CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Infectious diseases continue to pose serious public health challenges across the world. They contribute significantly to illness and death and place additional financial demands on healthcare systems (Al-Tawfiq et al., 2020).

In December 2019, an outbreak of an unknown coronavirus was reported in Wuhan City, China, according to the World Health Organization (WHO, 2020). On January 8, 2020, the Chinese Center for Disease Control and Prevention (China CDC) announced that the disease was caused by a newly identified coronavirus (Al-Tawfiq et al., 2020). The virus was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Common symptoms of the infection include fever, coughing, sore throat, tiredness, and difficulty breathing. Research also confirmed that the virus could be transmitted between individuals, while proper hygiene practices could help prevent its spread (Chavis & Ganesh, 2020; Chen et al., 2020; Deng & Peng, 2020).

Following the emergence of the coronavirus pandemic in Nigeria, the government, like those of other countries, introduced several restrictions to control the spread of the infection. These measures included cancelling events, limiting international flights, and suspending social, official, and religious gatherings (Adamu, 2020).

Several preventive strategies were adopted during the COVID-19 pandemic to reduce the transmission of SARS-CoV-2 (Chou & Budenz, 2020). Among these strategies, vaccination was considered one of the most important public health interventions for controlling the disease. Towards the end of 2020, COVID-19 vaccines became available, and many countries identified healthcare workers (HCWs) as priority groups for vaccination. The success of vaccination programmes largely depends on the willingness of eligible individuals to receive the vaccines. Healthcare workers are particularly important in this regard because of their professional responsibilities and their influence on public attitudes towards immunization (Logunov et al., 2021).

Healthcare workers are exposed to a greater risk of contracting SARS-CoV-2 because their duties involve direct contact with patients. They may also unintentionally transmit infections within healthcare facilities, where they provide services to vulnerable individuals, including older people and patients with existing medical conditions. Since these individuals often require special attention and medical care, preventing infection in healthcare environments is particularly essential (Loomba et al., 2021). Some studies have suggested that nurses may demonstrate greater willingness to accept COVID-19 vaccination than members of the general population, possibly because they recognize their increased exposure to the virus (Cucinotta & Vanelli, 2020).

Compliance with disease-prevention measures is influenced by people's attitudes, perceived risk of infection, and understanding of the dangers associated with a disease. During the COVID-19 pandemic, some studies observed higher compliance with preventive practices among individuals experiencing psychological distress, anxiety, increased awareness of their vulnerability to infection, and stronger concerns about germs (Odriozola-González et al., 2020). Similarly, the decision to accept or reject vaccination is affected by different considerations. These include fears of adverse reactions, concerns about vaccine safety, doubts about effectiveness, insufficient knowledge about the disease and its vaccines, low perceived risk of infection, fear of injections, and the belief that the disease is not serious enough to require vaccination (Jiang et al., 2021).

In 2020, several COVID-19 vaccine candidates were undergoing clinical evaluation, while some had already received approval for use in certain countries (World Health Organization, 2020). Vaccination on a large scale was considered an important measure for reducing the spread of the virus. Reports indicated that China began administering its vaccine to nurses in early July 2020 (Helen, 2020). On December 30, 2020, Singapore became the first country in Asia to approve the Pfizer-BioNTech vaccine, Tozinameran, for use, including among healthcare workers (Singapore Ministry of Health, 2020). Other Asian countries also made plans to commence their vaccination programmes in early 2021. However, the effectiveness of these programmes depended on the willingness of eligible people to receive the vaccines. Consequently, vaccine hesitancy became a major concern in efforts to control the pandemic. The World Health Organization had earlier identified vaccine hesitancy as one of the ten leading threats to global health in 2019 (World Health Organization, 2019).

Nurses play an important role in providing health information, especially on disease prevention. Their professional knowledge and opinions can influence the decisions people make about vaccination (Kreps et al., 2020). Studies on nurses' vaccination practices and opinions concerning vaccines for influenza, human papillomavirus (HPV), hepatitis B, and other infectious diseases have indicated that knowledge of vaccine safety and effectiveness can improve healthcare workers' confidence in immunization and their willingness to recommend vaccines. Encouragement from colleagues and positive acceptance within society may also influence their decisions (Baden et al., 2021). It is therefore necessary to understand healthcare workers' views, intentions, and concerns about vaccination, as well as how their sociodemographic characteristics may relate to their willingness to receive COVID-19 vaccines.

Nursing students also have an important role to play in vaccination and disease-prevention activities. Their training exposes them to practical healthcare environments, and some may already be working within the health sector. Through their education, they are prepared to participate in health promotion, disease prevention, and patient education (Kreps et al., 2020). Research into the preventive practices of nursing students during the COVID-19 pandemic has generally shown that many students followed the recommended protective measures (Van Bavel et al., 2020). Nevertheless, some individual studies have identified weaknesses in students' understanding of basic measures for preventing viral transmission in hospitals and communities (Dong et al., 2020). There has also been limited research specifically addressing nursing students' intentions to receive COVID-19 vaccines. For instance, a study conducted in the United States reported that just 45% of the nursing students who participated intended to receive a COVID-19 vaccine (Bell et al., 2020).

Given their future responsibilities as healthcare professionals, nursing students are expected to contribute to healthcare teams and participate in activities that promote vaccination and prevent disease. Research has therefore examined their preventive practices, willingness to receive vaccines, and readiness to recommend vaccination to others. One such study assessed these issues among nursing students in Slovenia, Poland, and Serbia. These three Central and Eastern European countries have nursing education systems with similarities based on European Union Directive 2005/36/EC (Helmy et al., 2020). The research was expected to add to existing knowledge about nursing students' attitudes towards preventive practices, vaccine acceptance, and their willingness to encourage others to get vaccinated. It also aimed to identify areas requiring additional investigation and practical attention. The study proposed that previous work experience could be associated with better compliance with preventive measures, greater willingness to receive vaccination, and increased readiness to recommend vaccines. It further examined whether a sense of responsibility towards patients could motivate nursing students to accept vaccination.

In view of these issues, the present study examines the acceptance of and attitudes towards COVID-19 vaccination among student nurses at Seventh-day Adventist School of Nursing, Ile-Ife, Osun State. Specifically, it investigates their knowledge of the COVID-19 vaccine, their willingness to receive it, and their perceptions and attitudes towards its use.

1.2 Statement of the Problem

The emergence of coronavirus disease 2019 (COVID-19) in Nigeria generated considerable fear, anxiety, and concern among members of the public. Unlike many previously known infectious diseases, COVID-19 created a serious public health problem because of its ability to spread rapidly and cause severe illness in some infected individuals. The pandemic also placed considerable pressure on healthcare facilities and increased the responsibilities of healthcare professionals.

By December 2020, reported cases of COVID-19 in Europe had exceeded 18 million, while deaths had surpassed one million, based on the figures cited in the original study. The pandemic placed hospitals under significant pressure and negatively affected the working conditions and psychological well-being of healthcare professionals. During this period, the first COVID-19 vaccines were undergoing assessment and receiving authorization from the European Medicines Agency and the European Commission. Governments and international health organizations were also developing strategies for the introduction and distribution of vaccines.

Under the European vaccination strategy, healthcare workers were included among the priority groups for immunization. The strategy established a target of vaccinating 80% of healthcare workers by August 2021 (Abdallah & Lee, 2021). This decision was based on the need to protect healthcare personnel, ensure the continued delivery of essential medical services, and reduce the possibility of infection within healthcare facilities.

However, the introduction of COVID-19 vaccines was accompanied by concerns about their acceptance among healthcare professionals in different countries. Research conducted during the early stages of vaccination programmes showed that some healthcare workers were uncertain about receiving the vaccines or were unwilling to do so. In a study conducted among healthcare professionals in Quebec, France, and Belgium between October and November 2020, Verger et al. (2020) found that 43.8% of respondents were certain that they would receive the COVID-19 vaccine, while 28.5% said they would probably receive it. These results created concerns about whether vaccination coverage would reach the levels expected by public health authorities. Similarly, Gharpure et al. (2021) reported that the median percentage of participating long-term care workers in the United States who received their first vaccine dose between mid-December 2020 and mid-January 2021 was 37.5%. This finding demonstrated the difficulties associated with achieving high vaccination uptake among certain categories of healthcare workers.

Although healthcare professionals are expected to have adequate medical knowledge and promote healthy practices, their professional education does not automatically prevent doubts or unfavourable opinions about vaccination. Nursing students deserve particular attention because their training combines classroom instruction with practical clinical experience, during which they may interact directly with patients. Their understanding, perceptions, and willingness to receive COVID-19 vaccination may affect their personal safety, their future professional conduct, and their ability to provide accurate information about immunization to patients.

At Seventh-day Adventist School of Nursing, Ile-Ife, Osun State, it is necessary to understand how student nurses perceive COVID-19 vaccination and whether they are willing to receive the vaccine. Examining their knowledge and attitudes may reveal misconceptions, safety concerns, and other issues that could influence their decisions. It is against this background that the present study investigates the acceptance of and attitudes towards COVID-19 vaccination among student nurses in the institution.

1.3 Objectives of the Study

The main objective of this research is to examine 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 level of knowledge of student nurses at Seventh-day Adventist School of Nursing concerning the COVID-19 vaccine.

2. Determine the extent to which student nurses at Seventh-day Adventist School of Nursing accept COVID-19 vaccination.

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 are formulated to guide the study:

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

2. To what extent do student nurses at Seventh-day Adventist School of Nursing accept COVID-19 vaccination?

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

1.5 Justification and Significance of the Study

Healthcare workers have played a central role in the prevention and management of the COVID-19 pandemic (Chew et al., 2020a; Chew et al., 2020; Tan et al., 2020). For this reason, several countries made healthcare personnel a priority group for early vaccination to protect them against infection and ensure that essential health services could continue without interruption (Sun et al., 2021). However, reports of vaccine hesitancy among members of the public in different European countries raised questions about the difficulties of achieving widespread acceptance of COVID-19 vaccination (Lazarus et al., 2021).

Studies examining the willingness of healthcare workers to receive COVID-19 vaccines have focused on understanding their concerns, the reasons behind their hesitation, and the factors that influence their vaccination decisions. These investigations have also sought to identify factors that independently predict willingness to be vaccinated. Considering reports of reluctance towards COVID-19 vaccination among different population groups (Lazarus et al., 2021), it is important to understand the issues influencing vaccine acceptance. Such knowledge can support the development of appropriate interventions to increase vaccination uptake among frontline healthcare workers.

This study is important because it will provide information on the knowledge, acceptance, and attitudes of student nurses towards COVID-19 vaccination at Seventh-day Adventist School of Nursing, Ile-Ife, Osun State. Its findings may reveal areas of misunderstanding, concerns about vaccine safety, and gaps in information that could affect the students' willingness to receive the vaccine.

The findings may also benefit nursing educators, healthcare administrators, and public health professionals by providing information that can guide the development of educational programmes and effective communication strategies. Understanding the concerns of student nurses will make it easier to identify areas where additional explanations and health education are needed. This may support the preparation of appropriate health messages that can improve awareness and encourage positive attitudes towards vaccination.

In addition, the study may contribute to existing research on vaccine acceptance among nursing students and serve as a reference for further investigations in related educational institutions and healthcare settings. Its findings may also support health promotion and disease-prevention efforts by providing a better understanding of the factors that shape student nurses' opinions and decisions concerning immunization.

1.6 Scope of the Study

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

1.7 Limitations of the Study

The conduct of this research may be affected by certain challenges, particularly limitations relating to finance and time.

Financial Constraints: Limited financial resources may affect the researcher's ability to obtain necessary research materials, access relevant literature, collect information, and cover other expenses associated with the study. These financial difficulties may influence the extent and efficiency of the research activities.

Time Constraints: The researcher will conduct this study while attending to other academic responsibilities. As a result, the time available for reviewing relevant literature, gathering data, analysing the findings, and completing the research may be insufficient.

1.8 Definition of Terms

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

Attitude: Attitude describes a person's established thoughts, feelings, opinions, or responses towards a particular issue. In this study, it refers to the perceptions, opinions, and feelings of student nurses concerning COVID-19 vaccination.

Coronavirus Disease (COVID-19): COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease may produce respiratory symptoms such as fever and coughing and can sometimes result in breathing difficulties and other serious health complications.

COVID-19 Vaccine: A COVID-19 vaccine is a biological preparation developed to stimulate the body's immune system and provide protection against SARS-CoV-2, the virus responsible for COVID-19.

Nursing Student: A nursing student is a person enrolled in an academic and professional training programme designed to develop the theoretical knowledge, practical abilities, and professional skills needed to practise nursing.

Vaccination: Vaccination refers to the process of administering a vaccine to stimulate the body's immune system and provide protection against a particular infectious disease.

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