ABSTRACT
The COVID-19 pandemic can be controlled by vaccination in addition to public health measures. This study investigate the impact of Health Literacy (HL) on vaccination and COVID-19. 334 patients and patient’s relatives aged 18 to 65 years who were followed up at the Infectious Diseases Clinic between March and July 2022 for reasons other than COVID-19 disease were included in the study. The COVID-19 vaccination status of each participant was queried and the preferred vaccination was recorded on the case form. The mean age was 40.9 years, and 52.4% (n:175) of participants were women. It was found that 82.3% (n:275) of participants had received at least one dose of the vaccine COVID-19. It was found that 17.6% of participants had not been COVID-19 vaccinated. It was found that 60.7% (n:203) of participants received ≥ 2 doses of the mRNA-based viral vaccine. Vaccination rates were found to be significantly lower in patients with ‘inadequate’ HL (p = .047). In addition, the vaccination rate was lower in people aged 39 years and younger and in the presence of one or more chronic diseases. When chronic diseases are present, COVID-19 becomes more severe. On the other hand, the disease shows a moderate clinical picture and plays a significant role in transmission to risk groups in the young population, where vaccination rates are low. This situation in the context of COVID-19 demonstrates once again the importance of informing at-risk groups and the healthy young population about vaccine-preventable diseases.
KEYWORDS: COVID-19 vaccines, health literacy, vaccine hesitancy
Introduction
The rapid spread of the COVID-19 pandemic has prompted clinicians to search for treatments and vaccines that can effectively control COVID-19 disease. Before vaccination practices became widespread, efforts to ensure epidemic control in the fight against pandemics relied primarily on public health measures such as social distancing, self-isolation, travel restrictions, hand hygiene, the mandatory or recommended wearing of masks in public places, the dissemination of COVID-19 tests and isolation measures when necessary.1 However, it is a fact that vaccination against infectious diseases is one of the most effective ways to protect vulnerable populations and that with adequate immunization, herd immunity can be achieved.2 WHO reports that there are 175 vaccines in clinical development and 199 vaccines in preclinical development to protect against COVID-19 disease.3 For COVID-19 vaccination, depending on countries’ procurement and licensing procedures, vaccine types obtained by different methods are preferred, such as mRNA vaccines, protein subunit vaccines, viral vector vaccines and inactivated vaccines.4,5 In the control of COVID-19 maintaining an adequate vaccination rate is pivotal. Therefore, vaccine hesitancy is an important issue and has been ranked as one of the top 10 public health threats.6 Vaccine hesitancy is a delay in accepting or refusing vaccines despite the availability of immunization services.7 Vaccine refusal or inadequate vaccination at the community level leads to the resurgence of vaccine-preventable diseases such as measles and pertussis. In this regard, epidemic clusters related to these diseases are observed in societies where vaccination is inadequate.8 During the pandemic, discourses on social platforms about economic interests and vaccine safety COVID-19 have reached alarming proportions.9 If we look at the vaccination situation in Turkey, we find that the first-time vaccination rate for COVID-19 vaccination is over 90% (57 958 884 doses).10 However, it is noteworthy for the vaccination situation in Turkey that the second (85.7%, 53 194 422 doses) and third doses (53%, 28 235 956 doses) of vaccination do not achieve the desired rates.4 Health Literacy (HL) is defined by the World Health Organization as the cognitive and social skills that individuals need to obtain, understand, and use health information to maintain and improve their health status and that are effective in creating and maintaining a healthy life.10 Health literacy is the gap between people’s understanding and use of information to make decisions about their health.11 Health literacy also enables individuals to correctly interpret information received from various sources in order to make the right decisions about their own health. However, It is very difficult to measure individual health literacy. It is multidimensional, complex, and can take years to develop.11 It is well known that adults with low health literacy are less likely to use preventive services.12 Concerns, hesitations and misunderstandings about possible side effects of vaccines are becoming more common nowadays. Vaccine hesitancy, vaccine rejection and anti-vaccination approaches have increased over the years, and these issues were discussed in Turkey until recently. During the COVID-19 pandemic, people with low health literacy in many parts of the world had difficulty analyzing and using the right and wrong information about the disease.11
This shows that HL plays an important role in preventing communicable diseases as well as non-communicable diseases. The Health Literacy Questionnaire (HLQ) is used to assess patients’ HL status, which is an abstract concept. The aim of the study was to identify the factors influencing COVID-19 vaccination by examining the impact of HL, which plays an important role in the use of preventive health services, on COVID-19 vaccination.
Material and method
Patients and Patient’s relatives who did not have COVID-19 and presented to the infectious disease clinic for reasons other than COVID-19 between March 10, 2022 and July 28, 2022 were included in this study. The patient’s relatives of patients who had presented to the Infectious Diseases Clinic were informed about the study so that they could also participate. Each participant gave informed consent to participate in the study. The guiding principles of the Declaration of Helsinki were followed in the conduct of the study. The study was approved by the local ethics committee. (Decision date: 09/03/2022, Decision no:2011-KAEK-25 2022/03–06).
Study sample
Patients and patient’s relatives who are Turkish citizens, between 18 and 65 years old, and can read and understand Turkish participated in the study. Patients with diseases such as central nervous system infections, encephalopathy, mental retardation or Alzheimer’s disease that would prevent them from understanding the questions were excluded from the study. A questionnaire on occupation, marital status, education level, and chronic diseases was completed by patients and their relatives with the help of staff. The previously validated European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess the level of health literacy in the Turkish population.13 In the infectious disease and clinical microbiology clinics, questionnaires were completed by both outpatients and inpatients in a face-to-face interview. The 47 questions were scored on a 4-point scale, with response options arranged in the following order: 1 = very difficult, 2 = difficult, 3 = easy, and 4 = very easy. Questions that were not answered were not included. Inadequate HL is defined as a score from 0 to 25, problematic-limited HL is defined as a score from > 25 to 33, adequate HL is defined as a score from > 33 to 42, and excellent HL is defined as a score from > 42 to 50. (Formula Index = (mean of each item−1)* (50/3), where the index was a specially calculated index, 1 was the smallest possible value of the mean, 3 was the range of the mean, and 50 was the maximum value chosen for the new metric. In the evaluation of HLS-EU, questions 1–47 indicate the general HL index, questions 1–16 indicate the health care sub-index HL, questions 17–31 indicate the disease prevention sub-index HL and questions 32–47 indicate the health promotion sub-index HL.
The COVID-19 vaccination status and vaccination preferences
The COVID-19 vaccination status of each participant was asked, and the vaccination preferences of participants who wished to be vaccinated were recorded on the case form. At the time of the study, the mRNA-based vaccine BNT162b2 (Pfizer/Biontech) and the inactivated virus vaccine CoronaVac (Sinovac) were available in Turkey. Participants were asked about their preferred COVID-19 vaccine, using the vaccines’ trade names and manufacturer’s information.
Vaccination protocols:
Inactivated virus vaccine + Inactivated virus vaccine
Inactivated virus vaccine + Inactivated virus vaccine + Inactivated virus vaccine
Inactivated virus vaccine + Inactivated virus vaccine + mRNA-based vaccine
mRNA-based vaccine + mRNA-based vaccine
mRNA-based vaccine + mRNA-based vaccine + mRNA-based vaccine
Inactivated virus vaccine + Inactivated virus vaccine + mRNA-based vaccine + mRNA-based vaccine
Other (vaccination with a single dose of mRNA-based vaccine, a single dose of inactivated virus vaccine or a vaccine not available in our country). Participants’ vaccination status was analyzed by classifying them as ‘fully vaccinated’ or ‘incompletely vaccinated’ according to the protocol established by the Association of Infectious Diseases Physicians (KLİMİK) for the administration of the vaccine COVID-19.14 The distinction between fully vaccinated and incompletely vaccinated was made according to on the Table 1 definitions.
Table 1.
The definitions fully vaccinated and incompletely vaccinated.
| Incompletely Vaccinatied | Inactivated virus vaccine + Inactivated virus vaccine | Inactivated virus vaccine + Inactivated virus vaccine + Inactivated virus vaccine | mRNA-based vaccine + mRNA-based vaccine vaccine | Inactivated virus vaccine+ Inactivated virus vaccine+ mRNA-based vaccine |
| Fully vaccinated | mRNA-based vaccine+ mRNA-based vaccine+ mRNA-based vaccine±mRNA-based vaccine | Inactivated virus vaccine+ Inactivated virus vaccine+ Inactivated virus vaccine+ mRNA-based vaccine | Inactivated virus vaccine+ Inactivated virus vaccine+ mRNA-based vaccine+ mRNA-based vaccine | Inactivated virus vaccine+ Inactivated virus vaccine+ mRNA-based vaccine+ mRNA-based vaccine |
Statistical analysis
Statistical analyses for the study were performed using the SPSS software. Nominal data were defined by ratios and percentages, while numerical data were described by means and standard deviation. The Pearson chi-square test was used in the analyses to compare COVID-19 vaccination status and COVID-19 vaccine preferences according to patients’ sociodemographic characteristics and general health status. Similarly, the Pearson chi-square test was used in the analyses to compare COVID-19 vaccination status by health literacy status. P < .05 was accepted as statistically significant.
Results
Patient characteristics
334 patients and patients’ relatives participated in the study; mean age was 40.9 (±11.8) years. 52.4% (n:175) were female and 47.6% (n:159) were male. 76.6% of the participants were married. 105 (31.4%) of the participants had a chronic disease. Among the participants, 26 had diabetes mellitus and 24 had hypertension. It was found that 82.3% (n:275) of the 334 participants agreed to receive at least one dose of the vaccine COVID-19 (Table 2). 17.6% refused vaccination against COVID-19. It was found that 60.7% (n:203) of the participants had received 2 doses or more than 2 doses of the Biontech and 9.9% (n:33) of them had received 2 doses or more than 2 doses of the Sinovac. It was found that 34.1% (114) of the participants had a university degree and/or higher education level (Tables 2, Table 4). The mean health literacy index of all participants was 35.3 (±9.06). Examination of the HL status of the people participating in the study participants revealed that 32.6% (n:109) had problematic-limited HL and 10.5% (n:35) had inadequate HL (Table 2, Table 4).
Table 2.
The effect of participants’ sociodemographic characteristics and general health status on the decision to be vaccinated against COVID-19.
| COVID-19 vaccination status |
||||
|---|---|---|---|---|
| All of participants | Vaccinated (n), % | Unvaccinated (n), % | P value | |
| Age mean(±SD) | 40,9(±11,8) | 275, 82.3% | 59, 17.6% | |
| 39 years and under | 155, 46.4% | 124, 80.0% | 31, 20.0% | 0,456 |
| Between 40-49 | 100, 29.9% | 82, 82.0% | 18, 18.0% | |
| Between 50-59 | 53, 15.9% | 45, 84.9% | 8, 15.1% | |
| Between 60-65 | 26, 7.8% | 24, 92.3% | 2, 7.7% | |
| Gender | ||||
| Female | 175, 52.4 % | 141, 80.6% | 34, 19.4% | 0,375 |
| Male | 159, 47.6 % | 134, 84.3% | 25, 15.7% | |
| Educational Status | ||||
| Primary school | 82, 24.6 % | 70, 85.4% | 12, 14.6% | 0,224 |
| Middle school | 43, 12.9 % | 35, 81.4% | 8, 18.6% | |
| High school | 95, 28.4 % | 72, 75.8% | 23, 24.2% | |
| University and/or Above | 114, 34.1 % | 98, 86.0% | 16, 14.0% | |
| Marital status | ||||
| Married | 256, 76.6 % | 214, 83.6% | 42, 16.4% | 0,349 |
| Others | 76, 22.8 % | 60, 78.9% | 16, 21.1% | |
| Occupation | ||||
| Office Employee | 53, 15.9 % | 45, 84.9% | 8, 15.1% | 0,962 |
| Healthcare Professionals | 16, 4.8 % | 13, 81.3% | 3, 18.8% | |
| Blue-collar worker | 105, 31.4 % | 86, 81.9% | 19, 18.1% | |
| Unemployed/ Retired | 160, 47.9 % | 131, 81.9% | 29, 18.1% | |
| Presence of Chronic Disease | ||||
| Present | 105, 31.4 % | 90, 85.7% | 15, 14.3% | 0,273 |
| Absent | 229, 68.6 % | 185, 80.8% | 44, 19.2% | |
| HLS-EU-Q47 questionnaire scores, mean(±SD) | 35,3(± 9,06) | |||
| Inadequate (0-25 point) | 35, 10.5 % | 23, 65.7% | 12, 34.3% | *0,047 |
| Problematic-limited (>25-33) | 109, 32.6 % | 91, 83.5% | 18, 16.5% | |
| Adequate (>33-42) | 103, 30.8 % | 89, 86.4% | 14, 13.6% | |
| Excellent (>42-50) | 87, 26 % | 72, 82.8% | 15, 17.2% | |
Table 4.
The effect of participants’ sociodemographic characteristics and general health status on COVID-19 vaccine preferences.
| All of participants (n), % | Fully vaccinated (n), % | Incompletely Vaccinated (n),% | Unvaccinated (n),% | P value | |
|---|---|---|---|---|---|
| Age, mean(±SD): 40,9(±11,8) | *0,017 | ||||
| 39 years and under | 155, 46.4% | 34, 21.9% | 90, 58.1% | 31, 20.0% | |
| Between 40–49 | 100, 29.9% | 40, 40.0% | 42, 42.0% | 18, 18.0% | |
| Between 50–59 | 53, 15.9% | 21, 39.6% | 25, 47.2% | 7, 13.2% | |
| Between 60–65 | 26, 7.8% | 12, 46.2% | 12, 46.2% | 2,7.7% | |
| Gender | 0,566 | ||||
| Female | 175, 52.4% | 52, 29.7% | 90, 51.4% | 33, 18.9% | |
| Male | 159, 47.6% | 55, 34.6% | 79, 49.7% | 25, 15.7% | |
| Educational Status | 0,073 | ||||
| Primary school | 82, 24.6% | 19, 23.2% | 52, 63.4% | 11, 13.4% | |
| Middle school | 43, 12.9% | 17, 39.5% | 18, 41.9% | 8, 18.6% | |
| High school | 95, 28.4% | 31, 32.6% | 41, 43.2% | 23, 24.2% | |
| University and/or Above | 114, 34.1% | 40, 35.1% | 58, 50.9% | 16, 14% | |
| Marrital status | 0,365 | ||||
| Married | 256, 76.6% | 87, 34.0% | 128, 50.0% | 41, 16.0% | |
| Others | 76, 22.8% | 20, 26.3% | 40, 52.6% | 16, 21.1% | |
| Occupation | 0,982 | ||||
| Office Employee | 53, 15.9% | 18, 34.0% | 27, 50.9% | 8, 15.1% | |
| Healthcare Professionals | 16, 4.8% | 5, 31.3% | 8, 50.0% | 3, 18.8% | |
| Blue-collar worker | 105, 31.4% | 30, 28.6% | 56, 53.3% | 19, 18.1% | |
| Unemployed/Retired | 160, 47.9% | 54, 33.8% | 78, 48.8% | 28, 17.5% | |
| Presence of Chronic Disease | *0,020 | ||||
| Present | 105, 31.4% | 26, 24.8% | 65, 61.9% | 14, 13.3% | |
| Absent | 229, 68.6% | 81, 35.4% | 104, 45.4% | 44, 19.2% | |
| HLS-EU-Q47 questionnaire scores, mean(±SD) | 35,3(± 9,06) | 0,311 | |||
| Inadequate (0–25 point) | 35, 10.5% | 8, 22.9% | 16, 45.7% | 11, 31.4% | |
| Problematic-limited (>25–33) | 109, 32.6% | 39, 35.8% | 52, 47.7% | 18, 16.5% | |
| Adequate (>33–42) | 103, 30.8% | 32, 31.1% | 57, 55.3% | 14, 13.6% | |
| Excellent (>42–50) | 87, 26% | 28, 32.2% | 44, 50.6% | 15, 17.2% | |
Variables influencing the decision for or against COVID-19 vaccination
When examining the association between age and COVID-19 vaccination, it was found that 7.7% of participants aged 60–65 years had not been vaccinated against COVID-19. Characteristics such as gender, marital status and education level were found to have no effect on vaccination against COVID-19 (p > .05), (Table 2). Occupational groups also had no influence on the decision to get vaccinated against COVID-19 (p = .962), (Table 2). The results also show that the presence of a chronic disease did not significantly influence vaccination against COVID-19 (p > .05). It was found that the vaccination rates of patients with an “inadequate” HL level were significantly lower than those of patients with other HL levels when their vaccination status was compared according to their HL level (p = .047). While the influence of education level on vaccination against COVID-19 could not be established, an ‘inadequate’ level of HL was found to influence the tendency to vaccinate against COVID-19.The HL health care sub-index (p = 0.681), the HL disease prevention sub-index (p = 0.209) and the HL health promotion sub-index (p = 0.434) had no significant effect on immunization status when the effect of the HL sub-index on vaccination status was examined (Table 3).
Table 3.
The effect of HL subındexes on COVID-19 vaccınatıon status.
| COVID-19 vaccination status | Vaccinated, mean(±SD) | Unvaccinated, mean(±SD) | P value |
|---|---|---|---|
| Health care HL subindex (q 1–16) | 51,69(±8,25) | 51,19(±9,7) | 0,681 |
| Disease prevention HL subindex (q 17–31) | 47,88(±9,5) | 45,86(±11,3) | 0,209 |
| Health promotion HL subindex (q 32–47) | 48,66(±11,07) | 47,1(±14,1) | 0,434 |
Variables influencing incomplete/full vaccination status against the vaccine COVID-19
When comparing the vaccination status of COVID-19 by age, the rate of under-vaccination was significantly higher in people aged 39 years and younger than in other age groups (p = 0.017), (Table 4). When the incomplete or full vaccination status was compared by sex and marital status, it was found that there was no significant difference between the groups (p = 0.566), (p = 0.365), (Table 4). It was also observed that education status had no significant effect on incompletely or fully vaccinated (p = 0.073), (Table 4).
The rate of fully vaccinated individuals with one or more chronic diseases was significantly lower than those without any disease (p = 0.02) (Table 4). It was found that the level of HL influencing get of COVID-19 vaccination did not have a statistically significant effect on whether a person received incomplete or full vaccination (p = 0.311) (Table 4). The age factor was found to have no effect on vaccination against COVID-19, but the rate of those fully vaccinated in the 60–65 age group was 46.2%, while this rate was 21.9% for 39 years and younger.
This is attributed to the fact that the younger group experienced infection with COVID-19 with a lower morbidity and mortality rate than those over 40 years of age. It was also found that the presence of chronic disease had no effect on the status of vaccination against COVID-19, but had a significant negative effect on full vaccination. This suggests that if a chronic disease is present, there may be concerns due to side effects such as vaccine side effects and drug interactions.
Discussion
The main objective of the study was to investigate the impact of HL on vaccination and COVID-19. The results of the study showed that vaccination rates were lower in patients with ‘inadequate’ HL. It was also found that the status of being fully vaccinated was lower in participants with chronic diseases and participants under 39 years of age than in other groups. The results of the study show that the COVID-19 vaccine is not achieving the vaccination rates (70–75%) needed to prevent the spread of the disease among young people and people with chronic diseases. It was found that all groups accepted the first dose of vaccination with the effect of the pandemic. The purpose of vaccination is to protect at-risk groups and prevent the spread of the disease in the community, especially in the event of a pandemic. Previous studies have shown that the prevention rate of an COVID-19 is at least 70% when 75% of the population is vaccinated.15 Reasons that may lead to vaccination hesitancy worldwide include concerns about the efficacy and safety of vaccines, a perception of low risk of exposure to the disease or ignorance of the severity of the disease, a lack of information, a lack of belief that vaccination is medically necessary, and conspiracy theories. In Turkey, religious reasons and the foreign origin of the vaccine are added.16 In the study conducted by İkiışık et al. to investigate the acceptability of the vaccine COVID-19, it was found that 54.7% (n:210) of participants said they would have the vaccine approved by the Ministry of Health.17 Salalı et al, in their study conducted simultaneously in the UK and Turkey, reported that the rate of COVID-19 vaccine hesitancy was 31% higher in Turkey than in the UK (p < .001).18 It was found that 82.3% (n:275) of participants in this study agreed to get at least one dose of COVID-19 vaccine (Table 2). Considering that the data of both studies were collected during the initial phase of COVID-19 vaccination in our country, it is noteworthy that the vaccination rate in our study was obviously higher. It is believed that the reason for this is the greater acceptance of COVID-19 vaccines among the population, which was achieved with the start of large-scale vaccination against COVID-19 throughout the country.
The presence of vaccines obtained in different countries using different techniques in the fight against COVID-19 leads to various confusions in the society. In the study conducted by Hossain et al. in Bangladesh, 75.1% of participants were dissatisfied with the side effects of the vaccine and only 9.1% of participants believed that the vaccine was effective.19 In another study conducted in Bosnia and Herzegovina on the desire to be vaccinated against COVID-19 and preferences for the vaccine, it was found that 378 (66.4%) participants had a positive desire to be vaccinated. It was reported that 221 people (58.5%) who participated in the study preferred Pfizer-BioNTech’s vaccine, and 33 people (8.7%) preferred Sinovac’s vaccine.20 It was found that 60.7% (n:203) of participants in our study were vaccinated with 2 doses or more than 2 doses of an mRNA-based viral vaccine, while 9.8% (n:33) of participants were vaccinated with 2 doses or more than 2 doses of an inactivated viral vaccine. Although the COVID-19 vaccination campaign in Turkey started on 14 January 2021 with inactivated COVID-19 vaccine, it was found that the majority of participants (60.7%) had received at least two doses of the mRNA-based vaccine.
In a study conducted by the Ministry of Health in our country, the level of HL was found to be ‘insufficient’ in 30.9%, ‘problematic-limited’ in 38%, ‘adequate’ in 23.4% and ‘excellent’ in 7.7%.10 In the same study, the HL rates of the region where this study was conducted were measured to be 19.7% ‘insufficient,’ 61.7% ‘problematic-limited,’ 16.2% ‘sufficient’ and 2.3% ‘excellent.’10 In the study by Ishikawa et al, the change in the status of HL in the Japanese population in 2020 and 2021 was examined. As a result of the study, it was determined that HL, which was 30.5 ± 8.8 in 2021, decreased to 28.75 ± 8.82 during the pandemic period (p < .001).21 In addition, in the study by McCaffery et al, in which they assessed HL with SLIS, reported that participants with ‘inadequate’ HL were more likely to believe that they would not get COVID-19 than participants with adequate HL (p = 0.018).22 The mean HL index score of the participants in our study was measured as 35.3 (±9.06). It was observed that 32.6% (n:109) of the participants were at the ‘problematic-limited’ level and 10.5% (n:35) were at the ‘inadequate’ level. Our data showed that participants with ‘inadequate’ HL were not vaccinated against COVID-19 (p = 0.047). However, ‘inadequate’ HL status did not affect incompletely or fully vaccinated in the COVID-19 vaccine group (p = 0.311). When the results of McCaffery et al. and the data of this study were analyzed together, it was concluded that people with ‘inadequate’ HL do not prefer to be vaccinated because they perceive a lower risk of infection with COVID-19.
Significant risk factors for COVID-19 disease include age over 60 years, immunosuppression (e.g. cancer), male gender, obesity, hypertension, type 2 diabetes mellitus and related chronic diseases.23,24 It is well known that the presence of low health literacy among individuals with chronic diseases is associated with poor quality of life, lower adherence to treatment and follow-up protocols, minimal or no self-care, increased health care expenditures, morbidity and mortality.25 In the Heyne et al. study of cancer patients, 438 patients participated in the study, 79.5% of patients received two doses of the Biontech/Pfizer vaccine, and the rate of non-vaccinated was 4.5%.26 At the same time, plans are in place to prevent the possibility of contracting COVID-19 by having business people self-isolate and work from home, with curfews and time restrictions for people with chronic diseases and the elderly during the pandemic period. In this study, the chronic disease group was found to have fewer COVID-19 vaccines. This situation can be explained by the reservations due to the side effects of the vaccine, but also by the arrangements provided for these people, such as self-isolation, curfews, provision of the medicines they use due to chronic diseases by pharmacies without hospital visits and the possibility of working from home. The study also examined the association between age, a risk factor other than chronic disease, and vaccination against COVID-19. While no significant association was found between age and vaccination against COVID-19, analysis conducted by dividing the age distribution into subgroups showed that booster doses of participants in the COVID-19 vaccinations were significantly lower in the 39 years and younger group than in the other age groups (p = 0.017). The rate of full vaccination was also found to be low in the group with chronic diseases (p = 0.020).
This study has thus shown that sufficient knowledge about the infection COVID-19 influences people’s decision to get vaccinated. Health literacy is a topic that has recently come to the fore and has become even more important with the pandemic. From this perspective, it has become apparent that there is a need for more information on COVID-19 vaccination among people with chronic diseases and in the young population, which can effectively prevent the spread of the disease in the community.
Limitations
The first limitation of the study is that it was conducted on a small sample. COVID-19 vaccination and HL is a special topic that needs to be studied in larger populations. The second limitation is that at the beginning of COVID-19 vaccination in Turkey, the diversity of vaccines was insufficient compared to other countries. It is hypothesized that this situation may influence participants’ vaccine preferences. In the study, it was observed that the group with chronic diseases had a lower propensity to be vaccinated with the COVID-19 vaccine. However, due to the small sample size, detailed analyses could not be conducted by creating subgroups such as diabetes mellitus, hypertension, etc. Studies with larger samples on COVID-19 vaccination in chronically ill groups will further strengthen this study.
Acknowledgments
I would also like to thank Associate Professor Ozgur Dagli who made an important contribution to this study but unfortunately passed away before its publication.
Funding Statement
The author(s) reported there is no funding associated with the work featured in this article.
Author contribution
Concept: M.S.S., A.A. Design: M.S.S., A.A., Data Collection and/or Processing: M.S.S., M.O.A. Analysis and/or Interpretation: I.N.H. Literature Search: M.S.S., M.O.A. Writing: M.S.S. Critical Reviews: I.N.H., A.A., M.O.A.
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
- 1.Hudson A, Montelpare WJ.. Predictors of vaccine hesitancy: implications for COVID-19 public health messaging. Int J Environ Res Public Health. 2021;18(15):8054. doi: 10.3390/ijerph18158054. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Tao L, Wang R, Han N, Liu J, Yuan C, Deng L, Han C, Sun F, Liu M, Liu J, et al. Acceptance of a COVID-19 vaccine and associated factors among pregnant women in China: a multi- center cross-sectional study based on health belief model. Hum Vaccin Immunother. 2021;17(8):2378–6. doi: 10.1080/21645515.2021.1892432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.World Health Organisation . COVID-19 vaccine tracker and landscape. [accessed 2023 March 28]. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines.
- 4.T.C . Sağlık Bakanlığı COVID-19 Aşısı bilgilendirme platformu. [accessed 2023 August 19]. https://covid19asi.saglik.gov.tr/?_Dil=2.
- 5.Centers for Disease Control and Prevention . Overview of COVID-19 vaccines. [accessed 2023 March 28]. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html.
- 6.World Health Organisation . Ten Threats to global health in 2019. [accessed 2023 March 28]. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.
- 7.European Centre for Disease Prevention and Control . Vaccine Hesitancy. [accessed 2023 March 28]. https://www.ecdc.europa.eu/en/immunisation-vaccines/vaccine-hesitancy.
- 8.Willis DE, Andersen JA, Bryant-Moore K, Selig JP, Long CR, Felix HC, Curran GM, McElfish PA. COVID-19 vaccine hesitancy: race/ethnicity, trust, and fear. Clin Transl Sci. 2021;14(6):2200–7. doi: 10.1111/cts.13077. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Puri N, Coomes EA, Haghbayan H, Gunaratne K. Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases. Hum Vaccin Immunother. 2020;16(11):2586–93. doi: 10.1080/21645515.2020.1780846. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Özkan S, Baran Aksakal FN, Çalışkan D, Dikmen AU, Tüzün H. Türkiye Sağlık Okuryazarlığı Düzeyi ve İlişkili FaktörlerıAraştırması. Ankara (TR): Sağlık Bakanlığı Yayınları; 2018. [Google Scholar]
- 11.Feinberg I, Scott JY, Holland DP, Lyn R, Scott LC, Maloney KM, Rothenberg R. The Relationship between health literacy and COVID-19 vaccination prevalence during a rapidly evolving pandemic and infodemic. Vaccines. 2022;10(12):1989. doi: 10.3390/vaccines10121989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Biasio LR. Vaccine hesitancy and health literacy. Hum Vaccin Immunother. 2017;13(3):701–2. doi: 10.1080/21645515.2016.1243633. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Okyay P, Abacıgil F. Türkiye sağlik okuryazarliği ölçekleri güvenilirlik ve geçerlilik çalişmasi. Vol. 1. Ankara (TR): Sağlık Bakanlığı Yayınları; 2016. [Google Scholar]
- 14.Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği. [accessed 2023 March 28]. https://www.klimik.org.tr/2022/03/25/covid-19a-karsi-guncel-bagisiklama-onerileri/.
- 15.Bartsch SM, Shea KJO, Ferguson MC, Bottazzi ME, Wedlock PT, Strych U, McKinnell JA, Siegmund SS, Cox SN, Hotez PJ, et al. Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention. Am J Prev Med. 2020;59(4):493–503. doi: 10.1016/j.amepre.2020.06.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Ata Teneler A, Ayhan F, Zaim E, Ozek U. A community-based study in the central district of Giresun: COVID-19 vaccine hesitancy. Hum Vaccin Immunother. 2022;18(6):2092362. doi: 10.1080/21645515.2022.2092362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.İ̇̇kiışık H, Sezerol MA, Taşçı Y, Maral I. COVID-19 vaccine hesitancy: a community-based research in Turkey. Int J Clin Pract. 2021;75(8):e14336. doi: 10.1111/ijcp.14336. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Salali GD, Uysal MS. COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol Med. 2020;19(15):1–3. doi: 10.1017/S0033291720004067. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Hossain E, Rana J, Islam S, Khan A, Chakrobortty S, Ema NS, Bekun FV. COVID-19 vaccine-taking hesitancy among Bangladeshi people: knowledge, perceptions and attitude perspective. Hum Vaccin Immunother. 2021;17(11):4028–37. doi: 10.1080/21645515.2021.1968215. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Šljivo A, Ćetkovic A, Abdulkhaliq A, Kiseljakovi M, Selimoviç A, Kulo A. COVID-19 vaccination knowledge, attitudes and practices among residents of Bosnia and Herzegovina during the third wave of COVID-19 outbreak. Ann Ig. 2022;34(5):490–500. doi: 10.7416/ai.2021.2489. [DOI] [PubMed] [Google Scholar]
- 21.Ishikawa H, Kato M, Kiuchi T. Declines in health literacy and health- related quality of life during the COVID-19 pandemic: a longitudinal study of the Japanese general population. BMC Public Health. 2021;21(1):2180. doi: 10.1186/s12889-021-12092-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Mccaffery KJ, Dodd RH, Cvejic E, Ayrek J, Batcup C, Isautier JM, et al. Health literacy and disparities in COVID-19 – Related knowledge, attitudes, beliefs and behaviours in Australia. Public Health Res Pract. 2020;30:30342012. doi: 10.17061/phrp30342012. [DOI] [PubMed] [Google Scholar]
- 23.Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, Li T, Margolick JB, Pawelec G, Leng SX, et al. Aging in COVID-19: vulnerability, immunity and intervention. Ageing Res Rev. 2021;65:101205. doi: 10.1016/j.arr.2020.101205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y. Prevalence and impact of cardiovascular metabolic diseases on COVID‑19 in China. Clin Res Cardiol. 2020;109(5):531–8. doi: 10.1007/s00392-020-01626-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Heyne S, Esser P, Werner A, Lehmann-Laue A, Mehnert-Theuerkauf A. Attitudes toward a COVID‑19 vaccine and vaccination status in cancer patients: a cross ‑ Sectional survey. J Cancer Res Clin Oncol. 2022;148(6):1363–74. doi: 10.1007/s00432-022-03961-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Gautam V, Dileepan S, Rustagi N, Mittal A, Patel M, Shafi S, Thirunavukkarasu P, Raghav P. Health literacy, preventive COVID-19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan. Diabetes Metab Syndr. 2021;15(1):205–11. doi: 10.1016/j.dsx.2020.12.023. [DOI] [PMC free article] [PubMed] [Google Scholar]