Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3, 922-931 2025 Publisher: Learning Gate DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate © 2025 by the authors; licensee Learning Gate History: Received: 8 January 2025; Revised: 25 February 2025; Accepted: 26 February 2025; Published: 12 March 2025 * Correspondence: awirut@yala.ac.th Did health professionals accept the COVID-19 vaccination at the initial period of its introduction? Awirut Singkun1*, Natthawadee Maneeprom2, Piriya Patiwikraiwong3, Hanifah Booraka4 1,2,3,4Sirindhorn College of Public Health, Yala, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Yala Province, 95000 Thailand; awirut@yala.ac.th (A.S.) natthawadee@yala.ac.th (N.M.) piriya.p@pi.ac.th (P.P.) hanifah@yala.ac.th (H.B.). Abstract: Health professionals are essential informants to encourage people to receive the COVID-19 vaccination for herd immunity, ensuring that all people in the community are protected. This study aimed to assess the COVID-19 vaccination rate and associated factors among health professionals. A cross-sectional study was conducted among 220 health professionals using a rapid online survey in April 2021. The instrument was a self-administered questionnaire tested for content validity and reliability. Demographic data, history of COVID-19 vaccination, and work experiences were presented using frequency and percent. Associated factors were analyzed using binary logistic regression (stepwise LR). A p-value of less than 0.05 was considered statistically significant. The vaccination rate for the COVID- 19 vaccination among health professionals was high (83.2%). The associated factors with receiving vaccination were contact with patients and their belongings (aOR 3.9, 95% CI: 1.489–10.468), respected persons (aOR 2.9, 95% CI: 1.114–7.582), and vaccination passports (aOR 2.4, 95% CI: 1.071–5.552). Work characteristics, role models, and approval for vaccination enhanced vaccination acceptance. The benefit of this study could be implemented by increasing self-evaluation of susceptible risk for infection, encouraged by respected persons, and promoting the use of an approval document for vaccination. Keywords: COVID-19 vaccine, Health professional, Vaccination, Voluntary. 1. Introduction The world pandemic of SARS-CoV-2 (Coronavirus disease 2019; COVID-19) has negative impacts on people’s health, society, economy, and daily life, as well as the health system and public health [1, 2]. The measures for COVID-19 prevention in Thailand were multiple measures in order to have the most effective prevention and control of the pandemic of the disease. For example, individual practices— handwashing with soap, alcohol gel, or alcohol spray; wearing a face mask; social distancing, staying far from each other, avoiding crowded events, and avoiding touching others’ belongings [3-5]; personal protective equipment [4]. In addition, for social or government measures, there are lockdowns, as well as the introduction of COVID-19 vaccines [3, 6]. In the era of non-stopped spreading, herd immunity or mass vaccination was believed to control the pandemic, prevent the severity of infection, and reduce the mortality rate when people infected with COVID-19. That the COVID-19 vaccines were emergency-approved to use against its pandemic. However, vaccine hesitancy was an essential factor affecting acceptance for vaccination [7-9]. The vaccination rate of the COVID-19 vaccine varied from country to country as well as differed from their sociodemographic factors [7, 10-15]. A survey in 19 countries reported 71.5% of COVID-19 vaccination acceptance [12]. The vaccination rate was 62.1% in Japan [10] 64.7% in Saudi Arabia [7], and 60.8% in India [13]. A study in a northern province of Thailand in April 2021 found that the vaccination rate of household https://orcid.org/0000-0002-2934-3598 https://orcid.org/0000-0002-6931-5882 https://orcid.org/0009-0005-0413-1774 https://orcid.org/0009-0001-5450-7515 923 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate participants was 41.1% [11]. It was a similar finding of a national survey of more than one hundred ninety-three thousand participants across country reported the vaccination rate of 44.0% [16]. The vaccination rate fluctuated at varied times and increased in August 2021, almost up to 90% [16]. This study was conducted since only a health expert was the subject of certain research about the acceptance of the COVID-19 vaccine [17, 18]. Non-clarified healthcare workers and a restricted area in a central province of Thailand were the subjects of another investigation [19]. The acceptance of the COVID-19 vaccine among health professionals must then be investigated in order to determine the vaccination rate and the factors that are associated with their acceptance. 2. Literature Review The COVID-19 pandemic has had a negative impact on almost every aspect of life. This is because the pandemic has caused each country around the world to have to take measures to prevent and control the spread of the virus [20]. Measures to prevent and control the spread of infection at the individual level, for example, wearing a face mask, washing hands with soap or alcohol gel, keeping a distance from others, avoiding contact with sick people and their belongings, and self-quarantining from others when there is a risk of infection [21]. In addition, there are social measures both at the national and international levels, such as closing areas or communities, arranging quarantine areas for those at risk of infection, prohibiting travel across areas, temporarily closing service establishments such as hotels, cinemas, shopping malls, parks, public transportation, etc., including closing the country [22, 23]. Vaccination is a way to prevent and control the spread of infection and reduce the severity of the disease if infection occurs. It is expected that if at least 80% of the population is vaccinated, herd immunity can be achieved [8, 24]. However, the emergency use authorization of COVID-19 vaccines during the pandemic has led to public hesitation about vaccine efficacy, side effects, and other adverse reactions [7, 25, 26]. Therefore, it is necessary to encourage people to get vaccinated against COVID- 19 [16, 19]. It is expected that health professionals will be the group of people who can encourage people to cooperate in getting vaccinated [25]. Before building public confidence to cooperate in getting vaccinated against COVID-19, it is necessary to study the acceptability of COVID-19 vaccines among health personnel. When they have confidence in the vaccines and accept vaccination, they will be able to better reduce vaccine hesitancy among the public [25]. 3. Methodology 3.1. Study design A cross-sectional online survey was implemented for data collection in April 2021. 3.1.1. Inclusion Criteria • Health professionals • Having a computer or other devices connected to an internet • Able to read and write Thai language • Exclusion criteria • Incomplete response questionnaire 3.2. Research Tools A self-administered questionnaire was developed by the researcher from the literature review. There are 3 domains: 1) demographic characteristics and history of COVID-19 vaccination (11 items); 2) working characteristics (10 items); and 3) factors related to decision-making of receiving COVID-19 vaccination (11 items). 924 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate 3.3. Tools Measurement Five experts conducted a content validity index (CVI), assigning scores of 4-3-2-1 for highly relevant, quite relevant, somewhat relevant, and irrelevant categories, respectively [16]. The CVI; item CVI (scale CVI) was 0.98 for domains 1 and 2 and 1.0 for domain 3. The questionnaire had high reliability in a pilot group (n = 55). The Cronbach's α coefficient was 0.87 and 0.91 for domains 2 and 3, respectively. 3.4. Data Collection The research team was a representative health professional from 44 provinces out of 77 provinces of Thailand, attended a national conference, and formed an academic network. The research team purposively sampled the eligible participants and distributed the link of an online questionnaire to them via social networks and email. The online survey was conducted in April 2021. The eligible participants may receive repeated invitation, please only one. 1,218 overall participants 19.9% incomplete responses 976 completed answers 756 general population participants 220 health workers (The manuscript was published elsewhere) [27] 3.5. Data Analysis Descriptive statistics, including frequency, percentage minimum, maximum, and standard deviation (SD) were used to present demographic characteristic, working characteristic, and motivation to COVID-19 vaccination. Chi-squared test was performed in univariate analysis to assess significant factors of COVID-19 vaccination. Binary logistic regression was performed to identify the predictive factors. A p-value of 0.05 was considered as a significant level. 4. Results of the Study Table 1 presents the participants’ demographic characteristics. Most of the participants were female (75%), aged 40 to 49 years (31.8%), and Buddhist (71.4%). The proportion of married participants was nearly equal to that of single participants, at 50.0% and 46.4%, respectively. Most of the participants reported having a bachelor's degree (81.4%). 925 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate Table 1. Demographic characteristics of participants (n = 220) General information Frequency % Sex Female 165 75.0 Male 55 25.0 Age (years) 20–29 60 27.3 30–39 59 26.8 40–49 70 31.8 50–60 31 14.1 mean: 38.01, SD: 9.80, min: 22.6, max: 57.0 Marital status Married 110 50.0 Single 102 46.4 Widow/Separated 8 3.6 Religion Buddhist 157 71.4 Islam 63 28.6 Education level Bachelor 179 81.4 Master and higher 41 18.6 Position Nurse 102 46.4 Public Health Technical Officer 63 28.6 Thai medical medicine 26 11.8 Pharmacist 17 7.7 Dental Public Health Technical Officer 12 5.5 Level of health service Primary health care 86 39.1 Secondary health care 109 49.5 Tertiary health care 25 11.4 Income/month (35 Baht ≈ 1 USD) < 15,000 Baht 29 13.2 15,001–30,000 Baht 79 35.9 30,001–45,000 Baht 64 29.1 45,001–50,000 Baht 24 10.9 > 50,000 Baht 24 10.9 Duration of working (years) 0–5 56 25.5 6–10 45 20.5 11–15 26 11.8 16–20 17 7.7 > 20 76 34.5 Region of Thailand South 68 31.0 North-eastern 52 23.7 North 32 14.5 Central 26 11.8 East 21 9.5 West 21 9.5 COVID-19 vaccinated Yes 183 83.2 No 37 16.8 926 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate The study includes participants in five different careers: nurses (46.4%), public health technical officers (28.6%), Thai traditional medicine personnel (11.8%), pharmacists (7.7%), and dental public health technical officers (5.5%). Half of participants were working in secondary health care (49.5%), with an income of 15,001-30,000 Baht/month (35.9%), and working more than 20 years (34.5%). One-third worked in the southern region of Thailand. (31.0%). Most of the participants were COVID-19 vaccinated (83.2%) Table 2 presents the participants’ working characteristics. Almost all participants wore a face mask when staying close to their patients (98.2%), staying close to their colleagues (95.5%), and wearing a face mask during their working hours, except while drinking or eating (89.1%). Table 2. Working characteristics (n = 220) Working characteristics Frequency (%) Yes No Wearing a face mask when staying close to clients 216 (98.2) 4 (1.8) Staying close to colleagues 210 (95.5) 10 (4.5) Wearing a face mask in working time, except while drinking or eating 196 (89.1) 24 (10.9) Direct contact with clients 191 (86.8) 29 (13.2) Direct contact with colleagues 188 (85.5) 32 (14.5) Wearing a face mask when staying close to the colleagues 161 (73.2) 59 (26.8) Stay close to other people 157 (71.4) 63 (28.6) Direct contact with other people 130 (59.1) 90 (40.9) Stay close to the service client 85 (38.6) 135 (61.4) Changing a new face mask after taking off the old one 59 (26.8) 161 (73.2) Table 3. Motivation for COVID-19 vaccination (n = 220) Antecedents COVID-19 vaccinated acceptance Frequency (%) Yes No Perceiving high prevalence and incidence rate of COVID-19 174 (79.1) 46 (20.9) Vaccination certificate 166 (75.5) 54 (24.5) Free COVID-19 vaccination 152 (69.1) 68 (30.9) Perceiving a threat that people usually do not protect themselves from the COVID-19 infection 137 (62.3) 83 (37.7) Influenced by colleagues 114 (51.8) 106 (48.2) You can't always follow infection prevention measures, so you want to get vaccinated. 109 (49.5) 111 (50.5) Being a role model to encourage others to do so 95 (43.2) 125 (56.8) Influenced by respectful persons 76 (34.5) 144 (65.5) Influenced by Thai politicians 63 (28.6) 157 (71.4) Influenced by well-known persons 53 (24.1) 167 (75.9) Influenced by actors/actresses/singers/internet stars 33 (15.0) 187 (85.0) Table 3 presents the antecedents that motivate for the COVID-19 vaccination. The top three antecedents were perceiving a high rate of COVID-19 infection (79.1%), getting the approval document for COVID-19 vaccination (75.5%), and free COVID-19 vaccination (69.1%). 927 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate Table 4. Predicting factors of COVID-19 vaccinated acceptance. (n = 220) Factors Adjusted odds ratio 95% CI for EXP (B) p-value Lower Upper Participants’ characteristics Income (Bath/month) (34 Baht = 1 USD) < 15,000 0.367 0.065 2.084 0.258 15,001–30,000 1.762 0.513 6.050 0.368 30,001–45,000 0.346 0.082 1.459 0.148 45,001–50,000 0.170 0.017 1.745 0.136 > 50,000 (ref.) Characteristic of working Direct contact with clients (yes & no (ref.)) 3.948 1.489 10.468 0.006 ** Encouraged person or event Influenced by respectful persons (yes & no (ref.)) 2.906 1.114 7.582 0.029 * Vaccination certificate (yes & no (ref.)) 2.431 1.071 5.522 0.034 * Note: p-value * < 0.05, ** < 0.01 The univariate analysis to assess related factors of COVID-19 vaccination was performed by chi- square. (Table was not shown.) The significant factors include: age, religion, position, level of health service, income, duration of working, region of Thailand, direct contact with clients, vaccination certificate, perceiving threat that people usually not protect themselves from the COVID-19 infection, influenced by colleagues, being a role model to encourage others to do so, influenced by respectful persons, Thai politicians, actors/actresses/singers/internet stars (p-value < 0.25). These factors had non-multicollinearity, the variance inflation factors (VIF) < 4, tolerance > 0.2 [28, 29]. Then, these variables were included in the final model. Table 4 shows the predicting factors of COVID-19 vaccination. The significant factors were direct contact with clients (aOR = 3.948, 95% CI = 1.489–10.468), influenced by respectful persons (aOR = 2.906, 95% CI = 1.114–7.582), and the vaccination certificate (aOR = 2.431, 95% CI = 1.071–5.522). 5. Discussion A review reported the vaccination rate among healthcare workers from 33 countries, excluding Thailand, ranged from approximately 23.6 to 97.0% [30]. In Thailand, a survey in May 2021 showed the vaccination rate of approximately 59% in healthcare workers [14] 95.3% in nurses [17] and 95.6% among physicians in a university-based teaching hospital [18]. Compared to the general population, the vaccination rate of the COVID-19 vaccination was high (83.2%) among health professionals. These participants had good knowledge about the vaccine [25, 31] both for its effectiveness and adverse effects. Other studies found that sociodemographic determinants were associated with the vaccination rate [7, 10, 12, 19, 25] but not for our result. However, the finding is diverse from area to area and time to time. COVID-19 vaccination acceptance among health professionals is important since they are a key performance to encourage people to have vaccination [25]. Reducing vaccine hesitancy, they should get enough information for all COVID-19 vaccine dimensions in order to criticize and judge for the benefit of health outcomes. The higher the enhancement for cooperation, the higher the benefit of controlling the pandemic. This situation will successfully induce the vaccination rate when healthcare providers are likely to accept it first. Then, they would provide all essential information to recipients to persuade them for mass vaccination that reaches herd immunization. High risk of COVID-19 infection, for example, touching an infected person or their belongings, enhanced health professionals’ acceptance of the COVID-19 vaccination. National surveys [14, 16, 25] 928 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate found that people who were at high risk of infection were more likely to receive vaccinations [32]. Those who do not accept the COVID-19 vaccination (16.8%, Table 1) should be given vaccine information [13, 18, 33, 34] about the risk of side effects, how to manage them if they occur, how to reduce the severity of infection and mortality, and the benefit to society [34, 35] as a result of the COVID-19 mass vaccination. According to a preliminary study, the psychological impact of peer modeling boosted the COVID-19 vaccination rate [36]. Five categories of personal media were used in our study to promote vaccination acceptability (Table 3). The relationship with vaccine acceptance was only mentioned by a respected person. An approval document for COVID-19 vaccination was one of the strategic measures to encourage people to have vaccination [1, 37]. This study's conclusion that a COVID-19 vaccine approval certificate is one tactic that increases vaccination intention is consistent with earlier research [1]. The certificate serves as a passport or boarding pass to release people from home isolation, particularly when the lockdown period is ending. People could go outside for social activities, transportation, and traveling [1, 2, 38]. However, these activities still require the restriction for self-prevention from the disease infection. 6. Conclusion The vaccination rate for COVID-19 vaccination among health workers was high. Touching patients and their things made them feel susceptible to the risk of infection; respected people and vaccination passports influenced them for vaccination. The era of pandemic diseases that vaccination was believed to prevent and control its spreading, health personnel are one of the key informants to campaign and promote the people's cooperation to have vaccination. Funding: This research is supported by Sirindhorn College of Public Health, Yala, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute (Grant number 2/2564). The research grant covers materials, equipment, data analysis software, data recording fees, and certain publication fees. Institutional Review Board Statement: The study protocol was approved by the Ethics Committee for Human Research Subjects, Sirindhorn College of Public Health, Yala, on April 9, 2021 (Project number 049/2564). Since this research is an online data collection, we have written information about the research, research objectives, and contact channels with the researchers at the beginning of the questionnaire. The participants were explained and understood by reading it themselves. The questionnaire cannot be linked to an individual, so there is no negative effect on the respondents. If the research volunteer does not have to sign to consent to participate in the research, but answering the questionnaire means that they are willing and agree to participate in this research. Transparency: The authors confirm that the manuscript is an honest, accurate and transparent account of the study that no vital features of the study have been omitted and that any discrepancies from the study as planned have been explained. This study followed all ethical practices during writing. Competing Interests: The authors report no competing interests in relation to this work. The funder had no role in the study design, implementation, or decision to publish. 929 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 3: 922-931, 2025 DOI: 10.55214/25768484.v9i3.5382 © 2025 by the authors; licensee Learning Gate Authors’ Contributions: Awirut Singkun was responsible for project administration and supervision, study conceptualization, methodology, and wrote the original draft. Natthawadee Maneeprom, Piriya Patiwikraiwong, and Hanifah Buraka worked for data curation, analyzed the data. All authors proofread and approved the published version of this manuscript. Acknowledgments: We are grateful to a network of health professionals from 44 provinces across Thailand. They played a crucial role in distributing the questionnaire link. Copyright: © 2024 by the authors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). 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