The American Anti-Vaxxer COVID Dead: A Dynamic Chronicle of Failed Sacrifices

Unlike earlier pandemics, where a "politics of blame" was directed against those who spread infection, the COVID pandemic in the United States has created occasions for the deployment of a "politics of commendation" for performing acts of sacrifice. Frontline healthcare workers have been celebrated for sacrificing themselves in service to their patients, even as critics have charged their being hapless victims of "social murder" at the hands of irresponsible medical administrators. Governmental officials, notably in Texas, have also recommended the elderly to refuse COVID care, die and thus sacrifice themselves selflessly for the benefit of the younger generation. Lately, COVID vaccine-refusal has been seen as an act of noble political sacrifice-typically to further individual liberty against the coercive power of the Federal government's promotion or mandating of vaccination. Anti-vaxxers embracing the role of such political sacrifices, however, generally fail to realize this aspiration, insofar they are often just culpable of their own demise by neglecting public health advisories. Furthermore, the partisan politicization of their deaths militates against the normal recognition of their being sacrifices. Party political calculations have frequently demanded denial of the COVID origins of the anti-vaxxer deaths, and also effectively eliminated any normal attendant rites of reciprocation, memorialization or sacralization of the victims, typical of sacrifices, proper.

Vaccine hesitancy in the Gulf Cooperation Council countries.

Background: Vaccination has a tremendous impact on health at the regional and global levels, however, the tendency for people to hesitate on vaccination has been increasing in the past few decades. Aims: We assessed vaccine hesitancy and its determinants in the Gulf Cooperation Council countries. Methods: We conducted a literature review to assess peer-reviewed articles published up to March 2021 on vaccine hesitancy in the Gulf Cooperation Council countries using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A search was conducted via PubMed and 29 articles were identified. After the removal of duplicates and irrelevant articles, 14 studies remained relevant and were used for the review. Results: Vaccine hesitancy in the Gulf Cooperation Council countries ranged from 11% to 71%. Differences in rates were noted for vaccine type, with COVID-19 vaccine having the highest reported hesitancy (70.6%). The likelihood of accepting vaccination was associated with previous individual acceptance of vaccine, specifically the seasonal influenza vaccine. The most common determinants of vaccine hesitancy were distrust in vaccine safety and concerns about side-effects. Healthcare workers were among the main sources of information and recommendations about vaccination, but 17-68% of them were vaccine-hesitant. The majority of the healthcare workers had never received any training on addressing vaccine hesitancy among patients. Conclusions: Vaccine hesitancy is prevalent among the publics and healthcare workers in the Gulf Cooperation Council countries. There is a need to continually monitor perceptions and knowledge about vaccines and vaccination in these countries to better inform interventions to improve vaccine uptake in the sub-region.

Perceptions of vaccine trust and conspiracy among those with COVID-19 vaccine hesitancy and resistance: a cross-sectional study.

BACKGROUND: Individuals' beliefs in conspiracy theories and anti-vaccination defense play a role in the rates of COVID-19 spread. PURPOSE: This study aims to determine the perception of trust in, and the perception of conspiracy theories regarding vaccines among those with COVID-19 vaccine hesitancy and resistance in a province in Turkey. METHODS: This study was conducted with 1244 individuals who agreed to participate in the study in the province with the lowest vaccination rate in Turkey. The 'Personal Information Form' and the 'COVID-19 Vaccine Perception and Attitude Scale' were used to collect data. FINDINGS: Those who were resistant to vaccines had a low mean score on the Perception of Trust and a high mean score on the Perception of Conspiracy. The variable of conspiracy perception had a significantly negative and high effect on the perception of trust. CONCLUSION: The participants were highly resistant to COVID-19 vaccines. Their perception level of trust in COVID-19 vaccines was moderate and their perception level of conspiracy was high.

Vaccine refusal risk factors among parents of children with autism spectrum disorders.

BACKGROUND: Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population. METHODS: We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the `baseline` behavior, while the following sibling`s uptake was suggested as the `current` behavior. The risk factors of VR were determined with logistic regression analysis. RESULTS: The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of `baseline VR` was 12.7 % whereas the `current VR` was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR. CONCLUSIONS: The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population.

Refusing the covid-19 vaccine: What's wrong with that?

ABSTRACT COVID-19 vaccine refusal seems like a paradigm case of irrationality. Vaccines are supposed to be the best way to get us out of the COVID-19 pandemic. And yet many people believe that they should not be vaccinated even though they are dissatisfied with the current situation. In this paper, we analyze COVID-19 vaccine refusal with the tools of contemporary philosophical theories of responsibility and rationality. The main outcome of this analysis is that many vaccine-refusers are responsible for the belief that they should not be vaccinated and epistemically rational in holding it. This is an important result because it provides insights into the legitimacy of certain public health policies. In particular, this result shows that a public health policy that would abandon the project of convincing certain vaccine-refusers with reasons - e.g., by simply making vaccination compulsory - is prima facie illegitimate. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19 Vaccination Refusal-Which Factors are Related in the Czech Republic, One of the Most Affected Countries in the World?

Objective: This study examined the willingness to get vaccinated and the factors influencing this attitude in extreme settings-in the Czech Republic (at the time of the survey, the third-worst affected country in the world). Methods: We used national data from the general adult Czech population (N = 1,401) and measured attitudes towards vaccination, sociodemographic characteristics, government trust, knowledge about COVID-19 vaccines, personal characteristics, depression and anxiety. Results: Respondents who were more likely to refuse the vaccine were: female, younger, living without a partner, self-employed or unemployed, living in a town, believers outside the church, and did not trust the government, obtained information about the vaccine from social media, were extroverts and depressed. Conversely, respondents who were less likely to refuse the vaccine were: pensioners, people with higher education, respondents with better real knowledge about the COVID-19 vaccines, those who obtained information about the vaccine from an expert and those who had higher scores in neuroticism. Conclusion: This study thus offers a deeper understanding of the factors that might influence vaccine intention and subsequently the course of the COVID-19 pandemic.

Why do Chinese older adults in Hong Kong delay or refuse COVID-19 vaccination? A qualitative study based on Grounded Theory.

OBJECTIVES: Older adults have been disproportionately affected by the COVID-19 pandemic. While COVID-19 vaccines are effective for reducing mortality and severe complications, vaccine hesitancy remains a substantial concern particularly among older adults. This was a qualitative study to explore how Chinese older adults reached a decision to delay or refuse the COVID-19 vaccines in Hong Kong. METHODS: Semi-structured in-depth interviews were conducted with 27 older adults aged ≥60 years who had never received COVID-19 vaccines. Grounded Theory approach guided the selection of informants, data collection, data analysis and report writing. RESULTS: Older adults' vaccine hesitancy and resistance weaved into the context of lacking sufficient decisional support and attitude roots of negative perception of ageing, fatalistic risk attitudes, present-oriented time perspectives, and negative values on western biomedicine. Attitude roots were used as decisional anchors to further shape older adults' peripheral processing of vaccine-related information, resulting into a spectrum of vaccine-resistant and vaccine-hesitant attitudes. While participants refused or delayed COVID-19 vaccination, they engaged in alternative coping strategies to regain self-control and justify their vaccination disengagement in the pandemic. DISCUSSIONS: Interventions to address vaccine hesitancy in older adults should focus on addressing attitude roots and strengthening the connectivity of older adults with family, doctors, and government to engage older adults in the vaccination decision making. Risk communication should shift to provide more personal relevant information in a caring style, meet older adults' preference for peripheral information processing, and address their existing misperceptions about COVID-19 vaccines.

Motherhood and vaccine refusal in the United Kingdom: A new examination of gender, identity and the journey to contemporary non-vaccination.

INTRODUCTION: Contemporary research into non-vaccination has highlighted some of the attitudes, beliefs and characteristics of non-vaccinating parents with recent research also beginning to examine the journey to non-vaccination. However, the interaction between gender, identity and non-vaccination is less well understood, as well as the non-vaccination journey for parents in the United Kingdom. METHODS: Using purposive sampling, we recruited mothers who have rejected some or all of their child's routine vaccinations in the last 5-10 years. Semi- structured interviews were conducted by phone in late 2020 and analysed using thematic analysis. RESULTS: Ten mothers were interviewed. They differed in socio-economic, educational and cultural backgrounds, yet all wanted the same thing: to have happy and healthy children, a goal which they saw as their responsibility and within their control and did not include vaccination. Within this shared parenting priority, identities varied considerably. Most mothers strongly rejected the label or identity of 'anti-vaxxer', preferring alternative terms with less negative social connotations. The decision not to vaccinate was predominantly made by mothers, describing a dynamic where mothers (rather than fathers/partners) were clearly responsible for their children's health, but this largely appeared to be internalized as the mother's role. CONCLUSIONS: The heterogeneity of mother's identities within the non-vaccination movement and the pressures on mothers to raise children with 'optimum health' explored in this study suggest that non-vaccination is a largely individual choice that requires nuanced and compassionate engagement to understand the root causes behind this decision.

Novel COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students: a scoping review.

Medical students are likely to be exposed to COVID-19 patients so achieving high vaccination coverage rates for this group of healthcare workers is important, as is their potential as vaccination role models. The aim of this scoping review was to evaluate the current literature to determine the rates of COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students. Systematic searches of the Medline Ovid, Embase, PubMed, and Education Resources Information Centre (ERIC) online databases was conducted for relevant articles with keywords: 'COVID-19', 'vaccine hesitancy & acceptance' and 'medical students'. Articles were included for review if they reported the rates of vaccine hesitancy and acceptance, and associated factors, amongst medical students. Of the 258 articles identified, 52 met the inclusion criteria and underwent full-text review. Rates of vaccine hesitancy ranged from 5.4-86.7%, with generally positive attitudes towards COVID-19 vaccination. The main factors associated with vaccine hesitancy were concerns about the safety and efficacy of vaccines due to their accelerated development, being a pre-clinical medical student, and low perceived personal risk of COVID-19 infection. Inconsistencies were found for the influence of gender on attitudes towards vaccinations. Previous vaccination behaviours were predictive of willingness to receive the COVID-19 vaccine. Knowledge about COVID-19 vaccinations and their importance was found to be deficient amongst vaccine hesitant medical students. Generally, medical students express low levels of vaccine hesitancy. However, due to the variability in the factors associated with vaccine hesitancy across different populations and the dynamic and contextual nature of hesitancy, it is recommended that vaccination intent and associated attitudes are monitored on a longitudinal basis. It is important to map vaccine hesitancy at a local level to allow medical schools to develop strategies to encourage vaccination specific to their school's needs.

Vaccination coverage in children in the period before and during the COVID-19 pandemic in Brazil: a time series analysis and literature review.

OBJECTIVE: To evaluate the behavior of VCR and VCH, per municipality and per vaccines offered at the NVC, to identify priority areas for intervention. METHODS: Descriptive study of a time series, using secondary data and accompanied by a narrative review of the literature evaluating VCR and VCH. Vaccines offered to children under one year and to those aged one year in the pre-pandemic period of COVID-19 (2015 to 2019) were selected and compared to those offered during the pandemic period (2020 and 2021). RESULTS AND DISCUSSIONS: The decrease in VCR and VCH is a process that precedes the COVID-19 pandemic but was intensified during this period. In 2021, the VCR was around 70% for most vaccines. This phenomenon encompasses the entire country; however, it is more intense in the states/municipalities located in the north and northeast regions, suggesting greater difficulty in accessing health services. CONCLUSIONS: Low and heterogeneous VCR requires the adoption of practices that were previously implemented, establishing partnerships with governmental and non-governmental institutions, with adequate communication, active search for non-compliance and non-adherence to the regular vaccination program, adopting intra- and extramural vaccination strategies, to reverse the current situation and reduce the risk of recurrence of diseases that have been already controlled and eliminated.

Near-Complete SARS-CoV-2 Seroprevalence among Rural and Urban Kenyans despite Significant Vaccine Hesitancy and Refusal.

Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6−91.2%), including 96.7% (95% CI, 95.2−97.9%) among urban and 83.6% (95% CI, 80.6−86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to <20% of the urban population, suggesting more recent infections or vaccinations in the rural population. More than 45% of the vaccine-eligible (≥18 years old) persons had not taken a single dose of the vaccine (hesitancy), including 47.6% and 46.9% of urban and rural participants, respectively. Vaccine refusal was reported in 19.6% of urban and 15.6% of rural participants, attributed to concern about vaccine safety (>75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants.

COVID-19 vaccination refusal and suspension of work among healthy healthcare personnel in Italy: A cross-sectional study of their knowledge and attitudes toward vaccinations.

Despite the initial optimistic projections from various countries and the evidence that vaccination against coronavirus disease 2019 (COVID-19) reduces the associated hospitalization rates and mortality, vaccine hesitancy and refusal among healthcare personnel (HCP) became a major public health concern globally. The aim of this survey was to estimate the knowledge about the Italian Vaccination Plan for HCP and attitudes about occupational vaccinations for HCP among Italian HCP who refused COVID-19 vaccination and were suspended from work. A total of 52 HCP participated in the study. Nurses were the prevalent profession among vaccination refusers. About COVID-19, 24 (26.2%) of all responders have been involved in COVID-19 care and 21 (40.4%) had a history of COVID-19. None had received influenza and pneumococcus vaccination in the past. Knowledge of vaccinations recommended for HCP was high, ranging from 75% to 98% by vaccine. Instead, all HCP were against any mandatory vaccination policy for all HCP. Finally, most HCP questioned the expected benefits and safety of vaccines in general, raised issues of mistrust of information provided for authorities and of compliance with their HCP' vaccination recommendations. Our study indicates good knowledge of occupational vaccinations but strong anti-vaccination beliefs among Italian HCP who refused COVID-19 vaccination and were suspended from work.

Exploring the ethical complexity of pediatric organ transplant candidates and COVID-19 vaccination: Tensions between autonomy and beneficence, children and parents.

BACKGROUND: POT is emotionally sensitive due to cohort vulnerability, their lack of decisional capacity, and waitlist mortality. The COVID-19 pandemic has added complexity to the setting of pediatric transplantation, as well as living donation, due to tensions about COVID-19 vaccination for recipients, donors, and parent-caregivers. METHODS: In the context of COVID-19 vaccination, two ethicists present four pediatric donation and transplant dilemmas for ethical exploration and offer guidance to clinical teams, noting that mandates are controversial, and there is no global harmonization regarding requirements. RESULTS: As with all vaccinations, they are a tool of organ stewardship aimed to optimize outcomes and, in the setting of pediatrics, ensure optimal caregiving for these vulnerable recipients. Current evidence supports the ethical permissibility of COVID-19 vaccination mandates for transplant candidates aged 6 months and older. CONCLUSION: Our guidance considers the tensions of autonomy and beneficence and the ethical duty of organ stewardship. The harms of being unvaccinated and risking the harms of COVID-19 and long-COVID post-transplant support the ethical permissibility of vaccination mandates in countries where the vaccine has pediatric regulatory approval.

COVID-19 vaccine refusal associated with health literacy: findings from a population-based survey in Korea.

BACKGROUND: Poor health literacy is associated with lower utilization of preventable services. However, the relationship between health literacy and COVID-19 vaccine hesitancy remains controvertible. METHODS: This study used data from 229,242 individuals who completed the Community Health Survey in Korea from August 16 to October 31 in 2021. To operationalize COVID-19 vaccine hesitancy, we measured vaccine refusal, which is defined as not having been vaccinated and not intending to get vaccinated against COVID-19. Health literacy is operationalized in two dimensions; the ability to understand spoken directions from health professionals and the ability to understand written information regarding health. Covariates include sex, age, educational level, marital status, employment status, basic living security pension status, and subjective health status. Two multivariable logistic regression models were run to determine factors associated with COVID-19 vaccine refusal. Model 1 included sociodemographic characteristics and subjective health status. Model 2 added two health literacy variables. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Only 3.9% of the Korean adult population were estimated to refuse COVID-19 vaccine. The most commonly cited reasons for COVID-19 vaccine refusal were concerns about vaccine adverse events (47.6%), followed by the assessment of one's own health status (29.5%). Individuals who found spoken directions very difficult to understand were more likely to refuse COVID-19 vaccine than those who found spoken directions very easy (OR = 1.55, 95% CI: 1.28-1.87, p < 0.001). People who did not pay attention to written information were more likely to refuse COVID-19 vaccine than those who reported it to be very easy to understand (OR = 1.28, 95% CI: 1.13-1.45, p < 0.001). People in all other categories of the literacy spectrum for either spoken or written information did not have an increased risk of COVID-19 vaccine refusal. CONCLUSION: Health literacy was significantly associated with COVID-19 vaccine refusal. Health literacy programs could be beneficial to reduce vaccine refusal, particularly for the people who find spoken directions from health professionals very difficult to understand and those who do not pay attention to written information.

Hesitancy and acceptance of COVID-19 vaccines among Iraqi medical students: A cross-sectional study

Background: Vaccine development against coronavirus disease 2019 (COVID-19) is vital for pandemic containment. Reluctance or fear of taking the vaccine is a significant impediment to achieving full population immunity coverage. Medical students' knowledge and education about vaccination are essential, as they will serve as healthcare providers. Objective(s): This study aimed to verify the major factors and barriers affecting vaccine acceptance. Material(s) and Method(s): A cross-sectional study was carried out in four of the main medical universities in the middle of Iraq. The survey was achieved via an online questionnaire in December 2021 from 638 medical students. Result(s): Out of 4500 medical students, there were 638 participant respondents to the survey with a response rate of 14.2%. The main factor affecting vaccine acceptance is the probability of getting infected. The vaccination rate was significantly higher in those vulnerable to infections (pvalue = 0.03). Most students (50.3%) believe that the vaccine was safe, and the vaccination rate was statistically significant in those groups (p-value = 0.0001). About 46.2% of the students believe that the vaccine is effective against the infection of COVID-19 (p-value = 0.0001), 44.8% of students were sure that the vaccine did not have major complications (p-value = 0.00001), and 41% (n = 262) of participants thought that the immunity acquired after SARS-CoV-2 infection is better than the immunity acquired by vaccination (p-value = 0.00001). Conclusion(s): Vaccine efficacy and beliefs in immunity following COVID-19 were the most influential factors in vaccine intake. The concept of vaccination is widely accepted among medical students, and there is raised awareness about how important to get vaccinated.

A County-Level COVID-19 Response

Accurate COVID-19 information has seemed contradictory and inconvenient to find since the beginning of the pandemic in March of 2020. There are many sources that could be blamed for this, including the newspapers, Facebook, or the government itself at federal or even county levels. But where does the average user stand in their ability to access and understand accurate, relevant information relating to COVID-19? We explored twelve county websites picked from six states across the country—Washington, New York, Nevada, Kansas, Louisiana, and Ohio—to see how effective and accessible information at the county-level response differs between Democrat and Republican-leaning states, when those counties acted, and how the information compares regarding lockdowns, vaccines, and quality-of-life documents (such as unemployment forms and aid) during the pandemic. For a birds-eye view of this government information problem, we have chosen to highlight five of these sites to provide a brief look at our findings, which includes observations on population size, political leanings, and information availability and accessibility. [ FROM AUTHOR]

Hesitancy or Resistance? Differential Changes in COVID-19 Vaccination Intention Between Black and White Americans.

The literature on COVID-19 vaccination has rarely taken a macro and longitudinal approach to investigate the nuanced racial and ethnic differences in vaccine hesitancy and refusal. To fill this gap, this study examines the relationships between race, time, and COVID-19 vaccine hesitancy and refusal using state-level data from the US Census Household Pulse Survey, 2020 US Decennial Census, and other sources (i.e., American Community Survey, Human Development Index database, and Centers for Disease Control and Prevention). Four longitudinal Generalized Estimating Equations (GEEs) were estimated to analyze how time-variant and time-invariant measures, and time itself influenced COVID-19 vaccine hesitancy and refusal rates, controlling for the effect of other relevant covariates. The results provide descriptive evidence that COVID-19 vaccine hesitancy had decreased in the USA, but vaccine refusal remained stable between January and October 2021. The GEEs further indicated that the proportion of the Black population was positively associated with both vaccine hesitancy and refusal rates, while the proportion of the White population was positively associated with the vaccine refusal rate but not associated with the vaccine hesitancy rate. In addition, over the 10-month period, COVID-19 vaccine hesitancy and refusal in the Black population declined rapidly, but vaccine refusal in the White population stayed fairly stable. More research and practical efforts are needed to understand and inform the public about these important but overlooked trends.

Personal believes - Barriers to vaccination against Covid-19

Introduction: The ongoing global pandemic of Covid-19 had a huge pressure to accelerate the development process of Covid-19 vaccine. This acceleration of the vaccine appearance raised many concerns regarding the effectiveness and the adequate safety of the vaccine among general population. Objective(s): The aim of the study is to determine the reasons behind vaccine refusal among general population. Method(s): Online questionnaire with the subjects' agreement;The study included 61 participants aged between 18 and 40 years old. The study was effectuated in October 2021. Result(s): Most of the participants (n=60, 98.36%) declared that they knew some persons who have refused the Covid-19 vaccine. Moreover, a number of 29 participants (48.33%) declared that vaccine refusal among the people who refused the vaccine was due to personal believes. Conclusion(s): The success of the vaccination programs mainly depends on the proportion of the population that receive the vaccine. It is crucial to implement new strategies to increase the acceptability of Covid-19 vaccine.

COVID-19 vaccine attitude: A review on turkey

The study investigates the anti-vaccine attitude and the attitude towards COVID-19 in Turkey. Within the scope of the study, an online questionnaire was applied to 564 volunteers with a convenience sampling technique between 21/05/2021 and 01/06/2021. Analysis was performed with descriptive and inferential statistical analysis techniques and a multiple probit model. As a result of the estimation, it has been determined that negative claims about the vaccine have an increasing effect on the probability of being vaccinated or undecided, according to the probability of being vaccinated. It has been seen that it has a reducing effect on their thoughts about making the vaccine compulsory. Opposition to the COVID-19 vaccine has become global, and people's behaviors endanger their health, public health, and global health due to the following unscientific theories that need to be further examined scientifically. In particular, awareness-raising activities for individuals, more efficient use of social media channels for communication, support of countries' academic studies on the subject, and transparent sharing of scientific data with the public will change the attitude toward vaccines. When we look at the literature, it has been seen that social media channels are neglected in the vaccination attitude. However, it was found to be an essential factor in line with the findings obtained from the study. For this reason, it is thought that it will contribute to future studies. © 2022 The Authors.