Barriers to COVID-19 vaccination among medical students in Kazakhstan: development, validation, and use of a new COVID-19 Vaccine Hesitancy Scale

Figures & data

Table 1. Characteristics of the study population (N = 888)

Variables	N (%)	COVID-19 vaccination status
		Vaccinated	Agree to be vaccinated	Disagree to be vaccinated
Gender, χ^2 = 21.2, p < .001
Male	209 (23.5)	11 (5.3)	59 (28.2)	139 (66.5)
Female	679 (76.5)	7 (1.0)	140 (20.6)	532 (78.4)
Year of study, χ^2 = 27.8, p < .001
1-year	161 (18.1)	2 (1.2)	36 (22.4)	123 (76.4)
2-year	186 (21.0)	1 (0.5)	36 (19.4)	149 (80.1)
3-year	295 (33.2)	5 (1.7)	50 (16.9)	240 (81.4)
4-year	184 (20.7)	8 (4.4)	60 (32.6)	116 (63.0)
5-year	62 (7.0)	2 (3.2)	17 (27.4)	43 (69.4)
Total	888	18 (2.0)	199 (22.4)	671 (75.6)

Table 2. Preference in the choice of vaccines against COVID-19 and the proportion of vaccine acceptance compared to those who previously refused vaccination

Vaccines	n (%)	Previously COVID-19 vaccine hesitancy before choosing a vaccine type (N = 671) n (%)
Sputnik V (Russia)	202 (22.7)	89 (13.3)
Sputnik V (Kazakhstan)	100 (12.5)	39 (5.8)
JNJ-78436735 (Johnson & Johnson, Netherlands, USA)	68 (7.7)	40 (6.0)
QazCovid-In (Kazakhstan)	66 (7.4)	27 (4.0)
AstraZeneca (Covishield, UK)	66 (7.4)	38 (5.7)
Moderna (Moderna, BARDA, NIAID, USA)	61 (6.9)	35 (5.2)
Comirnaty (Pfizer, BioNTech; Fosun Pharma)	49 (5.5)	24 (3.6)
CoronaVac (Sinovac, China)	31 (3.5)	19 (2.8)
BBIBP-CorV (China)	20 (2.3)	10 (1.5)
Convidicea (Ad5-nCoV), CanSino Biologics (China)	14 (1.6)	6 (0.9)
EpiVacCorona (Russia, Turkmenistan)	10 (1.1)	6 (0.9)
Covaxin (Bharat Biotech, ICMR, India)	10 (1.1)	7 (1.0)
Total	697	207 (30.8)*

*Since respondents had the option to choose several vaccines, this number summarizes the total number of respondents who indicated at least one type of vaccine.

Table 3. Participants’ barriers associated with COVID-19 vaccine acceptance (n = 888)

Barriers associated with COVID-19 vaccine acceptance	M (SD)	Vaccine refuses (N = 671)
I am concerned about the possible side effects of the COVID-19 vaccine	3.82 (1.08)	489 (72.9%)
I believe there is not enough scientific and clinical evidence on the effectiveness and safety of the COVID-19 vaccine	3.52 (1.12)	381 (56.8%)
I have not received sufficient information on the quality and effectiveness of the COVID-19 vaccine	3.19 (1.19)	282 (42.0%)
Vaccination against COVID-19 is not required because I am confident that my immune system will cope with this infection.	3.05 (1.10)	259 (38.6%)
I do not consider vaccination against COVID-19 an effective way to deal with the COVID-19 pandemic	3.06 (1.10)	224 (33.4%)
I refuse vaccination as the environment in which I grew up (my family, guardians) is against vaccination in general, and in particular against the COVID-19 vaccine	2.51 (1.20)	178 (26.5%)
I am concerned that the COVID-19 vaccination is a purely commercial exercise designed to increase the profits of pharmaceutical companies	2.75 (1.08)	155 (23.1%)
In general, I do not consider vaccination to be an effective way to fight infectious diseases	2.73 (1.09)	155 (23.1%)
Vaccination against COVID-19 is not required if I have had COVID-19	2.84 (0.99)	141 (21.0%)
I do not believe that COVID-19 is a dangerous infection for me	2.57 (1.07)	113 (16.8%)
I do not know where and how to get the COVID-19 vaccine	2.55 (1.08)	96 (14.3%)
I am concerned that the developed COVID-19 vaccine contains chips to control my privacy	2.31 (1.09)	82 (12.2%)
I refuse vaccinations for religious reasons	2.07 (0.98)	49 (7.3%)

Table 4. Factor loadings for development of a 6-factor scale version of the COVID-19 Vaccine Hesitancy Scale (N = 888)

Item	Standardized factor loading
	Efficacy and Safety (EE)	Risk Perceptions (RP)	Conspiracy (C)	Knowledge and information (KI)	Trust (T)	Social norm (SN)
1. I am concerned about the possible side effects of the COVID-19 vaccine	0.569
2. I do not consider vaccination against COVID-19 an effective way to deal with the COVID-19 pandemic	0.446
3. Vaccination against COVID-19 is not required if I have had COVID-19		0.618
4. Vaccination against COVID-19 is not required because I am confident that my immune system will cope with this infection		0.767
5. I do not believe that COVID-19 is a dangerous infection for me		0.593
6. I am concerned that the COVID-19 vaccination is a purely commercial exercise designed to increase the profits of pharmaceutical companies			0.765
7. I am concerned that the developed COVID-19 vaccine contains chips to control my privacy			0.698
8. I have not received sufficient information on the quality and effectiveness of the COVID-19 vaccine				0.781
9. I believe there is not enough scientific and clinical evidence on the effectiveness and safety of the COVID-19 vaccine				0.698
10. In general, I do not consider vaccination to be an effective way to fight infectious diseases.					0.547
11. I refuse vaccinations for religious reasons						0.733
12. I refuse vaccination as the environment in which I grew up (my family, guardians) is against vaccination in general, and in particular against the COVID-19 vaccine						0.777

Figure 1. Confirmatory factor analysis of the COVID-19 Vaccine Hesitancy Scale (COV-VHS) [χ2/df = 2.819; RMSEA = 0.0452, CFI = 0.902, TLI = 0.966].

Figure 2. Receiver operating characteristic (ROC) of the COVID-19 Vaccine Hesitancy Scale (COV-VHS).

Figure 3. Media content analysis of information about the COVID-19 vaccine in the Republic of Kazakhstan (RK). (a) major information from the Ministry of Healthcare of the RK before the start of COVID-19 vaccination (31.01.2021); (b) major information from the Ministry of Healthcare of the RK for the period from February 1, 2021, to April 1, 2021; (c) information from Astana Medical University.

Data availability statement

All data available by request to corresponding author.