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 Table of Contents  
ORIGINAL RESEARCH
Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 175-181

Practices, attitudes, and factors associated with COVID-19 vaccination among Peruvian dental students vs. different health science fields: A cross-sectional study


1 Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
2 Academic Department, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
3 Academic Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
4 Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru

Date of Submission14-Nov-2021
Date of Decision07-Feb-2022
Date of Acceptance14-Feb-2022
Date of Web Publication26-Apr-2022

Correspondence Address:
Dr. Frank Mayta-Tovalino
Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima
Peru
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_314_21

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  Abstract 

Aim: To determine practices, attitudes, and factors associated with COVID-19 vaccination among students from different health science schools. Materials and Methods: This was an analytical, observational, and prospective study. This study evaluated students from different health science schools of the Universidad Nacional Federico Villarreal, Lima, Peru, from March to July 2021. This was the period during which the national vaccination campaign began in Peru. Data collection was carried out using a validated, anonymous, and virtual questionnaire using Microsoft Forms. This measured the acceptance of the COVID-19 vaccine and consisted of 23 questions that addressed the dimensions of practices and attitudes toward vaccination. Finally, a logistic regression model was used to determine the factors associated with vaccination practices and attitudes, with a significance level of P<0.05. Results: Female subjects were more prevalent with 489 (75.5%) students, and the professional school of medicine had the most representatives, with 146 (22.5%) subjects. Most of the students belonged to cycle VIII, with 140 (21.6%). The statistical regression model showed that only sex was a factor associated with COVID-19 vaccination practices and attitudes, with odds ratio = 0.60; confidence interval = 0.42–0.93, and P =0.019. Conclusion: Undergraduate Peruvian students from all areas of health sciences showed significant practices and attitudes toward vaccination against COVID-19. However, of all the associated factors, sex was the only statistically significant factor.

Keywords: Attitudes, COVID-19, Practices, Students, Vaccination


How to cite this article:
Alvitez J, Huarachi L, Temoche A, Ramirez A, Alvitez-Temoche D, Mayta-Tovalino F. Practices, attitudes, and factors associated with COVID-19 vaccination among Peruvian dental students vs. different health science fields: A cross-sectional study. J Int Oral Health 2022;14:175-81

How to cite this URL:
Alvitez J, Huarachi L, Temoche A, Ramirez A, Alvitez-Temoche D, Mayta-Tovalino F. Practices, attitudes, and factors associated with COVID-19 vaccination among Peruvian dental students vs. different health science fields: A cross-sectional study. J Int Oral Health [serial online] 2022 [cited 2022 Jun 27];14:175-81. Available from: https://www.jioh.org/text.asp?2022/14/2/175/344064


  Introduction Top


At the end of 2019, an outbreak of pneumonia of unknown cause in Wuhan, China unexpectedly burst onto the global health scene.[1] The pathogen was identified as a new beta-type coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), as it shares 79% phylogenetic similarity with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and with Middle East Respiratory Syndrome (MERS).[2] Therefore, the World Health Organization (WHO) named it COVID-19 (Coronavirus Disease 2019).[1]

The disease spread rapidly around the world, leading the WHO to declare it as a global pandemic, with millions of confirmed cases and deaths reported, with the Americas being the most affected continent. The most common symptoms are dry cough, fever, fatigue, dyspnea, or difficulty breathing, whereas in the most severe cases, it can cause viral pneumonia and lead to severe acute respiratory syndrome and even death.[3] High rates of mortality were reported mainly in elderly and middle-aged patients with pre-existing conditions (tumors, liver cirrhosis, coronary heart disease, hypertension, diabetes, etc.).[4] The most widely accepted transmission mode of SARS-CoV-2 in humans is via the airborne route from person to person through respiratory droplets on close contact, with an incubation period that averages 5 days, but can last up to 14 days.[5]

The development of vaccines is important to control the pandemic and protect people from the disease and its consequences, along with the economics of distancing measures, restrictions, and quarantines. The methodologies used for vaccine development vary, such as mRNA or inactivated virus technology.[6] As of September 2020, eight vaccine candidates have initiated Phase III clinical trials.[7] However, as of February 2021, 10 vaccines have been approved by official agencies in different countries for emergency use, and several vaccine candidates are being evaluated in human clinical trials, with only a few in phase III clinical trials (final phases of testing).

Currently, of the eight vaccines that have been approved with emergency authorization worldwide, only three types are being applied in Peru: Pfizer/BioNTech (USA) with 95% effectiveness, Sinopharm (China) with 79.34% effectiveness, and AstraZeneca (UK) with 70% effectiveness. According to these laboratories, vaccination plans in Peru consist of two doses for those vaccinated with Pfizer, Moderna, and Sinopharm with a 21-day interval between both doses, according to the Peruvian Ministry of Health. However, as in the rest of the world, there are many people called antivaccine, who refuse to receive the drug. This turns out to be a public health problem since it has been demonstrated in the evidence that these people are the ones who will fall ill with severe cases of the disease. As of December 11, 2021, the Peruvian Ministry of Health has reported that 23,395,630 people have been vaccinated with the first dose and 19,839,968 with the second dose corresponding to 84.8% with complete vaccinations.[7]

Despite all the advances, there are doubts and resistance to COVID-19 vaccination in some sectors. The motivations are varied, ranging from concerns about possible side effects, distrust of pharmaceuticals, distrust of the state, doubts about its efficacy, anti-vaccine beliefs, or a pre-existing medical condition.[7],[8] The hypothesis of this study was that health science students have appropriate practices and attitudes about the process of vaccination against COVID-19. The aim of this study was to determine the practices, attitudes, and factors associated with COVID-19 vaccination in Peruvian students from different schools of health sciences.


  Materials and Methods Top


Study design

The study was a analytical, observational, and prospective study. The research evaluated all health sciences students at the Universidad Nacional Federico Villarreal, Lima, Peru, during the months of March to July 2021, the period in which the national vaccination campaign began in Peru. The sample (n = 648) students were calculated using the formula for estimating proportion through the Stata 15 program Stata 15® (College Station, TX, USA), with an alpha of 0.05 and a beta of 0.8. The manuscript was written following the guidelines of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology).

Selection criteria

The inclusion criteria were (a) students of the health sciences faculties (Faculty of Medicine Hipólito Unanue, Medical Technology, Dentistry and Psychology) of the Universidad Nacional Federico Villarreal; (b) those enrolled in the 2020-II academic period; and (c) over 18 years of age of both sexes. The exclusion criteria were (a) students who did not agree to participate voluntarily in the study and (b) students who had received the vaccine against COVID-19.

Ethical aspects

This study was revised and approved by the Ethics Committee of the Faculty of Medicine of the Universidad Nacional Federico Villarreal, Registration No. 1327–2021, CIEI, DICTAMEN 02-2021-CIEI.

Data collection

The instrument for data collection was a self-administered, anonymous, virtual questionnaire using Microsoft Forms. The questionnaire was the one previously used in the study by Wang et al.,[9] which was developed based on previous studies that used the same structure to determine the acceptance, practices, and attitudes toward vaccination against emerging infectious diseases such as H1N1 (Cronbach’s alpha = 0.91), a questionnaire that was also used in different studies.[7],[8] The questionnaire consisted of 23 questions in three sections: (a) Section I: the first 15 questions addressed the associated factors (sociodemographic and effects of the pandemic); (b) Section II: 2 questions addressed the dimension of practices in relation to previous vaccinations; and (c) Section III: 6 questions addressed the dimension of attitudes toward vaccination for COVID-19.

The questions were closed-ended and polytomous in Section I and dichotomous in the following two sections. Participants provided informed consent before answering the survey questions, and participants’ willingness was obtained by answering the “yes/no” question. Confidentiality was maintained for all students in the research. The virtual questionnaire was distributed via e-mail to all students. Then, data analysis was performed to describe the sociodemographic characteristics, practices, attitudes, and factors associated with COVID-19 vaccination. To identify predictors of respondents’ intention to be vaccinated, a multivariate logistic regression was performed.

Statistical analysis

A descriptive analysis was performed through frequencies and percentages of categorical variables. Normality was evaluated using the Kolgomorov–Smirnov test. Pearson’s χ2 test was used for inferential analysis. Finally, multivariate analysis was performed by logistic regression using odds ratio (OR). A significance level of P<0.05 was established. All statistical analysis was performed using Stata 15® software (College Station, TX, USA).


  Results Top


Of the 648 health science students, it was found that the female sex was more prevalent, with 489 (75.5%), whereas male students were only 159 (24.5%). This is due to the fact that in Peru, demographically, the female sex predominates at the national level, and this is reflected in the Peruvian university system. The most prevalent age group was 21–24 years, with 391 (60.3%) participants. The majority [621 (95.8%)] of the health sciences students were single. The Professional School of Medicine had the most representatives, with 146 (22.5%) subjects. Finally, most of the students belonged to cycle VIII, with 140 (21.6%) participants [Table 1].
Table 1: Sociodemographic characteristics of undergraduate health science students

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We find that concerning the questions measuring practices on vaccination against COVID-19, statistically significant associations were only found in questions Q1: Location (the most prevalent category belongs to the coast, 24.1% men and 75.9% women), Q3: Employment status (the studying and working category was the most prevalent, 24.2% men and 75.8% women), Q5: Health status (the very good category was the most prevalent, 39.1% men and the good category 77.3% women), Q7: Perceived risk of infection (the very low category was the most prevalent, 64.3% men and the very high category 81.6% women), and finally, the question Q8: Pandemic impact on daily life; according to the sex of the Peruvian students of health sciences they were also associated with sex significantly (P < 0.05) [Table 2].
Table 2: Practices on vaccination against the COVID-19 of Peruvian students of sciences of health

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Contrary to the practices, in relation to the questions that measure attitudes toward vaccination against COVID-19, a statistically significant association was found only in question Q17: Accept vaccination with COVID-19 vaccine successfully developed and approved for listing (44.7% of men said no, whereas 76.7% of women said yes), according to the sex of the Peruvian health sciences students (P < 0.05) [Table 3].
Table 3: Attitudes on vaccination against the COVID-19 of Peruvian students of sciences of health

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In the adjusted model, the prevalence of good practices on vaccination against COVID-19 was higher only in obstetrics students than in other areas [OR= 2.6; confidence interval (CI) = 1.04–6.43, P =0.040]. On the contrary, in relation to the semester, the prevalence of practices on vaccination against COVID-19 was higher only in IV cycle students, among other areas (OR= 3.4; CI = 1.23–9.27, with P =0.018) [Table 4].
Table 4: Factors associated with practices and attitudes on vaccination against the COVID-19

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In contrast, in relation to attitudes, the prevalence of good attitudes about vaccination against COVID-19 was lower in the male sex (OR= 0.6; CI = 0.40–0.94, with P =0.028) [Table 4].


  Discussion Top


In the Peruvian University System, health sciences students generally take courses that provide them with sufficient medical experience[10] to evaluate the risks and benefits of influenza vaccination and COVID-19.

In the present study, 76.7% of those who would accept vaccination against COVID-19 were women and only 23.3% were men; however, in patients who stated that they would not accept vaccination, 55.3% were women and 44.7% were men; moreover, an association was found between acceptance and sex (P=0.003). These results were similar to studies by Saied et al.[11] and Riad et al.[12] conducted elsewhere, although they found no association with sex. On the contrary, a 91% acceptance rate was obtained in China[9]; 88.1% in medical students and 76.2% in nursing students in Israel[1]; and 78% acceptance rate in dental students.[12] In France, 76.9% of healthcare personnel were willing to be vaccinated when the vaccine was not yet available[13]; and there was a 71% acceptance rate in medical students in Egypt[11]; all of these were studies in which no association with sex was found.

The results show associations between the decision to accept COVID-19 vaccination and current employment status, perceived risk of infection, health status, and the effect of the pandemic on daily life, similar to a study conducted in China,[9] which may indicate a perception by respondents of vaccination as a recovery tool in these aspects of life. The results are consistent with those of studies in which college education is an important factor in the acceptance of vaccination.[14],[15],[16] For example, Lazarus et al.[16] found that 46.8% of the participants strongly agreed with vaccination, 24.7% somewhat agreed, and 14.2% were neutral. In contrast, 6.1% partially disagreed with vaccination, whereas 8.1% completely disagreed; 88.6% of Chinese participants responded that they were willing to be vaccinated against COVID-19. Respondents from China gave the highest frequencies of positive responses (631 of 712 respondents, 88.6%) and the lowest proportion, whereas only 54.9% of Russians expressed intentions to be vaccinated. Participants older than 25 years (OR=1.46–1.73) were more likely to accept vaccination when compared with the group aged 18–24 years. People with an income of at least $32 per day were more likely (OR=2.18) to accept vaccination than those with an income of $2 per day. Participants with a medium, high, and very high educational level were more likely to accept vaccination (OR=1.24).

In our study, multivariate logistic regression was performed to identify the factors influencing practices and attitudes toward COVID-19 vaccination. We found no influence of the associated factors of sex, age, professional school, semester, and marital status on the decision to accept COVID-19 vaccination. The results obtained were similar to a study conducted in China by Wang et al. However, they found a higher probability of acceptance in males (OR=1.25, CI= 1.03–1.52) and married people (OR=1.7, CI=1.26–2.29), similar to a study by Guidry et al.[15] carried out in the USA. However, they found a lower probability of acceptance in older people (P<0.001) and African-Americans (P<0.001), in addition to a higher probability of acceptance in persons with university education (P<0.001). Fisher et al.[8] reported that 57.6% of the participants (n = 571) were destined to be vaccinated, whereas 31.6% (n = 313) were not insured and 10.8% (n = 107) did not intend to be vaccinated themselves. The results shown are consistent with the higher acceptance of vaccination among university students, a characteristic of the population of the present study, which is composed of university students of health sciences.[17],[18]

The main strengths of this study are that it provides scientific evidence of the possible practices of Peruvian health science students regarding vaccination against COVID-19, as well as identifying attitudes and associated factors that may influence vaccination against COVID-19 in this population, which, due to the nature of their activities, is exposed to a high risk of contagion of this disease. In addition, educational and communication strategies can be established to provide the necessary information to students, to absolve doubts, possible fears, or possible adverse attitudes to vaccination against COVID-19 in this important group that may be exposed to the risk of contagion. Finally, it helps to improve the scope of vaccination in Peruvian university students and the community in general, to achieve higher levels of collective immunity.

One of the principal limitations was that the sample was only carried out in a public university located in Lima, the capital of Peru. Secondly, most of the responses to the questionnaire were collected when vaccination had already begun worldwide; although, in Peru, it was still in an initial stage for health workers, during the second wave of the COVID-19 pandemic, which could influence perceptions about vaccination in better-informed sectors. Finally, epidemiological studies are very important[19],[20],[21],[22] because they make it possible to establish public policies for the benefit of society.


  Conclusion Top


Within the limitations of this study, it was concluded that undergraduate Peruvian students from all areas of health sciences showed significant practices and attitudes toward vaccination against COVID-19. However, sex was the only statistically significant factor of all the associated factors. Therefore, these findings could help to address correct information on vacancies in the student population.

Clinical significance

This study allows us to identify the associated factors among different health sciences students and how practices and attitudes toward the process of vaccination against COVID-19 vary.

Acknowledgements

We want to thank the Universidad San Ignacio de Loyola.

Financial support and sponsorship

None to declare.

Conflicts of interest

None to declare.

Authors’ contributions

Study conception (JA, LH, AT), data collection (AR, DA-T), data collection and analysis (FM-T, DA-T, JA, LH, AT, AR), data interpretation (FM-T, DA-T, JA, AT, LH), and article writing (DA-T, JA, AT, FM-T, AR, LH).

Ethical policy and Institutional Review Board statement

This study was revised and approved by the Ethics Committee of the Faculty of Medicine of the Universidad Nacional Federico Villarreal, Registration No. 1327–2021, CIEI, DICTAMEN 02-2021-CIEI.

Patient declaration of consent

Patients voluntarily agreed to participate in the study by informed consent.

Data availability statement

The data that support the study results are available from the author (Dr. Juan Alvitez, e-mail: [email protected]) on request.

 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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