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Considering the Attitudes toward the COVID-19 Vaccine, the 
Levels of Vaccine Hesitancy among Family Healthcare Center 

(FHC) Employees: A Cross-Sectional Study 
 

1 Y. Sombabu, 2 SK. Baji baba, 3 M.Rajesh, 4 V.Mariya Babu  

1 Assistant Professor, 2,3,4  IV year Students, Civil Engineering Department, Sree Vahini Institute of 

Science and Technology, Tiruvuru 
 

 

1. Introduction 
Ever since it first emerged in 2019, the new 

coronavirus—officially known as coronavirus disease 

2019 (COVID-19)—has been causing a worldwide 

epidemic [1]. Worldwide, there have been a total of 

5,91,683,619 cases and 6,443,306 fatalities as of August 

19, 2022 [2], according to the World Health Organisation 

(WHO) report. Vaccination is a well-known and 

effective method for fighting the COVID-19 pandemic. 

The disease's mortality and morbidity rates have been 

significantly reduced because to this preventative 

strategy [3]. Because of their long history of reliable use 

and outstanding effectiveness, vaccines have come to 

represent preventative health care in the public eye [4]. 

Vaccines have been used effectively for a long time to 

prevent illnesses that can be vaccinated against. 

Vaccines are very effective in disease control, yet a large 

section of the population is still quite hesitant to get them 

[5, 6]. Vaccine scepticism was named by the World 

Health Organisation (WHO) as one of the ten most 

pressing issues in global health in 2019 [7].  

The phrase "vaccine hesitancy" encompasses a wide 

variety of responses to any and all recommended 

vaccinations, including waiting, refusing, or accepting 

each and every COVID-19 vaccine. Vaccine reluctance 

is a complex phenomenon with several levels. This one-

of-a-kind ailment might manifest differently in different 

eras and due to different immunisation programmes [8]. 

People who work in healthcare also have reservations 

regarding vaccinations, just as the general public. 

Healthcare personnel are at a higher risk of contracting 

COVID-19 due to the increased probability that they will 

come into touch with the illness and transmit it to both 

their surroundings and patients [9]. Due to [10], 

healthcare professionals are one of the people who 

Abstract— Aim. The primary objective of this study was to investigate the attitudes towards the COVID-19 vaccine, 

the extent of vaccine hesitancy, and the factors influencing the Family Healthcare Center staf who are responsible for 

delivering primary healthcare services. Methods. The research, which employed a cross-sectional design, was carried out 

with a sample of 102 healthcare professionals employed at family healthcare centers located in the city center. The study 

data were collected using three in- struments: the “Personal Information Form,” the “Vaccination Hesitancy in Pandemic 

Scale,” and the “Attitudes towards COVID-19 Vaccine Scale.” Results. A total of 13.7% of the participants said that 

they were hesitant about having themselves 

the total score of attitude towards the COVID-19 vaccine in the pandemic. It was also found that the situation 
of considering the 

vaccine as partially necessary increases the vaccine hesitancy in the pandemic and the decrease in the degree of considering 

the childhood vaccines as necessary decreases the attitude towards the COVID-19 vaccine. Discussion. Despite the 

relatively low prevalence of vaccination hesitancy among healthcare workers, it remains a noteworthy concern. It is 

imperative to conduct a thorough investigation into the various factors that contribute to vaccine hesitancy and the attitudes 

held by healthcare professionals, with a particular focus on those factors having a negative impact. 

 



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should get an immunisation first. Health care providers 

deliberately impact vaccination uptake [11]. As a result, 

disapproval of the COVID-19 vaccine and other signs of 

vaccination reluctance may reduce the efficacy of 

ongoing global immunisation programmes [12, 13]. 

There is a heavy burden on primary healthcare workers 

like those who work for Family Healthcare Centres 

(FHCs) to increase public trust in vaccinations and 

decrease vaccination hesitancy [14]. An essential part of 

healthcare prevention is family healthcare centres 

(FHCs). They are in a unique position to provide 

continuous, affordably priced, and readily available 

services to all parts of society, and they are also 

trustworthy resources for knowledge on vaccines and the 

people who need them [15]. The existence of 

geographical differences in medical staff's views and 

hesitations about the COVID-19 vaccine vaccination. As 

an example, a review research indicated that healthcare 

professionals throughout the globe were hesitant to get 

the COVID-19 vaccination, with rates ranging from 

4.3% to 72.0% [12]. Also, pro-vaccine sentiments 

decreased COVID-19 vaccination hesitation in the UK, 

while around 25% of healthcare workers were hesitant to 

get the vaccine [16]. Vaccinations are a topic that 

healthcare personnel in Turkey often raise questions 

about [17, 18]. Half of the primary care providers 

surveyed expressed a willingness to get the COVID-19 

vaccination, while a third were uncertain and a quarter 

were against it [19]. Many factors have been identified 

in prior research as contributing to the general public's 

negative perception of and unwillingness to get the 

COVID-19 vaccination. Most notably, there is a general 

distrust about immunisations [20, 21].  

 

People working in healthcare made up the bulk of the 

subjects in the first research on this topic. Employees at 

FHCs, who are the primary points of contact for 

vaccination services in Turkey, have been the subject of 

little research. Furthermore, no research has been 

published that addresses vaccination reluctance during 

the pandemic and opinions on the COVID-19 vaccine at 

the same time. Our hope is that this study will contribute 

to existing literature, inspire further research, and 

provide the groundwork for important policy 

developments in this field. A cross-sectional research 

was carried out in the city centre of Mardin to better 

understand the attitudes towards the COVID-19 

vaccination, levels of vaccine hesitancy, and influencing 

variables among FHC staff delivering primary 

healthcare.  

Methods 

Research Methods and Subjects 1.1. From January 

1, 2022, to May 1, 2022, researchers conducted the 

cross-sectional investigation. Healthcare workers 

from Mardin's Family Health Centres (FHCs) in the 

heart of the city, in Turkey's Southeastern Anatolia 

Region, took part. Around 186,622 people are 

served by the 20 Family Health Centres (FHCs) 

located in the heart of Mardin. Of the 110 healthcare 

workers surveyed, 20 worked in Family Health 

Centres (FHCs) in Mardin's central business 

district. Instead of picking a random sample, we 

tried to get in touch with every single healthcare 

worker at the FHCs. Five people did not want to be 

a part of the research, and three others were not 

included in the assessments because their 

questionnaires were not fully filled out. An 

extensive survey was filled out by 102 medical 

experts. The percentage of those who took part in 

the research was 92.7%. Direct one-on-one 

interviews were the means of data collection. The 

researchers sent out the questionnaire and then got 

it back from the subjects in an envelope. At the 

beginning of the questionnaire, we included some 

clarification on the study objective, confidentiality, 

and anonymity. In addition, participants were told 

orally that taking part in the study was completely 

optional, that they may stop at any moment, and that 

their data would only be used for research reasons. 

The questionnaire was filled out and returned by the 

participants who happily agreed to participate in the 

study. No compensation or other benefits were 

offered to participants in the research. We did not 

do a pilot study of this topic. Data collecting took 

10–15 minutes.1.2. Those who take part. People 

who are willing to give their time, work as 

healthcare employees, and are employed by one of 

the Family Health Centres (FHCs) in the heart of 

Mardin are eligible to participate in this research.No 

one will be considered for inclusion in this research 

if they do not meet the following criteria: they are 

not healthcare employees, they are not volunteers, 

they have not finished the questionnaire, or they 

work for the FHC but live outside of Mardin's city 

centre.  

Part 1.3: The Methods Used to Gather Information. 

Researchers used three different measures to 



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compile their findings: the "Personal In-formation 

Form," the "Vaccination Hesitancy in Pandemic 

Scale," and the "Attitudes Towards COVID-19 

Vaccine Scale." Researchers prepared the Personal 

Information Form after scouring the current 

literature. Participants' age, gender, marital status, 

and socioeconomic position were among the eight 

items measured by the survey's demographic 

information form. The survey also included 9 

questions designed to elicit responses on the 

participants' views on vaccination [22].  

After some tweaks, the "Vaccination Hesitance 

Scale in Pandemic" was born out of the Vaccine 

Hesitancy Scale that Larson et al. had previously 

created. This modification was made after a 

research in Turkey was carried out by Çapar and 

Çınar, which evaluated the reliability and validity 

of the scale [23, 24]. A 5-point Likert-style scale is 

used as a measuring instrument in this 

investigation. In this research, a scoring system was 

used, where a score of 1 signifies total disagreement 

and a score of 5 full agreement. A high score on the 

scale indicates that there was a considerable amount 

of vaccination reluctance during the epidemic. 

Every one of the 10 components that make up the 

scale is further subdivided into two. Eight 

components make up the first subdimension, "Lack 

of Confidence," and they are M1-T, M2-T, M3-T, 

M4-T, M5-T, M6-T, M7-T, and M8. This method 

has been reversed for the items that have the letter 

"T" next to them. Scores that are higher during the 

epidemic indicate a greater degree of scepticism 

against vaccinations on this specific dimension. 

Included in the second sub-dimension, "Risk," are 

two items: M9 and M10. During the pandemic, a 

high score on this subscale indicates a high 

likelihood of receiving a vaccine. The scale has a 

Cronbach's alpha score of 0.901. The reliability of 

the scale was determined to be 0.914 in this 

research.4. Analyses based on statistics. The 

statistical software programme SPSS 22.0 was used 

to analyse the data acquired in this research. Mean 

and standard deviation statistics were used to 

examine the scale, while frequency and percentage 

analyses were used to determine the participants' 

descriptive features. In order to determine whether 

the research variables followed a normal 

distribution, the Kurtosis and Skewness values were 

examined. The research variables were found to 

follow a normal distribution, which supported the 

use of parametric analytic methods. In order to learn 

more about the connections between the 

dimensions that decide the participants' scale levels, 

this research used regression and correlation 

analysis. This study makes use of dependent 

variables. What this means is that people's attitudes 

and levels of vaccination reluctance towards the 

COVID-19 vaccine are at a pandemic level. Every 

other variable is considered an independent 

variable. The first step in analysing the scale 

variations based on their descriptive qualities was 

to use the T-test and one-way analysis of variance 

(ANOVA). We next included in the regression 

analysis the variables that showed statistical 

significance in the T-test and ANOVA. For the 

dependent variable of vaccine hesitancy in the 

pandemic, these analyses found the following 

variables: vaccination opinion, vaccination opinion 

regarding childhood, vaccination necessary, 

vaccination having negative information about 

vaccination, thinking that not having vaccine is a 

parent's right, and opinion about vaccines in 

general. Opinions about vaccines, views on 

childhood vaccines, hesitancy about getting 

vaccinated, seeing vaccine as necessary, having 

negative information about vaccination, and 

thinking that not having vaccine is a parent's right 

were all factors that made up the dependent variable 

of attitude towards the COVID-19 vaccine. 

Researchers used a set of independent factors in 

multiple linear regression analysis to predict how 

vaccine hesitant people would be and how they 

would feel about the COVID-19 vaccine during the 

epidemic. When we were looking at the scales' 

internal consistency, we calculated Cronbach's 

alpha. A slant analysis was used for every single 

analysis. A significance threshold of p < 0.05 was 

determined for all results.  

2. Results 
The percentage of those who took part in the 

research was 92.7%. The current research included 

45.1% males, 61.8% females, and 39.2% with 10 



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  TaBlE 1: The distribution of the employees according to descriptive characteristics (n � 102).  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TaBlE 2: The mean scores of vaccine hesitancy and attitude towards COVID-19 vaccine in pandemics. 
 

      

 

Significant results were obtained from the 

regression analysis that sought to establish a cause-

and-effect relationship between various factors 

related to vaccines, including thoughts about 

childhood vaccines, the belief that it is a parent's 

right not to get vaccinated, the belief that the 

Characteristics n % 

Age   

20–25 years 15 14.7 

26–30 years 25 24.5 

31–40 years 46 45.1 

<40 years 16 15.7 

Gender 
Female 63 61.8 

Male 39 38.2 

Marital status   

Married 69 67.6 

Single 33 32.4 

Income level 
Income more than expenses 27 26.5 

Income equal to expenses 33 32.4 

Income less than expenses 42 41.1 

Duty 
Doctor 45 44.1 

Nurse 31 30.4 

Midwife 20 19.6 

Emergency medical technician (EMT) 
Professional years 

6 5.9 

<1 year 4 3.9 

1–5 years 24 23.5 

6–10 years 34 33.3 

>10 years 
Time spent at first-step healthcare institution 

40 39.3 

<1 year 6 5.9 

1–5 years 40 39.2 

6–10 years 29 28.4 

>10 years 27 26.5 

Educational status 
High school 15 14.7 

Associate degree 6 5.9 

Undergraduate/medicine 75 73.5 

Postgraduate 
Opinions about vaccines 

6 5.9 

Very necessary 63 61.8 

Necessary 34 33.3 

I have no idea/I do not know 
Opinions about children’s age vaccines 

5 4.9 

Very necessary 76 74.5 

Necessary 26 25.5 

Thinking that not having vaccine is the right of parents 
Yes 20 19.6 

No 61 59.8 

I am indecisive 21 20.6 

Having received in-service training about vaccine rejection 
Yes 37 36.3 

 



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vaccine is necessary, the presence of negative 

information about vaccination, and the overall score 

of vaccine hesitancy during the pandemic (F 6.898; 

p ≤ 0.001). Consideration of the vaccine as 

essential, receiving negative information about 

vaccination, thinking about childhood vaccines, 

thinking that not being vaccinated is a parent's right, 

and thinking about vaccines in general accounted 

for 22.6% of the total change in vaccination 

hesitancy during the pandemic (R2 0.226). 

According to Table 4, vaccination hesitation during 

the pandemic is increased when people see the 

vaccine as somewhat required (β 3.894).  

 

We found a significant cause-and-effect 

relationship (F 4.396; p ≤ 0.001) in our regression 

analysis of the following variables: overall vaccine 

thinking, vaccine thinking about childhood, belief 

that parents should be able to choose not to 

vaccinate their children, hesitations about previous 

vaccinations, necessaryness of vaccine, negative 

information about vaccination, and attitude towards 

the COVID-19 vaccine. Factors such as considering 

the vaccine necessary, thinking negatively about 

vaccination, hesitating to get vaccinated, believing 

that not getting vaccinated is a parent's right, and 

thinking about vaccines in general accounted for 

16.8% of the total change in attitude towards the 

COVID-19 vaccine (R2 0.168). According to Table 

5, there is a decline in the level of agreement that 

children immunisations are important, which in turn 

affects the attitude towards the COVID-19 vaccine 

(β −0.453).  

3. Discussion 
Getting healthcare providers to vaccinate against 

COVID-19 as intended requires research on 

vaccine hesitancy and their perspectives on the 

vaccine, as well as the variables that shape these 

perspectives [26]. The present research set out to 

examine how people feel about the COVID-19 

vaccination, how hesitant people are to get the 

vaccine, and what variables are affecting the 

primary healthcare providers at the Family Health 

Centre (FHC). Only a few of people who took part 

in the study had concerns about getting 

immunisations. Previous studies found conflicting 

results. A study found that healthcare workers 

throughout the world showed a range of vaccination 

reluctance for COVID-19, from 4.3% to 72.0%, 

which is in line with our findings [27–29]. The 

COVID-19 vaccination was reportedly a source of 

anxiety for 41.0 percent of South African healthcare 

staff [30]. While earlier studies had a more 

optimistic view of vaccinations, the current study 

takes a more cautious approach, recognising that 

data obtained after the global and national 

distribution of COVID-19 vaccines may reveal 

different degrees of vaccine reluctance.  

 

 

 

Results showed that participants had a high degree 

of risk perception, with a risk subscore above the 

mean, and overall scores for vaccination hesitancy 

and lack of confidence below the mean in the 

context of the pandemic. Prior study has recorded 

the attitudes voiced by healthcare workers towards 

new vaccinations, and our discovery adds to that 

body of evidence. Healthcare professionals in Italy 

were hesitant to get the COVID-19 vaccination 

because they didn't believe it would protect them 

against the virus [31]. A large percentage of 

healthcare personnel in Ethiopia were hesitant to 

get the COVID-19 vaccination, according to a 

recent research [22]. Vaccine reluctance in China is 

mostly due to healthcare providers' mistrust of the 

COVID-19 vaccine [32]. Healthcare providers in 

Turkey were hesitant to use the COVID-19 

vaccination for a variety of reasons, including 

scepticism over the vaccine's effectiveness [33, 34]. 

The rarity of vaccination scepticism and low levels 

of distrust 
 

4. Conclusion 

In conclusion, FHC employees had low vaccine hesitancy 

and high COVID-19 vaccine attitudes. As FHC employees 

be- come more hesitant about the COVID-19 vaccine, their 

at- titudes change. Considering the vaccine as partially 

necessary increases vaccine hesitancy in the pandemic and 

decreases the attitude towards the COVID-19 vaccine as the 

degree of needing childhood vaccines decreases. The 

present study found low vaccination hesitancy and a 



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positive attitude to- ward the COVID-19 vaccine, but the 

rate of 13.7% is still important for FHC employees, who are 

society’s role models and the primary application for 

vaccination. Thus, FHC staf vaccination hesitancy and 

attitude must be thoroughly ex- amined. Policies must be 

developed to give them more transparent information on the 

COVID-19 vaccine and to combat vaccine hesitancy. 

Methods must be developed to reduce the lack of 

confidence and risk perception toward vaccines, and firm 

steps must be taken in this regard. 

Data Availability 

The datasets used and/or analyzed during the study are 

available from the corresponding author upon reasonable 

request. 

Ethical Approval 

The study adhered to the Declaration of Helsinki principles. 

The study was approved by the Noninvasive Clinical Re- 

search Ethics Committee of a university 

(13.12.2021/36846). 

Consent 

Informed consent was obtained from all participants 

before their participation. 

Conflicts of Interest 

The authors declare that they have no conflicts of 

interest. 

Authors’ Contributions 

VBD and GY conceptualized the study; VBD and GY su- 

pervised the study; VBD and GY were responsible for 

materials; VBD and GY were responsible for data 

collection and/or processing; VBD and GY performed 

analysis and/or interpretation; VBD and GY wrote the 

original manuscript; VBD initiated the draft of the article 

and approved the final draft. 

Acknowledgments 

We would like to thank all Family Healthcare Center 

health workers who voluntarily participated in this study. 

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