Google form data_ Public awareness and acceptance of COVID-19 vaccine: An online cross-sectional survey, conducted in the first phase of vaccination drive in India

AbstractThe context-specific, complex issue of ‘vaccine hesitancy’ is explicated in terms of delay or refusal of vaccination despite the availability of vaccine services. Although eleven million beneficiaries were administered the COVID-19 vaccine in India from 16th January 2021 till 20th February 2021, however, the turnout seemed dismal in various regions. We report the response (collected between Feb 1, 2021 and Feb 15, 2021) of 358 voluntary respondents who participated in an online questionnaire-based pan-India survey, executed to assess their knowledge and acceptance towards the COVID-19 vaccination program in its first phase. The survey questionnaire consisted of demographic characteristics of the respondents and queries pertaining to knowledge (7 items) and acceptance (3 items). The overall correct rate and the average knowledge score of the participants were 78 % and 5.46 ± 1.4/7 respectively. The acceptance score was 3.50 ± 1.6/5 while 70 % of participants agreed against the 20 % of respondents who neither agreed nor disagreed to take the vaccine. Around 66 % believed that the vaccines, currently being administered in India are safe. Fear about possible side effects (44 %) and inadequacy of comprehensive clinical trial data (29 %), seemed to be the major players in fortifying the vaccine hesitancy among the respondents, exhibiting negative acceptance. Although maximum respondents demonstrated a good level of knowledge (82%) and acceptance (88%), significant differences were observed among some demographic variables. In general, a positive correlation was observed between knowledge and acceptance against a negative correlation, observed in specific provinces. Despite the good acceptance and knowledge, a considerable fraction of the participants (30%) expressed hesitancy. Counselling, mobilization, and feedback from vaccinated individuals about safety should be encouraged. However, due to the limited sample size, we must be cautious when generalizing these findings. Nevertheless, the major elucidations of this study may be utilized in planning vaccination campaigns in further phases. Methods<b><i>Survey plan and Participants</i></b><b> </b>The time-frame of this cross-sectional survey was set from February 01, 2021 to February 15, 2021. During this period, the first phase of COVID-19 vaccination was initiated among the healthcare workers and frontline workers. The lockdown was relaxed, although citizens were advised to maintain social distancing, wear masks and wash hands. The nation also witnessed partial reopening of educational institutions in various states. However, it was not feasible as well as advisable to conduct any off-line survey during this period, therefore, we decided to collect the data online using Google form. A one-page poster (<i>Electronic Supplementary Fig. ES1</i>) was prepared and posted through various social media platforms like WhatsApp, Facebook, Twitter, and Telegram, based on the authors’ network. The poster contained an introduction and objectives of the work, besides information about requirements on the part of the participants, nature of voluntary participation, declaration of anonymity and confidentiality, online link, and the invigilators' details. The respondents were Indian citizens, aged 18 years or more, who understood the content of the poster and voluntarily agreed to participate in the study without receiving any compensation or remuneration. An e-certificate was provided to the participants as a token of appreciation (directly delivered via e-mail), therefore, we had requested the submission of the name and e-mail address of each respondent through the Google form. <b><i>Questionnaires and score</i></b> We designed a survey questionnaire, based on the current situation. The questionnaire consisted of demographics of the participants, knowledge, and acceptance-attitude towards the current COVID-19 vaccination program in India. Demographic variables included gender, age, state, marital status, education status, occupation, area (urban vs. rural) and the state/union territory of residence (province) (Table 1). A total of 7 questions, pertaining to the assessment of the knowledge about COVID-19 were framed (Table 2). These questions were primarily multiple options based or of true/false nature with an additional ‘I don't know’ choice. A correct answer was awarded 1 point and an incorrect/unknown answer, a 0 point. The total knowledge score ranged from 0 to 7; a cut-off score of &lt;4 was set as ‘poor’ and &gt;5, ‘good’ knowledge. A total of 3 questions for acceptance (Table 3) were prepared and rated on the 5-points Likert scale ranging from strongly disagree (1), disagree (2), neutral (3), agree (4) and strongly agree (5). Five points were awarded to the responses, marked as 'strongly agree' with scores decreasing to 1 for the responses of 'strongly disagree', as far as the positive-acceptance questions were concerned. For the negative-acceptance questions, a score of 1 was awarded for the response- 'strongly agree', with the score increasing to 5 corresponding to the response, 'strongly disagree'. People who scored &gt;7 were classified as those with an attitude of ‘positive’ acceptance while the participants, scoring &lt;7 were considered as those with a ‘negative’ acceptance-attitude towards the vaccination.<b> </b> <b><i>Statistical analysis</i></b> The data collected from the survey were collated while the incomplete and repeated/multiple responses were deleted. The first completed responses were considered as accurate. The descriptive statistics and one-way analysis of variance (ANOVA) or Chi-square test as appropriate were performed using Microsoft Excel to determine the differences between the groups for selected demographic variables and their knowledge and acceptance towards COVID-19 vaccination. Regression tests were applied to assess any correlation between knowledge and acceptance scores. The statistical significance level was set at p<i>&lt;</i>0.05.<b></b> <b>Ethical considerations</b>All procedures performed in this study, involving human participants, complied with the institutional ethical standards and were approved by the Ethical Committee of the Institute of Advanced Research, Gujarat, India. Moreover, the study was designed and conducted in accordance with the ethical principles established by the “Committee on Publication Ethics (COPE)” guidelines to handle publication ethics. The online pages for the self-administered questionnaire could be accessed by the participants for attempting and completion, subjected to indication (through a click on ‘Yes’ button) of consent for voluntary participation. Confidentiality of the participants' information was ensured throughout the study.