Knowledge and Confidence of Doctors Advising and Counseling Patients on COVID-19 Vaccines in Kingdom of Saudi Arabia

Background

While COVID-19 continues to rage worldwide, effective vaccines are highly anticipated in the Kingdom of Saudi Arabia. However, doctors still have concerns regarding their confidence in counseling patients about the COVID-19 vaccine in Saudi Arabia. this study aimed to assess how confident are healthcare providers in giving counseling to patients about COVID-19 vaccine in Saudi Arabia?

Method

cross-sectional study was conducted from June 2022 to August 2022 via online questionnaires to investigate the confidence and knowledge of the doctors regarding the COVID-19 vaccine who live in Saudi Arabia.

Results

332 out of 400 was completed the questionnaire, significant differences were found between the qualification of the participant as, interns and residents show significantly lower confidence compared to consultants. Specifically, interns have a mean difference of -1.578 (p = 0.004), Vaccine development and vaccine trials" and "Vaccine efficiency," with mean scores notably higher than those of interns, residents, and specialists. Specifically, consultants show significantly higher confidence in vaccine development and trials compared to other ranks, as indicated by the ANOVA results (F = 5.050, p = 0.002). However, the ANOVA results also reveal that confidence levels in areas such as "Vaccine administration," "After vaccine administration," "Vaccine misinformation," and "Vaccine information" do not show significant differences between ranks (p > 0.05).

conclusion

The study found that doctors confidence levels ranging from low to moderate. The researchers recommend further investigation into the adverse effects of COVID-19 vaccine trials in other countries.

Keywords: Saudi Arabia, doctors, covid-19 vaccines, counseling, confident

Introduction

The first human cases of COVID-19 were indeed identified in Wuhan, China, in December 20191,2The virus outbreak posed significant challenges due to limited understanding of its origin, nature, mechanism, and prevention at that time1,3This lack of understanding contributed to the difficulty in containing the spread of the virus, despite strict lockdown attempts3.

Meanwhile, The World Health Organization declared the COVID-19 outbreak a “Public Health Emergency of International Concern” on 30th of January 2020 4 and a pandemic on 11 March 2020 5. The domino effect of COVID-19 would not only be limited to individuals, but also extend to have a major impact on the economy6 and the most important impact relevant for this study is the COVID-19 effect on the healthcare system4. To tackle the spread of the virus, many pharmaceutical companies have made the vaccine available for public use. The first vaccines to be approved globally by the World Health Organization (WHO) on December 31, 2020, were Pfizer-BioNTech, followed by AstraZeneca/Oxford COVID-19 vaccines on February 15, 2021; Johnson & Johnson vaccines on March 12, 2021; Moderna vaccines on April 30, 2021; Sinopharm vaccines on May 7, 2021; and Sinovac vaccines on June 1, 20217. Of those mentioned vaccines only 3 are currently used in the kingdom of Saudi Arabia. Pfizer-BioNTech, Oxford/AstraZeneca and Moderna vaccines 8.

As there is no absolute certainty of the possible outcome of administering the vaccines therefore no clear comparison among them, doctors may find it difficult to recommend one vaccine above the other for certain groups of people, i.e., individuals with a chronic condition or pregnant women. Some of the rare reported adverse effects were pericarditis in Pfizer and blood clotting in AstraZeneca/Oxford 9. The vaccines are continued to be promoted by world leaders and government officials as a way to encourage the public to take them. One method for promoting vaccination in Saudi Arabia was when King Salman 10 and the Prince Mohammed bin Salman 11 appeared on national television taking the vaccine, which motivated the public. In Saudi Arabia, A total of 68,534,631 vaccination doses had been given as of April 24, 202312

In the literature review a study done among a general practitioner (GP) who work in the UK to assess their confidence in counselling patients about COVID-19 vaccine The participants showed a marked low confidence in answering critical questions regarding vaccine safety and efficacy which are commonly asked by the public13. however a study done among health care worker globally measuring their knowledge about COVID-19, and they found among the study participants, a strong gap in the sources of information, low levels of understanding, and varied perspectives on COVID-1914. on the other hand., according to the study done in India, the majority of health care workers (HCWs) had a good attitude, an appropriate degree of knowledge, and were generally practicing safely 15. whereas a study conducted in Saudi Arabia among 510 health care worker they found that Approximately 72.2% of HCWs had a favorable attitude, and two-thirds (67.8%) had adequate knowledge16. Even though there are numerous studies on doctors' knowledge regarding COVID-19 pandemics, there have been no studies conducted in Saudi Arabia measuring the confidence of Saudi doctors regarding counselling their patients. COVID-19 vaccines, so this study aimed to find out how confident doctors are in counseling patients about the COVID-19 vaccine in Saudi Arabia.

Materials And Methods

A cross-sectional questionnaire-based study conducted to assess confidence of doctors to counsel patients about COVID-19 vaccines in Saudi Arabia. The inclusion criteria were doctors who work at hospital, healthcare centres and clinic who dealing with COVID-19 patients and welling to answer our questionnaire. Whereas exclusion criteria were doctors who don’t deal with covid-19 patients and doctors who refuse to answer our survey.

Study instrument:

The survey was taken from a previous study(Armitage, 2021)[13] then questionnaire was submitted to 20 doctors as a pilot; subsequently, the results were statistically analyzed using Cronbach’s alpha. The reliability coefficient yielded 0.929 across 24 items of the scale. This suggests a high level of internal consistency for assessing perceptions and concerns related to vaccine development, administration, misinformation, safety, efficacy, eligibility, and distribution. final version with 29 questions was created. Five questions in the first section assessed demographic information. In the second section, 24 questions evaluated physicians' confidence in their understanding and provided counseling to patients regarding COVID-19 vaccination on nine distinct topics, including: vaccine development and vaccine trials, vaccine safety, vaccine efficiency, vaccine eligibility and prioritization vaccine? practicalities of delivering vaccines to patients, vaccine administration, after vaccine administration, vaccine misinformation, vaccine information.

construct validity

The concept validity of the scale was tested through the process of items’ development and a group of experts to validate that the scale effectively measures public perceptions and concerns of vaccines. The scale items cover vaccine development, administration, safety, efficacy, misinformation, and accessibility that align with the theoretical frameworks and previous research on vaccine-related attitudes. A group of expert reviewers in public health and epidemiology were asked to critically read the content of the scale to confirm its relevance, clarity, and appropriateness to assess the accurate construct. The strong conceptual grounding and expert validation support the scale’s validity in assessing vaccine-related perceptions

Data source and collection:

the population were collected via snowball simple sampling technique in Saudi Arabia between June and August 2022. The estimated sample size was 400. Then online questionnaire was generated through Google Form and distributed through social media network (WhatsApp, Instagram, Facebook, Snapchat…etc)

The estimated sample size is: N = (Z 2 ) × P (1−P)/E2 , N = (1.962 ) × 0.5 (1−0.5)/(0.052 = 384−400), where N is the sample size, E is the margin of error, Z is the critical value, and P is the prevalence.

Ethical considerations:

Ethical approval was taken from Research Ethics Committee(REC), Arabian Gulf University, College of Medicine and Medical Science with number E1-PI-4-22/Group1. Answering the questioner where consider as an approval to participate to this study, the information that acquires from applicants were anonymous. After the completion of the research, the applicants’ answers were discarded for confidentiality and privacy purposes.

Statistical analysis:

The data were statistically analyzed using One-Way ANOVA test was used to compare confidence levels according to participants' position, followed by a post-hoc analysis using the LSD test to identify specific differences between groups. Excel and SPSS v.²⁹ (IBM, Inc., Armonk, NY, USA) were used for data collection, tabulation, and analysis.

RESULTS

Fig 1. represents the sociodemographic characteristics of the sample. 332 out of 400 was completed the questionnaire and majority of participants were males with a percentage of 60.5%. 25 - 30 years old participants were the majority among other age groups with a percentage of 52.7% followed by the 31 - 40 years age group with 33.7% and lastly came the >40 years age group with only 15.7%. 50.6% is the percentage of the primary health care doctors. The survey included 33.7% of resident physicians, followed by specialists, interns, and consultants (30.1%, 27.1%, and 9%, respectively). 25.9% of participants were doctors with more than ten years of experience (fig1).

)Fig1. Sociodemographic characteristics(

Participants’ answers to the questions were categorized as low confident, moderate confident and high confident. To determine how confident are healthcare providers in counselling patients about the COVID-19 vaccine, table1 shows that confidence is generally high in areas such as the overall development and administration of vaccines, with notable percentages expressing high confidence in the necessity of continuing public health measures post-vaccination and the practicality of vaccine delivery locations. However, there are significant gaps, particularly concerning specific aspects of vaccine trials and misinformation. For instance, a substantial portion of respondents expressed low confidence regarding the inclusion of certain groups in trials and the choice of vaccines available to patients. Confidence in understanding vaccine safety, especially for specific groups, and the detailed efficacy of vaccines, also varies, with many respondents showing uncertainty. The high level of concern about vaccine misinformation underscores the need for improved public education. Overall, while there is a solid foundation of confidence in general vaccine information and logistics, addressing these areas of uncertainty could further bolster public trust and understanding.

)Table 1: Participant Confidence Levels in Counseling Patients about COVID-19 Vaccines(

To find out whether confidence levels in counselling about the COVID-19 vaccine vary based on the sociodemographic characteristics, the independent samples t-test was used to compare the confidence levels based on participants’ gender, specialty, and practicing medicine duration. One-Way ANOVA test was used to compare the confidence levels based on participants’ age and rank.

Tables 2 and 3 shows the results of rank differences in confidence levels related to COVID-19 vaccines among the study participants. Table 2 shows that consultants generally exhibit the highest confidence across most areas, including "Vaccine development and vaccine trials" and "Vaccine efficiency," with mean scores notably higher than those of interns, residents, and specialists. Specifically, consultants show significantly higher confidence in vaccine development and trials compared to other ranks, as indicated by the ANOVA results (F = 5.050, p = 0.002). Similarly, significant differences are observed in confidence related to "Vaccine safety" (F = 3.656, p = 0.013), suggesting that consultants have greater confidence in this area as well. However, the ANOVA results also reveal that confidence levels in areas such as "Vaccine administration," "After vaccine administration," "Vaccine misinformation," and "Vaccine information" do not show significant differences between ranks (p > 0.05), indicating that these areas are perceived with similar confidence levels across all professional ranks.

)Table 2: Descriptive statistics of rank differences in confidence levels related to COVID-19 vaccines (

)Table 3: One-Way ANOVA results of rank differences in confidence levels related to COVID-19 vaccines(

As for the items that show statistically significant differences, the post-hoc test was analyzed in Table 4 to determine which groups differ. For vaccine development and trials, interns and residents show significantly lower confidence compared to consultants. Specifically, interns have a mean difference of -1.578 (p = 0.004) and residents have a mean difference of -1.880 (p = 0.001) compared to consultants, indicating that consultants feel much more confident in this area. Similarly, there is a significant difference between residents and specialists (mean difference = -0.880, p = 0.015), with specialists feeling more confident. Though the difference between specialists and consultants is not significant, it approaches significance (mean difference = -1.000, p = 0.066), suggesting a trend towards higher confidence among consultants. For vaccine safety, the confidence differences are also notable. Residents exhibit significantly lower confidence compared to specialists (mean difference = -1.014, p = 0.001). Although the differences between other ranks are not statistically significant, the trend suggests varying levels of confidence across different professional ranks.

)Table 4: LSD Post-Hoc Test for rank differences in confidence related to vaccine development and vaccine trials and vaccine safety(

Discussion

The concept of the commencement of a vaccine for the prevention of a pandemic was seen as an impossible measure, especially with the large numbers of severe cases all over the world. On the other hand, people were eagerly aspiring for the vaccine as a solution that will end the pandemic17

in this study, 332 Saudi doctors were participating in a self-structured questionnaire to assess their knowledge and confidence in advising and counseling patients on COVID-19 vaccines in Kingdom of Saudi Arabia.

The survey results indicate that the majority of respondents expressed high confidence in the overall development and administration of vaccines, as well as the need for continued public health measures and the practicality of vaccine delivery locations. However, there were significant gaps in confidence, particularly regarding specific aspects of vaccine trials and misinformation. A substantial proportion of respondents reported low confidence in the inclusion of certain groups in trials and the available vaccine options. Confidence in understanding vaccine safety, especially for specific groups, and the detailed efficacy of vaccines, also varied, with many respondents exhibiting uncertainty. The high level of concern about vaccine misinformation underscores the need for enhanced public education. Although there is a solid foundation of confidence in general vaccine information and logistics, addressing these areas of uncertainty could further strengthen public trust and understanding.

In the present study the consultants show interns and resident showing lower confidence than consultant regarding vaccine development and vaccine trails items, this in consistent to a study done by Gadoth et al., 2020 In Los Angeles which done among more than thousand healthcare workers as most of the participant didn’t trust the development process of the vaccine, these findings suggest a widespread lack of confidence in the vaccine development process among healthcare workers, which could have significant implications for public acceptance and uptake of future vaccines18. It is crucial for public health authorities to address these concerns and provide transparent information to build trust in the vaccine development process.

On the other hand, a question related to the reasons of developing multiple vaccine, the total participant showing moderate to high confidence (76.6%) in counseling patient in such a question and this in consistent to a study done

by Armitage, 2021 as (69.1%) of the participant showing fairly confident to high confident in counseling patient about the development reasons of multiple Covid-19 vaccines. It is crucial for healthcare providers to stay informed about the various vaccine options available and their respective benefits and risks13. so can help alleviate any doubts or uncertainties that may worries their patients.

The data reveals that 72% of physicians reported low to moderate confidence in their capacity to counsel patients on their willingness to receive any of the approved vaccines, while only 28% expressed high confidence in their counseling abilities. This finding suggests a need for additional training and education to effectively address patient concerns and provide accurate vaccine-related information.

However, 62.6% of doctors showed low to moderate confidence regarding counseling patients about whether they need to follow public health guidelines (e.g., mask-wearing, physical distancing, etc.). It had been approved that, in order to prevent the disease from spreading to others and themselves, those who have already received vaccinations or the COVID-19 vaccine booster dose should keep taking all the necessary precautions19. Conversely, a majority of the participants who endorsed the practice expressed low self-assurance in providing counseling on patient misinformation. Nevertheless, insufficient confidence among physicians in delivering such counseling may be associated with heightened vaccine hesitancy within the healthcare workforce, as evidenced by findings from multiple studies. 20,21

The present study found that 75.3% of participants reported moderate to high confidence in their ability to access reliable information about vaccines. This contrasted with a previous study conducted in the UK, where less than half of participants expressed similar levels of confidence in accessing trustworthy vaccine-related information, a lower proportion compared to the current sample13 . The discrepancy may be attributable to the UK study being conducted during a time when vaccine-related information

However, residents exhibit considerably lower confidence in vaccine safety compared to specialists, which aligns with findings from a previous study conducted in Los Angeles where respondents expressed strong concerns about vaccine safety18 , In a recent meta-analysis, Wu et al. summarized the safety profile of COVID-19 immunizations, concluding that the approved vaccines demonstrated a satisfactory short-term safety profile based on the available evidence22.

Additionally, our participants expressed low confidence in questions regarding the safety of vaccines for particular groups and the potential for undetected adverse effects. This demonstrated a significant lack of confidence between the qualifications of our participants, aligning with the findings of a published study conducted among healthcare workers in Saudi Arabia. That study found that the most important predictors of vaccine refusal among Saudi Arabian healthcare workers were concerns about vaccination efficacy and safety, as well as fear of unfavorable side effects23. The limited and variable data regarding vaccinations for vulnerable populations, such as older adults, children, pregnant or lactating individuals, and those with pre-existing medical conditions, may contribute to this issue 24.

The participants exhibited a low to moderate level of confidence in the vaccine's efficacy, particularly regarding the need for a future booster dose. In this regard, 82.5% of respondents expressed low to moderate confidence. This heightened hesitancy toward the booster dose was nearly identical to the findings of a 2022 study conducted in Greece, which revealed that a significant number of nurses lacked confidence in receiving the new COVID-19 vaccine or a second booster dose25. The COVID-19 pandemic containment efforts may be hampered by this hesitancy and lack of confidence. It is important to note that a study was conducted to predict the effectiveness of a COVID-19 booster dose, and the prediction was that combining the original vaccinations with a booster dose to boost immunity against SARS-CoV-2 variant viruses can greatly improve protection against both symptoms and severe disease25.

Doctors who participated in the study replied to the questions of vaccine eligibility and prioritizing, with results falling into the low, moderate, and high confidence categories. This hesitation may be linked to a general unwillingness to accept vaccine eligibility 26. Some doctors expressed low confidence in determining vaccine eligibility and prioritization due to the evolving nature of the virus and the limited data available. Additionally, concerns about the potential side effects and long-term effectiveness of the vaccines may contribute to their hesitation.

The researchers recommend that more intensive research is still needed to find more about the other side effects of the COVID-19 vaccine trials in other countries and the impact of those trials on people in different countries.

The study limitation was related to the results are based solely on self-reported responds; as such, they may not fully represent the participants' true knowledge and confident. As well as the snowball sampling technique was used which reduce the representativeness of the sample.

Conclusions

The study found that most doctors scored low to moderate confidence rates in many aspects of the stud. Whereas that a high level of confidence was noted in practicalities of delivering vaccines to patients, vaccine eligibility and prioritization, vaccine information, after vaccine administration, and a question related to the reason for developing multiple vaccines.

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