Assessing knowledge, attitude, practices and vaccine hesitancy in nurses: a pilot study

BACKGROUND: The use of a validated and reliable tool to assess knowledge, attitude, practices (KAP) and vaccine hesitancy (VH) in nurses is critical to developing tailored public health strategies to implement adherence to recommended vaccines for healthcare workers (HCWs) and reduce the chance of spreading vaccine-preventable diseases. The aim of this study is to develop and validate a tool to assess nurses’ vaccine hesitancy and KAP regarding recommended vaccines for HCWs. METHODS: Following a systematic review of the literature (PROSPERO ID:CRD42020212252), a new tool was built to assess vaccine hesitancy using the framework of the WHO Strategic Expert Advisory Group on Immunization. The pilot study collected responses from a random sample of nurses and nursing students. The content validity (including face-validity) was evaluated with a panel of experts. Internal reliability was tested using Cronbach's alpha (α). RESULTS: The final questionnaire consisted of three sections and forty items. A total of 124 individuals, 40 nurses and 84 nursing students were enrolled. Regarding KAP: only ten nurses (26.3%) reported adequate knowledge of recommended vaccines for HCWs, while no students reported knowing the vaccines included in the recommendations. 40% of nurses and 63% of nursing students discuss safety and efficacy of vaccinations during clinical practice. Twelve (32%) nurses and 42 (50%) students reported VH for at least one of the recommended vaccines for HCWs, with particular regard to flu vaccination and COVID-19 vaccine for which, despite being vaccinated, half of nurses and students reported concerns mainly about efficacy and safety. The reliability of vaccine hesitancy scales in nurses (α = 0.82) and nursing students (α = 0.85) could be considered good. CONCLUSIONS: Following the validation of this tool, a multicenter cross-sectional study will be conducted involving three universities (Sapienza, Bicocca, Turin) on a national sample of nurses and nursing students. KEY MESSAGES: • Systematically measuring vaccine hesitancy in at-risk populations with a nationally validated tool enables implementation of targeted public health strategies. • Identifying nurses’ knowledge, attitudes, and practices regarding vaccination and vaccine hesitancy enables organizations to adequately address the training needs of their health workers.