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Awareness of Covid-19 and attitudes toward vaccination in parents of children between 0 and 18 years: A cross-sectional study

Published:April 09, 2022DOI:https://doi.org/10.1016/j.pedn.2022.03.011

      Highlights

      • In conclusion, the parents in this study exhibited a moderate level of awareness of Covid-19.
      • In addition, parental desire to have their children vaccinated against Covid-19 was low.
      • In order to increase Covid-19 vaccination rates, doubts and lack of information concerning the vaccine need to be overcome by identifying reasons for vaccine hesitancy.
      • Doubts and lack of information concerning the vaccine can be resolved by providing greater information on the subject and through vaccination campaigns.

      Abstract

      Purpose

      Many countries are struggling with the covid-19 pandemic. Although many measures have been adopted to reduce the transmission of the virus, vaccination is the only solution for controlling and ending the pandemic. The purpose of this study is to evaluate the awareness of covid-19 and attitudes toward covid-19 vaccination in parents.

      Design and study

      The research is a descriptive and cross-sectional study. The online survey was conducted. The population of the study consisted of parents of children aged 0–18 who agreed to participate through the social media (Facebook and Instagram) between May 26 and July 7, 2021. With the community research model, the minimum sample size was determined as 384. A parent description form and the Coronavirus (Covid-19) Awareness Scale (CAS) were used for data collection.

      Results

      The mean Contagion Precaution Awareness sub-factor score of the CAS was 28.84 ± 10.55, the mean Awareness of Following Current Developments sub-factor score was 10.27 ± 4.63, and the Hygiene Precaution Awareness sub-factor score was 9.54 ± 3.55. Thirty-seven percent of the parents wanted their child/children to be vaccinated against Covid-19. A statistically significant association was determined between wished to have their child/children vaccinated against covid-19 and the mean CAS sub-factors scores (p < 0.05).

      Conclusions/practice implications

      Parents' awareness of covid-19 in this study was moderate. The willingness of parents to have their children vaccinated against covid-19 was also low. In order to increase Covid-19 vaccination rates, doubts and lack of information concerning the vaccine need to be overcome by identifying reasons for vaccine hesitancy.

      Keywords

      Introduction

      Covid-19 is a respiratory disease caused by the novel coronavirus SARS-CoV-2, discovered in 2019. The virus is thought to be transmitted from person to person through respiratory droplets emitted by an infected individual coughing, sneezing, or speaking (). The World Health Organization (WHO) reports that 172,345,882 individuals had been infected since the start of the pandemic up to 13 July 2021, that 98% of cases to date have been cured, while mortality has occurred in 2%. In addition, as of 13 July 2021, there were reported to be 12,107,917 active cases worldwide, 99.3% of which were mild, while 0.7% were severe or critical. In Turkey, 5,493,244 individuals were reported to have been infected as of 13 July 2021, with 50,324 deaths ().
      Measures aimed at reducing the spread of Covid-19 and protecting the individual and others include wearing masks that cover the nose and mouth, maintaining social distancing of approximately 2 m, avoiding crowded and enclosed areas, frequent handwashing with soap and water or disinfectant if these are unavailable, and Covid-19 vaccination ().
      Despite several methods being available for slowing the transmission of the virus, vaccination is the sole means of controlling and eradicating the pandemic (
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Caserotti M.
      • Girardi P.
      • Rubaltelli E.
      • Tasso A.
      • Lotto L.
      • Gavaruzzi T.
      Associations of COVID-19 risk perception with vaccine hesitancy over time for Italian residents.
      ;
      • Pogue K.
      • Jensen J.L.
      • Stancil C.K.
      • Ferguson D.G.
      • Hughes S.J.
      • Mello E.J.
      • Poole B.D.
      Influences on attitudes regarding potential Covid-19 vaccination in the United States.
      ). All countries fighting the Covid-19 pandemic are racing to develop and apply a safe and effective vaccine against the virus. The first mass vaccination program in the world commenced in December 2020 (). All countries have their own national Covid-19 vaccination strategies, and different countries have approved the use of different Covid-19 vaccines. The Pfizer-BioNTech, Moderna and Janssen Covid-19 vaccines have been approved by the U.S. Food and Drug Administration (FDA) (). The Covid-19 vaccines approved in the United Kingdom are Pfizer/BioNTech, Oxford/AstraZeneca, Janssen, and Moderna (). The Sinovac and Pfizer-BioNTech vaccine are administered in Turkey. Agreement has also been reached for Sputnik V to be manufactured in Turkey.
      Various priority groups are identified based on an evaluation of risks of exposure to Covid-19 disease, a severe course, and transmission to others, and vaccines are administered in order of priority (
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Republic of Turkey Ministry of Health COVID-19 Vaccine Information Platform
      COVID-19 vaccine national implementation strategy.
      ). All vaccines have been approved for adult use, while vaccine tests for children are still continuing, and children are not currently vaccinated. However, the WHO has concluded that the Pfizer/BionTech vaccine is suitable for use in children aged 12 years or more. This vaccine is recommended for children aged 12–15 years with a high risk of severe Covid-19 ().
      In order for a vaccination program to be successful, the vaccine must be accepted by the great majority of the population (
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Pogue K.
      • Jensen J.L.
      • Stancil C.K.
      • Ferguson D.G.
      • Hughes S.J.
      • Mello E.J.
      • Poole B.D.
      Influences on attitudes regarding potential Covid-19 vaccination in the United States.
      ). The main causes of vaccine refusal include believing that the vaccine is ineffective, and general distrust of vaccines (
      • Al-Qerem W.A.
      • Jarab A.S.
      COVID-19 vaccination acceptance and ıts associated factors among a middle eastern population.
      ;
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Eguia H.
      • Vinciarelli F.
      • Bosque-Prous M.
      • Kristensen T.
      • Saigí-Rubió F.
      Spain’s hesitation at the gates of a COVID-19 vaccine.
      ;
      • Pogue K.
      • Jensen J.L.
      • Stancil C.K.
      • Ferguson D.G.
      • Hughes S.J.
      • Mello E.J.
      • Poole B.D.
      Influences on attitudes regarding potential Covid-19 vaccination in the United States.
      ;
      • Taylor S.
      • Landry C.A.
      • Paluszek M.M.
      • Groenewoud R.
      • Rachor G.S.
      • Asmundson G.J.G.
      A proactive approach for managing COVID-19: The importance of understanding the motivational roots of vaccination hesitancy for SARS-CoV2.
      ), and concerns over the safety of vaccines (
      • Ahmed N.J.
      • Alkhawaja F.Z.
      • Alrawili A.S.
      Barriers ınfluencing COVID-19 vaccination uptake among the public in Saudi Arabia.
      ;
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Neumann-Böhme S.
      • Varghese N.E.
      • Sabat I.
      • Barros P.P.
      • Brouwer W.
      • van Exel J.
      • Stargardt T.
      Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19.
      ;
      • Pogue K.
      • Jensen J.L.
      • Stancil C.K.
      • Ferguson D.G.
      • Hughes S.J.
      • Mello E.J.
      • Poole B.D.
      Influences on attitudes regarding potential Covid-19 vaccination in the United States.
      ;
      • Taylor S.
      • Landry C.A.
      • Paluszek M.M.
      • Groenewoud R.
      • Rachor G.S.
      • Asmundson G.J.G.
      A proactive approach for managing COVID-19: The importance of understanding the motivational roots of vaccination hesitancy for SARS-CoV2.
      ;
      • Yoda T.
      • Katsuyama H.
      Willingness to receive Covid-19 vaccination in Japan.
      ). Unfavorable attitudes toward vaccines and reluctance or uncertainty on the subject of vaccination represent the principal obstacles to long-term pandemic management (
      • Paul E.
      • Steptoe A.
      • Fancourt D.
      Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications’.
      ). For that reason, before producing appropriate policies and preparations for Covid-19 vaccination, unfavorable opinions concerning vaccines need to be identified (
      • Eguia H.
      • Vinciarelli F.
      • Bosque-Prous M.
      • Kristensen T.
      • Saigí-Rubió F.
      Spain’s hesitation at the gates of a COVID-19 vaccine.
      ). It is therefore of very great importance to determine awareness of Covid-19 and the acceptability of vaccines. However, studies and information on this subject are insufficient. The purpose of this study was to evaluate Covid-19 awareness among parents of children aged 0–18 years and the acceptability for children of a future Covid-19 vaccine.

      Research hypotheses

      Those with high education and socioeconomic status, who and their child/children had infected with Covid-19, who lost a close friend or relative to Covid-19, who are anxious about their child/children getting Covid-19 disease, who think Covid-19 is very dangerous and who are health workers parents have higher awareness of coronavirus.
      Parents with high covid-19 awareness are more willing to have their child/children vaccinated against Covid-19 than parents with low Covid-19 awareness.

      Methods

      Participants

      This descriptive, cross-sectional study was conducted between 26 May and 7 July 2021. The study population consisted of parents of children aged 0–18 agreeing to take part through the social media (Facebook and Instagram) in Turkey between those dates. The sample size was determined using the formula shown below adopting N > 10,000 as the total research model.
      N=S2×Zα2d2


      Standard deviation in the formula was set at S = 1 Z0.05 = 1.96 with an effect size (d) of 0.1, and a minimum sample size of 384 was calculated (Fig. 1).
      Fig. 1
      Fig. 1Data collection and recruitment flowchart.

      Materials

      A parent description form and the Coronavirus (Covid-19) Awareness Scale (CAS) were used for data collection via Google Forms.

      Parent description form

      This form was prepared by reviewing the relevant literature. (
      • Brandstetter S.
      • Böhmer M.M.
      • Pawellek M.
      • Seelbach-Göbel B.
      • Melter M.
      • Kabesch M.
      • KUNO-Kids study group
      Parents’ ıntention to get vaccinated and to have their child vaccinated against COVID-19: Cross-sectional analyses using data from the KUNO-kids health study.
      ;
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ;
      • Lima G.
      • Hwang H.
      • Cha C.
      • Cha M.
      Public willingness to get vaccinated against COVID-19: How aı-developed vaccines can affect acceptance.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ;
      • Zhang K.C.
      • Fang Y.
      • Cao H.
      • Chen H.
      • Hu T.
      • Chen Y.Q.
      • Wang Z.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years: Cross-sectional online survey.
      ).This consists of three section, one of six questions investigating parents' sociodemographic characteristics, one of eight questions about Covid-19, and one of five questions about vaccines.

      Coronavirus (Covid-19) awareness scale (CAS)

      The CAS was developed by
      • Bilgin O.
      Development of coronavirus (Covid-19) awareness scale: Validity and reliability study.
      for measuring awareness of Covid-19. It consists of 17 items and three sub-factors – Contagion Precaution Awareness (items 1–9), Awareness of Following Current Developments (items 10–13), and Hygiene Precaution Awareness (items 14–17). The CAS is a five-point Likert-type scale (1 = never, 2 = rarely, 3 = frequently, 4 = generally, 5 = always). No items are reverse-scored. The sub-factors are evaluated separately. The highest possible scores are 45 for the Contagion Precaution Awareness and 20 for the Awareness of Following Current Developments and Hygiene Precaution Awareness sub-factors. High scores on the sub-factors indicate a high level of awareness of that factor (
      • Bilgin O.
      Development of coronavirus (Covid-19) awareness scale: Validity and reliability study.
      ). Permission was obtained from the author who developed the scale.

      Statistical analysis

      Data analysis was performed on SPSS 23.0 software (Statistical Package for Special Sciences). Since the data were found not to be normally distributed with the Kolmogorov Smirnov test, non-parametric tests were applied. Descriptive analyses (percentage, arithmetic mean etc.), the Mann Whitney U test, the Kruskal Wallis test, and correlation analysis (Spearman Brown Rank-Order Correlation Coefficient).

      Results

      The mean age of the parents was 38.98 ± 8.65 years, 68.8% were mothers, 20.8% were health workers (nurse, midwife, physician, dentist, pharmacist, or emergency medicine technician), and 90.1% were married. In addition, 64.3% of parents were educated to university level or higher, and 64.6% had moderate socioeconomic levels.(Table 1).
      Table 1Distribution of parents' descriptive characteristics.
      Descriptive characteristicsMin-MaxX ± SS
      Mean age19–6738.98 ± 8.65
      Gender of the parentsN%
      Mother26468.8
      Father12031.3
      OccupationN%
      Health workers (nurse, midwife, physician, dentist, pharmacist, or emergency medicine technician)8020.8
      Housewife6817.7
      Architect and engineer6717.4
      Private sector5614.6
      Teacher4110.7
      Officer369.4
      Employee369.4
      Marital statusN%
      Married34690.1
      Single389.9
      EducationN%
      Primary school4812.5
      Secondary School359.1
      High school5414.1
      University level or higher24764.3
      Socioeconomic statusN%
      Low5915.4
      Moderate24864.6
      High7720.1
      Analysis showed that 35.7% of parents had been infected with Covid-19, the children of 22.1% had also been infected with Covid-19, 88.0% were anxious concerning their children contracting Covid-19, 38.8% had lost a close friend or relative to Covid-19, 46.6% regarded their levels of knowledge concerning Covid-19 as adequate, 66.1% regarded Covid-19 as highly dangerous, 26.0% regarded the social protective measures adopted against Covid-19 as adequate and 65.4% regarded the personal protective measures adopted against Covid-19 as adequate. In addition, 79.2% of parents had allowed their children to be given free-of charge-vaccines under the immunization schedule, 33.3% had been vaccinated against, 37% wished to have their children vaccinated against Covid-19 and Covid-19, 58.6% wished to receive the BioNTech/Pfizer vaccine. Additionally, 21.4% of parents were reluctant to receive Covid-19 vaccines because these were new and produced very quickly, 10.4% due to insufficient evidence concerning the effects and reliability of the vaccine, 6.3% due to fear of vaccine side-effects, 1.8% because they were not in the at-risk group, 1.3% due to having already contracted Covid-19 disease, and 0.3% because they regarded the vaccine as unnecessary (Table 2).
      Table 2Distributions of parental statements regarding Covid-19 and vaccination.
      Statements regarding Covid-19 and vaccination
      Have you had infected with Covid-19?N%
      Yes13735.7
      No24764.3
      Have your child/children been infected with Covid-19?N%
      Yes8522.1
      No29977.9
      Are you anxious about your child/children getting covid-19?N%
      Yes34589.8
      No3910.2
      Have you lost a close friend or relative to Covid-19?N%
      Yes14938.8
      No23561.2
      Do you think you have adequate knowledge about Covid-19?N%
      Yes17946.6
      No11229.2
      Not sure9324.2
      How dangerous do you think Covid-19 is?N%
      Highly dangerous25466.1
      Moderately dangerous11529.9
      Not dangerous153.9
      Do you think the social protective measures adopted against Covid-19 as adequate?N%
      Yes10026.0
      No28474.0
      Do you think the personal protective measures adopted against Covid-19 as adequate?N%
      Yes25165.4
      No13334.6
      Have you allowed your child/children to be given free-of charge-vaccines under the immunization schedule?N%
      Yes30479.2
      No8020.8
      Have you been vaccinated against Covid-19?N%
      Yes12833.3
      No25666.7
      Do you wish your child/children to be vaccinated against Covid-19?N%
      Yes14237.0
      No10326.8
      Not sure13936.2
      Which Covid-19 vaccine do you wish your child to receive?N%
      Sinovac7541.4
      BioNTech/Pfizer10658.6
      What is your reason for being reluctant to receive the Covid-19 vaccine?N%
      I think the Covid-19 vaccine is new and produced very quickly8221.4
      Insufficient evidence for the effects and reliability of the vaccine4010.4
      I'm afraid of the side effect of the covid-19 vaccine246.3
      I'm not in the at-risk group71.8
      I have already contracted Covid-19 disease51.3
      I think the Covid-19 vaccine is unnecessary10.3
      * You can mark more than one option.
      The mean CAS sub-factor scores were 28.84 ± 10.55 for Contagion Precaution Awareness, 10.27 ± 4.63 for Awareness of Following Current Developments, and 9.54 ± 3.55 for Hygiene Precaution Awareness (Table 3).
      Table 3Mean parental CAS sub-factor scores.
      CAS sub-factorsMin-MaxX ± SS
      Contagion Precaution Awareness9–4528.84 ± 10.55
      Awareness of Following Current Developments4–2010.27 ± 4.63
      Hygiene Precaution Awareness4–209.54 ± 3.55
      The mean CAS contagion and hygiene precaution awareness sub-factor scores differed significantly depending on the gender of the parents (p < 0.05), but no gender difference was observed in terms of mean Awareness of Following Current Developments sub-factor scores (p > 0.05). Mothers exhibited greater contagion and hygiene awareness than fathers. Statistically significant associations were observed between mean CAS sub-factor scores and occupation, marital status, education, socioeconomic status, and number of children (p < 0.05). Higher levels of coronavirus awareness were determined among parents who were teachers, married, and educated to university level or above.(Table 4).
      Table 4Mean CAS scores in terms of parental descriptive characteristics.
      Descriptive characteristicsMean CAS sub-factor Scores
      Contagion precaution awarenessAwareness of following current developmentsHygiene precaution awareness
      Gender of the parentsX ± SSX ± SSX ± SS
      Mother29.78 ± 10.6110.30 ± 4.819.94 ± 3.66
      Father26.78 ± 10.1610.20 ± 4.248.65 ± 3.15
      Statistical analysisU = 13,345.0

      p = 0.013*
      U = 15,705.50

      p = 0.893
      U = 12,626.50

      p = 0.001*
      OccupationX ± SSX ± SSX ± SS
      Health workers30.88 ± 11.4311.30 ± 4.6410.26 ± 3.86
      Housewife26.92 ± 9.349.17 ± 4.659.08 ± 3.75
      Architect and engineer30.71 ± 10.1011.25 ± 4.029.25 ± 3.06
      Private sector23.85 ± 10.158.64 ± 3.798.46 ± 2.99
      Teacher33.00 ± 9.3712.68 ± 4.8910.53 ± 3.39
      Officer28.61 ± 10.979.86 ± 5.0710.02 ± 4.24
      Employee27.69 ± 9.808.47 ± 4.289.41 ± 3.10
      Statistical analysisKW = 24.314

      p = 0.000*
      KW = 29.066

      p = 0.000*
      KW = 12.749

      p = 0.026*
      Marital statusX ± SSX ± SSX ± SS
      Married29.64 ± 10.5410.46 ± 4.759.68 ± 3.59
      Single21.52 ± 7.448.52 ± 2.868.28 ± 2.98
      Statistical analysisU = 3668.0

      p = 0.000*
      U = 5176.50

      p = 0.031*
      U = 5158.50

      p = 0.029*
      EducationX ± SSX ± SSX ± SS
      Primary school20.16 ± 8.166.60 ± 3.587.52 ± 3.20
      Secondary School25.77 ± 8.319.14 ± 4.399.48 ± 3.73
      High school30.05 ± 9.319.42 ± 3.969.409.40 ± 3.48
      University level or higher30.70 ± 10.6111.33 ± 4.569.97 ± 3.49
      Statistical analysisKW = 46.775

      p = 0.000*
      KW = 52.799

      p = 0.000*
      KW = 23.163

      p = 0.000*
      Socioeconomic statusX ± SSX ± SSX ± SS
      Low22.86 ± 8.777.22 ± 4.048.40 ± 3.48
      Moderate31.74 ± 9.8811.51 ± 4.3710.14 ± 3.58
      High24.09 ± 10.348.63 ± 4.328.46 ± 3.05
      Statistical analysisKW = 51.768

      p = 0.000*
      KW = 61.160

      p = 0.000*
      KW = 20.684

      p = 0.000*
      *p < 0.05 **p < 0.01.
      Significant associations were observed between mean CAS Contagion Precaution Awareness sub-factor scores and a child or children having contracted Covid-19, having lost a close friend or relative to Covid-19, and regarding personal protection measures adopted against Covid-19 as adequate (p < 0.05). However, no significant association was observed with mean Awareness of Following Current Developments or Hygiene Precaution Awareness scores (p > 0.05). Parents who had themselves been infected with the disease or with a child or children who had contracted Covid-19, who had lost a close friend or relative to Covid-19, and who regarded personal protection measures adopted against Covid-19 as adequate exhibited greater contagion precaution awareness. Anxiety concerning a child or children contracting Covid-19 and the degree to which parents regarded the disease as dangerous were significantly associated with mean CAS contagion and hygiene precaution awareness scores (p < 0.05). However, so statistically significant associated was determined with Awareness of Following Current Developments (p > 0.05). Parents who were anxious about a child or children contracting Covid-19 and regarding the disease as moderately dangerous exhibited higher contagion and hygiene precaution awareness. Regarding their levels of information about Covid-19 as adequate and regarding the social protection measures adopted against the disease as sufficient were significantly associated with mean CAS sub-factor scores (p < 0.05). Parents who regarded their levels of information about Covid-19 as adequate and regarding the social protection measures adopted against the disease as sufficient exhibited higher levels of coronavirus awareness (Table 5).
      Table 5Parents' statements regarding Covid-19 and mean CAS scores.
      Statements regarding Covid-19 and vaccinationMean CAS sub-factor Scores
      Contagion precaution awarenessAwareness of following current developmentsHygiene precaution awareness
      Have you had infected with Covid-19?X ± SSX ± SSX ± SS
      Yes26.13 ± 10.179.82 ± 4.479.22 ± 3.47
      No30.34 ± 10.4810.52 ± 4.719.72 ± 3.59
      Statistical analysisU = 12,926.0

      p = 0.000*
      U = 15,445.0

      p = 0.155
      U = 15,788.50

      p = 0.276
      Have your child/children been infected with Covid-19?X ± SSX ± SSX ± SS
      Yes25.84 ± 10.149.60 ± 4.508.94 ± 3.47
      No29.69 ± 10.5310.46 ± 4.669.71 ± 3.56
      Statistical analysisU = 10,126.50

      p = 0.004*
      U = 11,307.50

      p = 0.119
      U = 11,178.50

      p = 0.089
      Are you anxious about your child/children getting covid-19?X ± SSX ± SSX ± SS
      Yes29.45 ± 10.3110.37 ± 4.579.73 ± 3.52
      No23.46 ± 11.249.35 ± 5.157.84 ± 3.45
      Statistical analysisU = 4516.0

      p = 0.001*
      U = 5667.50

      p = 0.105
      U = 4447.50

      p = 0.000*
      Have you lost a close friend or relative to Covid-19?X ± SSX ± SSX ± SS
      Yes26.53 ± 10.359.95 ± 4.569.23 ± 3.61
      No30.31 ± 10.4410.48 ± 4.689.74 ± 3.51
      Statistical analysisU = 13,977.0

      p = 0.001*
      U = 16,335.50

      p = 0.267
      U = 16,081.50

      p = 0.117
      Do you think you have adequate knowledge about Covid-19?X ± SSX ± SSX ± SS
      Yes28.79 ± 11.3210.96 ± 4.749.50 ± 3.66
      No25.73 ± 9.509.06 ± 4.708.91 ± 3.30
      Not sure32.68 ± 8.9310.40 ± 4.0610.36 ± 3.51
      Statistical analysisKW = 21.198

      p = 0.000*
      KW = 14.176

      p = 0.001*
      KW = 7.484

      p = 0.024*
      How dangerous do you think Covid-19 is?X ± SSX ± SSX ± SS
      Highly dangerous28.55 ± 10.6610.27 ± 4.749.88 ± 3.59
      Moderately dangerous30.54 ± 9.5310.69 ± 4.249.31 ± 3.34
      Not dangerous20.66 ± 12.447.13 ± 4.655.60 ± 1.18
      Statistical analysisKW = 11.467

      p = 0.003*
      KW = 10.508

      p = 0.005
      KW = 25.734

      p = 0.000*
      Do you think the social protective measures adopted against Covid-19 as adequate?X ± SSX ± SSX ± SS
      Yes25.62 ± 10.908.31 ± 4.068.21 ± 3.13
      No29.97 ± 10.2010.96 ± 4.6310.01 ± 3.68
      Statistical analysisU = 10,756.0

      p = 0.000*
      U = 9373.0

      p = 0.000*
      U = 10,011.0

      p = 0.000*
      Do you think the personal protective measures adopted against Covid-19 as adequate?X ± SSX ± SSX ± SS
      Yes27.69 ± 10.8310.01 ± 4.569.34 ± 3.51
      No31.01 ± 9.6610.75 ± 4.749.92 ± 3.62
      Statistical analysisU = 13,825.0

      p = 0.006*
      U = 15,268.0

      p = 0.167
      U = 15,085.0

      p = 0.119
      p < 0.05.
      A statistically significant association was determined between parents wishing to have themselves and their children receive the Covid-19 vaccine and mean CAS sub-factor scores (p < 0.05). Parents wishing to have themselves and their children receive the Covid-19 vaccine, or who were undecided on the subject, exhibited a higher level of coronavirus awareness (Table 6).
      Table 6Parents' statements concerning the vaccine and mean CAS.
      Statements concerning the vaccineMean CAS sub-factor Scores
      Contagion precaution awarenessAwareness of following current developmentsHygiene precaution awareness
      Have you vaccinated against Covid-19?X ± SSX ± SSX ± SS
      Yes30.89 ± 10.5511.22 ± 4.7410.11 ± 3.62
      No27.82 ± 10.429.80 ± 4.519.25 ± 3.49
      Statistical analysisU = 13,673.0

      p = 0.008
      p < 0.05.
      U = 13,558

      p = 0.006
      p < 0.05.
      U = 13,917.50

      p = 0.016
      p < 0.05.
      Do you wish your child/children to be vaccinated against Covid-19?X ± SSX ± SSX ± SS
      Yes29.64 ± 10.6311.04 ± 4.7510.21 ± 3.72
      No26.13 ± 11.349.34 ± 4.588.57 ± 3.43
      Not sure30.03 ± 9.5310.17 ± 4.459.58 ± 3.32
      Statistical analysisKW = 9.688

      p = 0.008
      p < 0.05.
      KW = 8.790

      p = 0.012
      p < 0.05.
      KW = 14.569

      p = 0.001
      p < 0.05.
      low asterisk p < 0.05.
      A statistically significant association as also determined between parents having their children receive the free-of-charge vaccines in the immunization schedule and wishing to have Covid-19 vaccination performed (p < 0.05). More than half of the parents who had their children receive the free-of-charge vaccines in the immunization schedule were undecided concerning Covid-19 vaccination.

      Discussion

      Studies have shown that people in several countries are opposed to the Covid-19 vaccine, although different hesitancy rates have been reported. For example, between 15.57% and 25% of participants in a study from the USA (
      • Pogue K.
      • Jensen J.L.
      • Stancil C.K.
      • Ferguson D.G.
      • Hughes S.J.
      • Mello E.J.
      • Poole B.D.
      Influences on attitudes regarding potential Covid-19 vaccination in the United States.
      ;
      • Taylor S.
      • Landry C.A.
      • Paluszek M.M.
      • Groenewoud R.
      • Rachor G.S.
      • Asmundson G.J.G.
      A proactive approach for managing COVID-19: The importance of understanding the motivational roots of vaccination hesitancy for SARS-CoV2.
      ), 20% in Canada (
      • Taylor S.
      • Landry C.A.
      • Paluszek M.M.
      • Groenewoud R.
      • Rachor G.S.
      • Asmundson G.J.G.
      A proactive approach for managing COVID-19: The importance of understanding the motivational roots of vaccination hesitancy for SARS-CoV2.
      ), 14% in the UK (
      • Paul E.
      • Steptoe A.
      • Fancourt D.
      Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications’.
      ), 17.5% in Brazil (
      • Oliveira B. L. C. A. de
      • Campos M.A.G.
      • Queiroz R.C. de S.
      • Britto e Alves M.T.S.S.de
      • Souza B.F.de
      • Silva A.A.M.da
      Prevalence and factors associated with Covid-19 vaccine hesitancy in Maranhão, Brazil.
      ), 55.3% in Saudi Arabia (
      • Magadmi R.N.
      • Kamel F.O.
      Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia.
      ), 4.9% in Australia (
      • Dodd R.H.
      • Cvejic E.
      • Bonner C.
      • Pickles K.
      • McCaffery K.J.
      • Sydney Health Literacy Lab COVID-19 group
      Willingness to vaccinate against COVID-19 in Australia.
      ), 33.2%–47.8% in China (
      • Chen M.
      • Li Y.
      • Chen J.
      • Wen Z.
      • Feng F.
      • Zou H.
      • Sun C.
      An online survey of the attitude and willingness of chinese adults to receive COVID-19 vaccination.
      ;
      • Wang J.
      • Jing R.
      • Lai X.
      • Zhang H.
      • Lyu Y.
      • Knoll M.L.
      • Fang H.
      Acceptance of Covid-19 vaccination during the Covid-19 pandemic in China.
      ), 36.8% in Jordan (
      • Al-Qerem W.A.
      • Jarab A.S.
      COVID-19 vaccination acceptance and ıts associated factors among a middle eastern population.
      ), 12.3% in Japan (
      • Yoda T.
      • Katsuyama H.
      Willingness to receive Covid-19 vaccination in Japan.
      ) and 3% in Turkey (
      • Salali G.D.
      • Uysal M.S.
      COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey.
      ) have reported being unwilling or doubtful concerning the vaccine. A study performed in seven European countries (Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK) reported that 7.2% of participants were unwilling to receive the vaccine. The highest rates of opposition to the vaccine were determined in residents of Germany and France (10%) (
      • Neumann-Böhme S.
      • Varghese N.E.
      • Sabat I.
      • Barros P.P.
      • Brouwer W.
      • van Exel J.
      • Stargardt T.
      Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19.
      ).
      Studies involving parents have reported different rates for parents and children (
      • Brandstetter S.
      • Böhmer M.M.
      • Pawellek M.
      • Seelbach-Göbel B.
      • Melter M.
      • Kabesch M.
      • KUNO-Kids study group
      Parents’ ıntention to get vaccinated and to have their child vaccinated against COVID-19: Cross-sectional analyses using data from the KUNO-kids health study.
      ;
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ;
      • Wang Z.
      • She R.
      • Chen X.
      • Li L.
      • Li J.
      • Huang Z.
      • Lau J.T.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: A cross-sectional online survey.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ;
      • Zhang K.C.
      • Fang Y.
      • Cao H.
      • Chen H.
      • Hu T.
      • Chen Y.Q.
      • Wang Z.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years: Cross-sectional online survey.
      ). Fifty-eight percent of parents in Germany wished to be vaccinated themselves, while 51% wished to have their children vaccinated (
      • Brandstetter S.
      • Böhmer M.M.
      • Pawellek M.
      • Seelbach-Göbel B.
      • Melter M.
      • Kabesch M.
      • KUNO-Kids study group
      Parents’ ıntention to get vaccinated and to have their child vaccinated against COVID-19: Cross-sectional analyses using data from the KUNO-kids health study.
      ), 44.5–72.6% of parents in China wished to have their children vaccinated (
      • Wang Z.
      • She R.
      • Chen X.
      • Li L.
      • Li J.
      • Huang Z.
      • Lau J.T.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: A cross-sectional online survey.
      ;
      • Zhang K.C.
      • Fang Y.
      • Cao H.
      • Chen H.
      • Hu T.
      • Chen Y.Q.
      • Wang Z.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years: Cross-sectional online survey.
      ), 60% in Canada wished to have their children vaccinated (
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ), while 59.9% of parents in Turkey wished to receive the vaccine for themselves and 36.3% for their children (
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ). Parents in studies appear to be more reluctant for their children to be vaccinated than themselves (
      • Lima G.
      • Hwang H.
      • Cha C.
      • Cha M.
      Public willingness to get vaccinated against COVID-19: How aı-developed vaccines can affect acceptance.
      ). Similarly to previous studies from Turkey, the majority of parents in the present research allowed their children to receive free-of-charge vaccines in the immunization schedule, but only 37% wished to have their children receive the Covid-19 vaccine. We think that parents' reluctance to allow their children to receive the Covid-19 vaccine derives from its being new and untested for children. However, 33.3% of parents in the present study had received the Covid-19 vaccine themselves. The reason for this low level is that due to an insufficiency of vaccines in Turkey, vaccination commenced with at-risk groups and the elderly. Vaccination was performed in this manner during the data collection stage of this study. However, there are currently abundant stocks of vaccine in Turkey, and everyone who wishes is vaccinated, irrespective of age and risk. We therefore think that parental vaccination rates will have increased by now.
      Some of the most important reasons for parents being reluctant to have their children vaccinated are anxieties about the reliability of the vaccine and its side-effects (
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ;
      • Yigit M.
      • Ozkaya-Parlakay A.
      • Senel E.
      Evaluation of COVID-19 vaccine refusal in parents.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ), a lack of sufficient scientific research (
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ), doubts about the assistant substances in the vaccine, and lack of belief in its efficacy (
      • Yigit M.
      • Ozkaya-Parlakay A.
      • Senel E.
      Evaluation of COVID-19 vaccine refusal in parents.
      ), fear of long-term side-effects (
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ), and the fact the vaccine is new and was produced in haste (
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ). Consistent with previous studies, parents in the present study were reluctant to have Covid-19 vaccines administered for reasons such as the vaccine being new and produced very quickly, a lack of sufficient evidence about its effectiveness and reliability, fear of vaccine side-effects, being in an at-risk group, having already had Covid-19 disease, and believing the vaccine is unnecessary.
      Increasing awareness of Covid-19 can also reduce the spread of the disease (
      • Akwa T.E.
      • Muthini M.J.
      • Ning T.R.
      Assessing the perceptions and awareness of COVID-19 (coronavirus) in Cameroon.
      ). However, studies on the subject have determined only moderate levels of awareness of Covid-19 (
      • Alahdal H.
      • Basingab F.
      • Alotaibi R.
      An analytical study on the awareness, attitude and practice during the COVID-19 pandemic in Riyadh, Saudi Arabia.
      ;
      • Labban L.
      • Thallaj N.
      • Labban A.
      Assessing the level of awareness and knowledge of COVID 19 pandemic among Syrians.
      ). Similarly in the present study, parents exhibited a moderate level of awareness of Covid-19. In addition, 46.6% of parents regarded their level of knowledge of Covid-19 as adequate.
      • Alahdal H.
      • Basingab F.
      • Alotaibi R.
      An analytical study on the awareness, attitude and practice during the COVID-19 pandemic in Riyadh, Saudi Arabia.
      reported that fathers possessed higher levels of awareness of Covid-19 than mothers (
      • Alahdal H.
      • Basingab F.
      • Alotaibi R.
      An analytical study on the awareness, attitude and practice during the COVID-19 pandemic in Riyadh, Saudi Arabia.
      ), while in the present study, mothers exhibited higher levels of awareness and hygiene precautions. We attribute this to mothers playing a greater role and assuming greater responsibility in child care in Turkey.
      • Sizer B.
      • Yıldız I.
      • Yılmaz U.
      • Demir S.
      • Sırma E.
      • Çelik A.
      • Topçu I.
      COVID-19 pandemic awareness in patients admitted to otorhinolaryngology polyclinic: A cross-sectional study.
      and
      • Labban L.
      • Thallaj N.
      • Labban A.
      Assessing the level of awareness and knowledge of COVID 19 pandemic among Syrians.
      reported a higher level of information concerning Covid-19 among individuals with high education and income levels (
      • Labban L.
      • Thallaj N.
      • Labban A.
      Assessing the level of awareness and knowledge of COVID 19 pandemic among Syrians.
      ;
      • Sizer B.
      • Yıldız I.
      • Yılmaz U.
      • Demir S.
      • Sırma E.
      • Çelik A.
      • Topçu I.
      COVID-19 pandemic awareness in patients admitted to otorhinolaryngology polyclinic: A cross-sectional study.
      ). In addition,
      • Labban L.
      • Thallaj N.
      • Labban A.
      Assessing the level of awareness and knowledge of COVID 19 pandemic among Syrians.
      determined greater information concerning Covid-19 among health workers. In the present study, and consistent with other research, parents educated to university level and above exhibited greater awareness of Covid-19. However, although healthcare workers represented the largest group in our sample (20.8%), parents who were teachers exhibited higher levels of Covid-19 awareness. This may be associated with parents' learning and research characteristics deriving from their occupations. It is also possible that awareness declined in healthcare worker parents since they had come to regard Covid-10 as a normal part of life.
      Parents who fear contracting Covid-19, or that their children may become infected, hold more favorable opinions concerning the Covid-19 vaccine and are more willing to have their children immunized (
      • Yigit M.
      • Ozkaya-Parlakay A.
      • Senel E.
      Evaluation of COVID-19 vaccine refusal in parents.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ). However, parents in regions where the virus is less common are less desirous of having their children vaccinated (
      • Lima G.
      • Hwang H.
      • Cha C.
      • Cha M.
      Public willingness to get vaccinated against COVID-19: How aı-developed vaccines can affect acceptance.
      ). Occupation, marital status, education level, and socioeconomic status all affect parents' willingness to have their children vaccinated. Parents with high levels of education (
      • Brandstetter S.
      • Böhmer M.M.
      • Pawellek M.
      • Seelbach-Göbel B.
      • Melter M.
      • Kabesch M.
      • KUNO-Kids study group
      Parents’ ıntention to get vaccinated and to have their child vaccinated against COVID-19: Cross-sectional analyses using data from the KUNO-kids health study.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ), those with good economic status (
      • Bell S.
      • Clarke R.
      • Mounier-Jack S.
      • Walker J.L.
      • Paterson P.
      Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ), parents with a single child (
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ), and parents who are health workers (
      • Wang J.
      • Jing R.
      • Lai X.
      • Zhang H.
      • Lyu Y.
      • Knoll M.L.
      • Fang H.
      Acceptance of Covid-19 vaccination during the Covid-19 pandemic in China.
      ;
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      ) are generally more eager to have their children vaccinated. However, in contrast to these studies,
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      reported that parents with low levels of education and poor economic status were more willing to have their children vaccinated (
      • Hetherington E.
      • Edwards S.A.
      • MacDonald S.E.
      • Racine N.
      • Madigan S.
      • McDonald S.
      • Tough S.
      Covid-19 vaccination ıntentions among Canadian parents of 9-12 year old children: Results from the all our families longitudinal cohort.
      ).
      Parents who are hesitant about having their children immunized in childhood are also reported to be less willing to have their children vaccinated against Covid-19 (
      • Lima G.
      • Hwang H.
      • Cha C.
      • Cha M.
      Public willingness to get vaccinated against COVID-19: How aı-developed vaccines can affect acceptance.
      ). In the present study, a statistically significant association was determined between parents allowing their children to receive free-of-charge vaccines in the immunization schedule and the wish to have children vaccinated against Covid-19. More than half of the parents who allowed their children to receive free-of-charge vaccines in the immunization schedule were found to want their children to be vaccinated against Covid-19, or undecided on the subject. However,
      • Yılmaz M.
      • Sahin M.K.
      Parents’ willingness and attitudes concerning the COVID-19 vaccine: A cross-sectional study.
      determined no significant association between allowing children to receive free-of-charge vaccines in the immunization schedule and the wish to have children vaccinated against Covid-19. In the study of
      • Wang Z.
      • She R.
      • Chen X.
      • Li L.
      • Li J.
      • Huang Z.
      • Lau J.T.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: A cross-sectional online survey.
      with Chinese healthcare workers, it was determined that the acceptability of the Covid-19 vaccine for children under the age of 18 was low (
      • Wang Z.
      • She R.
      • Chen X.
      • Li L.
      • Li J.
      • Huang Z.
      • Lau J.T.
      Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: A cross-sectional online survey.
      ).

      Practice implications

      In order to increase Covid-19 vaccination rates, doubts and lack of information concerning the vaccine need to be overcome by identifying reasons for vaccine hesitancy. Doubts and lack of information concerning the vaccine can be resolved by providing greater information on the subject and through vaccination campaigns.

      Limitations

      The Discussion section was limited by the insufficiency of studies evaluating parents' awareness of Covid-19 together with their acceptance of Covid-19 vaccination for their children. Since this study was conducted with a small number of samples, it cannot be generalized to the whole population. Since we collect data from social media (Facebook and Instagram), there is no specific location where the research was conducted.

      Conclusions

      In conclusion, the parents in this study exhibited a moderate level of awareness of Covid-19. In addition, parental desire to have their children vaccinated against Covid-19 was low.

      Funding

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Ethical approval and permissions

      Before commencement of the research, permission was obtained from the Health Ministry Health Services General Directorate Scientific Research Platform, and approval was granted by the XXX University Non-Interventional Clinical Research Ethical Committee.

      Author statement

      EBK and HK contributed to the planning and design of the study. EBK and HK assembled the data. EBK performed the statistical analysis, interpreted the data and assisted with the revisions of the article, read and approved the final article.

      Declaration of Competing Interest

      The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this study.

      Acknowledgments

      EBK ve HK contributed to the study conception and design. Material preparation were performed by EBK. Data collection were performed by EBK and HK. Data analysis were performed and the first draft of the manuscript was written by EBK. EBK and HK commented on previous versions of the manuscript, read and approved the final manuscript.

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