Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era (preprint)

The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses.

Increased job burnout and reduced job satisfaction for nurses compared to other healthcare workers after the COVID-19 pandemic (preprint)

Background Nurses experience high levels of job burnout and low levels of job satisfaction, while COVID-19 pandemic has deteriorated working conditions.Aim To compare levels of job burnout and job satisfaction among nurses and other healthcare workers after the COVID-19 pandemic. Moreover, we investigated the influence of demographic and job characteristics on job burnout and satisfaction.Methods We conducted a cross-sectional study with a convenience sample of 1760 healthcare workers. We collected data during June 2023. Our healthcare workers came from different clinical settings including hospitals, health centers, etc. We used the single item burnout measure to measure levels of burnout among our healthcare workers. Moreover, we used the “Job Satisfaction Survey” to measure levels of satisfaction in our sample.Results Nurses experienced moderate and high levels of burnout more often than other healthcare workers. In particular, 91.1% of nurses experienced high levels of burnout, while the respective percentage for the other healthcare workers was 79.9%. Nurses’ satisfaction was lower than other healthcare workers. In particular, 61.0% of nurses experienced low levels of satisfaction, while the respective percentage for the other healthcare workers was 38.8%. Multivariable analysis identified that nurses, healthcare workers with a MSc/PhD diploma, shift workers, and those who considered their workplace as understaffed had higher burnout score and lower satisfaction score. Moreover, we found that clinical experience was associated with increased burnout and decreased satisfaction.Conclusions Our results showed that nursing profession was an independent factor of job burnout and job satisfaction. Several other demographic and job characteristics affected burnout and satisfaction. Policy makers, organizations and managers should adopt appropriate interventions to improve work conditions.

The influence of job burnout on quiet quitting among nurses: the mediating effect of job satisfaction (preprint)

Introduction: Quiet quitting seems to be a new threat for healthcare workers and organizations. Individuals now tend to stay at their jobs covering only the bare requirements. High levels of burnout among nurses especially after the COVID-19 pandemic could further increase their levels of quiet quitting. Objective: To investigate the impact of nurses’ job burnout on their quiet quitting. Moreover, we assessed the mediating effect of job satisfaction on the relationship between burnout and quiet quitting. Methods: We conducted a cross-sectional study in Greece. We collected data during June 2023. A convenience sample of 946 nurses was obtained. We used the “Quiet Quitting” Scale (QQS) to measure levels of quiet quitting within nurses, the “Copenhagen Burnout Inventory” to measure job burnout, and “Job Satisfaction Survey” (JSS) to measure job satisfaction. In mediation analysis, we controlled for the effects of demographic and job characteristics. Results: Mean score on QQS was 2.36, while on JSS was 101.23. Also, mean scores on work-related burnout, personal burnout, and client-related burnout were 62.25, 64.53, and 64.45 respectively. Job burnout was a positive predictor of quiet quitting (beta = 0.009, 95% confidence interval = 0.007 to 0.012, p < 0.001), while job satisfaction was a negative predictor of quiet quitting (beta = -0.004, 95% confidence interval = -0.006 to -0.003, p < 0.001). Job satisfaction partially mediated the positive relationship between burnout and quiet quitting (indirect effect = 0.0035, 95% confidence interval = 0.0021 to 0.0051, p < 0.001). Conclusion: Job burnout affected quiet quitting within nurses through the mediating effect of job satisfaction. It is essential to reduce burnout and improve satisfaction to decrease level of quiet quitting among nurses. Effective measures should be taken to decrease nurses’ job burnout in order to improve their job satisfaction and thereby reduce their quiet quitting.

Nurses quietly quit their job more often than other healthcare workers: an alarming issue for healthcare services (preprint)

Background: Quiet-quitting phenomenon in not new but has been frequently discussed during the COVID-19 pandemic. Interestingly, the level of quiet quitting among healthcare workers (HCWs) has not been measured yet. Objective: To assess the level of quiet quitting among HCWs, and identify possible differences between nurses, physicians, and other HCWs. Moreover, we investigated the impact of socio-demographic variables, job burnout, and job satisfaction on quiet quitting levels. Methods: We conducted a cross-sectional study with a convenience sample of HCWs during June 2023. HCWs included nurses, physicians, dentists, pharmacists, midwives, psychologists, and physiotherapists that have been working in healthcare services. We measured socio-demographic characteristics of HCWs, job burnout with “Copenhagen Burnout Inventory”, job satisfaction with “Job Satisfaction Survey”, and quiet quitting with “Quiet Quitting” Scale. Results: Study population included 1760 HCWs with a mean age of 41.1 years. Among our sample, 57.9% were quiet quitters, while 42.1% were non quiet quitters. In particular, 67.4% of nurses were quiet quitters, while prevalence of quiet quitting for physicians and other HCWs were 53.8% and 40.3% respectively (p<0.001). Multivariable linear regression analysis identified that the levels of quiet quitting were higher among nurses than physicians and other HCWs. Moreover, greater job burnout contributed more to quiet quitting, while less satisfaction implied more quiet quitting. Shift HCWs, and those working in private sector experienced higher levels of quiet quitting. Additionally, we found a negative relationship between clinical experience and quiet quitting. Conclusions: More than half of our HCWs were described as quit quitters. Levels of quiet quitting were higher among nurses even when controlling for several confounders. Higher levels of job burnout and lower levels of job satisfaction were associated with higher levels of quiet quitting.

Prevalence and risk factors of adverse effects after the first COVID-19 booster dose: evidence from Greece (preprint)

Background: In general, COVID-19 vaccines are safe and effective, but minor adverse effects are common. Objective: To estimate the prevalence of adverse effects after the first COVID-19 booster dose, and to identify possible risk factors. Material and methods: We conducted a cross-sectional study with a convenience sample in Greece during November 2022. We measured several adverse effects after the booster dose, such as pain at the injection site, swelling at the injection site, fatigue, muscle pain, headaches, fever, chills, nausea, etc. We considered gender, age, chronic disease, self-assessment of health status, COVID-19 diagnosis, and self-assessment of COVID-19 course as possible predictors of adverse effects. Results: In our sample, 96% developed at least one adverse effect. Half of the participants (50.2%) developed one to five adverse effects, 35.9% developed six to ten adverse effects, and 9.5% developed 11 to 16 adverse effects. Mean number of adverse effects was 5.5. The most frequent adverse effects were pain at the injection site (84.3%), fatigue (70.8%), muscle pain (61%), swelling at the injection site (55.2%), headache (49.8%), fever (42.9%), and chills (41%). Females developed more adverse effects than males (p<0.001). Also, we found a positive relationship between severity of COVID-19 symptoms and adverse effects of COVID-19 vaccines (p=0.005). Moreover, younger age was associated with increased adverse effects (p<0.001). Conclusions: Almost all participants in our study developed minor adverse effects after the booster dose. Female gender, worse clinical course of COVID-19, and decreased age were associated with increased adverse effects.

Post-COVID-19 syndrome and related dysautonomia affect patients life and work productivity (preprint)

Background: A significant percentage of COVID-19 patients experience post-COVID-19 symptoms and signs. Post-COVID-19 syndrome affects physical and mental health of patients in several ways. Aim: To investigate the impact of post-COVID-19 syndrome and related dysautonomia on patients life and work productivity. Methods: We conducted a cross-sectional study in Greece using an online questionnaire. Study population included 108 workers over 18 years old that have been diagnosed with post-COVID-19 syndrome. Patients were recruited from the Long COVID Greece patients society. We measured demographic and clinical characteristics of patients, resilience, and social support. Results: Among patients, 68.5% stated that post-COVID-19 syndrome affected their daily life to a great extent, 25% to a moderate level, and 6.5% to a small extent. Moreover, 56.5% stated that post-COVID-19 syndrome affected their work productivity to a great extent, 27.8% to a moderate level, and 15.7% to a small extent. Multivariable analysis identified that females and patients with post-COVID-19 dysautonomia had more problems in their daily life. Moreover, increased duration of COVID-19 symptoms was associated with increased daily problems. Increased resilience was related with fewer problems in daily life. Also, we found that patients with post-COVID-19 dysautonomia had less work productivity. Moreover, increased duration of COVID-19 symptoms was associated with more problems in work. Resilience was related with increased work productivity. Conclusions: Post-COVID-19 syndrome and related dysautonomia affect significantly patients daily and work life. Also, resilience is an important preventive factor improving patients life. Policy makers should develop and implement educational programs to improve patients life. Healthcare professionals should be aware of the post-COVID-19 syndrome and its consequences in order to understand post-COVID-19 patients and their problems.

Post-COVID-19 syndrome and related dysautonomia reduce quality of life, and increase anxiety and depressive symptoms: evidence from Greece (preprint)

Background: Post-COVID-19 syndrome affects a significant number of SARS-CoV-2 infected individuals even asymptomatic cases causing several neurological and neuropsychiatric symptoms and signs. Materials and Methods: An online cross-sectional study with a convenience sample was conducted in Greece from November 2022 to January 2023. We measured demographic and clinical characteristics of patients, post-COVID-19 dysautonomia, quality of life with the EQ-5D-3L, and anxiety and depressive symptoms with the Patient Health Questionnaire-4. Results: Study population included 122 patients with post-COVID-19 syndrome. One out of four patients (27.8%) manifested post-COVID-19 dysautonomia, while mean duration of COVID-19 symptoms was 11.6 months. Anxiety and depressive symptoms were worse after the post-COVID-19 syndrome (p<0.001 in both cases). A statistically significant reduction in quality of life was observed among patients after the post-COVID-19 syndrome (p<0.001 for both EQ-5D-3L index value and EQ-5D-3L VAS). Post-COVID-19 dysautonomia increased depression symptoms after the post-COVID-19 syndrome (p=0.02). We found a negative relationship between duration of COVID-19 symptoms and quality of life (p<0.001). Moreover, our results showed that depressive symptoms were more often among females after the post-COVID-19 syndrome (p=0.01). Also, quality of life was lower among females than males (p=0.004 for EQ-5D-3L index value, and p=0.007 for EQ-5D-3L VAS). Conclusions: Our results suggest that post-COVID-19 syndrome causes a tremendous impact on patients quality of life and mental health. In addition, we found that the groups most psychologically affected were patients with post-COVID-19 dysautonomia, females, and patients with longer duration of symptoms. Policy makers should attach priority to vulnerable groups in future psychiatric planning. Policy measures should focus on mental health of post-COVID-19 patients who seem to be particularly vulnerable.

Resilience and social support improve mental health and quality of life in patients with post-COVID-19 syndrome (preprint)

The effects of post-COVID-19 syndrome on patients' life are significant. As there is no prior study available, we investigated the impact of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4, and the EuroQol-5D-3L. Multivariable analysis identified that resilience and social support reduced anxiety and depression among our patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. In conclusion, our findings suggest that resilience and social support can be protective by reducing anxiety and depression, and improving quality of life among patients with post-COVID-19 syndrome. Policy makers should develop and implement healthcare management programs to provide psychological support to these patients.

COVID-19-related burnout reduces COVID-19 vaccination intention in cardiac patients: a cross-sectional study in Greece (preprint)

Background: New SARS-CoV-2 variants have emerged and COVID-19 is still a public health issue, especially for vulnerable groups such as people with chronic medical conditions. Objective: To investigate the impact of COVID-19-related burnout on COVID-19 vaccination intention in cardiac patients. Moreover, we investigated other possible demographic and psychological predictors of vaccination intention in cardiac patients. Methods: We conducted a cross-sectional study in Greece using a convenience sample. Data collection was performed from 20 November 2022 to 10 January 2023. We measured demographic data, COVID-19-related burnout, anxiety, depression, social support, and resilience. We used the following valid tools: COVID-19 burnout scale, Patient Health Questionnaire-4, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. Results: Among patients, 45.8% were willing to accept a COVID-19 booster dose, 25.3% were hesitant, and 28.9% were unwilling. Patients experienced moderate levels of COVID-19-related burnout. After multivariable linear regression analysis, we found that increased age and decreased emotional exhaustion due to COVID-19 were associated with increased vaccination intention. Moreover, patients who have already received a booster dose had also a greater willingness to accept a new booster dose. Conclusions: Identification of factors that influence patients decision to accept a COVID-19 booster dose is crucial to maintain a high vaccination coverage rate among them in order to avoid COVID-19-related outcomes. Since a COVID-19 booster dose on an annual basis seems to be necessary policy makers should develop and implement vaccination programmes tailored for patients.

The COVID-19 burnout scale: Development and initial validation (preprint)

We developed and validated a self-assessment instrument to measure COVID-19 pandemic-related burnout in the general population. We assessed the psychometric properties of the COVID-19 burnout scale (COVID-19-BS). Exploratory and confirmatory factor analysis identified three factors for the COVID-19-BS; emotional exhaustion, physical exhaustion, and exhaustion due to measures against the COVID-19. Cronbach alpha coefficients for the three factors and the COVID-19-BS ranged from 0.860 to 0.921. Kaiser-Meyer-Olkin value was 0.945 and p-value for Bartlett test was <0.001 indicating highly acceptable values. Convergent validity results indicated a significant positive correlation between COVID-19-BS and anxiety and depression. Known-groups analysis identified the ability of COVID-19-BS to discriminate groups according to gender, chronic condition, and health status. Our findings indicate that the final 13-item model of COVID-19-BS is a brief, easy to administer, valid and reliable scale for assessing COVID-19-related burnout in the general public.

Attitudes toward COVID-19 pandemic among fully vaccinated individuals: evidence from Greece two years after the pandemic (preprint)

Background: Considering the major effects of COVID-19 pandemic on health, social, economic, and political dimensions of all countries, positive attitudes toward COVID-19 pandemic are essential to control the pandemic. In our study, we investigated attitudes toward COVID-19 pandemic among fully COVID-19 vaccinated individuals two years after the pandemic and we identified predictors of attitudes. Materials and Methods: We conducted an on-line cross-sectional study with 815 fully COVID-19 vaccinated individuals in Greece during May 2022. A self-administered and valid questionnaire was disseminated through social media platforms. We measured socio-demographic variables and COVID-19-related variables as potential predictors of attitudes toward COVID-19 pandemic. The outcome variable was attitudes toward COVID-19 pandemic (compliance with hygiene measures, trust in COVID-19 vaccination, fear of COVID-19, and information regarding the COVID-19 pandemic and vaccination). Results: We found a very high level of compliance with hygiene measures, a high level of trust and information about the COVID-19 pandemic and vaccination, and a moderate level of fear of COVID-19. Also, we identified that females, participants with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis adhered more in hygiene measures. Trust in COVID-19 vaccination was higher among females, older participants, those with a higher educational level, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis. Moreover, females, older participants, those with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, those that received a flu vaccine in previous season, and those without a previous COVID-19 diagnosis experienced more fear of the COVID-19. Finally, level of information regarding COVID-19 pandemic and vaccination was higher for participants with a higher educational level, those without a chronic disease, those with a better self-perceived physical health, and those that received a flu vaccine in previous season. Conclusions: Understanding predictors of attitudes toward COVID-19 pandemic among fully vaccinated individuals is crucial for developing appropriate public health campaigns in the future. Vaccination should be accompanied by positive attitudes in order to decrease the frequency of negative outcomes of COVID-19, such as hospitalization, complications and mortality.

Predictors of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses: a cross-sectional study (preprint)

Aims and objectives: To assess the levels of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses and explore the potential predictors of vaccine hesitancy. Background: COVID-19 full vaccination seems to be highly effective against highly contagious variants of SARS-CoV-2. Healthcare workers are a high-risk group since they have experienced high levels of COVID-19-associated morbidity and mortality. Methods: An on-line cross-sectional study was carried out in Greece in May 2022, using a self-administered questionnaire. The study population included nurses in healthcare services who were fully vaccinated against COVID-19 at the time of study. We considered socio-demographic characteristics, COVID-19-related variables, and attitudes toward COVID-19 vaccination and pandemic as potential predictors of vaccine hesitancy. Results: Among 795 nurses, 30.9% were hesitant toward a second booster dose or a new COVID-19 vaccine. Independent predictors of hesitancy included lower educational level, absence of a chronic condition, good/very good self-perceived physical health, lack of flu vaccination during 2021, front-line nurses that provided healthcare to COVID-19 patients during the pandemic, nurses that had not been diagnosed with COVID-19 during the pandemic, and nurses that had at least one relative/friend that has died from COVID-19. Moreover, increased compliance with hygiene measures, increased fear of a second booster dose/new COVID-19 vaccine, and decreased trust in COVID-19 vaccination were associated with increased hesitancy. Conclusions: Our study shows that a significant percentage of nurses are hesitant toward a second booster dose/new COVID-19 vaccine. This initial hesitancy could be a barrier to efforts to control the COVID-19 pandemic. There is a need to communicate COVID-19 vaccine science in a way that is accessible to nurses in order to decrease COVID-19 vaccine hesitancy.

Predictors of Willingness of the General Public to Receive a Second COVID-19 Booster Dose or a New COVID-19 Vaccine: A Cross-Sectional Study in Greece (preprint)

Given the concerns of waning immunity from the primary COVID-19 vaccines and the first booster dose, we conducted an on-line cross-sectional study in May 2022 to investigate willingness to receive a second COVID-19 booster dose or a new COVID-19 vaccine and its associated factors. Overall, 22.7% of participants were willing to be vaccinated, 39.3% were unsure, but tend to be willing, 25.8% were unsure, 4.9% were unsure, but tend to be unwilling, and 7.4% were unwilling to be vaccinated. The main reasons against accepting a second COVID‐19 booster dose or a new COVID-19 vaccine COVID-19 dose included concerns about the side effects, the opinion that further vaccination is unnecessary, and effectiveness uncertainties. Males, younger individuals, participants without a previous COVID-19 diagnosis, and those with good/very good self-perceived physical health were significantly more frequently willing to receive a second COVID‐19 booster dose or a new COVID-19 vaccine. Also, increased fear of the COVID-19, increased trust in COVID-19 vaccination and decreased fear of a second booster dose or a new COVID-19 vaccine were associated with increased willingness. Our results show some hesitancy and unwillingness toward further COVID-19 vaccination and indicate that fear of COVID-19 and trust in COVID-19 vaccination affect public opinion

Psychosocial predictors of COVID-19 vaccine uptake among pregnant women: a cross-sectional study in Greece (preprint)

Background: Unvaccinated pregnant women with symptomatic COVID-19 have been found to have a higher risk of iatrogenic preterm births, intensive care unit admission, and invasive ventilation. Objective: To estimate the vaccination rate of pregnant women against the COVID-19 and to evaluate psychosocial factors associated with vaccine uptake among them. Methods: We conducted an anonymous cross-sectional study with a convenience sample in Greece from December 2021 to March 2022. We measured socio-demographic data of pregnant women, COVID-19-related vaccination status, worry about the side effects of COVID-19 vaccines, trust in COVID-19 vaccines, and COVID-19-related stress. Results: The study population included 812 pregnant women with a mean age of 31.6 years. Among the pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with COVID-19 vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated against the COVID-19. Conclusions: An understanding of the psychosocial factors associated with COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against the COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce COVID-19 vaccine hesitancy in pregnancy.

Uptake of COVID-19 vaccines among pregnant women: a systematic review and meta-analysis (preprint)

Background Mass vaccination against the COVID-19 is essential to control the pandemic. COVID-19 vaccines are recommended now during pregnancy to prevent adverse outcomes. Objective To evaluate the evidence from the literature regarding the uptake of COVID-19 vaccination among pregnant women. Methods We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched PubMed, Medline, Scopus, ProQuest, Web of Science, CINAHL, and a pre-print service (medRxiv) from inception to March 23, 2022. We included quantitative studies reporting COVID-19 vaccination uptake among pregnant women, studies that examine predictors of COVID-19 vaccination uptake and studies that examine reasons for decline of vaccination. We performed meta-analysis to estimate the overall proportion of vaccinated pregnant women against the COVID-19. Results We found 11 studies including 703,004 pregnant women. The overall proportion of vaccinated pregnant women against the COVID-19 was 27.5% (95% CI: 18.8-37.0%). The pooled proportion for studies that were conducted in Israel was higher than the proportion for studies that were conducted in USA and other countries. Predictors of COVID-19 vaccination uptake were older age, ethnicity, race, trust in COVID-19 vaccines, and fear of COVID-19 during pregnancy. On the other hand, mistrust in the government, diagnosis with COVID-19 during pregnancy, and worry about the safety and the side effects of the COVID-19 vaccines were reasons for decline of vaccination. Conclusions The global COVID-19 vaccination prevalence in pregnant women is low. There is a large gap in the literature on the factors influencing the decision of pregnant women to be vaccinated against the COVID-19. Targeted information campaigns are essential to improve trust and build vaccine literacy among pregnant women. Given the ongoing high case rates and the known increased risks of COVID-19 in pregnant women, our findings could help policy makers to improve the acceptance rate of COVID-19 vaccines in pregnant women especially in vulnerable subgroups.

Cross-cultural adaptation and validation of the COVID Stress Scales in Greek (preprint)

Background: During the COVID-19 pandemic, several instruments were developed to measure the psychological impact of COVID-19, such as fear, anxiety, post-traumatic stress, phobia, etc. Objective: To adapt cross-cultural and validate the COVID Stress Scales in Greek. Methods: We conducted a cross-sectional study with 200 participants between November 2021 to February 2022. All participants were adults, and a convenience sample was obtained. We applied the forward-backward translation method to create a Greek version of the COVID Stress Scales. We assessed the reliability of the questionnaire with the test-retest method in a 10-day window, and we assessed the validity of the questionnaire with exploratory factor analysis. Results: Our five-factor model explained 72% of the variance and totally confirmed the factors of the initial COVID Stress Scales. In particular, we found the following five factors: (a) COVID-19 danger and contamination (eleven items), (b) COVID-19 socioeconomic consequences (six items), (c) COVID-19 xenophobia (six items), (d) COVID-19 traumatic stress (six items), and (e) COVID-19 compulsive checking (six items). Cronbach coefficients alpha for the five factors that emerged from the exploratory factor analysis were greater than 0.89 indicating excellent internal reliability. Conclusions: We found that the COVID Stress Scales is a reliable and valid tool to measure stress due to the COVID-19 in the Greek population.

Development and validation of a questionnaire to measure attitudes toward COVID-19 vaccination and pandemic (preprint)

Background Accurate measurement of individuals’ attitudes toward COVID-19 vaccination and pandemic is critical to understand the way that people respond during a major crisis such as the COVID-19 pandemic. Objective To develop and validate a questionnaire to assess attitudes toward COVID-19 vaccination and pandemic. Methods We performed a reliability and validity study in a sample of the general population in Greece. Data were collected online through social media between 15 August and 7 September 2021. Thus, a convenience sample was obtained. Reliability and validity of the questionnaire were assessed with a Delphi study, an exploratory factor analysis, and a test-retest study. Also, we calculated Cronbach’s coefficient alpha for the factors that emerged from the exploratory factor analysis. Results The final study included 1959 adults from the general population in Greece. Our four-factor model explained 73% of the variance and confirmed out initial hypothesis regarding the factors of the questionnaire. In particular, we found the following four factors: (a) fear against the COVID-19 (five items), (b) information regarding the COVID-19 (two items), (c) compliance with hygiene measures (two items), and (d) trust in COVID-19 vaccination (seven items). Cronbach’s coefficients alpha for the four factors that emerged from the exploratory factor analysis were greater than 0.82. Pearson’s correlation coefficients for the 16 items and the four factors were greater than 0.67 (p-value<0.001 in all cases). Conclusions We developed a reliable and valid questionnaire to measure attitudes toward COVID-19 vaccination and pandemic. Further studies should be conducted to expand our knowledge and infer more valid results.

Predictors of parents’ intention to vaccinate their children against the COVID-19 in Greece: a cross-sectional study (preprint)

Background Parents’ intention to vaccinate their children against the COVID-19 is envisaged as critical strategy to control the pandemic. Objective To investigate the intention of parents to vaccinate their children against the COVID-19 and the factors influencing this intention. Methods We conducted an online cross-sectional study in Greece and we collected data during the first week of September 2021. A convenience sample was used by collecting questionnaires through social media. Our study population included adult parents with children aged 12-17 years who were eligible for a COVID-19 vaccine. Results Study population included 813 parents with a mean age of 42.3 years. Among parents, 36% reported that they will vaccinate their children against the COVID-19, 33.5% denied vaccination and 30.5% were undecided. Concerns about the safety, effectiveness and side effects of COVID-19 vaccines were the most important reasons for decline of COVID-19 vaccination. Parents who took the flu vaccine in 2020 and those who had more knowledge and fewer concerns about COVID-19 vaccines had a greater probability to vaccinate their children against the COVID-19. Increased self-perceived severity of COVID-19, and increased trust in COVID-19 vaccines and the government regarding the information about the COVID-19 vaccines were associated with parents’ intention to vaccinate their children. However, increased knowledge regarding COVID-19 was associated with decreased intention of parents to vaccinate their children. Conclusions Parents’ intention to vaccinate their children against the COVID-19 was low. Our findings could contribute to the development of target strategies to implement adherence to COVID-19 vaccination campaigns.

Cross-sectional assessment of predictors for COVID-19 vaccine uptake: an online survey in Greece (preprint)

BackgroundA high level of COVID-19 vaccine uptake in the general population is essential to control the pandemic. ObjectiveTo estimate the percentage of the general population vaccinated against the COVID-19 and to investigate the factors associated with COVID-19 vaccine uptake. MethodsWe conducted an online cross-sectional study in Greece during August 2021. We included individuals over 18 years of age. Independent variables included socio-demographic data of the participants and attitudes towards COVID-19 vaccination and pandemic. Our outcome variable was COVID-19 vaccination status, measured through "yes/no" answers. ResultsMost participants had been vaccinated against the COVID-19 (87.8%), while about half had been vaccinated against the influenza (52.5%). Multivariate analysis identified that increased age and higher level of education were associated with an increased likelihood of COVID-19 vaccination. Also, participants working in health services, participants without a previous COVID-19 diagnosis and those with previous seasonal influenza vaccination history had a greater probability to take a COVID-19 vaccine. Additionally, increased self-perceived severity of COVID-19, knowledge regarding COVID-19, and trust in COVID-19 vaccines and scientists were associated with COVID-19 vaccine uptake. On the other hand, the likelihood of vaccination was lower for participants who were more concerned about the side effects of COVID-19 vaccination. ConclusionsUnderstanding the factors affecting individuals decision to take a COVID-19 vaccine is essential to improve the COVID-19 vaccination coverage rate. Policymakers and scientists should scale up their efforts to increase the COVID-19 vaccination rate among specific population groups such as young people, people with low level of education, people with negative attitudes towards vaccination, etc.

Predictors of COVID-19 vaccine uptake in healthcare workers: a cross-sectional study in Greece (preprint)

BackgroundThe role of healthcare workers (HCWs) in the general public health is crucial and their decision to vaccinate against the COVID-19 can have a positive impact on the general population facilitating widespread COVID-19 vaccine uptake. ObjectiveTo estimate the uptake of a COVID-19 vaccine in HCWs and to expand our knowledge regarding the predictors of COVID-19 vaccine uptake. MethodsAn on-line cross-sectional study was conducted in Greece during August 2021. We collected socio-demographic data of HCWs and we measured attitudes towards vaccination and COVID-19, knowledge and trust. We used a convenience sample since we distributed the questionnaire through social media and e-mails. ResultsStudy population included 855 HCWs. The majority of HCWs were vaccinated against the COVID-19 (91.5%). According to multivariate analysis, females, HCWs without a previous COVID-19 diagnosis, and HCWs with previous seasonal influenza vaccination history had a greater probability to take a COVID-19 vaccine. Also, increased self-perceived knowledge regarding COVID-19 and increased trust in COVID-19 vaccines and government regarding the information about the COVID-19 vaccines were associated with COVID-19 vaccine uptake. On the other hand, HCWs with more concerns about the side-effects of COVID-19 vaccination were more reluctant to take a COVID-19 vaccine. ConclusionsOur study provides a timely assessment of COVID-19 vaccination status among HCWs and identifies specific factors associated with COVID-19 vaccine uptake. By understanding these factors, policy makers and scientists will be able to develop novel strategies to improve COVID-19 vaccine uptake among HCWs.