Prevalence and Factors associated with Caregivers' Hesitancy in Immunizing Dependent Older Adults with COVID-19 Vaccines: A Cross-Sectional Survey

Abstract

Background: Coronavirus disease 2019 (COVID-19) vaccinations were proven to prevent infection, hospitalization, and mortality. However, some caregivers may be hesitant to provide COVID-19 vaccine to ones under their care. Our study aimed to evaluate factors associated with caregivers' hesitancy to immunize the dependent older adults with COVID-19 vaccines.

Method: We conducted a cross-sectional telephone survey about vaccine hesitancy among caregivers of dependent older patients in a geriatric clinic, Ramathibodi hospital. Caregivers were contacted and interviewed by the trained interviewers from June 20 to July 25, 2021.

Results: The study had a total of 318 participants. Mean age of participants was 55.9 year. The majority of participants were the patients' offspring (86.5%). 39.9% of participants were hesitant to provide the older adults with COVID-19 vaccines.  Factors associated with caregivers' vaccine hesitation were caregivers who sometimes felt uneasy, anxious, agitated, sad, or worried when they practiced social distancing, caregivers with COVID-19 vaccine refusal, and vaccine manufacturers.

Conclusion: The prevalence of the caregivers' hesitancy to allow the older adults to get the COVID-19 vaccine was relatively high. Some factors were associated with higher vaccine hesitancy among the caregivers. The findings may aid in endorsing COVID-19 immunization in dependent older adults.

Introduction

Since the Coronavirus disease 2019 (COVID-19) pandemic began in January 2019 [1], over 400 million people worldwide got infections by March 2022 [2]. Some of those developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, leading to a large number of morbidities and mortalities. In Thailand, there have been 2.9 million confirmed COVID-19 patients and over 22,000 deaths as of March 2, 2022 [3]. Older people were among most vulnerable groups for SARS-CoV-2 infection [4–7] According to a report by World Health Organization (WHO) Thailand, Thai older people had a 7.4% mortality rate, compared to 0.98 percent for the general population [8].

COVID-19 vaccinations could prevent infection, hospitalization, and mortality [9–11]. However, as SARS-CoV-2 evolved over time from a wild type to a newly predominant omicron variant [12], COVID-19 vaccine effectiveness seemed to be reduced against the new variant infection and required the booster doses [13, 14]. Despite the vaccine efficacy and significantly increased mortality rates, some older adults were still hesitant to get COVID-19 vaccination. The Strategic Advisory Group of Experts on Immunization from the World Health Organization (WHO) defined vaccine hesitancy as the delay in acceptance or refusal of vaccination despite the availability of vaccination services [15, 16]. One systematic review and meta-analysis demonstrated the prevalence of unwillingness and uncertainty for the COVID-19 vaccine in older adults were 27.0% and 19.3%, respectively. The factors associated with vaccine unwillingness were a low income, a low level of education, and Hispanics living in the United States [17].

In our recent study focusing on COVID-19 vaccine hesitancy in Thai older adults revealed 44.3% of participants were hesitant to get COVID-19 vaccination [18]. In our geriatric clinic, some older patients depended on their caregivers due to their underlying conditions. Thus, they lacked the capacity to make their own vaccination decisions. Their caregivers, mainly their family members, need to take over the decision to get COVID-19 vaccination for them [19]. Some caregivers may be hesitant and refuse to provide COVID-19 vaccine to ones under their supervision. The goal of this study is to determine the factors that contribute to COVID-19 vaccine apprehension in the caregivers to provide vaccination for the dependent older adults. The findings of this study will help encourage immunization among dependent older people.

Materials And Methods

Setting and study design

The Human Research Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, COA. MURA2021/1063, approved the study protocol. We conducted a cross-sectional telephone survey about vaccine hesitancy among caregivers of older patients in a geriatric clinic, Ramathibodi hospital which provides a tertiary care for older patients. The hospital database was used to retrieve the names of 318 dependent patients aged 60 and up who visited a geriatric clinic in the past two years.   The dependent patients were defined by elderly who had physical and mental dependence and cognitive impairment. Thus, 318 caregivers of the dependent patients who identified themselves as patients' representatives and were responsible for making COVID-19 vaccination decisions for the patients under their care were contacted and asked to take part in this study. All participants, on the other hand, provided verbal informed consent, which was recorded according to the verbal informed consent protocol approved by the Human Research Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We did not obtain written informed consent because we conducted a telephone survey and it was inconvenient for participants to sign written informed consent forms and handle documents during the pandemic. The agreed-upon participants were interviewed by a trained interviewer. The survey was performed over the phone from June 20 to July 25, 2021. The study was conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines. [20, 21]

Questionnaire 

The questionnaire used in this study was developed after a review of the literature [22-34] and consensus among the experts including the psychiatrists and geriatricians. The questionnaire was structured into 5 sections, including caregiver sociodemographic data, patient sociodemographic data, medical history, COVID-19 pandemic-related information, and COVID-19 vaccine-related information. A pilot sample (n = 10) was used to improve the language and clarity of expression of the survey items. The pilot sample's data was not used in any subsequent analysis. The final version of the questionnaire required 30-45 minutes to complete on average. The questionnaire was originally developed in the Thai language. 

Caregiver sociodemographic characteristics

Participants were asked about their sociodemographic information, including age, gender, marital status, education, relation with patient, employment status, monthly income, income loss due to COVID-19, and vaccination history including influenza, pneumococcal, zoster, and diphtheria-tetanus-pertussis (DTP) vaccines.

Patient sociodemographic characteristics and medical history

The sociodemographic characteristics of the patients were collected similar to the caregivers. In addition, participants were asked to report patients' medical history, including their body mass index (BMI), ambulation, hearing problem, visual problem, history of smoking and alcohol drinking, food and drug allergy, underlying diseases, cognitive complaint, hospitalization in the previous year, and overall health perception.

COVID-19 pandemic-related information

Participants were questioned on their general knowledge about COVID-19, the primary source of information regarding COVID-19, confidence in government and public health agency information about COVID-19, confidence in Thailand's healthcare system's capability to care for COVID-19 patients, measurements from the government to control COVID-19 infection, risk of getting COVID-19 infection, self-perception to develop severe COVID-19 infection and attitude towards social distancing, and intention to get COVID-19 vaccination.

COVID-19 vaccine-related information

Participants were questioned about their hesitations towards administering the COVID-19 vaccine to patients who were under their care. They were asked if they knew people who developed a severe reaction to the COVID-19 vaccine, had an intention to get COVID-19 vaccination, had already received the COVID-19 vaccination, wanted the patients to be vaccinated for COVID-19, and thought the manufacturer of the COVID-19 vaccine influenced their decision to let the patients get vaccinated. Participants were also asked whether they still wanted the patients to get vaccinated if the patients were offered vaccines from the manufacturer they had never expected before. Those who were hesitant to allow their patients to acquire the COVID-19 vaccines were questioned why they were hesitant. Furthermore, every participant was asked why they were willing to immunize the older adults with COVID-19 vaccines.

Statistical analysis 

The number and percentage of patients were used to summarize nominal data, such as the presence of underlying disorders. Based on the normality of the distribution, continuous variables, such as age, were summarized as mean, standard deviation (SD). For categorical variables, a Chi-square test or Fisher's test was used, and for continuous variables, an independent t-test was used. Binary logistic regression was used to investigate the influencing factors. Only statistically significant factors from the univariable logistic regression model were analyzed further in the multivariable logistic regression model. SPSS 26.0 (IBM Corp., Armonk, NY, USA) for Windows was used for all statistical analysis.   Statistical significance was defined as a p-value of less than 0.05.

Results

Among 318 participants, 127 (39.9%) were hesitant to provide the dependent older adults to get COVID-19 vaccination, whereas 191 (60.1%) showed their willingness.

Sociodemographic characteristics of participants

Sociodemographic data of the caregivers were shown in Table 1 and Table 2. Our participants' ages ranged from 26 to 91 years old with a mean ± SD age of 55.9 ± 11.5 years. Most of the caregivers were female (76.4%), married (53.8%), and had a bachelor's degree or higher (87.1%). The relationship between caregivers and patients were offspring (86.5%), spouse (9.1%), and sibling (4.4%). 

Sociodemographic characteristics and medical history of dependent older adults

 The dependent older patients' sociodemographic data were described in Table 3 and Table 4. Older patients' ages were between 60-107 years and mean ± SD ages were 83.8 ± 8.4 years. Most of the patients were female (73.6%), Thai ethnic (93.1%), married (45.0%), and lived in Bangkok (63.2%). Regarding health status, 19.2% were bedbound and 10.1% depended on tube feeding. Up to 84.6% of the patients had cognitive complaints, and 61.0% were diagnosed with dementia. 31.4% of the patients fell, and 30.2% were admitted to the hospital at least once in the previous year.

COVID-19 pandemic related information

            The result from COVID-19 pandemic-related information was demonstrated in Table 5. Most of the participants (52.5%) thought they knew quite a lot or a lot about COVID-19 and the majority (43.4%) of the participants' COVID-19 information came from television or radio. When compared to caregivers who were hesitant to allow the dependent older adults to receive the COVID-19 vaccines and those who had vaccine acceptance, caregivers who sometimes felt uneasy, anxious, agitated, sad, or worried when they practiced social distancing had a higher hesitancy to immunize dependent older with COVID-19 vaccination, odd ratio (OR) = 2.508 [95% confident interval (CI) 1.400-4.491, p=0.002]. (Table 6)

COVID-19 vaccine-related information

            COVID-19 vaccine-related information outcomes were described in Table 5. 39.9% of the caregivers revealed they were hesitant to immunize older adults with COVID-19 vaccines, and 13.5% did refused to allow the ones under their care to get vaccinated. Up to 96.2% of the caregivers had an intention to get the COVID-19 vaccine for themselves, while 76.7% had already received the COVID-19 vaccination. The most common reasons for COVID-19 vaccine hesitancy among the caregivers of older persons were because they were fearful of COVID-19 vaccine adverse effects (40.2%), possible complications caused by their underlying disease (18.9%), and they believed the vaccine was not effective enough to prevent against COVID-19 infection (7.9%). (Figure 1) The most important reasons for vaccination were as follows; COVID-19 vaccine could prevent severe COVID-19 infection or death (45.3%), they were a vulnerable group for COVID-19 infection (18.2%), and the COVID-19 vaccine could protect older adults from COVID-19 infection (14.5%). (Figure 2) By comparing vaccination hesitation with vaccine acceptance, the caregivers who refused to allow the dependent older adults to get COVID-19 vaccines had higher vaccine hesitancy, OR=3.779 (95%CI 1.652-8.648, p=0.002). Caregivers who believed COVID-19 vaccine manufacturers did not influence their decision to allow the older person to obtain vaccination had less vaccine hesitancy, OR = 0.267 (95% CI 0.152-0.471, p<0.001). 

            Insert Figure 1 about here.

            Insert Figure 2 about here.

Discussion

Our study was the first study investigating the hesitancy of the caregivers to provide COVID-19 vaccination for dependent older adults to our knowledge. Three hundred eighteen caregivers were contacted and completed the interviews. We discovered that 39.9% of participants were hesitant to allow the older persons to get vaccinated. This study found that factors associated with higher hesitancy to immunize older adults with COVID-19 vaccines were caregivers who sometimes felt uneasy, anxious, agitated, sad, or worried when they practiced social distancing, caregivers with COVID-19 vaccine refusal, and vaccine manufacturers. In a recent systematic review and meta-analysis, other factors related to vaccine hesitation in older adults were a low income, a low level of education, and Hispanics living in the United States [17].  

This study demonstrated that the caregivers who sometimes felt uneasy, anxious, agitated, sad, or worried when they practiced social distancing had higher hesitancy to let the older patients get vaccinated than those who did not experience it. Some studies showed that practicing social distancing and people with anxiety were linked with COVID-19 vaccine hesitancy [35-37]. Less complying with social distancing was associated with higher vaccine hesitancy in some studies.[35, 36] People who were mildly anxious and severely anxious were more likely to be undecided whether they would get vaccinated [37].

We observed that COVID-19 vaccine refusal was associated with more vaccine hesitancy among the caregivers. Our study defined vaccine hesitancy as the delay in acceptance or refusal of vaccination despite the availability of vaccination services [15, 16].  In contrast, vaccine refusal was described as a complete rejection of vaccination.[38] Vaccine refusal showed stronger intention not to get vaccinated than vaccine hesitancy, causing the obstacle to achieving herd immunity. Some studies demonstrated the pattern of COVID-19 vaccine hesitancy and COVID-19 vaccine refusal or rejection were relatively similar and linked [38, 39].

Vaccine manufacturers were one of the factors associated with caregivers' hesitation to get older adults vaccinated. When this study was conducted, Thailand was facing a new delta variant, causing a surge in cases [40]. There were two available COVID-19 vaccines which were Oxford-AstraZeneca ChAdOx1 nCoV-19 vaccine (ChAdOx1 nCoV-19) and inactivated SARS-CoV-2 vaccine (CoronaVac). However, only ChAdOx1 nCoV-19 was proved its efficacy against the delta variant [41]. This could explain why COVID-19 vaccine manufacturers affected the caregivers' decisions. This study had a similar result to our previous study focusing on the older adult's vaccine attitude [18].

In comparison with a result from the recent systematic review and meta-analysis finding that a low income and a low level of education were associated with higher vaccine hesitancy in older adults, we could not replicate this finding in our research. We could collect data on the caregivers' income from only 75.2% of participants. Among those who reported their income, 63.6% had higher than the average income of Thai people [42]. Furthermore, the majority of the caregiver (87.1%) reported they graduated bachelor's degree or higher. These could affect our study results because our participants might have a better socioeconomic baseline than the general population. Besides, our research studied the caregivers' attitudes, not the older adults. The factors influencing the hesitation might not be exactly the same 

The strength of our study was this study was the first paper to study the attitude of the caregivers to provide COVID-19 vaccines for the older adults under their care. The caregivers had a crucial role in making a decision for the dependent older ones. To promote COVID-19 immunization among dependent older people, understanding their caregivers was one of the keys to success.

Our study has some limitations. We retrieved the participants from a hospital database from a geriatric clinic in a university hospital. Thus, the results from our study should be interpreted carefully. Some participants refused to give the information on sensitive questions such as their incomes. So, we were missing out on some information. Finally, although we demonstrate an association between some factors affecting the higher chance of the caregivers' hesitancy to provide COVID-19 vaccine immunization for older adults, we could not prove causality.

Conclusion

The prevalence of the caregivers' hesitancy to immunize the older adults with COVID-19 vaccination was relatively high. Caregivers who sometimes felt uneasy, anxious, agitated, sad, or worried when they practiced social distancing, caregivers with COVID-19 vaccine refusal, and vaccine manufacturers were all linked to more COVID-19 vaccine hesitation among the caregivers. The findings may aid in endorsing COVID-19 immunization in dependent older adults.

Abbreviations

COVID-19: Coronavirus disease 2019; WHO: World health organization; DTP: diphtheria-tetanus-pertussis; BMI: body mass index; SD: standard deviation; OR: odd ratio; 95% CI: 95% confident interval; ChAdOx1 nCoV-19: Oxford-AstraZeneca ChAdOx1 nCoV-19 vaccine; CoronaVac: inactivated SARS-CoV-2 vaccine

Declarations

The authors declare that all methods were carried out in accordance with relevant guidelines and regulations.

Ethics approval and consent to participate

The study protocol was approved by the Human Research Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, COA. MURA2021/1063. The study was conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines. All participants provided verbal informed consent, which was recorded according to the verbal informed consent protocol approved by the Human Research Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We did not obtain written informed consent because we conducted a telephone survey and it was inconvenient for participants to sign written informed consent forms and handle documents during the pandemic.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding Information:

This research project is supported by Faculty of Medicine, Ramathibodi Hospital, Mahidol University 

Author Contributions:

All authors were responsible for the conception and design of the study. S.T., S.C. and P.I. designed the study. S.T., S.C., P.C. and P.I collected the data. S.T., K.S. and P.I analyzed the data. S.T., S.C., K.S. and P.I. interpreted the data. S.T, S.C. and P.I wrote the original draft of manuscript. P.I. and S.T. reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

Acknowledgment

We would like to thank all interviewers and the caregivers of older patients who participated in our research.

References

1. Li J, Gong X, Wang Z, Chen R, Li T, Zeng D, Li M: Clinical features of familial clustering in patients infected with 2019 novel coronavirus in Wuhan, China. Virus Res 2020, 286:198043.
2. WHO Coronavirus (COVID-19) Dashboard [https://covid19.who.int/]
3. COVID-19 Situation, Thailand 2 March 2022 [https://cdn.who.int/media/docs/default-source/searo/thailand/2022_03_02_tha-sitrep-225-covid-19.pdf?sfvrsn=32cca21b_5]
4. Yanez ND, Weiss NS, Romand JA, Treggiari MM: COVID-19 mortality risk for older men and women. BMC Public Health 2020, 20(1):1742.
5. Ward H, Atchison C, Whitaker M, Ainslie KEC, Elliott J, Okell L, Redd R, Ashby D, Donnelly CA, Barclay W et al: SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic. Nat Commun 2021, 12(1):905.
6. Pastor-Barriuso R, Perez-Gomez B, Hernan MA, Perez-Olmeda M, Yotti R, Oteo-Iglesias J, Sanmartin JL, Leon-Gomez I, Fernandez-Garcia A, Fernandez-Navarro P et al: Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study. BMJ 2020, 371:m4509.
7. O'Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H: Age-specific mortality and immunity patterns of SARS-CoV-2. Nature 2021, 590(7844):140–5.
8. COVID-19 Situation, Thailand 22 December 2021 [https://cdn.who.int/media/docs/default-source/searo/thailand/2021_12_22_tha-sitrep-215-covid-19.pdf?sfvrsn=232b8cc4_5]
9. Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, Angus B, Baillie VL, Barnabas SL, Bhorat QE et al: Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 2021, 397(10269):99–111.
10. Jara A, Undurraga EA, Gonzalez C, Paredes F, Fontecilla T, Jara G, Pizarro A, Acevedo J, Leo K, Leon F et al: Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile. N Engl J Med 2021.
11. Haas EJ, Angulo FJ, McLaughlin JM, Anis E, Singer SR, Khan F, Brooks N, Smaja M, Mircus G, Pan K et al: Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet 2021, 397(10287):1819–29.
12. Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern [https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern]
13. Accorsi EK, Britton A, Fleming-Dutra KE, Smith ZR, Shang N, Derado G, Miller J, Schrag SJ, Verani JR: Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by the SARS-CoV-2 Omicron and Delta Variants. JAMA 2022, 327(7):639–51.
14. Andrews N, Stowe J, Kirsebom F, Toffa S, Rickeard T, Gallagher E, Gower C, Kall M, Groves N, O’Connell A-M et al: Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant. N Engl J Med 2022.
15. Report of the SAGE Working Group on Vaccine Hesitancy [https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf]
16. MacDonald NE, Hesitancy SWGoV: Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015, 33(34):4161–4.
17. Veronese N, Saccaro C, Demurtas J, Smith L, Dominguez LJ, Maggi S, Barbagallo M: Prevalence of unwillingness and uncertainty to vaccinate against COVID-19 in older people: A systematic review and meta-analysis. Ageing Res Rev 2021, 72:101489.
18. Thanapluetiwong S, Chansirikarnjana S, Sriwannopas O, Assavapokee T, Ittasakul P: Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors. Patient Prefer Adherence 2021, 15:2389–403.
19. Wongsawang N, Lagampan S, Lapvongwattana P, Bowers BJ: Family caregiving for dependent older adults in Thai families. J Nurs Scholarsh 2013, 45(4):336–43.
20. World Medical A: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013, 310(20):2191–4.
21. WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects [https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/]
22. Robertson E, Reeve KS, Niedzwiedz CL, Moore J, Blake M, Green M, Katikireddi SV, Benzeval MJ: Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study. Brain Behav Immun 2021, 94:41–50.
23. Lin C, Tu P, Beitsch LM: Confidence and Receptivity for COVID-19 Vaccines: A Rapid Systematic Review. Vaccines (Basel) 2020, 9(1).
24. Okubo R, Yoshioka T, Ohfuji S, Matsuo T, Tabuchi T: COVID-19 Vaccine Hesitancy and Its Associated Factors in Japan. Vaccines (Basel) 2021, 9(6).
25. Soares P, Rocha JV, Moniz M, Gama A, Laires PA, Pedro AR, Dias S, Leite A, Nunes C: Factors Associated with COVID-19 Vaccine Hesitancy. Vaccines (Basel) 2021, 9(3).
26. Fridman A, Gershon R, Gneezy A: COVID-19 and vaccine hesitancy: A longitudinal study. PLoS One 2021, 16(4):e0250123.
27. Kreps S, Prasad S, Brownstein JS, Hswen Y, Garibaldi BT, Zhang B, Kriner DL: Factors Associated With US Adults' Likelihood of Accepting COVID-19 Vaccination. JAMA Netw Open 2020, 3(10):e2025594.
28. Kelly BJ, Southwell BG, McCormack LA, Bann CM, MacDonald PDM, Frasier AM, Bevc CA, Brewer NT, Squiers LB: Predictors of willingness to get a COVID-19 vaccine in the U.S. BMC Infect Dis 2021, 21(1):338.
29. Syed Alwi SAR, Rafidah E, Zurraini A, Juslina O, Brohi IB, Lukas S: A survey on COVID-19 vaccine acceptance and concern among Malaysians. BMC Public Health 2021, 21(1):1129.
30. Daly M, Robinson E: Willingness to Vaccinate Against COVID-19 in the U.S.: Representative Longitudinal Evidence From April to October 2020. Am J Prev Med 2021, 60(6):766–73.
31. Loomba S, de Figueiredo A, Piatek SJ, de Graaf K, Larson HJ: Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nat Hum Behav 2021, 5(3):337–48.
32. Callaghan T, Moghtaderi A, Lueck JA, Hotez P, Strych U, Dor A, Fowler EF, Motta M: Correlates and disparities of intention to vaccinate against COVID-19. Soc Sci Med 2021, 272:113638.
33. Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, Fang H: Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China. Vaccines (Basel) 2020, 8(3).
34. Ward JK, Alleaume C, Peretti-Watel P, Group C: The French public's attitudes to a future COVID-19 vaccine: The politicization of a public health issue. Soc Sci Med 2020, 265:113414.
35. Latkin CA, Dayton L, Yi G, Colon B, Kong X: Mask usage, social distancing, racial, and gender correlates of COVID-19 vaccine intentions among adults in the US. PLoS One 2021, 16(2):e0246970.
36. Rane MS, Kochhar S, Poehlein E, You W, Robertson MKM, Zimba R, Westmoreland DA, Romo ML, Kulkarni SG, Chang M et al: Determinants and trends of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults: A longitudinal study. Am J Epidemiol 2022.
37. Sekizawa Y, Hashimoto S, Denda K, Ochi S, So M: Association between COVID-19 vaccine hesitancy and generalized trust, depression, generalized anxiety, and fear of COVID-19. BMC Public Health 2022, 22(1):126.
38. Muhajarine N, Adeyinka DA, McCutcheon J, Green KL, Fahlman M, Kallio N: COVID-19 vaccine hesitancy and refusal and associated factors in an adult population in Saskatchewan, Canada: Evidence from predictive modelling. PLoS One 2021, 16(11):e0259513.
39. Shih SF, Wagner AL, Masters NB, Prosser LA, Lu Y, Zikmund-Fisher BJ: Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States. Front Immunol 2021, 12:558270.
40. Coronavirus disease 2019 (COVID-19) WHO Thailand Situation Report – 22 July 2021 [https://cdn.who.int/media/docs/default-source/searo/thailand/2021_07_22_eng-sitrep-193-covid19.pdf?sfvrsn=a0fdd5a7_3]
41. Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, Stowe J, Tessier E, Groves N, Dabrera G et al: Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med 2021.
42. Thailand Economic Overview [https://www.boi.go.th/index.php?page=macroeconomics&language=th]

Tables

Table 1. Baseline characteristics of caregivers (n=318)

n number, % percent, DTP Diphtheria-Tetanus-Pertussis

Table 2. Baseline characteristic factors of caregivers associated with caregivers’ hesitancy to immunize dependent older adults with COVID-19 vaccines

n number, % percent, χ² Chi-Square, DTP Diphtheria-Tetanus-Pertussis

*p<0.05
 

Table 3. Baseline characteristics of dependent older adult (n=318)

n number, % percent, BMI Body Mass Index, DTP Diphtheria-Tetanus-Pertussis

Table 4. Baseline characteristic factors of dependent older adults associated with caregivers’ hesitancy to immunize them with COVID-19 vaccines

n number, % percent, χ² Chi-Square, BMI Body Mass Index, DTP Diphtheria-Tetanus-Pertussis

*p<0.05

Table 5. COVID-19 pandemic and vaccine-related information factors associated with caregivers’ hesitancy to immunize dependent older adults with COVID-19 vaccines

n number, % percent, χ² Chi-Square

*p<0.05

Table 6. Logistic regression results for caregivers’ hesitancy to immunize dependent older adults with COVID-19 vaccines

OR Odds Ratios, aOR adjusted Odd Ratios, CI Confidence Interval, Ref Reference group