(VI)
Fifty-two studies reported on COVID-19 vaccination acceptability, intention, and hesitancy. In this review, most of these studies reported HCWs’ hesitation to accept the COVID-19 vaccines on the African continent. A qualitative study conducted by Ashipala and colleagues [ 63 ] did not provide information on nurses’ uptake of COVID-19 vaccines.
Twenty-seven studies reported on the intention to accept the COVID-19 vaccine. Intention to accept the vaccine varied dramatically from 21% to 90.1%. Notably, Fares and colleagues [ 47 ] found that Egypt (21%) had the lowest intention rate, while Adeniyi and colleagues [ 52 ] reported that South Africa (90.1%) had the highest intention rate. Based on the included studies in this review, the intention rate to uptake the COVID-19 vaccine among HCWs was below average [ 23 , 25 , 46 , 47 , 54 , 59 , 76 , 77 , 80 , 83 , 88 ]. Conversely, fourteen studies reported an above-average intention rate [ 48 , 49 , 51 , 52 , 55 , 60 , 69 , 71 , 79 , 82 , 88 , 91 , 92 ]. The overall average intention rate for HCWs to uptake the COVID-19 vaccines across all included studies was approximately 52%, indicating a suboptimal level of uptake among this population.
Medical students expressed a lack of willingness to accept the COVID-19 vaccine, with an acceptance rate ranging from 34.7% to 45.4%. A study conducted by Saied and colleagues [ 83 ] in Egypt found that only 34.7% of medical students were willing to accept the vaccine, which was disappointing. Most (45.7%) medical students hesitated to accept the vaccine. In addition, 71% intended to take the vaccine but would postpone doing so to wait and observe its effects on those who received it before making a decision themselves.
Twenty-nine studies examined HCWs’ hesitancy towards receiving the COVID-19 vaccine. The degree of hesitancy varied across these studies, ranging from 13.3% to 79%. Fares and colleagues [ 47 ] reported the highest VH rate (79%) in Egypt.
Subsequent studies reported HCWs’ acceptance towards the COVID-19 vaccines [ 43 , 57 , 65 , 68 , 74 , 75 , 78 , 86 , 87 , 89 , 90 , 93 , 95 ]. Among these ten studies, over half of the participants were vaccinated with at least one dose (see Figure 2 ). A study by Watermeyer and colleagues [ 90 ] reported the highest vaccination rate (90%) in South Africa. Additionally, a study conducted in Ethiopia by Zewude and Belachew [ 95 ] further depicted the intention to accept the second dose. Approximately 28.3% of HCWs were VH to accept the second dose.
An illustration of COVID-19 vaccine uptake rates among the included studies in Africa [ 23 , 47 , 50 , 51 , 52 , 55 , 57 , 59 , 61 , 63 , 65 , 67 , 69 , 71 , 73 , 75 , 77 , 79 , 81 , 82 , 84 , 86 , 88 , 89 , 91 , 92 , 95 ].
Table 3 reports various socio-demographic (individual level) factors influencing vaccine uptake. These factors varied across HCWs on the African continent. Twelve socio-demographic factors were associated with vaccine uptake in this review. Seven socio-demographic factors were prominent in influencing vaccine uptake. These included gender, age, level of education, marital status, presence of chronic illness, living area, and cadre. These factors were further divided into two categories, which include COVID-19 vaccine uptake associated with hesitancy and associated with acceptance. Factors associated with COVID-19 vaccine uptake included being male, middle-aged (older than 40), being a physician, and having a tertiary-level education. In contrast, factors associated with hesitancy towards the COVID-19 vaccine were females younger than 40 and having a tertiary education. Interestingly, a tertiary-level education was a significant factor associated with VA and VH among HCWs.
Socio-demographic determinants associated with vaccine uptake.
Factors | Associated with Hesitancy | Associated with Acceptance |
---|---|---|
Being female [ , , , , , ] | Being female [ ] Being male [ , , , , , , , , , , , ] | |
Younger [ ] <30 years [ , ] <35 years [ ] <40 years [ , , ] | Age [ ] >30 years [ ] >40 years [ , , , ] Older [ , , , ] | |
Amhara [ ] | ||
Tertiary level [ , , , ] | Secondary level [ , ] Tertiary level [ , , , , ] | |
Christian—Pentecostal denomination [ ] | Not specified [ ] Christian [ ] | |
Single [ ] | Single [ , ] Married [ , , ] | |
Being a parent [ ] | ||
Not being pregnant [ ] | ||
Presence of chronic illness [ ] | Presence of chronic illness [ , , , ] | |
Not specified [ , ] Rural [ ] Urban [ ] | ||
Nurses & midwives [ , ] Physicians [ , ] Medical laboratory technicians [ , , ] Environmental health specialist [ ] Medical students [ ] | Not specified [ , ] Nurses & midwives [ , , ] Physicians [ , , , , , , , ] Clinical health workers [ ] Public health specialist [ ] Academic staff working in hospitals [ ] | |
Average [ ] | Not specified [ , ] |
The following factors associated with VA were gender [ 23 , 46 , 56 , 65 , 67 , 72 , 74 , 76 , 77 , 79 , 80 , 87 ], age [ 43 , 46 , 48 , 54 , 56 , 57 , 65 , 74 , 87 , 94 ], education level [ 43 , 46 , 50 , 52 , 67 , 75 , 78 ], belonging to religion [ 48 , 74 ], marital status [ 43 , 72 , 76 , 77 , 78 ], being a parent [ 95 ], absence of pregnancy [ 43 ], presence of chronic illness [ 43 , 56 , 59 , 77 ], living area [ 65 , 67 , 77 , 79 ], cadre [ 23 , 43 , 48 , 49 , 51 , 53 , 57 , 59 , 61 , 65 , 73 , 79 , 80 , 87 ], and income level [ 43 , 46 ].
In contrast, the following factors were associated with VH, gender [ 50 , 55 , 85 , 86 , 89 , 94 ], age [ 50 , 53 , 58 , 64 , 73 , 86 , 94 ], ethnicity [ 64 ], education level [ 50 , 55 , 70 , 85 ], religion [ 71 ], marital status [ 58 ], presence of chronic illness [ 62 ], cadre [ 50 , 58 , 64 , 71 , 84 , 93 ], and income level [ 58 ].
At the intrapersonal level, three themes emerged: vaccine-related factors, COVID-19, and psychosocial factors. Within the theme of COVID-19 vaccines, ten sub-themes were identified, all acting as barriers to vaccine uptake. The most prominent sub-theme was safety concerns, which was reported as the primary barrier [ 23 , 25 , 43 , 47 , 50 , 51 , 55 , 56 , 57 , 60 , 61 , 65 , 66 , 67 , 68 , 69 , 70 , 72 , 74 , 75 , 76 , 77 , 78 , 81 , 82 , 83 , 84 , 85 , 86 , 88 , 90 , 91 , 92 , 95 ]. However, only three studies mentioned confidence in the COVID-19 vaccines, facilitating uptake [ 47 , 52 , 88 ]. Numerous studies [ 23 , 47 , 55 , 56 , 61 , 66 , 68 , 69 , 70 , 74 , 75 , 77 , 81 , 82 , 85 , 90 , 91 ] highlighted the prevalent mistrust in science among HCWs, often rooted in the belief that the COVID-19 vaccine has not undergone sufficient clinical trials. Concerns about the vaccine’s effectiveness were reported in 16 studies [ 23 , 25 , 65 , 67 , 69 , 70 , 76 , 77 , 78 , 82 , 84 , 85 , 86 , 88 , 92 , 95 ], with some expressing doubts about its ability to protect against COVID-19, particularly in Africa. In contrast, only one study reported that the vaccine was effective against COVID-19 [ 74 ]. Three studies mentioned that HCWs preferred alternative treatments to the COVID-19 vaccine, such as hydroxychloroquine, azithromycin, and ivermectin [ 61 , 81 , 94 ]. The subsequent studies reported on other COVID-19 vaccine-related barriers, which included poor vaccine knowledge [ 66 ], negative perceptions toward the vaccine [ 43 ], preference for waiting for another type of vaccine [ 70 ], and not considering the vaccine a priority [ 70 ]. Vaccine safety, mistrust in science, and efficacy were major concerns among HCWs within this theme. The following study [ 95 ] reported barriers to the uptake of the second vaccine dose, such as discomfort during the first dose and the belief that sufficient immunity had already been acquired.
The second theme in this level was COVID-19, with four sub-themes identified. The perception of susceptibility to contracting COVID-19 among HCWs was mentioned as both a barrier and a facilitator for vaccine uptake. HCWs who perceived themselves to be at a higher risk of contracting COVID-19 [ 25 , 47 , 59 , 63 , 88 , 92 ] were more willing to get vaccinated compared to those who perceived themselves to have a low risk [ 23 , 66 , 67 , 78 , 91 ]. HCWs who believed they needed the vaccine for protection were more likely to get vaccinated than those who relied on their immune system to prevent infection [ 65 , 68 , 76 , 77 , 95 ]. A prior diagnosis of COVID-19 was mentioned as a barrier to vaccine uptake as some HCWs believed that they had gained natural immunity and did not need the vaccine [ 23 , 67 , 91 , 92 ]. Side effects of COVID-19, such as loss of smell and taste, were mentioned as facilitators for vaccine uptake [ 56 ].
The final sub-theme at this level was psychosocial factors, which are individual factors that affect vaccine uptake. In separate studies, HCWs with pre-existing health conditions were mentioned as barriers and facilitators [ 56 , 59 ]. Female HCWs planning to conceive were less likely to get vaccinated [ 67 , 70 , 91 ]. Religious beliefs also played a role as a barrier, with Christian HCWs expressing concerns about the vaccine containing the mark of the beast [ 55 , 56 , 61 , 66 , 70 , 81 , 95 ]. Other barriers to uptake at this level included prior adverse reactions to vaccines [ 23 , 61 ], fear of needles and injections [ 70 ], and opposition to vaccinations in general [ 91 ].
At the interpersonal level, a significant factor relating to influences was discovered. HCWs reported that their relationships with colleagues played a role in encouraging vaccine uptake [ 63 ]. HCWs mentioned that their colleagues influenced their decision to get vaccinated. The connection between HCWs and their families also emerged as a crucial sub-theme. The desire to protect their loved ones motivated HCWs to receive the COVID-19 vaccine, as mentioned in eight studies [ 25 , 60 , 72 , 78 , 84 , 88 , 91 , 92 ].
Moreover, one study found that HCWs who had experienced the loss of a loved one due to COVID-19 were more likely to get vaccinated [ 55 ]. Within this theme, two barriers were identified. In one study, HCWs expressed the need for permission from their families before getting the COVID-19 vaccine [ 70 ]. In another study, HCWs reported facing disapproval from their families regarding the COVID-19 vaccine [ 66 ]. The last sub-theme explored religious leaders’ influences on HCWs, indicating that discouragement from religious leaders also acted as a barrier [ 66 ].
At the institutional level, there are significant challenges in the environmental structures. One identified barrier is the lack of trust in stakeholders, such as government and pharmaceutical companies [ 25 , 43 , 56 , 57 , 68 , 81 , 90 ]. Furthermore, a study [ 66 ] found that some HCWs would refuse the vaccine because government officials themselves did not accept it. The accessibility of the vaccine was mentioned as a barrier in four studies [ 63 , 65 , 70 , 75 ]. In contrast, one study suggested that the easy availability of the COVID-19 vaccine could be a reason for its uptake [ 63 ]. The workplace environment of HCWs also influences vaccine uptake. Lack of support from employers was identified as a barrier, leading HCWs to reject the vaccine [ 66 ]. Conversely, another study revealed that some HCWs felt compelled to accept the COVID-19 vaccine to continue working, per their company’s policy [ 91 ].
At the community level, a prevailing theme was centred around shared norms and myths. Within this overarching theme, three sub-themes were identified. Multiple studies [ 52 , 78 , 91 , 92 ] emphasized that HCWs viewed the uptake of the COVID-19 vaccine as a crucial public health responsibility for ending the pandemic. However, specific barriers to vaccine uptake were also identified. Several studies [ 23 , 25 , 57 , 61 , 63 , 67 , 70 , 78 ] observed that limited access to reliable information hindered the willingness of HCWs to receive the vaccine. Social media emerged as a significant influencer, with seven studies [ 57 , 60 , 63 , 68 , 70 , 72 , 90 ] reporting that HCWs subscribed to misinformation or conspiracy theories. These theories included beliefs that the vaccine was intentionally designed to cause harm to people in Africa, sterilize the African population, or even cause COVID-19.
At the policy level, an important theme that emerged was the implementation of COVID-19 policies. Within this theme, two specific sub-themes were identified. The first sub-theme focused on strategies to encourage HCWs to get vaccinated. It was supported by three studies, which highlighted that HCWs would be required to receive the vaccine to travel in the future [ 47 , 60 , 63 ]. Additionally, two studies indicated that HCWs are willing to accept the COVID-19 vaccine because it is free of charge [ 74 , 88 ]. However, it is worth noting that there is also a barrier at this level. This barrier stems from mandatory vaccination policies, which make HCWs feel coerced into accepting the vaccines [ 82 , 89 ]. HCWs believe they lack control over their health-related behaviours and refuse to be controlled by others, resulting in their rejection of the COVID-19 vaccine. Table 4 summarizes the factors influencing vaccine uptake.
Factors influencing vaccine uptake.
Table | Factors | Barriers | Facilitators |
---|---|---|---|
Safety concerns [ , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ] | Confident in the COVID-19 vaccines [ , , ] | ||
Concerns about the effectiveness of the vaccine [ , , , , , , , , , , , , , , , ] | Belief that the vaccine is effective in protecting against COVID-19 [ ] | ||
Having poor knowledge [ ] | |||
Having a negative perception [ ] | |||
Prefer to wait for another type of COVID-19 vaccine [ ] | |||
Not a priority [ ] | |||
Experiences of discomfort while receiving the first dose [ ] | |||
Sufficient immunity with the first dose [ ] | |||
Preferred alternative treatment to the COVID-19 vaccine [ , , ] | |||
Mistrust in science [ , , , , , , , , , , , , , , , , ] | |||
Prior diagnosis [ , , , ] | |||
Low perceived susceptibility [ , , , , ] | High perceived susceptibility [ , , , , , ] | ||
Previous history of loss of smell & taste [ ] | |||
Belief in one’s immune system [ , , , , ] | Requires the vaccine to protect oneself [ , , , , , , ] | ||
Presence of chronic illness [ ] | Presence of chronic illness [ ] | ||
Planning pregnancy [ , , ] | |||
Religious beliefs [ , , , , , , ] | |||
Prior adverse reactions to vaccines [ , ] | |||
Fear of needles & injections [ ] | |||
Against vaccinations in general [ ] | |||
Being influenced by colleagues [ ] | |||
Requires permission from their family before taking the COVID-19 vaccine [ ] | |||
Disapproval from family [ ] | |||
Desire to protect loved ones [ , , , , , , , ] | |||
Loss of someone to COVID-19 [ ] | |||
Discouragement from Religious leaders [ ] | |||
Lack of trust [ , , , , , , ] | |||
Government officials not accepting vaccine uptake [ ] | |||
COVID-19 vaccine inaccessible [ , , , ] | COVID-19 vaccine accessible [ ] | ||
To keep working [ ] | |||
Lack of support by employer [ ] | |||
To end the pandemic [ , , , ] | |||
Lack of information [ , , , , , , , ] | |||
Subscribing to misinformation or conspiracies [ , , , , , , ] | |||
Requires the vaccine for future travel [ , , ] | |||
Vaccines are provided free of charge [ , ] | |||
Feeling coerced into accepting vaccines [ , ] |
VH and refusal continue to jeopardize COVID-19 vaccination coverage in LMICs [ 23 ]. The fight against COVID-19 requires widespread vaccination uptake and acceptance [ 96 ]. In this review, 53 articles were selected and analysed, focusing on the intention, socio-demographical determinants, and factors influencing vaccine uptake. In this review, most studies were conducted in Ethiopia and Nigeria. The intention to take the COVID-19 vaccine is a challenge globally. We found that the proportion of HCWs who intend to take the COVID-19 vaccine was unsatisfactory (52%), with the intention rate ranging from 21% to 90.1%. This finding aligns with a global review by Li and colleagues [ 97 ] and Ghare and colleagues [ 98 ], who found similar acceptance rates among HCWs ranging from 27.7% to 77.3% and 30% to 98.9% (respectively). HCWs in Africa, particularly in countries such as Egypt, Uganda, and the DRC, seem hesitant about the uptake of the COVID-19 vaccination.
The results pertaining to VH in the studies are likely to be influenced to some extent by the timing of various Information, Education, and Communication (IEC) interventions within the different African countries and vaccine availability at the time of the respective studies. It should also be considered that despite the timing of the studies and vaccine availability in the respective African countries, research findings on vaccine side effects are likely to have played and continue to play a role in VH in particular African countries [ 99 ]. Furthermore, as outlined earlier, the previous negative experiences of many African countries with vaccines impact views about the desirability and safety of vaccines [ 100 ].
A better understanding of the factors influencing the uptake of COVID-19 vaccines is required to improve vaccine acceptance. Accordingly, this review was conducted using the SEM, which identified several factors that influence the uptake of COVID-19 vaccines. These factors were classified into five levels: intrapersonal, interpersonal, organizational, community, and policy. We found that socio-demographic determinants (intrapersonal level factors) were associated with COVID-19 vaccination. Li and colleagues’ [ 97 ] systematic review and Ghare and colleagues’ review [ 98 ] aligns with the findings of this scoping review. Socio-demographic determinants associated with COVID-19 vaccine uptake included being male, older age, physician, level of education, and presence of chronic illness. Studies have identified gender differences as a significant cause of VH in low-income countries [ 56 , 101 ]. VA was found to be significantly associated with gender, and specifically the male gender. Naidoo and colleagues’ [ 102 ] review reported that men were more accepting of the COVID-19 vaccines among the general African population. This finding is highly noteworthy in African society, where men make most family decisions, regardless of profession or social status [ 56 ]. In this review, we found that women were more likely than men to reject the COVID-19 vaccine. While Saied and colleagues [ 84 ] noticed that HCWs’ age could explain the difference in uptake; older HCWs appear more accepting due to the prevalence of co-morbidities and a high perceived susceptibility to contracting COVID [ 99 ].
Using the SEM, we have identified significant barriers within the five levels. Prominent individual-level barriers include vaccine safety and efficacy concerns and HCWs’ mistrust of science. Contrary to common assumptions that HCWs would have a positive attitude toward COVID-19 vaccines because of their expertise, Verger and colleagues [ 103 ] and El-Sokkary and colleagues [ 46 ] point out that HCWs are not a homogeneous group and that the vast majority are not immunization experts. Various information sources shape the general public’s vaccine knowledge, influencing vaccination attitudes, perceptions, and uptake [ 104 ]. Many studies have shown that individuals who lack adequate knowledge about vaccines or vaccine-preventable diseases (VPDs) are more prone to harbour a negative attitude towards vaccination [ 105 , 106 ]. The development of COVID-19 vaccines exposed a lack of knowledge in immunology among HCWs [ 46 ]. Two studies [ 25 , 81 ] cited that HCWs preferred using alternative treatments over accepting the COVID-19 vaccine. According to Oriji and colleagues [ 81 ], some (17%) respondents have already taken Hydroxychloroquine and Azithromycin as prophylaxis treatment for COVID-19. Allagoa and colleagues [ 56 ] and Oriji and colleagues [ 81 ] reported that most respondents who received the COVID-19 vaccine preferred a single-dose vaccine. The number of vaccine doses may have a negative impact on vaccination uptake. Religious beliefs were among the factors associated with vaccine refusal. Studies reviewed [ 55 , 56 , 81 ] discovered that those of Christian faith were more risk-averse regarding the uptake of the COVID-19 vaccines. However, fatalistic ideas combined with religious beliefs have been found to facilitate questioning about the efficacy of COVID-19 vaccines and that religious fatalism negatively impacts the acceptance of the SARS-CoV-2 vaccine [ 107 ].
Misinformation, primarily spread through social media, has fostered distrust in government officials, regulatory agencies, and pharmaceutical companies [ 102 ]. The media, particularly social media, has been a significant source of speculation and misinformation about the pandemic and COVID-19 vaccines [ 108 ]. According to some HCWs, the media has exaggerated the severity of the side effects of the vaccines [ 108 ]. HCWs are a trustworthy source of health information. Their acceptance or rejection of COVID-19 vaccines may impact the broader population’s acceptance and uptake of COVID-19 vaccines [ 23 ]. The low intention rate is due to the rapid development of COVID-19 vaccines, concerns about the vaccines’ safety and effectiveness, and cultural and social norms.
On a positive note, our review also identified facilitators at each level. At the intrapersonal level, HCWs’ high perceived susceptibility to COVID-19 and the desire to protect themselves were prominent factors. The African concept of ubuntu, which emphasizes interconnectedness and collective responsibility, influenced COVID-19 vaccine uptake at the interpersonal and community levels. HCWs were eager to receive the vaccine to protect their loved ones and saw it as a public responsibility to end the pandemic.
Governments, public health agencies, and private healthcare systems should collaborate in making educational resources available to inform HCWs about the vaccine’s safety, importance, and the negative consequences of refusing or delaying vaccination [ 69 ]. Most studies emphasized how crucial it is for stakeholders to inform and increase HCW awareness of COVID-19 vaccines. It is now up to various stakeholders and policymakers to take effective action to spread as much knowledge as possible among HCWs to increase vaccine acceptance and, thereby, address the pandemic’s detrimental effects on healthcare systems and socio-economic conditions. When tailored education campaigns are targeted to specific attitudes, beliefs, and experiences, they are beneficial [ 100 ]. The findings from this review will assist in the roll-out of other vaccination programmes.
The majority of articles reviewed adopted a quantitative approach. The present review investigates factors influencing HCWs’ intention and uptake of COVID-19 vaccines. Limitations are inherent in a scoping review approach. Some limitations should be considered in this review. This review did not undertake a quality or risk assessment bias of the included studies. Only studies published in English were considered. There is a bias in the body of literature towards VH. Due to the heterogeneity in the definition and assessment of VH in different studies, not all studies reported VH rates among HCWs. In some studies, the measurement scales used to assess the intention to uptake and VH rates for COVID-19 vaccines were either dichotomous or Likert. The varied sample size would be attributed to selection bias in studies focusing on HCWs. Social desirability on self-reported VH among the HCWs can also not be ruled out. At the time of data collection, some studies did not receive the COVID-19 vaccine. Therefore, intentions and VH may have influenced participants’ responses. The trends in acceptance might have changed after the vaccination programmes were implemented.
Preventive measures are essential to the global effort to mitigate the pandemic’s consequences. As a result, enormous resources have been dedicated to developing effective and safe COVID-19 vaccines. Using the SEM, this review explored various factors affecting the uptake, allowing for a more comprehensive understanding of vaccine uptake and the development of effective interventions. VI and VH rates vary greatly across countries or regions within the same country. Furthermore, the VI and VH rate is influenced by various factors. Most studies reviewed found significant barriers that affected vaccine uptake on the African continent among HCWs, resulting in a subpar intention to use COVID-19 vaccines. The low level of trust in COVID-19 vaccines and the concerns about the long-term efficacy of the vaccines, as well as the possible long-term side effects associated with the vaccine uptake, play a role in decision-making regarding vaccination. HCWs are influential in informing the general public about vaccines. Therefore, it is crucial to prioritize engagement with key stakeholders to address HCWs’ negative perceptions about vaccines and where they exist in efforts to increase vaccine uptake.
To improve vaccine uptake using the SEM, interventions should target multiple levels simultaneously. At an individual level, understand their concerns and reasons for hesitancy. Provide accurate information to address myths and misconceptions by implementing strategies addressing knowledge gaps and building trust among HCWs. At an organizational level, healthcare facilities should prioritize vaccination by educating staff, offering paid time off for vaccination and side effects, improving access by getting vaccinated as quickly and conveniently as possible, and incentivizing vaccination. They set the culture—if the leadership gets vaccinated, others will follow and leverage social networks and community influencers can have a synergistic effect on increasing vaccine acceptance and uptake. By considering the various levels of influence, the SEM provides a comprehensive framework for understanding and addressing VH and holistically promoting vaccine uptake.
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/vaccines11091491/s1 , Supplementary Materials S1: PRISMA-ScR-Fillable-Checklist—HCWs.
WorldCat Discovery search strategy.
Search Terms | Filters | Results |
---|---|---|
kw: COVID-19 vaccine AND | Format: Article | 16 |
kw: Vaccine Hesitancy AND | ||
kw: Vaccine acceptance AND | Language: English | |
kw: Africa AND | ||
kw: Healthcare workers | Publication Year: 2020–2023 |
PubMed search strategy.
Search Number | Query | Filters | Search Details | Results | Time |
---|---|---|---|---|---|
((((((COVID-19 vaccines[MeSH Terms]) AND (COVID-19)) AND (vaccines)) OR (covid vaccines)) OR (intention)) OR (vaccine hesitancy)) AND (vaccine acceptance) AND (healthcare workers) AND (Africa) | Full text, Humans, English, from 2020–2023 | (((“covid 19 vaccines” [MeSH Terms] AND (“covid 19” [All Fields] OR “covid 19” [MeSH Terms] OR “covid 19 vaccines” [All Fields] OR “covid 19 vaccines” [MeSH Terms] OR “covid 19 serotherapy” [All Fields] OR “covid 19 nucleic acid testing” [All Fields] OR “covid 19 nucleic acid testing” [MeSH Terms] OR “covid 19 serological testing” [All Fields] OR “covid 19 serological testing” [MeSH Terms] OR “covid 19 testing” [All Fields] OR “covid 19 testing” [MeSH Terms] OR “sars cov 2” [All Fields] OR “sars cov 2” [MeSH Terms] OR “severe acute respiratory syndrome coronavirus 2” [All Fields] OR “ncov” [All Fields] OR “2019 ncov” [All Fields] OR ((“coronavirus” [MeSH Terms] OR “coronavirus” [All Fields] OR “cov” [All Fields]) AND 2019/11/01:3000/12/31[Date—Publication])) AND (“vaccin” [Supplementary Concept] OR “vaccin” [All Fields] OR “vaccination” [MeSH Terms] OR “vaccination” [All Fields] OR “vaccinable” [All Fields] OR “vaccinal” [All Fields] OR “vaccinate” [All Fields] OR “vaccinated” [All Fields] OR “vaccinates” [All Fields] OR “vaccinating” [All Fields] OR “vaccinations” [All Fields] OR “vaccinations” [All Fields] OR “vaccinator” [All Fields] OR “vaccinators” [All Fields] OR “vaccines” [All Fields] OR “vaccined” [All Fields] OR “vaccines” [MeSH Terms] OR “vaccines” [All Fields] OR “vaccine” [All Fields] OR “vaccins” [All Fields])) OR ((“sars cov 2” [MeSH Terms] OR “sars cov 2” [All Fields] OR “covid” [All Fields] OR “covid 19” [MeSH Terms] OR “covid 19” [All Fields]) AND (“vaccin” [Supplementary Concept] OR “vaccin” [All Fields] OR “vaccination” [MeSH Terms] OR “vaccination” [All Fields] OR “vaccinable” [All Fields] OR “vaccinal” [All Fields] OR “vaccinate” [All Fields] OR “vaccinated” [All Fields] OR “vaccinates” [All Fields] OR “vaccinating” [All Fields] OR “vaccinations” [All Fields] OR “vaccinations” [All Fields] OR “vaccinator” [All Fields] OR “vaccinators” [All Fields] OR “vaccines” [All Fields] OR “vaccined” [All Fields] OR “vaccines” [MeSH Terms] OR “vaccines” [All Fields] OR “vaccine” [All Fields] OR “vaccins” [All Fields])) OR (“intention” [MeSH Terms] OR “intention” [All Fields] OR “intent” [All Fields] OR “intentions” [All Fields] OR “intentional” [All Fields] OR “intentioned” [All Fields] OR “intents” [All Fields]) OR (“vaccination hesitancy” [MeSH Terms] OR (“vaccination” [All Fields] AND “hesitancy” [All Fields]) OR “vaccination hesitancy” [All Fields] OR (“vaccine” [All Fields] AND “hesitancy” [All Fields]) OR “vaccine hesitancy” [All Fields])) AND ((“vaccin” [Supplementary Concept] OR “vaccin” [All Fields] OR “vaccination” [MeSH Terms] OR “vaccination” [All Fields] OR “vaccinable” [All Fields] OR “vaccinal” [All Fields] OR “vaccinate” [All Fields] OR “vaccinated” [All Fields] OR “vaccinates” [All Fields] OR “vaccinating” [All Fields] OR “vaccinations” [All Fields] OR “vaccinations” [All Fields] OR “vaccinator” [All Fields] OR “vaccinators” [All Fields] OR “vaccines” [All Fields] OR “vaccined” [All Fields] OR “vaccines” [MeSH Terms] OR “vaccines” [All Fields] OR “vaccine” [All Fields] OR “vaccins” [All Fields]) AND (“accept” [All Fields] OR “acceptabilities” [All Fields] OR “acceptability” [All Fields] OR “acceptable” [All Fields] OR “acceptably” [All Fields] OR “acceptance” [All Fields] OR “acceptances” [All Fields] OR “acceptation” [All Fields] OR “accepted” [All Fields] OR “accepter” [All Fields] OR “accepters” [All Fields] OR “accepting” [All Fields] OR “accepts” [All Fields])) AND (“health personnel” [MeSH Terms] OR (“health” [All Fields] AND “personnel” [All Fields]) OR “health personnel” [All Fields] OR (“healthcare” [All Fields] AND “workers” [All Fields]) OR “healthcare workers” [All Fields]) AND (“africa” [MeSH Terms] OR “africa” [All Fields] OR “africa s” [All Fields] OR “africas” [All Fields])) AND ((fft[Filter]) AND (humans[Filter]) AND (english[Filter]) AND (2020:2023[pdat])) | 41 | 9:28:21 |
ProQuest search strategy.
Set No. | Searched for | Databases | Results |
---|---|---|---|
S9 | ((factors associated with covid- 19 vaccine hesitancy among HCWs in Africa) AND (location.exact(“Africa” OR “South Africa” OR “Nigeria” OR “Ethiopia” OR “Egypt” OR “Ghana” OR “Uganda” OR “Central Africa” OR “North Africa” OR “Sierra Leone” OR “West Africa” OR “Zambia” OR “Zimbabwe” OR “Burkina Faso” OR “Cape Town South Africa” OR “Congo-Democratic Republic of Congo” OR “East Africa” OR “Eastern Cape South Africa” OR “Kano Nigeria” OR “Kenya” OR “Malawi” OR “Mozambique”) AND at.exact(“Article”) AND la.exact(“ENG”) AND PEER(yes))) AND ((factors associated with covid-19 vaccine uptake among HCWs in Africa) AND (location.exact(“Africa” OR “South Africa” OR “Nigeria” OR “Ethiopia” OR “Egypt” OR “Ghana” OR “Uganda” OR “Central Africa” OR “North Africa” OR “Sierra Leone” OR “West Africa” OR “Zambia” OR “Zimbabwe” OR “Burkina Faso” OR “Cape Town South Africa” OR “Congo-Democratic Republic of Congo” OR “East Africa” OR “Eastern Cape South Africa” OR “Kano Nigeria” OR “Kenya” OR “Malawi” OR “Mozambique”) AND at.exact(“Article”) AND la.exact(“ENG”) AND PEER(yes))) | Coronavirus Research Database, Ebook Central, Health Research Premium Collection, Publicly Available Content Database These databases are searched for part of your query. | 48 |
Included Study Characteristics.
Author(s) & Publication Year | Country & Data Collection Period | Methodology |
---|---|---|
Adane et al., 2022 [ ] | Ethiopia May 2021 | A quantitative cross-sectional study Physicians Medical Laboratory Technicians Nurses & Midwives Pharmacists Radiologists Anaesthesiologists Public Health Specialist Non-medical Auxiliary Staff : 404 Likert scale |
Adejumo et al., 2021 [ ] | Nigeria October 2020 | A quantitative cross-sectional study Physicians Nurses Medical Laboratory Technicians Pharmacists Physiotherapists Other 1470 Dichotomous scale |
Adeniyi et al., 2021 [ ] | South Africa November to December 2020 | A quantitative cross-sectional study Physicians Pharmacists Nurses Allied Health Professionals Support Staff 1380 Dichotomous scale |
Aemro et al., 2021 [ ] | Ethiopia May to June 2021 | A quantitative cross-sectional study Physicians Pharmacists Nurses Allied Health Professionals Support Staff 418 Dichotomous scale |
Agyekum et al., 2021 [ ] | Ghana January to February 2021 | A quantitative cross-sectional study Nurses & Midwives Allied Health Professionals Physicians 234 Dichotomous scale |
Ahmed et al., 2021 [ ] | Ethiopia January to March 2021 | A quantitative cross-sectional study Nurses & Midwives Psychiatrists Optometrists Physicians Health Officers Anaesthetics Medical Laboratory Technicians Radiologists Physiotherapists Pharmacists Other 409 Dichotomous scale |
Alhassan et al., 2021 [ ] | Ghana September to October 2020 | A quantitative cross-sectional study Pharmacists Other 1605 Dichotomous scale |
Allagoa et al., 2021 [ ] | Nigeria April 2021 | A quantitative cross-sectional study Physicians 182 Dichotomous scale |
Amour et al., 2023 [ ] | Tanzania October to November 2021 | A mixed-method study Physicians Nurses & Midwives Pharmacists Medical Laboratory Technicians Administrative Staff Other 1368 |
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This research received no external funding.
D.N., the first author, was responsible for the conceptualization and design of this research paper. He gathered data for the study, conducted data analysis, and authored the article. Supervised by Professor A.M.-W., who also gathered data for the study, conducted data analysis, and reviewed and provided constructive feedback. K.G. reviewed various drafts of the paper and provided feedback to the senior author. All authors have read and agreed to the published version of the manuscript.
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The circular economy practices contribute to sustainable development by maximising efficiency, utilising renewable resources, extending product lifespans, and implementing waste reduction strategies. This study investigates the individual impacts of four sources of the circular economy on the ecological footprint in Germany, a country that is among the pioneers in establishing a comprehensive roadmap for the circular economy. The four sources examined are renewable energy consumption (REC), recycling, reuse, and repair of materials. Using time series data from 1990 to 2021, the study employed the dynamic autoregressive distributed lag (ARDL) simulation technique and also applied kernel-based linear regression (KRLS) to test the robustness of the results. The findings revealed that reuse practices significantly reduce the ecological footprint in both the short and long run. REC and repair also substantially decrease the ecological footprint, as shown by the simulation analysis. Conversely, while recycling is generally considered crucial for minimising environmental impact, in this study, it was found to contribute to environmental degradation. This paradox may be attributed to the nascent state of the recycling industry and data limitations. The results from KRLS confirm the findings of the dynamic ARDL. It is recommended that policymakers develop measures that are appropriate, efficient, and targeted to enhance the role of each source of the circular economy in reducing the ecological footprint in Germany. The major limitation of the study is its reliance on the indirect measures of circular economy attributed to the non-availability of data on direct measures.
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Source: Dynamic ARDL post-estimation simulations. The black dots specify the predicted value, and dark blue to light blue lines denote 75%, 90%, and 95% confidence intervals, respectively
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The authors are grateful to the Accounting Research Institute (ARI-HICoE), Universiti Teknologi MARA, Shah Alam, Malaysia, and the Ministry of Higher Education for providing research funding.
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Kazi Musa, Naila Erum & Jamaliah Said
Department of Economics, Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
Saira Tufail
Faculty of Business Management & Professional Studies, Management & Science University (MSU), Shah Alam, Selangor, Malaysia
Abd Hadi Mustaffa
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ST has performed empirical analysis. AHM wrote the literature review. KM worked on the introduction and conclusion. NE worked on results and discussions. JS reviewed the manuscript and provided fruitful comments.
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We conducted a systematic review of the literature applying Elinor Ostrom's social-ecological systems framework (SESF), with a focus on studies using quantitative methodologies. We synthesized the step-by-step methodological decisions made across 51 studies into a methodological guide and decision tree for future applications of the framework. A synthesis of trends within each methodological ...
Bronfenbrenner's Ecological Systems Theory posits that an individual's development is influenced by a series of interconnected environmental systems, ranging from the immediate surroundings (e.g., family) to broad societal structures (e.g., culture). These systems include the Microsystem, Mesosystem, Exosystem, Macrosystem, and Chronosystem, each representing different levels of environmental ...
Bronfenbrenner's Ecological Systems Theory. A literature review was completed examining current research on the behavioral health needs of resettled refugee youth globally to inform treatment of refugee youth in primary care settings. Literature was organized using Ecological Systems Theory.
The literature review highlights the strong presence of English-language scholars and case studies in the debate. This was expected, given the major role played by "creative industries" policy and academic debates in the UK and Australia and by "creative economy" and "creative class" discourses in North America since the late 1990s.
The socioecological model is well established and can investigate how social and environmental factors across ecological levels (ie, individual, interpersonal, institutional, community, and policy) influence basic health care provision or lack thereof in underserved communities . This model assists in identifying context-specific factors, which ...
This process resulted in the removal of 79 articles. The remaining 157 articles were subjected to the review using the social ecological model assessment tool designed for this purpose (available on request). ... For practitioners looking for best practices, the public health and medical literature provides review articles (Dunn, Deroo, ...
Species distribution models (SDMs) are numerical tools that combine observations of species occurrence or abundance with environmental estimates. They are used to gain ecological and evolutionary insights and to predict distributions across landscapes, sometimes requiring extrapolation in space and time. SDMs are now widely used across terrestrial, freshwater, and marine realms. Differences in ...
Promoting the health of refugee women: a scoping literature review incorporating the social ecological model Int J Equity Health. 2021 Jan 23 ... The key terms used for our literature review were, health care, violence, social support, and mental health. In total, we included 52 articles, 3 books, and 8 other sources. ...
Keywords: Literature review, Refugee women's health, Health equity, Social ecological model Introduction Navigating healthcare systems and engaging in healthy behaviors can be difficult for those born in the countries they reside in; refugees however, contend with additional challenges and a myriad of factors affecting their health outcomes.
The socio-ecological model acknowledges that an individual's behavior is shaped through multi-level factors, including intrapersonal, interpersonal, ... March 2022 were included in the review. Articles characterized as conference abstracts, literature reviews, systematic reviews, meta-analyses, gray literature, editorials, and thesis ...
Using the social-ecological model as a framework, the literature was categorized into themes at the intrapersonal, interpersonal, organizational, community, and policy levels. We reviewed a total of fifty-three published academic articles, with the majority of studies conducted in Ethiopia and Nigeria.
The "Literature review" section presents the literature review. ... Table 5 Dynamic ARDL simulation model results for ecological impact index. Full size table. The results also show that recycling contributes positively to the ecological footprint and accelerates environmental degradation. Usually, the industry and individual-level ...