The current study showed three profiles (patterns) of the COVID-19 Vaccine Knowledge, Attitude, Practices, and Concerns. These patterns were included “Moderate to up for KAPC",” High KAP & Low C", " Moderate K & Low AP & High C". Students in the three profiles differed significantly in their KAPC factors. In other words, there is important heterogeneity or diversity of KAPC factors among students was provides posterior probabilities of each individual's membership in each profile. The most common pattern was Moderate to up for KAPC that included 70% of study population, while lowest pattern was Moderate K & Low AP & High C with 4% of study population.
Specially, Profile 3 was characterized by a very negative attitude towards COVID-19. The Profile 3's knowledge was almost similar but lower than the other two profiles. In addition, Profile 3 had the highest value regarding the level of concern along with profile 1. However, one of the characteristics of Profile 2 was their highest level of knowledge, practices, and attitude. Profile 1 had a moderate level of attitude, knowledge, practices, and concern. The results showed that Profile 3 had a 99% lower chance of being vaccinated than group 1. Moreover, the chance of vaccination in Profile 2 was 63% lower than Profile 1.
Numerous studies have been performed on different strata of the medical staff from physicians, nurses, dentists, and public health specialists, indicating an appropriate level of knowledge and attitude towards COVID-19[22–25]. But, in the current study, participations were categorized according to Knowledge, attitudes, and practices related to COVID-19. The classifying of individuals in homogeneous groups can help create interventions for increasing tendency to acceptance and subsequently for injection vaccine. Interventions should be comprehensive and specific to the target population. Intervenors should apply appropriate strategies for the best combination of interventions based on the typology.
As mentioned, Profile 1 with a medium to a high level in terms of KAPC, is more inclined to receive vaccines than the others. Therefore, an average KAPC about COVID-19 increase the chance of receiving the vaccine. These findings are consistent with pervious study in Korea, that had been shown individuals' knowledge, of COVID-19 and their concern and attitudes toward preventive measures can affect their performance concerning vaccination[26]. Indeed, it is reasonable, because high KAP lead to low concerns and and subsequently acceptance vaccine.
Knowledge is a prerequisite for creating prevention beliefs, forming a positive attitude and promoting positive behaviors; and people's knowledge and attitude towards the disease can effect on their coping strategies and behaviors. Naturally, the audience of the present study (medical students) is expected to have an acceptable knowledge of COVID-19 and its vaccine. Also, various trainings sources in different levels from university to society have increased their knowledge about this epidemic; and usually increasing knowledge leads to a change in people's attitudes and consequently change their practice[27].
Another studied component is attitude. It influenced by knowledge, which can be obtained through experience[28]. Attitude in social psychology is evaluating a subject, which varies from negative to very positive[29]. A complex and unique psychological structure in each person is acquired through individual experience and modeling. Attitude combines beliefs and emotions to evaluate different concepts in different ways and predict future behaviors[30]. According to the theory of planned behavior, attitude plays a vital role in health care behaviors[31] to have a better function and receive the vaccine because they feel positive about dealing with COVID-19 socially and individually.
Another component is concerns, which occurs when a stimulus or event threatens our physical, mental, or social health. Thus, concerns and fear have an external source as a common emotion to increase energy to preserve life[32, 33]. The fear and concern about the recurrence of the disease persist even after treatment. COVID-19 concern means anxiety from being infected due to anonymity and cognitive ambiguity[34]. A moderate level of concern and anxiety creates the motivation to pursue treatment and seek prevention.
Therefore, students should have a reasonable understanding of what behaviors are appropriate for the prevention and control of COVID-19 disease (awareness and knowledge). These knowledge are beneficial for their attitude and practice[35] to promote their health and show a greater willingness to be vaccinated for improvement. According to Profile 1, an acceptable knowledge about COVID-19 changes attitudes, and moderate attitude and concern affect the practice and, consequently, the desire to receive the COVID-19 vaccine.
Limitation
The current study has several limitations, Frist, that knowledge and attitude in epidemic conditions are not stable and are changeable, although the study showed the knowledge and attitude for participations during the time of data collection was stable (Appendix 2). Second, the survey was conducted online, so respondents may not be representness of all medical sciences students. Third, study population for this study was medical sciences students, then the generalizability of these findings to other subgroups of population is with caution. Finally, that the study design was cross-sectional and the extracted profiles of KPAC was in single time. Some ambiguities, such as “Is there change between latent profiles across time? If so, how can this change be characterized?" need to be addressed in future research by longitudinal study design.