CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Infectious diseases remain major public health challenges in many countries worldwide, contributing to increased morbidity and mortality, as well as additional expenditure on healthcare services (Al-Tawfiq et al., 2020).

In December 2019, cases of a previously unidentified coronavirus emerged in Wuhan City, China, as reported by the World Health Organization (WHO, 2020). On January 8, 2020, the Chinese Center for Disease Control and Prevention (China CDC) announced that the causative agent was a novel coronavirus (Al-Tawfiq et al., 2020). The virus was subsequently named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The symptoms associated with the infection include fever, cough, sore throat, fatigue, and difficulty breathing. Evidence established that the virus could spread from one person to another, while appropriate hygiene practices could help reduce the risk of infection (Chavis & Ganesh, 2020; Chen et al., 2020; Deng & Peng, 2020).

As the reality of the coronavirus pandemic became evident in Nigeria, the country, like many others across the world, began cancelling events, restricting flights, and suspending activities that involved social, official, and religious gatherings in an effort to limit transmission (Adamu, 2020).

Various preventive interventions were introduced during the COVID-19 pandemic to reduce the spread of SARS-CoV-2 (Chou & Budenz, 2020). Vaccination was considered one of the most important public health strategies for controlling the pandemic. Towards the end of 2020, COVID-19 vaccines became available, and healthcare workers (HCWs) were prioritized for vaccination in many countries. The effectiveness of vaccination programmes depends largely on the proportion of the population willing to receive the vaccines, particularly healthcare workers, who play an essential role in promoting vaccination and encouraging public confidence in immunization (Logunov et al., 2021).

Healthcare workers face an increased risk of exposure to SARS-CoV-2 because of their direct contact with patients. They may also contribute to the transmission of infections within healthcare facilities, where they attend to vulnerable individuals, including older adults and people living with underlying medical conditions. These patients often require specialized attention and care, making infection prevention particularly important in clinical settings (Loomba et al., 2021). Studies have indicated that acceptance of COVID-19 vaccination and willingness to be vaccinated may be higher among nurses than among members of the general population, partly because nurses may perceive themselves to be at greater risk of contracting the infection (Cucinotta & Vanelli, 2020).

Adherence to preventive measures is influenced by individuals' attitudes, perceptions of susceptibility, and understanding of disease risks. During the COVID-19 pandemic, greater compliance with preventive behaviours was observed among some individuals experiencing psychological distress, anxiety, heightened perceptions of susceptibility to infection, and stronger aversion to germs (Odriozola-González et al., 2020). Similarly, willingness to receive vaccines and vaccine hesitancy are influenced by several factors. These include concerns about adverse effects and vaccine safety, doubts about vaccine effectiveness, inadequate information about the disease and its vaccines, perceptions of a low risk of infection, fear of needles, and beliefs that the disease is not sufficiently severe to warrant vaccination (Jiang et al., 2021).

By 2020, numerous COVID-19 vaccine candidates were undergoing clinical trials, while some had received authorization for use in particular countries (World Health Organization, 2020). Widespread vaccination was regarded as an important step towards controlling the spread of the virus. China reportedly began vaccinating nurses with its vaccine in early July 2020 (Helen, 2020). On December 30, 2020, Singapore became the first country in Asia to authorize the Pfizer-BioNTech vaccine, Tozinameran, for use, including among healthcare workers (Singapore Ministry of Health, 2020). Other Asian countries subsequently planned to introduce vaccination programmes in early 2021. Nevertheless, the success of these programmes depended on the willingness of eligible individuals to receive the vaccines. Vaccine hesitancy therefore represented a significant obstacle to controlling the pandemic. In 2019, the World Health Organization identified vaccine hesitancy as one of the ten major threats to global health (World Health Organization, 2019).

Nurses are important sources of health information, particularly on disease prevention, and their professional opinions can significantly influence people's decisions about vaccination (Kreps et al., 2020). Research examining nurses' vaccination practices and attitudes towards vaccines against influenza, human papillomavirus (HPV), hepatitis B, and other infectious diseases has shown that knowledge of vaccine effectiveness and safety can strengthen healthcare workers' confidence in immunization and their willingness to recommend vaccines to others. Support from colleagues and wider societal acceptance have also been identified as factors that may influence vaccination decisions (Baden et al., 2021). It is therefore important to understand healthcare workers' opinions, intentions, and concerns regarding vaccination, as well as the relationship between sociodemographic characteristics and willingness to receive COVID-19 vaccines.

Nursing students are also important to vaccination and disease-prevention efforts because their training involves practical experience in healthcare settings, and some may already be employed within the health sector. Their education prepares them to contribute to health promotion, disease prevention, and patient education (Kreps et al., 2020). Studies investigating the preventive behaviours of nursing students during the COVID-19 pandemic have generally reported substantial adherence to recommended preventive measures (Van Bavel et al., 2020). However, findings from individual studies have identified gaps in students' knowledge of basic measures for preventing viral transmission in community and hospital settings (Dong et al., 2020). Research specifically examining COVID-19 vaccination intentions among nursing students has remained limited. For example, a study conducted in the United States found that only 45% of the nursing students surveyed intended to receive a COVID-19 vaccine (Bell et al., 2020).

Considering the future professional responsibilities of nursing students and their anticipated participation in healthcare teams, research has examined their preventive behaviours, vaccination acceptance, and willingness to recommend vaccination. One study investigated these issues among nursing students in Slovenia, Poland, and Serbia, three Central and Eastern European countries with comparable nursing education systems organized in accordance with European Union Directive 2005/36/EC (Helmy et al., 2020). The findings were expected to contribute to existing knowledge of nursing students' attitudes towards preventive practices, vaccine acceptance, and vaccination advocacy, while identifying areas requiring further research and practical intervention. The study hypothesized that previous work experience would be associated with greater adherence to preventive measures, stronger vaccination intentions, and increased willingness to recommend vaccination. It also considered responsibility towards patients as a potential motivation for accepting vaccination.

Against this background, the present study focuses on the acceptance of and attitudes towards COVID-19 vaccination among student nurses at Seventh-day Adventist School of Nursing, Ile-Ife, Osun State. It seeks to examine their knowledge of the vaccine, their willingness to receive it, and their attitudes towards its use.

1.2 Statement of the Problem

The outbreak of coronavirus disease 2019 (COVID-19) in Nigeria increased anxiety and concern among members of the public. Compared with many familiar infectious diseases, COVID-19 presented a significant public health challenge because of its capacity for transmission and the potentially severe symptoms experienced by infected individuals. The emergence of the pandemic placed considerable pressure on healthcare facilities and created additional demands on healthcare professionals.

By December 2020, more than 18 million COVID-19 infections had been recorded in Europe, with over one million deaths reported according to the figures cited in the original study. The pandemic had placed substantial pressure on hospitals and adversely affected the working conditions and mental well-being of healthcare professionals. At the same time, the first COVID-19 vaccines were being evaluated and authorized by the European Medicines Agency and the European Commission, while national and international vaccination strategies were being developed.

Within the European vaccination strategy, healthcare workers were designated as one of the priority groups for immunization. The strategy included a target of vaccinating 80% of healthcare workers by August 2021 (Abdallah & Lee, 2021). This prioritization reflected the importance of protecting healthcare personnel, maintaining essential health services, and reducing the risk of infection in healthcare environments.

Despite the introduction of COVID-19 vaccines, concerns about vaccine acceptance among healthcare professionals emerged in several countries. Studies conducted during the early stages of the vaccination campaign revealed that a considerable proportion of healthcare workers were uncertain or hesitant about receiving the vaccine. Verger et al. (2020), in a study involving healthcare professionals in Quebec, France, and Belgium in October and November 2020, reported that 43.8% of respondents stated that they would certainly receive the COVID-19 vaccine, while 28.5% indicated that they would probably receive it. These findings raised concerns about whether vaccination coverage would meet the expectations of public health authorities. Similarly, Gharpure et al. (2021) reported that the median proportion of participating long-term care staff in the United States who had received their first vaccine dose between mid-December 2020 and mid-January 2021 was 37.5%, indicating challenges in achieving high uptake among this group of healthcare workers.

Although healthcare workers are expected to possess relevant health knowledge and promote preventive practices, their professional training does not necessarily eliminate uncertainty or negative attitudes towards vaccination. Nursing students, in particular, require attention because they combine classroom learning with clinical training and may come into contact with patients during practical placements. Their knowledge, perceptions, and willingness to accept COVID-19 vaccination may influence their personal protection, their future professional practices, and their ability to educate patients about immunization.

At Seventh-day Adventist School of Nursing, Ile-Ife, Osun State, it is therefore important to investigate student nurses' understanding of COVID-19 vaccines, their willingness to accept vaccination, and their attitudes towards the vaccines. Understanding these issues can help identify possible misconceptions, concerns about safety, and other factors that may influence vaccine acceptance. Consequently, this study examines the acceptance of and attitudes towards COVID-19 vaccination among student nurses at the institution.

1.3 Objectives of the Study

The main objective of this study is to assess the acceptance of and attitudes towards COVID-19 vaccination among student nurses at Seventh-day Adventist School of Nursing, Ile-Ife, Osun State.

The specific objectives are to:

1. Assess the knowledge of student nurses at Seventh-day Adventist School of Nursing regarding the COVID-19 vaccine.

2. Determine the level of COVID-19 vaccine acceptance among student nurses at Seventh-day Adventist School of Nursing.

3. Examine the attitudes of student nurses at Seventh-day Adventist School of Nursing towards the COVID-19 vaccine.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of student nurses at Seventh-day Adventist School of Nursing regarding the COVID-19 vaccine?

2. What is the level of COVID-19 vaccine acceptance among student nurses at Seventh-day Adventist School of Nursing?

3. What attitudes do student nurses at Seventh-day Adventist School of Nursing demonstrate towards the COVID-19 vaccine?

1.5 Justification and Significance of the Study

Healthcare workers have remained at the forefront of efforts to prevent and manage the COVID-19 pandemic (Chew et al., 2020a; Chew et al., 2020; Tan et al., 2020). Consequently, many countries prioritized healthcare personnel for early vaccination to protect them from infection and maintain the continuity of essential healthcare services (Sun et al., 2021). However, reports of vaccine hesitancy among members of the public in various European countries raised concerns about the challenges associated with achieving widespread acceptance of COVID-19 vaccination (Lazarus et al., 2021).

Research examining willingness to receive COVID-19 vaccines among healthcare workers has sought to identify their concerns, reasons for hesitancy, and the factors associated with vaccination decisions. Such investigations have also aimed to identify independent predictors of willingness to be vaccinated. In view of the reported reluctance to receive COVID-19 vaccines in different populations (Lazarus et al., 2021), understanding the factors that influence vaccine acceptance is important for developing appropriate strategies to improve vaccination uptake among frontline healthcare workers.

The present study is significant because it will provide information about the knowledge, acceptance, and attitudes of student nurses towards COVID-19 vaccination at Seventh-day Adventist School of Nursing, Ile-Ife, Osun State. The findings may help identify misconceptions, concerns, and information gaps that could affect their vaccination decisions.

The study may also be useful to nursing educators, healthcare administrators, and public health practitioners in developing educational programmes and communication strategies that address student nurses' concerns about vaccination. By identifying areas where additional information is required, the findings may support the development of clear and persuasive health messages aimed at improving vaccine awareness and acceptance.

Furthermore, the findings may contribute to the existing body of knowledge on vaccine acceptance among nursing students and provide a basis for future studies in similar educational and healthcare settings. The results may also help strengthen health promotion and disease-prevention activities by improving understanding of the factors that influence student nurses' attitudes towards immunization.

1.6 Scope of the Study

This study focuses on the acceptance of and attitudes towards COVID-19 vaccination among student nurses. It is geographically limited to Seventh-day Adventist School of Nursing, Ile-Ife, Osun State. The investigation specifically examines the students' knowledge of the COVID-19 vaccine, their acceptance of vaccination, and their attitudes towards the vaccine.

1.7 Limitations of the Study

The study may encounter certain limitations, particularly financial and time constraints.

Financial constraints: Inadequate financial resources may limit the researcher's ability to obtain relevant materials, access literature, gather information, and meet other research-related expenses. These limitations may affect the scope and efficiency of the research process.

Time constraints: The researcher will undertake this study alongside other academic responsibilities. Consequently, the time available for reviewing literature, collecting data, analysing findings, and completing the research may be limited.

1.8 Definition of Terms

Acceptance: Acceptance refers to an individual's willingness to agree to, receive, or undertake something offered. In this study, it refers to student nurses' willingness to receive the COVID-19 vaccine.

Attitude: Attitude refers to an individual's established way of thinking, feeling, or responding towards a particular subject. In this study, it concerns student nurses' opinions, perceptions, and feelings about COVID-19 vaccination.

Coronavirus Disease (COVID-19): COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can cause respiratory symptoms such as coughing and fever, and may lead to difficulty breathing and other serious complications.

COVID-19 Vaccine: A COVID-19 vaccine is a biological preparation designed to stimulate the immune system to develop protection against SARS-CoV-2, the virus responsible for COVID-19.

Nursing Student: A nursing student is an individual enrolled in an educational programme designed to provide the theoretical knowledge, practical skills, and professional competencies required for nursing practice.

Vaccination: Vaccination is the administration of a vaccine to stimulate the immune system and help protect an individual against a particular infectious disease.

Vaccine: A vaccine is a biological preparation that stimulates the immune system to develop acquired protection against a specific infectious disease. Depending on the type, it may contain weakened or inactivated microorganisms, components of a microorganism, or instructions that enable the body to produce an antigen that triggers an immune response.