The authors of this article declare no conflict of interest.
This study seeks to analyse the relationship between needle-related fear (NF) and vaccination fear (VF), vaccination intention (VI), and the most commonly declared reasons for avoiding vaccination (RAV). The aim was to expand the information on the subject in a pandemic context. Just before starting the vaccination plan. A cross-sectional survey was applied to a sample (
El objetivo de este estudio es analizar la relación entre el miedo a la aguja (MA) y el miedo a la vacunación (MV), la intención de vacunarse (IV) y los motivos más comúnmente alegados para evitarlo (MEV). Se pretende ampliar la información sobre el tema en un contexto de pandemia. Justo antes de iniciar el plan de vacunación. Se aplicó una encuesta transversal a una muestra (
Vaccinations are the best way to promote health by reducing morbidity and mortality from infectious diseases. Nevertheless, the usual administration method, by needle puncture, can cause fear and generate a rejection or avoidance of vaccination.
The recorded prevalence of needle-related fear (NF) is highly variable. This is due to the fact that, in general, studies have been carried out in population groups subjected to treatments that require needle administration, as is the case of patients with allergies (e.g.,
Studies on avoidance of treatment due to NF have also been carried out in specific population groups such as those undergoing dental interventions (e.g.,
The prevalence of NF, and the avoidance of treatment due to this reason, is influenced by the sociodemographic variables of age and sex. Higher levels of prevalence have been observed in young people and women (e.g.,
At the time of this study no references were found on the prevalence of NF among adult citizens who needed vaccination as a result of a pandemic such as COVID-19, which affects the world population and has a high rate of infection and mortality, not being comparable to the cases studied referenced in the bibliography. Therefore, given the expected increase in the number of future pandemics and the possibility that NF has a negative impact on vaccination plans, it is considered necessary to address this knowledge gap.
In parallel to NF, in previous vaccination plans against influenza, measles, or papilloma, it has been observed that vaccine-related conspiracy theories (CTs) were associated with a greater vaccination refusal (e.g.,
In this context, the present study aims to expand previous research on the relationship between needle-related fear (NF), vaccination fear (VF), vaccination intention (VI), and some commonly used reasons to justify vaccination avoidance in adult Spanish citizens. The hypotheses of the study were that NF (1) will be influenced by demographic variables such as gender and age and will present (2) positive and significative relationships with VF, (3) negative and significative relationship with VI, and also (4) positive and significative relationships with alleged reasons to avoid vaccination (RAV) other than NF.
The study is carried out in December 2020, in the Autonomous Community of Catalonia (Spain) during the second wave of the COVID-19 pandemic. The date was very close to the implementation of the vaccination plan against the disease, which began at the end of that month. The selected context resembles that used by
Two thousand one hundred seventy-five adult Spanish citizens, residents in the Autonomous Community of Catalonia, were recruited for this study. Of this, 32.7% were men and 67.3% women, with a mean age of 37.61 (
This study was carried out from data obtained from three different databases. The first database includes the results from the recruitment of teachers, the second includes the results of university students and the third database includes the results of emergency medical personnel. Secure Google Forms was used for data collection and storage. The instruments were administered online. Recruitment was carried out with a message containing the study link, which was distributed by email. To obtain the first database, the message was sent to the general mail of all the infant, primary, and secondary education centres in Catalonia, so that they could voluntarily forward it to their teachers. For the second database, the message was sent to approximately 50% of the professors of all the Catalan universities, so that they would voluntarily forward it to their students. For the third database, the message was sent to the person in charge of human resources of the Medical Emergency Service of Catalonia, so that he or she could forward it to his staff. Participation was completely voluntary. Participants were not compensated in any way for their participation. Individuals who clicked the survey link were debriefed on the first page with a description of the study and its aims. Verification that participant data would be recorded anonymously and confidentially was provided, and a statement ensuring that they had the choice to stop participating in the survey at any point in time was also included. Participants digitally provided their informed consent by clicking to proceed to take part in the survey. Thus, to continue administering the questionnaires, each participant had to agree the terms of the study that complied with the Declaration of Helsinki. There were no additional institutional ethical requirements for the authors.
Participants were asked about age, gender, marital state, dependents in charge (with/without minors/older dependents), and employment.
Taking into account the experience followed by
It is a six-item scale rated on a 5-point scale from 1 (
We adapted the single item used by Jolley and Douglas (2017), and
It includes the most common reasons for avoid vaccination (RAV) in western societies. Several steps were taken to develop the battery of reasons for avoiding vaccination. First, a literature review was conducted to assess all reasons recorded by other researchers (e.g.,
RAV-1: I do not want to be vaccinated because I do not believe that the vaccines that will be used in Spain are effectives to control COVID-19.
RAV-2: I do not want to be vaccinated because I do not believe that the vaccines that will be used in Spain are safe for the population.
RAV-3: I do not want to be vaccinated because I do not believe that the disease is as deadly or serious as they say.
RAV-4: I do not want to be vaccinated because I believe that vaccination is just a way to earn money from pharmaceutical companies.
RAV-5: I do not want to be vaccinated because I believe that vaccination is an invention of the governments to limit the freedoms of the population.
The sentences were evaluated, using a Likert-type scale with five response options, ranging from 1 (
Demographic characteristics were studied using frequency analysis. To identify if there were significant differences in NF related to sociodemographic variables the Student’s
Demographic prevalences can see in
According to study data, 5.2% of the sample agree and strongly agree with the sentence related to NF and 40% would have VF (see
The mean, skewness, and kurtosis can be seen in
The results of the correlations between the analysed variables, as well as the strength and directionality of the associations, can be seen in
*All correlations were significant at the .01 level (two-tailed).
NF is significantly associated (
The sample analysed is large and has allowed the aims of this study to be achieved. In the first place, they allow us to establish prevalences of 5.1% for NF, 40% for VF, and 49.8% for VI. In turn, percentages of 44.8% were obtained for negative beliefs related to the usefulness of vaccines, 44.2% related to their safety, 6% who do not believe in the information on the severity of the disease, 12, 4% who see the interests of pharmaceutical companies behind, and 7.6% who distrust the information provided by the government. In any case, the percentage of people who declare neither for nor against is striking, being indicative of the high percentage of hesitant, especially for VI (23.7%) and for those who doubt the efficacy of the vaccine for controlling the infection (41.8%). The prevalence of 5.1% obtained for NF is within the range of 3.5 to 10% reported by
The analysis of NF related to sociodemographic variables indicates being a woman (
The correlation analysis results were in line with hypotheses 2 to 4. NF has weak but significant and positive correlations with VF (rho = .30,
The hierarchical regression analysis confirms the data found in the correlation analysis. The explained variance of NF on VF and VI is significant (β = .29,
In conclusion, the results confirm the study hypotheses. NF is influenced by sociodemographic variables of age, gender, and dependency. NF presents significant (although low) relationships with analysed variables, being positive with FV, negative with VI, and positive with RAVs related to negative beliefs about the safety of vaccines, hoax about the severity of the infection, and mistrust of pharmaceutical companies and the government. Only RAV on vaccine effectivity not was confirmed.
The results may be influenced by several limitations present in the study. First, the sample includes a high proportion of women, and teachers or students, not being representative of the general Spanish population. Second, the ethic approval did not enable the gathering of participants information before inviting them to enrol in the study. Thus, it is likely that the final sample examined in the study may not be representative of the analysed groups. So, it may be questionable how the results may apply to general population. In future studies, it would be advisable to test other population groups, which will allow a more precise estimate of the prevalence of needle-related fear and their relation with vaccination intention or reasons for avoiding vaccination. Third, the cross-sectional design of the study does not allow conclusions to be drawn on cause-effect. Long-term studies are recommended to delve into this topic. Finally, the current study relied exclusively on self-report. The nature of self-report measures has not allowed us to objectively evaluate the associations between the study variables, which could in turn be affected by factors of social desirability or other sources of bias, such as ease of access or use of on-line tools. All in all, the results open up the possibility of continuing the investigation on this matter.
This study analyses the relationship between NF and RAV, related to negative beliefs about the efficacy and safety of vaccines, and certain conspiracy theories of hoax and mistrust. The results indicate that people affected by NF were more likely to express RAVs related to hoax and mistrust. In general, these beliefs are characterized by being nebulous, resistant to refutation (
On the other hand, in this sample the percentage that answers neither for nor against when asked about NF (7.4%) or VI (23.7%) stands out. This percentage of hesitant constitutes an optimal working group to reduce the levels of NF and VI, since, as indicated by
Finally, although the data confirm that NF decreases with age, the maximum prevalences are around 20 and 40 years of age, so interventions to reduce NF in the adult population will be appropriate as a measure to reduce the vaccination avoidance.
Cite this article as: Malas, O. & Tolsá, M. D. (2022). Needle-related fear versus vaccination fear, vaccination intention, and declared reasons for avoiding vaccination.