradhya GJ, Isloor S, Rajasekhar M. Epidemiology, zoonotic aspects, vaccination and control/eradication of brucellosis in India. Vet Microbiol. 2020;90(1–4):183–195. doi:10.1016/S0378-1135(02)00253-5
  16. Qian H, Zheng X. Ventilation control for airborne transmission of human exhaled bio-aerosols in buildings. J Thorac Dis. 2018;10(Suppl 19):S2295–S2304. doi:10.21037/jtd.2018.01.24
  17. Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020;7(1):11. doi:10.1186/s40779-020-00240-0
  18. Holshue ML, DeBolt C, Lindquist S, et al.; Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel corona­virus in the United States. N Engl J Med. 2020;382(10):929–936. doi:10.1056/NEJMoa2001191
  19. Murhekar MV, Bhatnagar T, Selvaraju S, et al. Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May–June 2020. Indian J Med Res. 2020;152(1&2):48–60. doi:10.4103/ijmr.IJMR_3290_20
  20. American Dental Association, MouthHealthy™. 2020. Infection control. https://www.mouthhealthy.org/en/az-topics/i/infection-control. Accessed September 15, 2021.
  21. Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine. 2021;40:101113. doi:10.1016/j.eclinm.2021.101113
  22. Qabool H, Sukhia RH, Fida M. Knowledge and awareness of dental specialists, general dentists and dental assistants regarding SARS-CoV-2. Dent Med Probl. 2021;58(3):285–290. doi:10.17219/dmp/134964
  23. World Health Organization, Regional Office for the Eastern Mediterranean. COVID-19 situation in the Region. Situation as of October 4, 2021. http://www.emro.who.int/health-topics/corona-virus/index.html. Accessed September 15, 2021.