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CHAPTER I

INTRODUCTION

Vaccine hesitancy is defined by the World Health Organization (WHO) as a

delay in accepting or refusing a vaccine regardless of availability of vaccine services.
Vaccine hesitancy is common, and it has a long history, notably with the vaccine
dengvaxia, which has contributed significantly to the public's loss of faith in vaccines in
the immunization program (DOH, 2022). According to the most recent dataset from Our
World in Data on March 25, 2022, 64.2% of the world's population has gotten at least
one dose of the COVID-19 vaccination. Globally, 11.15 billion doses have been
delivered, with 16.69 million doses being administered every day. In low-income
nations, just 14.4% of people have got at least one dosage.  The current global
vaccination rate is 21,250,320 doses per day, with 4,143,803 individuals receiving their
first vaccine. Bloomberg (2022) estimated it to take 7 months to reach 75% of the global
population receiving at least one dose. On May 28, 2021, as reported by CNN
Philippines (2021), Health Undersecretary Maria Rosario Vergeire stated that the
Philippines' target of vaccinating at least 70% of the population remains unchanged. As
the year 2022 approached, progress toward the target appeared to be on track. As of
March 24, 2022, the Department of Health declared that the target population had been
achieved, 72.82% vaccination rate against coronavirus disease (COVID-19), which
equates to 65 million Filipinos. However, According to the report from Punzalan &
Gutierrez (2022), 2.5 million individuals aged 60 and up in the Philippines have yet to
be vaccinated against COVID-19. This is a major concern since, according to the World
Health Organization (2021), in order to optimize the potential advantages of the
vaccination goal, implementation among age groups should be categorized and
proceeded in a similar manner across nations, having older adults prioritized.
Considering the fact that the majority of those who are most vulnerable to the COVID-
19 pandemic are the older adults.

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The COVID-19 pandemic has created an emergency situation, pressuring

vaccine manufacturers to develop an efficient and safe vaccine, and as a natural
consequence, many questioned the safety and efficacy of these COVID-19 vaccines.
Despite some unfavourable criticism surrounding the COVID-19 vaccinations, the
World Health Organization stated that vaccines are a critical game-changing tool at this
time in our lives, especially in saving lives and lowering social instability. The first
batch of COVID-19 vaccine arrived in the Philippines on February 28, 2021, more than
a year after the country reported its first incident and the first death from the infectious
disease. Still, the public's wariness following these COVID-19 vaccines is conclusive.
Controlling the spread of COVID-19 requires more than only vaccination efficacy and
safety. Vaccine acceptance is critical to the pandemic's effective management, yet not
everyone has the same perspective and knowledge when it comes to administering a
newly developed vaccine. 

Many older adults face the decision of whether to receive a vaccine with ease;
they choose to get all recommended vaccines, or they refuse vaccines entirely. Here are
several factors associated with the COVID-19 vaccine hesitancy in different domains.
The identified factors included various socioeconomic and demographic characteristics
(e.g., age, sex, residence, income, occupation, and marital status) constructs of the health
belief model, constructs of theory of planned behavior and the 5c psychological
antecedents, vaccines-related knowledge, attitude towards COVID-19 vaccination,
conspiracy beliefs, trust and confidence, COVID-19 preventive behavioral practices, and
the perceived safety and side effects of the vaccines (Marzo et al., 2022).  The
vaccination's purpose is to stimulate our immune systems to produce effective
antibodies before we get exposed to the pathogen or what we call herd immunity.
Getting vaccinated prevents severe illness, hospitalizations, and death. Individuals aged
65 and up who got complete doses of the COVID-19 vaccine can decrease the hazard of
coronavirus-related hospitalization. 
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The researchers aimed to elucidate the underlying reasons for older adults'
reluctance to receive vaccinations, even during the surge of a pandemic. There is the
necessity for older adults to develop knowledge regarding vaccination, which has been
the primary objective in educating the public and assuaging their anxieties and concerns
about immunization. The study has the following objectives: to identify the underlying
causes of vaccination hesitancy in older adults; to explicate the significance of getting
vaccinated; to determine the common reasons that make older adults hesitate to get
vaccinated; and to transform the findings of the study into a clearly illustrated
infographic

Background of the Study

The government uses several techniques to ensure that individuals in the

community, particularly older adults, are adequately informed about immunizations,
such as posting infographics on social media sites such as Facebook.  As stated by
Montemayor (2022), the country has somehow reached its goal of vaccinating against
the COVID-19 and has reached 70.76 percent of the target population. However, there
are still barangays with poor immunization rates. That is why the researchers believe the
issue is due to older persons' noncompliance rather than a lack of government
intervention. As a result, the researchers chose to investigate and evaluate older persons'
access to the COVID-19 vaccine and the underlying reasons for their apprehension.
Another reason why the researchers were interested in the barriers to older individuals'
vaccination compliance is because of the COVID-19 vaccine disinformation circulating
on Tiktok, a social media platform. The researchers also look at this as a situation that

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should be taken action of, because older adults are the population that are most
vulnerable in COVID-19. 

Theoretical Framework 

This study is led by the Health Belief Model (HBM), which was introduced by
Houghbaum, G.M., Becker, M.H., Rosenstock, I.M., Stretcher, V.J., a group of social
psychologists working for the U.S. Public Health Service in the 1950's. This theory is
designed to understand why people do not participate in particular health practices and
explain the variety of factors that might be significantly affected by human cognitions
and beliefs (Oak Ridge Institute for Science and Education (ORISE), 2016).

The HBM is based on psychological and behavioral theory, with the two
components of health-related behavior being 1) the desire to prevent disease or, if
already sick, to recover; and 2) the belief that a specific health action will prevent or
cure illness. In the end, an individual's decision is typically influenced by their beliefs of
the rewards and drawbacks associated with health practice. The health belief model has
six constructs: the first four were developed as the HBM's main principle; perceived
susceptibility, perceived severity, perceived benefits, and perceived barriers, while the
final two were added as the health belief model's study progressed; cue to action, self-
efficacy (LaMorte, 2019).

According to Zampetakis & Melas (2021), the health belief model has been
validated as a viable theoretical behavioral change model for assessing intentions to
vaccinate against COVID-19, and stated that there is a considerable amount of
substantial research literature where Health Belief Model is applied and is supported by
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its constructs. The immediate implications of employing the HBM for interventions
were underlined in their research.

Statement of the Problem

This study will explore and discuss the experiences of older adults having second
thoughts in getting the COVID-19 vaccine. The researchers will ask the major probing
question, “What are the fundamental reasons for older adults being hesitant to get the
COVID-19 vaccine?” in order to get the themes that will emerge in this study followed
by a semi-structured interview guiding questions to elicit the participants’ natural
responses to a specific phenomenon.

1. What is the common reason that could exhibit in the interview of older adults
regarding COVID-19 vaccination hesitancy? 

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2. What demographic factor affects the decision-making of older adults in getting
the COVID-19 vaccine?
3. What are the internal and external factors that affect the decision-making of
older adults in getting the COVID-19 vaccine?

4. What is the initial reaction of older adults upon the introduction and release of
the COVID-19 vaccine?
5. What information do older adults have about the COVID-19 vaccine?
6. What information concerning the COVID-19 vaccination do older adults believe
and rely on?
7. What role does misinformation and hearsay play in the decision-making of older
adults regarding COVID-19 vaccination?
8. What measures do older adults do that makes them complacent of not getting the
COVID-19 vaccine? 
9. What comprehensive interventions can be implemented to improve the
information dissemination and education regarding the COVID-19 vaccine?
10. What kind approach should be used to ensure older adults’ compliance with the
COVID-19 vaccination?

Scope and Delimitation of the Study 

This research work focused on analyzing the underlying reasons of vaccine

hesitancy in older adults. All the participants were interviewed by the researchers
utilizing an interview questionnaire that has been confirmed by their thesis adviser.
Responses enabled researchers to establish reasons of vaccine hesitation among older
adults. The researchers studied each acquired audio recording which functioned as data.
Also, the researchers did not disclose any personal information of the participants. The
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participants’ identity was undisclosed throughout the release of findings regarding the
underlying causes of vaccine hesitancy in older adults.

Significance of the Study

The study findings could be pivotal in a possible pandemic surge in the future.
This study will benefit a variety of areas, including the following:

Older Adults. This study provides in-depth information about the COVID-19
vaccine and will help them broaden their knowledge about the vaccine. Additionally, it
will raise awareness among older adults about the vaccine's efficacy and how it will be
beneficial to them.

Nursing Practice. This study will present underlying reasons for vaccination
hesitancy on older adults and will help improve nursing practice by the respondent's
interview.

Nursing Students. This study will inform nursing students on what is happening
in the field and will help them broaden their knowledge. Also, this study may guide
future student nurses preparing to become professionals.

Local Government Unit (LGU). This study will heighten older adults' anxieties
about vaccination hesitancy and enable the local government unit to create policies that
address the underlying reasons.

Future Researchers. These study findings will provide background for topics
related to Covid-19 vaccination hesitancy. Gathered data from the participants of the
study also serves as guideline material for future researchers who wish to continue or
establish new research.
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 Community. This study will raise community members' awareness of the health
risks caused by the pandemic. Also, this study will demonstrate the need to provide
basic health information at the community level since this can result in lower disease
transmission.

Definition of Terms  

The following terms are defined according to its use in the present research.

COVID-19 - an infectious disease caused by the SARS-CoV-2 virus.

Cue to action - The stimulus needed to trigger the decision-making process to accept a
recommended health action.

Herd Immunity - State in which a large proportion of a population is able to repel an

infectious disease, thereby limiting the extent to which the disease can spread from
person to person.

Immunization - A process that allows a person to become protected and immune to the
SARS-CoV-2 virus.

Pandemic - A disease outbreak occurring worldwide, or over a very wide area, crossing
international boundaries and usually affecting a large number of people.

Perceived barriers - This refers to a person's feelings on the obstacles to performing a

recommended health action.

Perceived benefits - This refers to a person's perception of the effectiveness of various

actions available to reduce the threat of illness or disease (or to cure illness or disease).

Perceived severity - This refers to a person's feelings on the seriousness of contracting

an illness or disease (or leaving the illness or disease untreated).

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Perceived susceptibility - This refers to a person's subjective perception of the risk of
acquiring an illness or disease.

Perceived threat - An individual's cognitive assessment of the likelihood a danger will

affect them and how bad it will be if it does.

Self-efficacy - This refers to the level of a person's confidence in his or her ability to
successfully perform a behaviour. 

Vaccine - A substance that is used to boost the immune system's capacity to combat
illness.

Vaccination - The process of administering a vaccine to the body in order to provide

herd immunity against COVID-19.

Vaccine Hesitancy - Individual’s reluctance to take part in a vaccination program due

to various factors, such as misinformation.

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CHAPTER II

REVIEW OF RELATED LITERATURE 

The following works of literature contain content acquired from other sources
and written by various local and foreign authors. These sources contain information that
greatly aided the study's conduct by offering content, support, and knowledge.

As stated by Matsui (2021), the novel virus recently identified as the severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread fast throughout the
world, resulting in the pandemic known as the global coronavirus illness 2019 (COVID-
19). In January 2020, the World Health Organization (WHO) announced a worldwide
health emergency in response to this epidemic, which modern society had never
encountered. Vaccination is an essential factor in preventing the spread of SARS-CoV-2
infection and the COVID-19 pandemic. However, it is generally established that
vaccination hesitancy is a significant issue—the WHO recognized it as one of the top
ten global health issues in 2019. Vaccine hesitancy is an unwillingness or refusal to
vaccinate despite vaccine availability. While vaccine hesitancy was reported prior to the
COVID-19 pandemic, its message is similar to the current problems and is not unique to
this crisis.

Vaccine hesitancy has been seen regardless of individuals' educational

attainment, social class, or national origin. Acceptance of vaccines is explained by an
interest in personal protection against sickness and concerns about adverse occurrences,
such as safety. According to Saleska & Choi (2021), the most often stated reason for not
taking the SARS-CoV-2 vaccine was fear of side consequences. People were concerned
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about relatively minor and temporary occurrences, such as local pain, weariness, and
fever, which are commonly reported and have an apparent causal association, and rare,
deadly events, which have an opaque cause relationship.

Unsurprisingly, adverse event information could influence people's decisions and

behavior regarding vaccine uptake. On the other hand, the personal protection benefits
of vaccination would be challenging to realize for each individual; that is, because the
majority of developed countries have eradicated many vaccine-preventable diseases,
many people, including medical professionals, are unaware of the devastation caused by
such diseases in their respective countries. The vaccination advantage may also be
expected at the societal level to prevent a pandemic, but this would be more difficult for
a person to perceive who is hesitant to be vaccinated.

Along with adverse outcomes, bias influences people's concerns about

vaccination hesitancy. For instance, unpleasant information about adverse events
contributes to negative attitudes against vaccination. Humans are wired to prioritize
negative information, such as bad experiences, above positive information, including
risk reduction. Negative views result from often reported mild adverse effects, which
have a disproportionate impact on vaccine reluctance. Additionally, people tend to
overestimate their own risk of infection. Certain individuals assume or feel that the
vaccine is to blame for the condition, as the adverse effects mimic COVID symptoms.

Medical and scientific evidence has been accumulated regarding the efficacy of
vaccination. Vaccination has been shown to help prevent COVID-19-related
hospitalizations and fatalities. When exposed to the coronavirus, vaccines enable the
body's immune system to recognize, fight, and eliminate it. As of April 2021, the World
Health Organization has approved the following vaccines for safe and effective use:
AstraZeneca/Oxford, Johnson & Johnson, Moderna, and Pfizer/BioNTech. Additionally,

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when a more significant number of individuals receive vaccines and gain immunity, the
likelihood of the virus being mobilized diminishes, implying herd immunity. As a result,
the benefits of vaccination outweigh any conceivable, minor hazards associated with it,
such as allergic responses (Garcia & Yap, 2021).

Age-related Vulnerability

The ageing population is at risk for various diseases, including infectious

diseases. Age has been identified as a substantial risk factor for severe disease, and the
old are more susceptible to infection. Infections are the primary cause of death and
morbidity in the elderly population. Numerous research has demonstrated that the
elderly population is more susceptible to COVID-19. They are in danger of developing
severe COVID-19 infection and death. Chen et al. (2021) theorized that inflammaging
and immunosenescence play a significant role in increasing ageing adults' susceptibility
to severe COVID-19. The projected death rate of this condition is 18 percent in ageing
adults over the age of 76. Koff and Williams (2020) requested additional research on
COVID-19 in ageing populations from an immune standpoint. Vaccination has
established itself as an effective, safe, and beneficial procedure for the elderly. As a
result, COVID-19 vaccination is critical for ageing seniors to protect this vulnerable
population (Chakraborty et al., 2021).

Public Trust and Religion

With the global outbreak of COVID-19, it is critical to prioritize vaccination to

foster herd immunity. However, public confidence in immunization appears to be
receding. Even medical students are unwilling to be vaccinated, posing a threat to herd
immunity.  Concern over-vaccination hesitancy is reflected in religiosity; religious
teachings value prayers over medicine, resulting in vaccination hesitancy among devout
followers. This, combined with a lack of adequate understanding about existing
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vaccines, leads believers to adopt alternate disease treatment methods, such as the use of
holy water and prayers, out of concern that vaccination may result in their family
member’s death. Vaccines containing pork components are also prohibited by other
religious beliefs, such as Islam.

The Vatican, on the other hand, has stated its position on vaccination. They
remain adamant about using aborted fetus cell lines in COVID-19 vaccines. According
to the Instruction Dignitas Personae, such practice is 'morally' acceptable if (i) ethically
sound vaccines are not available for immunization, (ii) storage and transport procedures
require rigor and are thus difficult, or (iii) even if multiple vaccines are available,
individuals are not given the autonomy to choose their preferred vaccine. Other
religions, such as Buddhism and Judaism, do not appear to have any fundamental
doctrines about vaccination and hence commonly tolerate it (Garcia & Yap, 2021).

According to Gopez (2021), a recent correspondence emphasized establishing a

public trust to address the public's COVID-19 vaccination hesitation. Despite the
governments’ efforts to establish a vaccination program, some people are still reluctant
to receive the vaccine due to the vaccine's possible adverse effects. Additionally, the
vaccinations' efficacy is still disputed. In the Philippines, people are also wary following
the Dengvaxia crisis in February 2018, when the alleged vaccination resulted in the
deaths of over 100 people. One option to re-establish trust and restore Filipinos' belief in
vaccination is through the initiative of the country's Catholic bishops to be publicly
injected with the COVID-19 vaccine.

Archbishop Romulo Valles, president of the Catholic Bishops' Conference of the

Philippines (CBCP), stated that he was motivated by Pope Francis and Pope Emeritus
Benedict XVI's public vaccination on 13 January 2021. Francis defends vaccination,
defining it as an ethical act where individuals gamble with their own and others' lives.

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The CBCP stated that, if necessary, Filipino bishops are willing to be vaccinated in
public and even before television if doing so helps build confidence in the government's
vaccine campaign and alleviates public fear about vaccination.

The Filipino bishops' initiative aims to encourage individuals, particularly the

poorest of the impoverished, to be vaccinated. This is also a call from Pope Francis in
his Christmas message 2020: that government leaders, industry leaders, and
international organizations work cooperatively to advance vaccines for all, particularly
the most vulnerable and needy. According to Fr Nicanor Austriaco, OP, Filipinos are no
longer completely reliant on science due to the pandemic's fears. Rather than that,
individuals place a higher premium on their Church leaders.

Thus, the CBCP supports and collaborates with the Philippine government in
vaccinating the country's 70 million citizens against the new coronavirus in 2021 to
attain herd immunity. Valles has already taken the first step by offering the use of
Catholic churches as vaccination clinics for the government.

The Philippine Department of Health thanked the CBCP for assisting in

converting church facilities into immunization stations to hasten the delivery of critical
healthcare. As the bishops emphasized their readiness to be vaccinated, Health Secretary
Fernando Duque III stated that the CBCP contributes to public vaccination uptake.
Duque noted that the COVID-19 vaccination program cannot be carried out just by the
government but must involve all segments of society.

Social Media and its Adverse Effect 

While social media has increased the publics’ ability to communicate in

unprecedented ways, it has also been a significant contributor to the emergence of fringe
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beliefs detrimental to public health. Conciliating free speech ideals with the policing of
social media for harmful falsehoods continues to be a problem for democracies.

Vaccine hesitancy is not a new concern, but the spread of anti-vaccination

propaganda via social media has heightened its urgency, particularly in the coronavirus
pandemic and hopes for rapid development and deployment of a vaccine. Vaccine
hesitant groups have a substantial presence on social media. Studies dated back to the
early 2000s indicate that a sizable amount of the content about vaccines on prominent
social media platforms is anti-vaccine propaganda. By significantly lowering
communication's transaction costs, social media creates a 'long tail' effect, in which the
absence of any barrier to entry enables fringe groups to spread their message. In the case
of the anti-vaccination message, a phenomenon similar to ethnic outbidding can occur.
A fringe group's misinformation gets traction not because it is believed to be genuine but
because the repercussions would be horrible if it were true. Extreme advertising
emphasizing adverse effects is rewarded, resulting in a spiral of danger matched by
public dread (Wilson & Wiysonge, 2020).

Vaccination Hesitancy: Internal and External Factors

In 2016, the Philippines had one of the most contentious vaccination campaigns
in the country's history, which resulted in the death of over 600 individuals. No
government official or vaccine producer has been held accountable or legally sanctioned
yet. The horrifying and traumatic Dengvaxia experience contributed to vaccine
hesitancy as early as 2018 and continues to erode public trust in their government.

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On the other side, despite the Government's defense of the efficacy of certain
Chinese COVID-19 vaccinations, Filipinos continue to have a poor net trust rating for
China, owing in part to concerns about the West Philippine Sea and the COVID-19
virus. With the harassment in the West Philippine Sea, the Filipinos remain wary of the
Chinese Government's professed generosity in assisting the Philippine Government in
procuring vaccines.

Indeed, several mayors have opposed the use of vaccines of Chinese origin after
their citizens expressed their reservations and mistrust of the vaccines. If other vaccine
brands had been prioritized, trust in vaccination could have improved. Additionally,
several Filipinos harbor preconceived notions and unpleasant experiences regarding the
quality of Chinese items. Without a doubt, the Philippine Government's continuous
immunization program reactivates the societal traumas endured by Filipinos.

With the people's current societal traumas, the Philippine Government may
continue to encounter vaccine hesitation. Judith Herman asserts that traumas impair a
victim's capacity to enter into a trusting relationship. Herman identified three stages of
trauma healing that the Government may wish to address when establishing public trust:
safety, acknowledgment, and reconnection. Herman highlights the necessity of
establishing a safe environment during the safety stage. Transparency remains essential
and fundamental in this situation. Thus, the Government can demonstrate openness by
addressing issues such as smuggled vaccines, selective immunization, and vaccine
prioritization.

Herman's trauma rehabilitation progresses to the second stage, which entails

acknowledgment, justice, apology, and forgiveness. As previously stated, no one was
found accountable in the Dengvaxia case. Additionally, the Government's diplomatic
initiatives toward China sow uncertainty rather than trust among the populace. Such

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instances raise concerns about the Government's integrity and impartiality. Therefore,
the Government must embrace justice by holding people accountable and avoiding
disproportionate retribution against oppressors. Additionally, the Government may
consider the Filipino value of empathy, which is critical in establishing trust.

People finally liberate themselves from the trauma and understand that they
cannot change the past in the final stage of Herman's trauma rehabilitation. They finally
acknowledge that what happened in the past does not always imply what will happen in
the present or future. Reducing or eliminating vaccine reluctance among Filipinos will
be extremely difficult due to pre-existing social traumas. The Philippine Government
cannot simply demand that the populace trust the process. Before the Government can
even begin to expect faith, it must first earn the people's trust. Following Judith
Herman's lead, it is hoped that the Government will prioritize transparency and fairness
as guiding principles for the immunization campaign (Vergara, 2021).

Conspiracy Beliefs and Information Sources

In the study of Sallam et al. (2021), they assessed how the population in Jordan,
Kuwait, and other Arab nations felt about the potential COVID-19 vaccines. They also
assessed the association between vaccine acceptance and conspiracy beliefs. Vaccine
hesitancy was said to be one of the negative consequences of COVID-19 misinformation
and conspiracy beliefs, and this might be a significant impediment to the pandemic’s
successful management. Dependence on social media as the primary source of
information on COVID-19 vaccines is strongly associated with vaccine hesitancy. This
should serve as a reminder to governments, policymakers, and the general public of the

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significance of doing thorough fact checks. Their study showed that most female
respondents are subject to vaccine hesitancy while a greater proportion of male
respondents accepted the COVID-19 vaccination. This might be connected to males’
lower likelihood of believing in vaccine and viral origin conspiracies since they rely
more on medical physicians, scientists, and scientific publications than females, who
rely more on social media platforms. Furthermore, past research by Sallam et al. (2020)
has shown that females are less likely to see the disease as more dangerous, leading to a
decrease in vaccination adoption due to complacency. 

Another study from Wang et al. (2021) showed a declining willingness to adopt
the COVID-19 vaccine, which might be linked to personal protection behavior,
confidence, and complacency. Personal protective behaviors may be seen as an
alternative to vaccination in preventing illness among workers. It appears to them that
adopting these measures would be enough to avoid COVID-19. The general working
population, particularly those who are not professionals and are regularly exposed to
crowds, should be educated and given favorable policies about vaccination. For
information distribution, there should be messages expressing that vaccination is a part
of individual infection control measures that complement social distancing and
handwashing in disease prevention and might be helpful to both individuals and
communities to resume normal living.

From November 2020 to January 2021, Wang et al. (2021) held a cross-sectional
field survey with 7259 participants to investigate public perception, willingness, and
information sources for COVID-19 vaccination, focusing on the older adults and non-
communicable chronic disease (NCD) population. The older adults’ willingness to
accept the future COVID-19 vaccine (79.08 %) was lower than that of adults aged 18–
59. (84.75%). Concerns about vaccine safety, low infection risk, waiting and seeing
others get vaccinated, concern about vaccine effectiveness, and price were the main
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reasons for vaccine hesitancy among the general public. Their relative importance varied
between adults aged 18–59 and the older adults and between adults aged 18–59 who had
or did not have NCD. In both age groups, perceptions of vaccination importance,
vaccine confidence, and trust in health workers were significant predictors of
vaccination intention. The older adults who perceived a high risk of infection or had
faith in their governments were more likely to accept the vaccine. Compared to adults
aged 18–59, the elderly relied more on traditional media and family, relatives, and
friends for COVID-19 vaccination information.

To increase vaccine uptake, vaccination campaigns must include comprehensive

interventions to improve vaccination attitudes, vaccine accessibility, and affordability
and tailor strategies to address specific concerns among different population groups and
be delivered through trusted sources, particularly for the older adults.

Urban vs. Rural Living

In Bangladesh, there was a high prevalence of vaccine refusal and hesitancy

among rural and slum dwellers based on the study by Abedin et al. (2021). The rural
community and slum dwellers had low literacy rates, adherence to health safety
regulations, and trust in the healthcare system. The ongoing app-based vaccination
registration has increased hesitancy and reluctance in the low-educated group. Outreach
vaccination centers can be established for people living in rural, semi-urban, and slum
areas to ensure vaccine availability and reduce associated travel costs. In rural areas,
community health workers, respected community leaders, and non-governmental
organizations can be used to motivate and educate people about COVID-19 vaccination.

Furthermore, with tailored health messages and assurance from healthcare

professionals, special attention should be paid to the elderly and the ill. Finally,

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vaccination should be free of charge for Bangladesh's COVID vaccination program to
serve as a model for other low- and middle-income countries.

As stated by Heath (2021), more evidence is emerging of a rural-urban divide in

vaccine hesitancy. The most recent survey from SCAN Health Plan, conducted by
Wakefield Research (2021), indicates that family caregivers living in rural areas are
vaccine-hesitant themselves and will not help connect their family members to vaccine
appointments. A third of adult family caregivers in rural areas said they would not assist
their family members, such as elderly parents, get vaccines.

Only 16% of family caregivers in urban areas reported the same. These
decisions primarily influenced fear and uncertainty about vaccine safety and
effectiveness. According to the survey respondents as mentioned by Seeger (2021),
caregivers' refusal to acquire the vaccine for their loved ones and themselves is mainly
motivated by safety concerns. An overwhelming 81 % of family caregivers surveyed
have uncertainties that the COVID-19 vaccination is safe, and more than a quarter (28
%) are "not at all confident" in the vaccine's safety. Only 9% of their urban and
suburban friends are confident. Experts say the data highlight how tough it will be to
save lives in regions with limited healthcare access.

Information Dissemination

Regular news, individuals who rely on health care professionals (HCPs), social
media, other internet/web pages, and family/friends are all factors in the greater
likelihood of negative vaccination intentions. As determined by the study of Reñosa et
al. (2021), decision-making towards vaccination is complex and multifaceted, and those
who disseminate vaccine-related information holds the privilege to promote or dissuade
vaccine acceptance. Moreover, according to the study of Caple et al. (2021), the
majority of their respondents agreed to receive the COVID-19 vaccines only after it had
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been given to many others, or after it had been given to politicians.  A similar report
from Heath (2021) says that clinical practitioners are the most trusted vaccination
messengers, according to previous research. According to a Harris Poll done on behalf
of Updox in January, 87 percent of patients want to learn about the COVID-19
vaccination from their doctors. In terms of vaccination information, 34% of patient
respondents stated they trusted their physicians the most, making clinicians the most
trusted vaccine communicators. 

In relation to the Health Belief Model, external cues were also shown to be
essential. Household heads opposed to vaccinations, beliefs that vaccines are
unnecessary, and pressures from social and traditional media or neighbors all led to
increased vaccine refusal and delay (Landicho-Guevarra et al., 2021). To further
understand the perspective of unvaccinated individuals, Encallado et al. (2021)
conducted a study that suggests that COVID-19 vaccination participants' attitudes are
generally unfavorable. Vaccines are seen as quackery by them. However, they continue
to believe that immunizations are still necessary for combating the virus.  In a summary,
their respondents are still completely unaware of the vaccinations' efficiency,
functionality, and relevance in preventing illness. 

  

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CHAPTER III 

METHODOLOGY

This chapter discusses the design of the study, including the research methods
and techniques to be utilized, how subjects are selected, how the sample size is decided,
the instrument used and its validation, and the data collection procedure for data
analysis. Qualitative research creates a deep understanding of an existing phenomena as
well as how individuals build it within their own surroundings. Because the goal of
qualitative research is to adequately describe or explain a phenomenon, researchers
seldom seek to establish group comparisons (Polit & Beck, 2018).

Research Design 

The researchers used phenomenological research design to determine why older

adults hesitate to be vaccinated. This study was designed to gather data from the
unvaccinated older adults participants. This research involved the description,
documentation, analysis, and interpretation of the perception of unvaccinated older
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adults participants about vaccination. The researchers were to obtain access into the
participants' environment and access to their lived experiences through these interviews
(Polit & Beck, 2018).

The researchers used Giorgi’s method of analysis to comprehend important

concrete relationships that are inherent in the original description of experience in a
certain circumstance (Giorgi et al., 2017).

Research Locale

The researchers used convenience sampling in selecting the participants.

Participants are selected randomly depending on their accessibility and the researchers'
discretion. Since convenience sampling aims for easy access, the researchers will
interview three of their older adult acquaintances who have not yet been vaccinated.

Research Instrument

This research followed a qualitative approach. The instrument used to collect the
data was a self-made questionnaire. The questionnaire was made up of 20 questions that
aimed to determine the underlying reasons for vaccination hesitancy among older
adults. 

The self-made questionnaire for the participants was divided into two parts: The
first part dealt with the participants’ personal, socioeconomic, and demographic
characteristics such as (a) age, (b) religion, (c) existing health problems, and (d)
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companions in participants’ houses. This part elicited data on name, age, residence,
religion, present health problems, and the number of family members in the household.
The second part consists of answers about their vaccination hesitancy. 

Participants of the Study

To obtain the needed data, the researchers decided to use convenience sampling
as the sampling technique. The researchers decided to have three total unvaccinated
older adults as their participants; 3 came from the researchers' acquaintances in
Calamba, Laguna. 

Data Gathering Procedure 

After deciding on the research locale, sampling technique, and participants, the
researchers will submit a letter to the participants to inform them that all the data from
the interview will be anonymous. The researchers will go to their acquaintances of
unvaccinated older adults to interview them. Once the researchers locate their
participants and receive the signed consent forms, they will proceed to their data
collection. The self-made questionnaire with 20 questions will be given to the older
adults-participants. The data gathered will be converted into an analysis of each
participant’s answers about vaccine hesitancy. 

Using Giorgi's method of analysis, the researchers will begin by attentively

listening to each recorded interview multiple times and provide a detailed description of
each participant's experience with vaccination hesitancy. In the second phase, the
researchers will use their own phrases or expressions to find subjective meaning units
for vaccine hesitancy by discriminating meaning units of vaccination hesitancy from
each participant's recorded interview. Meaning units ranging from a few words to an
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entire phrase will be recorded each time a participant mentioned vaccination hesitancy.
In the third phase, the researchers will be collecting each participant's meaning units that
he or she used to express, for example, information sources, and a meaning structure, as
we termed it, will be formed. The meaning structure will be presented in such a way that
the most valued, in the participant's viewpoint, will be placed on top, and the others will
be placed below it and/or in parallel in an order that reflects how they will be related to
each other. The significance of each meaning structure will be decided by how the
participant describes his or her experience with it and how he or she refers to other
meaning structures.

This well-organized collection of codes will form a subjective meaning network.

In the synthesis, the fundamental themes of vaccination hesitancy will be extracted from
the meaning structure of all three participants. Following the phenomenological
tradition, some meaning structures will be merged and/or retitled to attain more clarity
and complexity.

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[Link]/doi/full/10.1111/aphw.12262

Questionnaire
1. Ano ang iyong pangalan? /What is your name?

2. Ilang taon ka na? /How old are you?

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3. Ano ang iyong relihiyon? /What is your religion?

4. Mayroon ba kayong problemang

pangkalusugan? /Do you have any health
problems?

5. Sinu-sino ang iyong kasama sa bahay? /Who are

you living with?

6. Ikaw lang ba ang hindi bakunado sa pamilya

niyo? /Are you the only unvaccinated member
within your family?

7. Ano ang iyong kaalaman tungkol sa bakuna ng

COVID-19? /What is your understanding about the
COVID-19 vaccine?

8. Kayo ba ay Anti-Vaxxer? /Are you an Anti-

Vaxxer?

9. Ayaw niyo lang sa COVID-19 vaccine? /Are you

simply against the idea of COVID-19 vaccination?

10. Ano ang iyong reaksyon noong nalaman niyong

magkakaroon na ng bakuna para sa COVID-19?
/What was your initial reaction when the COVID-
19 vaccines were introduced?

11. Malayo ba sa inyong pamayanan ang vaccination

site? /Is your community too distant from the
vaccination site?

12. Anong paniniwala mo sa pagpapaturok ng bakuna

laban sa COVID-19? /What are your perceived
beliefs towards COVID-19 vaccination?

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13. Lingid ba sa iyong kaalaman na ang pagpapa-
bakuna laban sa COVID-19 ay mayroon ding
benepisyo sa mga tao sa iyong paligid? /Do you
know that the benefits of the COVID-19 vaccine
influence not just you, but also those in your
immediate vicinity?

14. Nagdadalawang isip ba kayo na magpabakuna

maliban sa bakuna para sa COVID? /Are you
having any hesitations about receiving any type of
vaccine other than the COVID-19 vaccine?

15. Nagdalawang isip ka ba na magpabakuna dahil

mabilis ito nagawa? /Did you hesitate to get
vaccinated due to the vaccine’s rapid production?

16. May kakilala ka bang nakaranas ng matinding side

effects pagkatapos magpa-bakuna? /Do you know
anyone who has experienced severe adverse
effects after being vaccinated?
17. Mayroon ka bang kahit na anong mga
alternatibong hakbang sa pag-iwas o pag-gamot sa
COVID-19?

Kapag oo, sa palagay mo ba ay mas mahusay ito

kaysa sa bakuna? /Do you have any alternative
measures for preventing or treating COVID-19?

If yes, do you think it’s more efficient than the

vaccine?
18. Nakakita ba kayo ng fake news sa social media
tungkol sa bakuna? /Did you saw some fake news
in social media regarding to C0VID-19 vaccine

19. Naniwala ba kayo nung nakita niyo po ‘yun? /Did

you believe it when you saw that?

20. May nang-engganyo ba sa iyo na huwag nang

magpabakuna? /Has anyone persuaded you not to
get vaccinated?
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