Atif Towheed, PhD, OMS III, presented his study at the Annual Council of Osteopathic Student Government Presidents Winter Research Symposium in February 2020.
vaccine confidence

Health care worker views can impact public vaccination practices, DO and student-led study finds

Sparked by New York’s 2019 measles outbreak, the study’s preliminary findings are also pertinent to fostering patient confidence in the safety of COVID-19 vaccines.

In 2019, as New York state experienced its largest measles outbreak since the 1990s, Atif Towheed, PhD, OMS III, then a second-year medical student at Touro College of Osteopathic Medicine-Middletown (TouroCOM), and his colleagues wondered: do health care workers’ opinions on vaccination impact public vaccination practices?

To answer this question, Dr. Towheed, his colleagues and the research team’s principal investigator and project leader, Stephanie Zeszutek, DO, sent out a voluntary survey to physicians, medical students, nursing professionals and allied service providers.

570 respondents from 35 states provided the researchers with several interesting findings, namely that the views of health care workers do impact community vaccination, and that health care workers and their patients need more vaccine education. Dr. Towheed received the 2020 Burnett Osteopathic Student Researcher Award from the American Osteopathic Foundation for his efforts, and is currently submitting the study to peer-reviewed journals.

Of course, nobody could have known how pertinent the study would prove to be in 2020.

“We’re discussing this at a very opportune time because the lessons we learned very much apply to these COVID-19 vaccines in circulation,” Dr. Towheed said. “It was true of vaccines then and it’s true now: it all comes down to keeping ourselves abreast with the most updated, reliable and relevant information, and filtering out misinformation.”

In this edited Q&A, he discusses the study’s preliminary conclusions, the state of vaccine education in America, and what can be done to increase physician and other health care workers’ confidence in discussing the benefits and risks of vaccines.

Other than the measles outbreak in New York, what inspired you to start this research?

It started with a discussion about the key problems facing our communities when it comes to vaccinations, based on one of our team member’s experiences during her clinical rotations. We were discussing about the confidence levels among health care workers, and how that might impact the rate of vaccine uptake.

During those discussions, we realized that a lot of research had focused on the patient perspectives and their willingness to get vaccinated. Those who choose not to vaccinate have a significant impact on public health and the persistence of vaccine-preventable diseases.

So, we wanted to study the other side of the spectrum, the health care workers — people who administer these vaccines to patients. We wanted to determine whether their own perspectives and confidence levels about the risks and benefits of vaccines have a role to play in patients making those decisions.

How did you assess health care workers’ confidence levels in vaccines?

Some of the questions we asked included, “How frequently do you talk to your patients about vaccination?” and “How confident are you in talking about the risks and the benefits of vaccines?” and “How often do you get your flu shot?”

To understand disparities between confidence levels, we then asked, “Are you familiar with the vaccination laws and policies around your area?” and “What do you think are barriers to vaccination according to the patients’ perspective?” among other questions.

Our results indicate that a health care worker’s confidence in discussing the benefits of vaccines increases with age, which can reflect more experience. We also found differences in the confidence levels in rural, suburban and urban settings. Health care workers in rural settings reported less confidence in discussing the benefits of vaccines with their patients.

What relationship did you see between health care worker confidence and attitudes toward vaccines and reported patient uptake?

The top few reasons health care workers gave for patients’ perspectives on barriers to vaccination were: lack of patient awareness or education, safety concerns, or fear of getting sick from the vaccines.

These responses were important because they correlate to health care worker confidence. If a health care worker is not confident in discussing the benefits and/or risks of a vaccine or does not choose to discuss vaccines at all during a short visit, a patient misses a chance to have their concerns or questions addressed by a reliable source.

If a health care worker is knowledgeable and confident, they are well-positioned to convince a patient to get vaccinated or address questions about vaccines, thereby empowering them to make an informed decision.

Based on our data, I believe there is a connection between health care workers’ confidence and what they think are the barriers to vaccination from the patient perspective. That is one area we could really focus on as we construct and implement policies and improve vaccine education.

Did you get a sense for what specifically was preventing patients from getting the vaccine education that they need?

We explored it to a certain extent. However, this is a question pertaining to the patients. We wanted our study to be distinct and approached the issue from the perspective of health care workers.

Interestingly, 88% of the respondents thought social media played a role in how patients make their vaccine decisions. It comes down to the balance between information and misinformation. Misinformation is prevalent in today’s world of online information overload, which we believe impacts confidence levels and how frequently health care workers discuss vaccines with their patients.

Though this study was completed prior to COVID-19, what lessons do from it can be applied to help health care workers feel confident in distributing the COVID-19 vaccines?

We have to remember that this study stemmed from concerns about a measles outbreak and general findings of lack of confidence among health care workers. No one anticipated COVID-19, but this question of confidence and educational awareness has become so pertinent not only from the patient perspective but also from the health care workers’ perspective.

The COVID-19 vaccines are entirely new and developed in a record timeline. These factors have caused some apprehension among the public, including several health care workers I’ve worked with on my clinical rotations. Even though we are excited that we have efficacious vaccines, reports in the media suggest that a considerable percentage of the population wants to wait and see how it turns out just because they are so new.

We must avoid misinformation and use logic, rely on primary literature, and seek out information from experts with reliable credentials. Health care workers have to take their own confidence levels into account and get the most up-to-date information to ensure patients and they themselves feel confident getting the vaccine when it is their turn.

Related reading:

COVID-19 vaccine advice from DOs who’ve been vaccinated themselves

AOA statement regarding vaccine misinformation and hoaxes

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