Uptake of COVID-19 vaccines among healthcare workers and the impact of non-pharmaceutical interventions: A mixed methods study

Background During the COVID-19 pandemic, vaccination of healthcare workers (HCWs) has a critical role, because of their high-risk exposure, being a role model, and affecting to rate of vaccination rate in society. The aim of this study to investigate the vaccine hesitancy and the role of some different study nudging for unvaccinated HCWs. Methods We conducted a mixed-methods study, the quantitative and qualitative steps were applied in succession. In the quantitative phase the basic sociodemographic details were compared between vaccinated and unvaccinated HCWs, the responses of "The Vaccine Hesitancy Scale" and "The Vaccine Hesitancy Scale in Pandemics" were collected and the effect of three different nudging's were evaluated. In the qualitative phase, in-depth interviews were performed to investigate the vaccine-hesitancy among HCWs. The Health Belief Model was used to guide the in-depth interview questions. Results The rate of vaccine-hesitancy was higher among males than females (6% vs 3.6%, p=0.009) and staff in ancillary workers than in other health professions (10% vs 5-1%, p<0.001). At the end of in-depth interviews (n=13), the most common vaccine-hesitancy determinants were conflicting explanations about vaccines, suspicion, fear, self-confidence, feeling the pressure, the media effect, and obstinacy. After the first nudging, 83.33% (130/156) vaccine hesitant HCWs were vaccinated and 8.3% (13/156) after the second and third nudging's. Finally, the rate of COVID-19 vaccination was raised from 95.5% to 99.67 % (3927/3940) in two hospitals. Conclusions The initial vaccination rate was high (95.5%), however obligatory PCR testing for unvaccinated HCWs was highly effective. Our multi-dimensional efforts such as obligatory testing, group seminars, and dissemination of updated information were helpful to raise the rate of COVID-19 vaccination.