Intervention hesitancy among healthcare personnel: conceptualizing beyond vaccine hesitancy

Abstract

We propose an emerging conceptualization of “intervention hesitancy” to address a broad spectrum of hesitancy to disease prevention interventions among healthcare personnel (HCP) beyond vaccine hesitancy. To demonstrate this concept and its analytical benefits, we used a qualitative case-study methodology, identifying a “spectrum” of disease prevention interventions based on (1) the intervention’s effectiveness, (2) how the intervention is regulated among HCP in the Israeli healthcare system, and (3) uptake among HCP in the Israeli healthcare system. Our cases ultimately contribute to a more nuanced conceptualization of hesitancy that HCP express towards disease prevention interventions. Our case interventions included the seasonal influenza vaccine, the Mantoux test, and the hepatitis B (HBV) vaccine. Influenza and HBV are vaccine-preventable diseases, though their respective vaccines vary significantly in effectiveness and uptake among HCP. The Mantoux test is a tuberculin skin test which provides a prevention benchmark for tuberculosis (TB), a non-vaccine preventable disease. We conducted semi-structured interviews with relevant stakeholders and analyzed them within Israeli and international policy context between 2016 and 2019, a period just prior to the COVID-19 pandemic. We propose the conceptualization of “intervention hesitancy”—beyond “vaccine hesitancy”—as “hesitancy towards a wide range of public health interventions, including but not limited to vaccines”. Results suggested that intervention hesitancy among HCP is rooted in weak trust in their employer, poor employment conditions, as well as mixed institutional guidelines and culture. Conceptualizing intervention hesitancy expands the ability of healthcare systems to understand the root of hesitancy and foster a supportive institutional culture and trust, cognizant of diverse disease prevention interventions beyond vaccination.

Attitudes of Healthcare Workers in Israel towards the Fourth Dose of COVID-19 Vaccine

“…The evolving virus variants of SARS-CoV-2, such as the Omicron variant, which caused widespread morbidity, and the waning immunity to the virus, including that observed in vaccinated individuals, have led to the implementation of COVID-19 vaccine booster doses, which may become seasonal. HCW vaccination compliance is a challenge for health leaders as they are the most trusted advisors and influencers for vaccination decisions [ 24 ] and thus hesitant HCWs pose a risk of lowering intervention uptake among the general population [ 25 ].…”

“…The various concerns and perceptions expressed by HCWs with regard to the fourth vaccine dose highlight that HCWs have a unique position. On the one hand, they are an extension of healthcare systems, and on the other hand, they are part of the public as complex individuals with personal lives, values, and opinions that impact their attitudes, hesitancy, and behaviors towards disease prevention interventions [ 25 ].…”

“…Studies have shown that vaccinated HCWs are more likely to recommend vaccines to friends, family, and their patients [ 23 ]. Thus, hesitant HCWs pose a risk of lowering intervention uptake among the general population [ 25 ]. The health system should be more tolerant of their concerns and address them through communication [ 49 ].…”

Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

“…Notably, the increased contact with these patients decreased general vaccine hesitancy, not just COVID-19 vaccine hesitancy [ 63 ]. Additionally, studies note that the culture and guidelines of their institution prevent addressing vaccine hesitancy among HCPs adequately [ 71 ].…”

Supporting healthcare workers in vaccination efforts

“…We define healthcare workers as agents of change; therefore, their source of knowledge is important: they need available evidence-based information about COVID-19 vaccine. 6 Policy makers should be sure of its reliability and the accessibility to healthcare workers in a way that mobilizes them for health insights, and ensure that they have access to information appropriate for their perspectives and education level. 7 It should be noted that the information should be continuously updated and maintain its quality during the epidemic.…”