Misconceptions about COVID-19 vaccine among adults in Saudi Arabia and their associated factor

It is of the utmost importance for the elements that influence public compliance to the COVID-19 vaccine to be assessed, including misconceptions, rumors, and conspiracy theories. Hence our study aimed to estimate the distribution of the most common misconceptions and their predictors in Saudi Arabia. We distributed an online questionnaire to participants who were 18 years or older at the time of the survey, which included four sections: demographic characteristics of participants, level of their education, their sources of information, and perception of participants regarding eleven of the most common misconceptions in the community.

An evaluation of the relationships between different predictors and acceptance of these misconceptions was conducted using ordinal logistic regression; the most widely accepted misconception was that the vaccine has serious side effects, with 34.8% of participants reporting this.

Accepting this misinformation Factors that were significantly associated with acceptance or refusal of misconceptions were:

Gender, as females in this survey significantly accept rumors more than males (p<0.001);

Educational level, especially secondary school, was associated with a significant decrease in acceptance of misconceptions (p=0.001);

Information source. 60.5% of participants use social media as their primary source of information, and it was also a significant positive predictor of acceptance of misconceptions (p=0.034).

It is of utmost importance to increase assurance in the safety of the vaccine, as it was the most accepted misconception, and to address the elements that affect believing rumors among the population.

Methods
This study is a cross-sectional study in which an online survey was undertaken in Saudi Arabia between the 21st of April to December 28th, 2021. All adult male or female individuals (Citizens and Residents) who were older than 18 years and lived inside the Kingdom of Saudi Arabia during the study were allowed to participate. The data was gathered using a Google form-based Questionnaire and electronic invitations were sent using WhatsApp, Facebook, and Twitter.

In the first section of the questionnaire, participants were informed about the study's purposes and assured about the confidentiality of their information. Their consent was obtained before proceeding with the questionnaire, and they were allowed to withdraw at any time.

A pilot study was initially carried out with 10% of participants beforehand to test the applicability and accessibility of the study sample, to reveal the difficulties in the design and language that may arise in the questions, and to determine the best way to deal with them. The questions were written in the Arabic language because it is the official language of participants and then translated to English. Then results were retranslated back to Arabic to assure that no change in the meaning occurred.

 A Likert scale of 4-points was designed to assess the acceptance of many misconceptions that spread among the public and their predictors. In which agreeance to the misconception denoted the number: Strongly agree (4), Agree (3), Disagree (2); Strongly disagree (1).

Survey Items

The survey consists of two parts; the first section contains questions on the sociodemographic characteristics of participants, including gender, age, profession, and educational level, in addition to the origin of information in regard to COVID-19.

The second section was composed of 11 misconceptions, which were derived from literature, community, social media, and websites, and respondents were requested to demonstrate to what extent they agree or disagree with each of the ten items using a 4-point scale which was categorized into strongly disagree assigned (1) to strongly agree (4).

The eleven misconceptions discussed were:

1) I do not believe in the safety of the COVID-19 vaccine.

2) My genetic material will be affected by the COVID-19 vaccine.

3) A device will be implanted in my body using the COVID-19 vaccine.

4) The COVID-19 vaccine has serious side effects, such as causing a severe allergy.

5) Fertility is decreased in women by the COVID-19 vaccine.

6) I have been infected before with COVID-19 so vaccination is unnecessary.

7) Once I am vaccinated, I don't have to wear a facemask.

8) COVID-19 vaccine will change my test result to positive.

9) I'm unlikely to have complications from Covid-19, so it is not necessary for me to be vaccinated.

10) You can get COVID-19 from the vaccine.

11) If I am vaccinated I am more likely to get another disease.

评估影响公众新冠疫苗依从性的各类因素——包括错误认知、谣言与阴谋论——具有至关重要的意义。本研究旨在梳理沙特阿拉伯境内最常见的新冠疫苗相关错误认知及其影响因素的分布特征。本研究面向调查时年满18周岁的受访者发放线上问卷，问卷共包含四个模块：受访者的人口统计学特征、受教育水平、信息获取渠道，以及受访者对社区内11种最常见错误认知的认知态度。

本研究采用有序logistic回归分析不同影响因素与错误认知接受度之间的关联。结果显示，接受度最高的错误认知为「新冠疫苗存在严重不良反应」，共有34.8%的受访者表示认同该观点。与错误认知的接受或拒斥显著相关的因素包括：
1. 性别：本次调查中女性相较于男性更易接受谣言（p<0.001）；
2. 受教育水平：拥有中等教育（中学）学历的群体，其错误认知接受度显著降低（p=0.001）；
3. 信息获取渠道：60.5%的受访者将社交媒体作为主要信息来源，而社交媒体同时是错误认知接受度的显著正向预测因素（p=0.034）。

鉴于「新冠疫苗存在严重不良反应」是接受度最高的错误认知，提升公众对疫苗安全性的信心，并针对性干预影响民众轻信谣言的各类因素，具有极高的现实意义。

研究方法：本研究为横断面研究，于2021年4月21日至12月28日在沙特阿拉伯境内开展线上调查。所有在研究期间居住于沙特阿拉伯王国境内、年满18周岁的成年男性与女性公民及常住居民均可参与本研究。数据通过基于Google表单的问卷收集，调研邀请通过WhatsApp、Facebook及Twitter发送。

问卷第一模块向受访者说明本研究的研究目的，并承诺对其个人信息严格保密。受访者在填写问卷前需签署知情同意书，且可随时退出调研。

本研究先期开展了预实验，招募10%的受访者参与，以检验研究样本的适用性与可及性，排查问卷设计及语言表述中可能存在的问题，并确定针对性的优化方案。由于阿拉伯语为受访者的官方语言，问卷题目最初以阿拉伯语编写，随后译为英文，再将英文版本回译为阿拉伯语，以确保语义未发生偏移。

本研究采用4级李克特量表（Likert Scale）评估公众广泛传播的各类错误认知的接受度及其影响因素，评分规则为：完全同意（4分）、同意（3分）、不同意（2分）、完全不同意（1分），得分越高代表对错误认知的认同程度越高。

调研问卷模块设置：问卷共包含两个模块。第一模块为受访者的社会人口学特征相关问题，涵盖性别、年龄、职业、受教育水平，以及新冠疫情相关信息的获取渠道。

第二模块包含11种新冠疫苗相关错误认知，这些认知均来源于文献、社区讨论、社交媒体及公开网站。受访者需通过前述4级李克特量表（1分=完全不同意，4分=完全同意）表明对每条错误认知的认同程度。

本次调研涉及的11种错误认知如下：
1. 我不相信新冠疫苗的安全性
2. 新冠疫苗会改变我的遗传物质
3. 接种新冠疫苗会在我体内植入设备
4. 新冠疫苗存在严重不良反应，例如引发重度过敏
5. 新冠疫苗会降低女性的生育能力
6. 我曾感染过新冠病毒，因此无需接种疫苗
7. 接种疫苗后就无需佩戴口罩
8. 接种新冠疫苗会导致我的新冠检测结果呈阳性
9. 我感染新冠后不太可能出现并发症，因此无需接种疫苗
10. 接种新冠疫苗会感染新冠病毒
11. 接种新冠疫苗会使我更易罹患其他疾病