SCHOOL OF MEDICINE AND HEALTH SCIENCES
UPTAKE OF COVID-19 VACCINES: EXPERIENCES OF HEALTH CARE
WORKERS AT PETAUKE DISTRICT HOSPITAL
BY
DEAN FRED LUPUPA MWENYA
BSPH19114548
BSc PUBLIC HEALTH
SUPERVISOR: DR LYDIA HANGULU
A research Dissertation submitted to the University of Lusaka in partial fulfilment of
the requirements of a Degree in Bachelor of Science in Public Health
DECLARATION/APPROVAL
Student declaration
I, Dean Fred Lupupa Mwenya, Student Number: BSPH19114548, School of Health Sciences,
University of Lusaka, hereby declare that my proposal is entirely unique to me and has not
been submitted to, or been considered for certification by, any other university or institution.
All sources used herein have been dully acknowledged and cited using the current Harvard
System and in compliance with anti-plagiarism standards.
Date: 8th November, 2022
Signature:
Supervisor approval
I...Dr Lydia Hangulu... I hereby attest that I have read and assessed this project proposal. In my
capacity as the University supervisor, I hereby acknowledge that this proposal has been
submitted for evaluation with my approval.
Signature
Date: 10th November, 2022
ii
DEDICATION
I wish to dedicate this research to my Dad, Mr Fred Kelvin Mwenya, my forever hero.
iii
ACKNOWLEDGEMENTS
First and foremost all gratitude goes to Almighty God for being my source of inspiration and
direction throughout my time spent pursuing this Program. I would also like to extend my
sincere gratitude to my supervisor Dr Hangulu for your valuable and timely guidance during
the development of this research. Further, I extend my gratitude to all the lecturers who carried
me through all the years at University of Lusaka, in particular Mrs Musonda Mubanga, our
research “coach”, kudos to you Madam.
My appreciation also goes to all the participants who offered their valuable time and input by
participating in this study.
Lastly, my appreciation goes to my fellow students, with whom we started this course, “our
study posse”, Sylvana Mulikita, Victoria Kaunda, Ngoza Phiri, Genaroza, Pauline and Ilukena.
iv
ABSTRACT
Background: Health-Care workers (HCWs) are among the people who are most at risk of
contracting COVID-19 because of their occupational exposure. Healthcare workers may
comprise of cadres such as medical doctors, laboratory technicians, etc. HCWs are expected to
be the first to embrace the COVID-19 vaccine since they are at very high risk due to their high
occupational exposure to patients on a daily basis—deaths of Health Care Workers due to
COVID-19 have been recorded. However, there is an apparent apathy for Health Care Workers
taking the vaccine, and so this study aimed to outline the experiences of Health Care Workers
at Petauke District on the uptake of COVID-19 vaccines. This is expected to provoke a thought
and behavioural change as the knowledge gained is availed to the relevant authorities.
Methodology: This was a qualitative case study design whose study site was Petauke District
Hospital in Petauke District of Eastern Province. The population comprised of 30 Health Care
Workers (6 from ART Department, 2 from Laboratory, 2 from Dental Department and 20 from
Out Patient Department). Purposive sampling was used to select the participants using a
researcher administered structured interview guide adapted from the World Health
Organisation. The data was examined using thematic analysis. The steps that the researcher
followed in thematic analysis are familiarizing the data, generating initial codes, defining and
naming interpretive codes for the entire data set into themes, identifying patterns across all data
to derive themes for the data set, defining and naming themes, and concluding analysis.
Results: Most of the HCWs expressed concerns of getting COVID-19, they expressed having
negative feelings, such as fear, anxiety. Fear was the major feeling expressed; that is fear of
getting the virus since they work in close contact with patients who may be infected, fear of
dying from the virus, fear of it being severe and fear of passing it on to relatives, friends and
patients. However, on a positive note, some participants advocated for all people to get
vaccinated which would help lessen the spread of the virus. In addition, The HCWs had
experience hearing negative information from various sources, such as the community, social
media such as on Facebook, bloggers, etc. This negative information was mostly in form of
myths, which led to some HCW being nervous about getting the vaccine. On a positive note,
when asked about the safety of the vaccines the emerging themes were that the vaccines are
safe as they are a good option from preventing COVID-19, reducing the severity of the cases
when infected and reducing the number of new cases.
Conclusions: The uptake of the COVID-19 vaccines was determined to be high, 28 (93%) of
the Health Care Workers (HCWs) were vaccinated with only 2 not being vaccinated. A
comparable study conducted in Uganda (Katonsa et al., 2021) found that more than 70% of
people accepted the vaccine. However, this confidence needs to be maintained by ongoing,
focused public health education and HCWs sensitization seminars.
v
Table of Contents
DECLARATION/APPROVAL ..............................................................................................ii
DEDICATION........................................................................................................................ iii
ACKNOWLEDGEMENTS ................................................................................................... iv
ABSTRACT .............................................................................................................................. v
LIST OF ACRONYMS .......................................................................................................... ix
LIST OF TABLES ................................................................................................................... x
LIST OF FIGURES ................................................................................................................ xi
CHAPTER ONE ...................................................................................................................... 1
1.0 Background/Introduction .......................................................................................... 1
1.1 Statement of the problem ........................................................................................... 4
1.2 Justification of the study ............................................................................................ 4
1.3 General research objective ........................................................................................ 5
1.4 Specific research objectives ....................................................................................... 5
1.5 Research questions ..................................................................................................... 5
CHAPTER TWO ..................................................................................................................... 6
2.0 Literature review ........................................................................................................ 6
2.0.1 Origins of COVID-19 .............................................................................................. 6
2.0.2 Global, Regional and National Coverage of Covid-19 ......................................... 7
2.0.3 Global, Regional and National impact of Covid-19 .............................................. 9
2.0.4 How the world is fighting against COVID-19 ..................................................... 10
2.0.4.1 Maintaining physical Distance. ......................................................................... 11
2.0.4.2. Contact Tracing ................................................................................................. 11
2.0.4.3 Getting Tested ..................................................................................................... 11
2.0.4.4 Surge Capacity in Hospitals............................................................................... 11
2.0.4.5 Personal Protective Equipment (PPE) Supply ................................................. 12
2.0.4.6 Clear Communication ........................................................................................ 12
2.0.4.7 Quick and Decisive Action ................................................................................. 12
2.0.5 The COVID-19 Vaccines ....................................................................................... 13
2.0.6 “For” or “Against” getting the COVID-19 Vaccine ........................................... 14
2.1 Theoretical Framework ........................................................................................... 16
2.2 Conceptual framework............................................................................................. 18
.................................................................................................................................................. 18
CHAPTER THREE ............................................................................................................... 22
Methodology .................................................................................................................... 22
vi
3.1 Study Approach ........................................................................................................ 22
3.2 Study design .............................................................................................................. 22
3.3 Study population/Target population ....................................................................... 22
3.4 Sample size, sampling procedures ........................................................................... 23
3.5 Data collection methods ........................................................................................... 24
3.6 Data analysis ............................................................................................................. 24
3.7 Ethical considerations .............................................................................................. 24
CHAPTER FOUR .................................................................................................................. 26
4.0 Results ............................................................................................................................... 26
4.1 Socio-demographic details of the participants ....................................................... 26
4.2 What are the experiences of Health Care Workers that have been vaccinated
and those that have not been vaccinated on the uptake of COVID-19 Vaccines at
Petauke District Hospital? ............................................................................................. 26
4.2.1. Tell me about your concerns about acquiring COVID-19. ............................... 27
4.2.2 What are your thoughts on the COVID-19 vaccine?— Have you heard
something which makes you nervous?— Where did you get this information? ....... 28
4.2.3 What are your opinions on the vaccine's safety and newness of the vaccines? 29
4.2.4 How much do you trust the health care person who will administer the
vaccine?............................................................................................................................ 30
4.3 What are the reasons why some healthcare workers have not been vaccinated
yet at Petauke District Hospital..................................................................................... 31
4.4 What are some of the experiences from the Health Care Workers that can
promote the increase in the uptake of COVID-19 vaccines at Petauke District
Hospital. ........................................................................................................................... 32
4.4.1 What would make getting a COVID-19 vaccination easier for you if it was
recommended and available? ........................................................................................ 33
CHAPTER FIVE ................................................................................................................... 34
5.0 Discussion .................................................................................................................. 34
5.1 Limitations ............................................................................................................... 36
CHAPTER SIX ...................................................................................................................... 37
6.0 Conclusion and Recommendations ......................................................................... 37
6.1 Recommendations ..................................................................................................... 37
REFERENCES ....................................................................................................................... 39
APPENDICES ........................................................................................................................ 49
Appendix 1: Data collection tool: Qualitative Interview Guide ................................ 49
Appendix III: Consent Form ......................................................................................... 52
Appendix IV: Work plan ............................................................................................... 53
vii
Appendix V: Budget ....................................................................................................... 54
Appendix VI: UNILUS Letter ....................................................................................... 55
Appendix VII: NHRA Approval Letter........................................................................ 57
viii
LIST OF ACRONYMS
CDC
Centers for Disease Control and Prevention
COVID-19
Corana Virus Disease 2019
DNA
Deoxyribonucleic Acid
ELISA
Enzyme-Linked Immunosorbent Assay
HCW
Health-Care workers
PCR
Polymerase Chain Reaction
SARS
Severe Acute Respiratory Syndrome
SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2
WHO
World Health Organization
EUL
Emergency Use Listing
PPE
Personal Protective Equipment
PTSD
Post Traumatic Stress Disorder
OECD
Organisation for Economic Co-operation and Development
UNICEF
United Nations International Children's Emergency Fund
ix
LIST OF TABLES
Table 2.0.1
COVID-19 Myths vs COVID-19 Facts
Table 4.1
Socio-demographic details of the participants
x
LIST OF FIGURES
Figure 1.0
Confirmed COVID-19 Cases in Zambia (Daily)
Figure 2.0.1
Global and Regional Coverage of COVID-19
Figure 2.0.2 District level distribution of COVID-19 cases in Zambia as of 17/07/ 2020
Figure 2.2.1 Conceptual Framework
Figure 4.1
Word Cloud: HCW’s concerns about getting COVID-19 (Source: NVIVO
version 10)
Figure 4.2
Word Cloud: HCWs’ thoughts about the COVID-19 Vaccines (Source:
NVIVO version 10)
Figure 4.3
Word Cloud: HCWs’ opinions on the safety of the COVID-19 Vaccines
(Source: NVIVO version 10)
Figure 4.4
Word Cloud: HCWs’ trust of the HCW giving the COVID-19 Vaccines
(Source: NVIVO version 10)
Figure 4.4
Word Cloud: HCWs’ Experiences COVID-19 Vaccines Uptake (Source:
NVIVO version 10)
xi
CHAPTER ONE
1.0 Background/Introduction
Late in December 2019, China reported a viral pneumonia outbreak in Wuhan, Hubei Province,
which quickly expanded to neighbouring locations (Pan, et. al., 2020; Ai, 2020). COVID-19
caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global
concern and has become a substantial health hazard since the number of infected people and
affected nations has increased quickly, (Cheng and Shan, 2020). COVID-19 was named as a
pandemic by the World Health Organization on 11th March, 2020, with over 68 million cases
registered worldwide as of December 8, with over 1.5 million deaths reported and over 47
million recoveries in 218 countries across the globe (Cheng and Shan, 2020).
The very first incidences of COVID-19 in Zambia were in a husband and wife who visited
Europe, France to be specific and were exposed to port-of-entry observation and subsequent
remote monitoring of passengers with a history of foreign travel for a fortnight (14 days) after
arrival. They were pinpointed as having probable cases on 18th March, 2020, after developing
symptoms throughout the 14-day surveillance period and were tested for COVID-19 (CDC,
2020). The second case was that of a local businessman who had visited Pakistan. Initially, the
majority of cases were linked to international travel or the travellers’ household contacts.
Infections among overland travellers, notably truck drivers going across the Tanzanian border,
became a source of worry as a result (CDC, 2020). From the first reported case, to date (2022)
there has been an upward and downward trend in COVID-19 cases and subsequent deaths as
Figure 1.0 shows.
1
Figure 1: Confirmed COVID-19 Cases in Zambia (Daily) (source:
https://ourworldindata.org/coronavirus/country/zambia) Accessed on 25/02/2022.
Health-Care workers (HCWs) are among the people who are most at risk of contracting the
disease because of their occupational exposure (Sebetian, et. al., 2021). Healthcare workers
may comprise of cadres such as medical doctors, laboratory technicians, etc. This may also
include Non-medical support staff such as financial workers, human resource workers,
cleaners, Community Based workers and others (Sebetian, et. al., 2021).
Previous outbreaks of Severe Acute Respiratory Syndrome (SARS), took a toll on HCWs.
During the SARS epidemic in 2002, WHO recorded 8098 cases and 774 (9.6%) fatalities, with
HCWs accounting for 1707 (21%) of the cases. Furthermore, Singapore revealed that healthcare workers were responsible for 41% of the 238 probable SARS cases (Sebetian, et. al.,
2021). With the ongoing COVID-19 epidemic, occupational contact among HCWs is one of
the major risk factors for getting COVID-19for HCWs (Sebetian, et. al., 2021).
At a local scale, Fwoloshi, et al., (2020) conducted a cross-sectional survey in 20 health centres
in 6 districts in order to determine COVID-19 prevalence among Zambian HCWs in the month
of July 2020. Participants got examined for the presence of the COVID-19 virus and antibodies
2
using polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays,
respectively (ELISA). For each test, estimates of prevalence and 95 percent confidence
intervals (CIs) were computed independently, adjusted for health facility clustering, and a
composite measure for individuals who had PCR and ELISA was done. (Fwoloshi, et al., 2020).
From their study, there were 660 HCWs in total, out of which 450 (68.2%) submitted a
nasopharyngeal swab for PCR and 575 (87.1%) supplying a blood sample for ELISA. Sixtysix percent of those who took part were female, with a median age of 31.5 years (interquartile
range, 26.2-39.8). The combined measure's total prevalence was 9.3 percent (95 percent CI,
3.8 percent -14.7 percent ). COVID-19 PCR positivity was 6.6 percent (95 percent confidence
interval: 2.0 percent-11.1 percent), while ELISA positivity was 2.2 percent (95 percent CI, .5
percent -3.9 percent )Fwoloshi, et. al, 2020). During a phase of community transmission in
Zambia, Fwoloshi et al. (2020) concluded that COVID-19 prevalence among HCWs was
identical to a population-based estimate (10.6 percent).
Even though key interventions like social distancing, isolation, and quarantine are helpful in
preventing COVID-19 from spreading, symptomatic individuals are treated with remdesevir,
supplemental oxygen, anticoagulants, etc. (Kashif, et. al., 2021). The only long-term therapy
for SARS-CoV-2 is vaccination. Several vaccines have been developed, including Moderna
Inc.'s mRNA-based vaccine, CanSino Biologics' non-replicating vector-based vaccine,
Novavax's, Covigenix VAX-001, and COVIGEN, protein subunit vaccine, and many more
(Kashif, et. al., 2021).
However, in many places, getting people to take a COVID-19 immunization is difficult
(Kashif, et. al., 2021). “Vietnam (98%), China (91 %), India (91%), South Korea (87%) and
Denmark (87%), had the highest COVID-19 vaccine acceptance rates in the general population,
while Paraguay (51%), France (44 %), Lebanon (44%), Croatia (41%), Serbia (38%), and had
the lowest” (Shmidt, et al., 2021). HCWs, who play a critical role in decreasing the pandemic's
burden by modelling preventive behaviour and giving immunizations, have also reported high
levels of hesitation around the world (Shmidt, et al., 2021).
Zambia got 228,000 doses of COVID-19 vaccines on 12th April, 2021 as its first batch of
vaccines. The COVID-19 vaccination campaign was launched 2 days later by Minister of
Health Dr. Jonas Chanda. The objective was to vaccinate 8.4 million persons aged 18 and up
3
(CDC, 2021). Because of the severe difficulty of vaccine hesitancy, which is not unique to
Zambia, only 142,000 individuals had been vaccinated with dose 1 of the COVID-19 vaccine
on July 5, 2021, and only 23,000 people were fully vaccinated (CDC, 2021). According to
Reuters (2022), Zambia has provided at least 2,822,009 doses of COVID vaccinations as of
February 27, 2022. If each individual requires two doses, that would be enough to vaccinate
7.9% of the country's population. This proportion is still quite low, given the country's
population of about 18.4 million people as of mid-2020, 44 percent of whom were under the
age of 15 (Demographic dividend, 2020).
1.1 Statement of the problem
The COVID-19 virus or coronavirus, since its being discovered in China, quickly spread to
other countries of which Zambia has not been spared. Many deaths have so far been recorded
globally and locally. As of 8th December, 2020, way above 68 million cases of COVID-19
were documented globally, with over 1.5 million patients dying. This led to companies moving
in quickly to make Covid vaccines which were not available to developing countries, but,
thankfully are now available even in Zambia. However, the speed at which these vaccines were
developed and approved for use, plus some other prevailing myths has also brought about
apathy towards people getting vaccinated (CDC, 2021).
Health workers are expected to be the first to embrace the COVID-19 vaccine since they are at
very high risk due to their high occupational exposure to patients on a daily basis—deaths of
Health Care Workers due to COVID-19 have been recorded (WHO, 2021). However, there is
an apparent apathy for Health Care Workers taking the vaccine, and so this study aimed to
outline the experiences of Health Care Workers at Petauke District on the uptake of COVID19 vaccines. This is expected to provoke a thought and behavioural change as the knowledge
gained is availed to the relevant authorities.
1.2 Justification of the study
Health Care Workers are considered as frontline staff in the health sector which increases
their occupational exposure and risk of infection to infectious diseases such as COVID-19. In
light of this they are expected to embrace positive preventive measure such as the current
vaccinations going on in the country against COVID-19 and also be the carriers of a positive
4
message for all who are in their care to follow suit. This research, is therefore aimed at
exposing the outstanding perceptions against the COVID-19 Vaccination amongst Health
Care Workers which may promote the creation of targeted messages and trainings for Health
Care Workers concerning the importance of getting vaccinated against COVID-19. This in
turn may trickle down to the general public who are even more apathetic to getting the
COVID-19 Vaccine.
1.3 General research objective
To outline the experiences of Health Care Workers at Petauke District on the uptake of
COVID-19 vaccines.
1.4 Specific research objectives
1)
To explore the experiences of Health Care Workers that have been vaccinated and
those that have not been vaccinated on the uptake of COVID-19 Vaccines at Petauke District
Hospital.
2)
To understand the reasons why some healthcare workers have not been vaccinated yet
at Petauke District Hospital.
3)
To discover some experiences from the Health Care Workers that can promote the
increase in the uptake of COVID-19 vaccines at Petauke District Hospital.
1.5 Research questions
1)
What are the experiences of Health Care Workers that have been vaccinated and those
that have not been vaccinated on the uptake of COVID-19 Vaccines at Petauke District
Hospital.
2)
What are the reasons why some healthcare workers have not been vaccinated yet at
Petauke District Hospital.
3)
What are some of the experiences from the Health Care Workers that can promote the
increase in the uptake of COVID-19 vaccines at Petauke District Hospital.
5
CHAPTER TWO
2.0 Literature review
This chapter presents a review of the literature that is relevant to this study.
2.0.1 Origins of COVID-19
Coronavirus disease (COVID-19), according to Adhikari et al. (2020), is a highly infectious
illness triggered by the SARS-CoV-2 virus that can cause fever, breathing difficulty, lung
infection and pneumonia. According to Adhikari et al. (2020), these viruses are common in
animals all over the world, but just a few cases have been documented in humans. On the
other hand, according to WHO (2021), the Huanan marketplace in Wuhan was the original
and large epicenter of SARS-CoV-2 infection, as inferred from epidemiological data. In
December 2019, 55 percent of cases were exposed to the Huanan or other Wuhan markets,
with these instances being more widespread in the early part of the month (WHO, 2021).
As to whether SARS-CoV-2 could have escaped from a laboratory, Holmes et al., (2021)
refute this claim, claiming that no epidemic has ever been caused by a laboratory novel virus,
and no evidence exists that the WIV—or some other laboratory—was operating on SARSCoV-2, or another virus similar enough to be the progenitor, before the COVID-19 pandemic.
Viral genomic sequencing without cell culture, which had been regularly conducted at the
WIV, poses a minor risk, because viruses are inactivated during RNA extraction, according to
Holmes et al., (2021).
In their report, CRS (2021) put forward four (4) possible origins of the COVID-19Virus,
some of which are in agreement with the preceding assertions.
(1) An intermediate host species infected by an animal reservoir carrier (the animal in which
the virus lives, develops, and multiplies) conveyed the virus to humans, according to a
"likely-to-very-likely" scenario. No intermediate hosts, however, have been discovered (CRS,
2021).
(2) Direct zoonotic spillover, a "possible-to-likely" mechanism for SARS-CoV-2
transmission out of an animal reservoir host to a person. Several studies have demonstrated
substantial genetic similarities between SARS-CoV-2 and coronaviruses identified in some
bat species prevalent in China and elsewhere in South Asia, making bats a plausible reservoir
host (CRS, 2021).
6
(3) Infection via cold/food-chain items, a "possible" idea that persons got SARS-CoV-2 after
coming into touch with infected food, which might include frozen, imported foods. SARSCoV-2 has been found in frozen foods, their packaging, and cold-chain goods (CRS, 2021).
(4) An "very implausible" possibility is that SARS-CoV-2 was accidently infected and
transmitted by laboratory employees while investigating coronaviruses in bats. The WHO
study said that the possibility of the virus being purposefully disseminated was ruled out by
several scientists. In the end, the researchers were unable to pinpoint the origins of SARSCoV-2 and urged that more research be conducted. In addition, the panel recommended for
frequent administrative and internal evaluations of high-level biosafety facilities throughout
the world to address what they described as a data shortage (CRS, 2021).
2.0.2 Global, Regional and National Coverage of Covid-19
According to WHO (2022), “Globally, as of 7:33pm CET, 18th March, 2022, there have been
464,809,377 confirmed cases of COVID-19, including 6,062,536 deaths, reported to WHO”.
Figure 2.1 shows the breakdown of the total global confirmed cases of COVID-19 by region;
“Europe: 191, 842,819; Americas: 149,435,827; South-East Asia: 56, 667,275; Western
Pacific: 36,865,816; Eastern Mediterranean: 21, 478, 988; and Africa: 8,517, 888” (WHO,
2022).
Figure 2.0.1 Global and Regional Coverage of COVID-19 (Source: WHO Coronavirus
(COVID-19) Dashboard, Accessed: 18th March, 2022)
7
The COVID-19 pandemic spread across Africa on 14th February, 2020, according to Kaseje,
Dong, and Gardner (2020). The first confirmed case was recorded in Egypt. Kaseje (2020)
goes on to say that the majority of the cases detected in Africa during the early manifestation
of the pandemic were claimed to have come from three places: the USA, Europe, and China.
Africa had reached 200,000 cases by mid-June, with Egypt, South Africa, Ghana, Algeria and
Nigeria, accounting for 70% of the total (Dong and Gardner, 2020).
With respect to Zambia Simulundu, et al., (2020) reported that on March 18, 2020, the first
two instances of COVID-19 were imported from France. According to Osakwe (2021),
Zambia had showed minimal cases and fatalities in the first 6 months of 2020, but this
increased dramatically after 6 months of the year 2020, with the amount of cases soaring
from 1,594 just at the close of June 2020 to 20,727 by the conclusion of the year. By 6th
April, 2021, the total cases had moved to 89, 009, continuing the upward trend. He went on to
say that the number of fatalities had followed a similar increasing trajectory, moving from 24
at the close of June 2020 to 1,222 on 6th April, 2021. (Osakwe, 2021).
Science-direct (2020) took the liberty of summarizing the COVID-19 Coverage in Zambia as
at 17th July, 2020 using figure 2.2
Figure. 2.0.2 District level distribution of COVID-19 cases in Zambia as of 17/07/ 2020
(Modified from the Ministry of Health daily reports). (Source:
8
https://www.sciencedirect.com/science/article/pii/S2468227621001319; Accessed: 15th
March, 2022).
2.0.3 Global, Regional and National impact of Covid-19
Beyond the physical and human tragedy of COVID-19, the OECD (2020) regrets that it is now
widely acknowledged that the epidemic produced the most devastating economic catastrophe
since World War II. Disturbed global supply chains, decreased demand for imported products
and services, a reduction in international tourism, a decrease in business travel, and most
commonly a mix of these, according to the OECD (2020). Small and Medium Enterprises have
been seriously affected by the virus's containment measures (OECD, 2020).
Altena et al., (2020) agrees with the OECD (2020) that the global spread of the virus is a
significant global health catastrophes in history (one of such), with huge socioeconomic
consequences. Whereas the health effects are directly linked to the spread of the disease,
according to Altena et al. (2020), the economic effects are mostly a result of the preventative
actions which were undertaken by the individual governments to try and bring it to a stop. Most
nations had implemented partial or total economic lockdowns and border closures to prevent
the spread, which led to the temporary suspension of schools, companies, and social services,
etc (Altena et al., 2020).
However, Altena et al., (2020) laments that these policies have caused serious losses for
economies of Africa, specifically in terms of lost productivity and internal and external trade.
These policies imposed substantial strain on virtually all of many countries' essential growthenhancing industries, as well as their total revenue (Altena et al., 2020).
Health Care Workers (HCWs) around the globe are the most concerned, according to WHO
(2021), because the pandemic has increased the risk of occupational exposure to a new super
fast spreading disease and necessitated the adaptation of responsibilities and roles for a wide
variety of tasks and professional fields. Furthermore, the pandemic caused several diseases and
fatalities among HCWs and their families. Mixed analysis methods identify a range of 80 000
to 180 000 deaths worldwide, with a central population-based estimate of 115 500 deaths, based
on the International Labour Organization's estimated total of 135 million HCWs engaged in
human health and social activities and WHO monitoring data on all deaths reported to be due
to COVID-19 (WHO, 2021). Those working or contracted in the health-care sector suffer many
9
dangers that influence their physical, emotional, and social well-being, making it one of the
most severely affected by the epidemic. HCWs have been shown to have a greater risk of
SARS-CoV-2 infection than the overall population (WHO, 2021).
Stress, worry and sadness, alcohol use, eating challenges, starvation, and not being able to
predict the future are some of the initial mental health problems linked to the COVID-19
pandemic, according to Altena et al., (2020). On the other side, Wu and McGoogan (2019)
discovered traumatic events associated with the death of peers and relatives, job pressures,
social status, and COVID-19 symptoms. Anxiety, despair, sleeplessness, or other societal
issues such as an increase in violence against gender (GBV) during the lockdown might
increase the need for short-term mental health care (Altena et al., 2020). Post-traumatic stress
disorder (PTSD), sleeplessness, generalized anxiety disorder, and terror are all likely outcomes
of a worldwide epidemic that has infected about 10 million individuals and killed more than
half a million (Altena et al., 2020).
COVID-19 has had a detrimental influence on the Zambian economy, according to Tembo
(n.d.), owing to the loss of job, money, and in some cases, business. However, Tembo (n.d.)
predicts that the pandemic will derail the progress made during the Vienina Programme of
Action for LLDCs' Mid-Term Review for the decade 2014-2024. Furthermore, Osakwe
(2021) claims that the COVID-19 problem has had a particularly devastating impact on the
mining and tourist industries, with major declines in foreign exchange profits leading to a
steep devaluation of the local currency (Kwacha). These innovations have had tangible
economic effects. According to the World Bank (2020), Zambia’s poverty rate soared from
58.6% in 2019 to 60.5% in 2020, implying that 706 900 more individuals fell into poverty in
2020.
2.0.4 How the world is fighting against COVID-19
Gavi (2020) summarises the global fight against COVID-19 in 7 distinct ways outlined below;
however, at the time of their article, COVID-19vaccines must have not yet been developed or
approved as they do not include them. In view of this, COVID-19 vaccines are presented
separately in section 1.6.
10
2.0.4.1 Maintaining physical Distance.
Physical separation has been one of the most common techniques adopted across the world,
from recommending people to keep a distance of 1-2 meters from strangers and cancelling
major gatherings, to closing bars, shops, etc, and requesting people to remain at home.
Mounting evidence exists that such policies are effective and have led to the preventing of
countless deaths. However, they must be used in combination alongside other sanitation and
hygiene procedures including disinfection and handwashing. Others, on the other hand, say
that lockdowns are only a technique of buying time until additional measures can be scaled up
(Gavi, 2020).
2.0.4.2. Contact Tracing
Contact tracing is a method of tracking down COVID-19 instances in communities by tracking
down persons who had contact with a person sick with COVID-19 (Gavi, 2020). It's a strategy
that
has
been
employed
in
epidemic
response
for
many
years:
it
enabled
the eradication smallpox in the 1970s, and it was recently utilized in the Congo DR in reaction
to the Ebola virus, when located contacts were vaccinated with the latest Ebola vaccine (Gavi,
2020). Many of the nations that have fared well against COVID-19 have engaged in contact
tracing from the beginning, with the goal of controlling the spread. Smartphone applications
are being used in certain countries to inform people who most likely had been exposed to
COVID-19 (Gavi, 2020).
2.0.4.3 Getting Tested
A comprehensive testing capability is required for an approach like contact tracing. Even
persons who were not exhibiting symptoms were subjected to open public testing in South
Korea as early as February. Germany quickly followed suit, with laboratories in the country
having the ability to do 160,000 tests every week as early as March 20. These nations acquired
a precise picture of the level of viral transmission in their populations thanks to broad testing,
as well as more accurately identify people who could have been exposed and make sure that
they were isolated (Gavi, 2020).
2.0.4.4 Surge Capacity in Hospitals
Many of the nations that enacted tight lockdown measures, like as the United Kingdom, did so
because they were concerned of the possibility that their healthcare system would never be able
to handle the fast increasing number of cases. Many nations, on the other hand, as a result of
11
the SARS pandemic which happened in 2003, had already incorporated surge capacity in their
healthcare systems Following the SARS outbreak, Singapore increased isolation capability in
all healthcare facilities and even constructed an isolation facility with a bed capacity of 330
persons, which served as a buffer after COVID-19 struck (Gavi, 2020).
2.0.4.5 Personal Protective Equipment (PPE) Supply
The World Health Organization (WHO) issued a warning in March that scarcity of PPE, such
as gowns, masks, and gloves, constituted a serious threat to the Health workers’ safety
worldwide. They anticipated that equipment manufacture would need to grow by 40%. (Gavi,
2020). While governments focused on expanding the capacity of healthcare by adding more
ventilators and beds, few nations paid adequate focus on safeguarding the staff who are the
health system's most precious primary resource. Singapore, and other countries who
maintained stocks of PPE in their outbreak readiness infrastructure, were able to avert the virus
from spreading through healthcare (Gavi, 2020).
2.0.4.6 Clear Communication
Countries like New Zealand have been singled out for clearly communicating the hazards
presented by COVID-19 and the reasons for the response to the public. Jacinda Ardern, the
Prime Minister of New Zealand, was lauded for her concise but courteous comments on
reaction measures, urging the public to "unite against COVID-19." It's a different from the
pictures of conflict and anti-virus ads that some countries have used (Gavi, 2020).
While war analogies may appear appealing, they have been widely criticized for instilling fear
and fostering an inward-looking response to the infection. Simple protective tactics such as
hand cleanliness and mask use might potentially have a significant influence on transmission,
especially in settings where physical separation is difficult (Gavi, 2020).
2.0.4.7 Quick and Decisive Action
"The worst blunder is not to move," Dr Michael Ryan remarked during a WHO COVID-19
briefing on emergency response. Countries that quickly deployed control mechanisms, such as
lockdown or swiftly improving their capacity to contact trace and test, appeared to be doing
the best (Gavi, 2020). Other nations throughout the world, such as Japan, Switzerland, New
Zealand, and Germany stood out for their clear plan and clear messaging from the outset due
to strong political leadership (Gavi, 2020).
12
On a local scale (in Zambia), According to Osakwe (2021), the government imposed a number
of restrictions on March 14, 2020, in order to prevent COVID-19 from spreading and limiting
its negative on the Zambian citizens. These measures included the suspension of tourist visas,
a ban on non-essential foreign travel, masking up, the suspension of some transportation
services across the border, and more. However, even though such measures were needed to
contain COVID-19 and avert a public health calamity, they came at a macroeconomic cost in
the short and long term, according to Osakwe (2021).
2.0.5 The COVID-19 Vaccines
According to WHO (2022), the first major immunization campaign began in early December
2020. If the news of COVID-19's global spread dominated 2020, 2021 was focused on ending
the pandemic through vaccine distribution, and as a result, as of January 12th, 2022, the
following vaccines had received EUL (The WHO Emergency Use Listing process establishes
whether a product can be recommended for use based on all available data on safety and
efficacy, as well as its suitability in low- and middle-income countries):The Pfizer/BioNTech
Comirnaty vaccine, 31 December 2020.
o The SII/COVISHIELD and AstraZeneca/AZD1222 vaccines, 16 February 2021.
o The Janssen/Ad26.COV 2.S vaccine developed by Johnson & Johnson, 12 March 2021.
o The Moderna COVID-19vaccine (mRNA 1273), 30 April 2021.
o The Sinopharm COVID-19vaccine, 7 May 2021.
o The Sinovac-CoronaVac vaccine, 1 June 2021.
o The Bharat Biotech BBV152 COVAXIN vaccine, 3 November 2021.
o The Covovax (NVX-CoV2373) vaccine, 17 December 2021.
o The Nuvaxovid (NVX-CoV2373) vaccine, 20 December 2021
Locally, the Viper Group (2022) reported that as of 25th March, 2022, 4 Vaccines were
approved for Use in Zambia; which are (1) Pfizer, (2) AstraZeneca, (3) Sinopharm and, (4)
Janssen (Johnson & Johnson).
In terms of vaccines, WHO (2022) announced that 10,925,055,390 vaccines have been supplied
globally as of 17th March, 2022. Dr. Jonas Chanda, the Honourable Minister of Health, formally
introduced the COVID-19 immunization on April 14, 2021 in Lusaka, at the University
13
Teaching Hospital (WHO-Africa, 2021). 228,000 doses of COVID-19 vaccines arrived in
Zambia as the first shipment from the COVAX facility, a global initiative consisting of the
Global Alliance for Vaccines and Immunization (GAVI), the World Health Organization
(WHO), Coalition for Epidemic Preparedness Innovations (CEPI) and the United Nations
Children's Fund (UNICEF), working to ensure equitable distribution of COVID-19 vaccines
(WHO-Africa, 2021).
According to Zulu, et al. (2022), the Zambian Ministry of Health claimed that 21.6 percent of
persons were completely vaccinated as of February 21, 2022. They counter that, while
vaccination doses are gradually increasing in the country, with 6.2 million doses arriving as
of February 11, fewer than half of those doses have reached people's hands. Only 2.77
million pills have been distributed by February 23. Only 7.2 percent of persons have received
a vaccination by December 31, 2021, compared to a target of 40% (Zulu, et., 2022).
2.0.6 “For” or “Against” getting the COVID-19 Vaccine
CDC, (2022) outlines some key benefits below, to getting the COVID-19 vaccine:

Getting a COVID-19 vaccine narrows the chances of getting the virus COVID-19.
Vaccines can also assist in the prevention of major disease and death.

All precautions have been taken to guarantee that vaccinations for persons aged 5 and
up are effective and safe: Even if a person has already been vaccinated, he or she
should have another dose for further protection.

Vaccination against COVID-19 is a safer strategy to establish immunity: Getting the
COVID-19 vaccine is a better option that guarantees immunity than getting sick with
the virus. COVID-19 immunization protects a person by eliciting an antibody
response without requiring the individual to get ill. COVID-19 vaccines are suitable
for Children and Adults: While COVID-19 vaccines were developed quickly, all steps
have been taken to ensure their safety and effectiveness. A growing body of evidence
shows that the benefits of COVID-19 vaccination outweigh the known and potential
risks.

COVID-19 vaccinations work well: COVID 19 vaccinations are effective and can
reduce your risk of contracting and transmitting the COVID-19 virus. Even if children
and adults contract COVID-19, COVID-19 immunizations can help them avoid major
disease and death.
14
However, CDC (2022) describe the implications for not getting the COVID-19 as:

COVID-19 infection can have catastrophic consequences: COVID-19 infection can
cause serious sickness or death, especially in youngsters, and it is impossible to
determine who will have moderate or severe symptoms. COVID-19 infection can lead
to issues with long-term health. Even people who exhibit no symptoms when first
infected may acquire these long-term health problems.

Persons infected with COVID-19 may spread it to others, such as friends and
members of the family not eligible for vaccination and those who are at a higher risk
of getting COVID-19.
Despite the above mentioned benefits of getting the COVID-19 Vaccine, Leggett, (2022)
provides 7 reasons as to why people shun the COVID-19 vaccines; (1) "Its not been there
long enough; (2) People contract COVID-19 after receiving the vaccination." (3) If the
vaccination is so effective, why is it that we require a booster? (4) I've previously had
COVID-19, therefore I'm protected; (5) I'm concerned about vaccination adverse effects; (6)
The great majority of those who had COVID-19 have survived. I'm ready to accept the risk
(7) It's all up to me. If I become sick, I'm only harming myself." (Legget, 2022).
Dunning (2021) further adds to Leggetts (2022), that others aren't as enthusiastic. Some
people are afraid of vaccinations because they believe they were rushed or ‘,test-runs’, and
they may have heard bogus claims that immunizations cause infertility or include a microchip
(Dunning, 2021).
To put it all into proper perspective CDC (2021) provides “Myths” that people have
concerning the COVID-19 vaccine and “facts” that contradict the myths, summarised in
Table 2.1
1
MYTHS
COVID-19 vaccinations
contain hazardous
chemicals.
FACTS
Almost all of the constituents of
COVID-19 vaccines – fats, sugars, and
salts – are also found in numerous
meals.
15
2
3
4
5
The immunity I obtain
from becoming
infected with COVID-19
is greater than the
immunity I get through
immunization against
COVID-19.
Variants are caused by
COVID-19 vaccinations.
Vaccination is the cause
of all occurrences
documented to the
Vaccine Adverse Event
Reporting System
(VAERS).
The mRNA vaccine isn't
actually a vaccination.
6
Microchips are included
in COVID-19
vaccinations.
7
COVID-19 vaccination
can make you magnetic.
COVID-19 vaccinations
have the potential to
modify my DNA.
9 COVID-19 vaccines
have the potential to
make me ill.
10 My fertility will be
affected by the COVID19 vaccination.
8
COVID-19 vaccines are safer and more
trustworthy option to establish COVID19 immunity than being infected with
COVID-19.
COVID-19 vaccines don’t induce
variations of the COVID-19 virus.
COVID-19 vaccinations, on the other
hand, can assist in preventing the
development of new variants.
Even if it is unclear if a vaccination
caused the condition, anybody can
report it to VAERS. As a result,
VAERS data alone cannot indicate
whether a COVID-19 vaccine caused
the reported adverse event.
Pfizer-BioNTech and Moderna mRNA
vaccines function differently than other
forms of vaccinations, but they
nonetheless cause an immunological
reaction in your body.
Microchips are not present in COVID19 vaccinations. Vaccines are designed
to protect you from disease and are not
given to track your movements.
COVID-19 immunization does not turn
you magnetic, as well as at the injection
site, which is generally your arm.
COVID-19 vaccinations have no effect
on or interaction with your DNA.
With COVID-19, the vaccination
cannot make you sick.
There is currently no proof that any
vaccination, including the COVID-19
vaccine, causes reproductive
difficulties in either women or men.
Table 2.0.1 COVID-19 Myths vs COVID-19 Facts (Adapted from CDC
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html,)
2.1 Theoretical Framework
16
The theoretical framework for studying the uptake of COVID-19 vaccines among healthcare
workers can be informed by the Health Belief Model (HBM) (Rosenstock, 1974). The HBM
posits that an individual's beliefs about health and disease, as well as their perception of the
benefits and barriers to a particular health behaviour, influence their decision to engage in that
behaviour.
In the context of COVID-19 vaccination, healthcare workers' beliefs and perceptions can be
shaped by several factors, including their level of knowledge about the vaccine, their trust in
the safety and efficacy of the vaccine, their attitudes towards vaccination, and their social and
cultural background (Bish et al., 2011).
The Theory of Planned Behaviour (TPB) (Ajzen, 1991) can also provide insight into the factors
that influence healthcare workers' decision to get vaccinated. TPB posits that an individual's
attitude towards a behaviour, their perceived subjective norms (i.e., the perceived social
pressure to perform the behaviour), and their perceived behavioural control (i.e., the perceived
ability to perform the behaviour) influence their intention to engage in that behaviour.
In the context of COVID-19 vaccination, healthcare workers' intention to get vaccinated can
be influenced by their personal beliefs and attitudes towards vaccination, as well as the norms
and expectations of their colleagues and the wider healthcare community (Kaptein et al., 2021).
Finally, the Social Ecological Model (SEM) (Sallis et al., 2008) can help to understand the
broader social and environmental factors that influence healthcare workers' decision to get
vaccinated. SEM posits that an individual's behaviour is influenced by factors at multiple
levels, including individual, interpersonal, organizational, community, and policy levels.
In the context of COVID-19 vaccination, healthcare workers' decision to get vaccinated can be
influenced by factors such as the availability and accessibility of the vaccine, the support and
encouragement of their colleagues and supervisors, and the policies and regulations
surrounding vaccination in their workplace and community.
Overall, the Health Belief Model, Theory of Planned Behaviour, and Social Ecological Model
provide a comprehensive framework for understanding the factors that influence healthcare
workers' decision to get vaccinated against COVID-19. By considering the individual,
interpersonal, and broader social and environmental factors that shape vaccine uptake,
healthcare organizations and policymakers can develop more effective strategies for promoting
COVID-19 vaccination among healthcare workers.
17
2.2 Conceptual framework
Figure 2.2.1 shows the conceptual framework that relates to the study at hand.
Figure 2.2.1 Conceptual Framework (Source: Akther and Nur, 2022)
2.2.1 Belief in conspiracy theories and COVID-19 vaccination
A conspiracy belief is the unwarranted assumption of a conspiracy when other explanations
are more likely (Brotherton, et al., 2013). There is increasing evidence that BC can have
detrimental effects on attitudes and conduct. (Jolley, et al. 2020). Conspiracy theories have
long focused on the safety and effectiveness of vaccines, despite the fact that they are the most
effective means of preventing infectious illnesses. The main claim in these theories is that
major pharmaceutical firms and/or governments hide vaccine information in order to benefit
themselves. (Kata, 2009; Jolley and Douglas, 2017). Conspiracy beliefs against vaccinations
decrease vaccination plans. (Hornsey et al., 2018). Rumours about delays in the COVID-19
vaccine's creation or that the only people who will receive free vaccines are those who back
the current administration could breed mistrust between government stakeholders and the
general public. Any regulation relating to vaccinations may be impacted by this. Online
rumours and conspiracy theories that are not always supported by empirical proof are
18
frequently increased by health-related information. (Lavorgna, et al., 2018). Online platform
users who look for health information run the risk of being exposed to false information that
could jeopardise public health. (Waszak, et al., 2018). People who were exposed to information
about the COVID-19 vaccine on social media were more likely to be misled and vaccinehesitant, according to Stecula et al. (2020).
2.2.1.1 Impact of conspiracy beliefs on subjective norms
As a result of how strongly people are influenced by what they perceive to be societal standards,
conspiracy theories are common and can have detrimental effects. (Cookson, et al, 2021).
Social influence is the process by which views and actions are influenced by perceptions of
what other people believe and do. (Cialdini and Trost, 1998). Social standards serve as a
behavioural guide by delineating tacitly what is and is not appropriate in a particular situation
(Cialdini and Trost, 1998). Social standards are jointly agreed-upon guidelines for social
behaviour, according to Sherif (1936). Stronger group identification increases the likelihood
that a person will behave in line with group standards. (Terry and Hogg, 1996). Thus, perceived
standards of conspiracy belief may affect personal BC, particularly if individuals believe that
organisations with which they firmly associate support conspiracies. (Terry and Hogg, 1996;
Jolley, et ., 2019).
It is believed that BC, in specific anti-vaccine conspiracy beliefs, is more prevalent than it
actually is. (Cookson et al., 2021). This is important because, given the detrimental social and
health effects of harbouring conspiracy beliefs, especially anti-vaccine conspiracy theories, the
overestimation of in-group conspiracy beliefs may result in unjustified social pressure to also
support conspiracy beliefs. (Jolley and Douglas, 2019).
2.2.1.2 Impact of conspiracy beliefs on COVID-19 vaccine acceptance
Conspiracy ideas and rumours may increase people's anxiety about vaccines. (Islam et al.,
2021). Uptake of vaccines has traditionally been affected by unfavourable claims about vaccine
effectiveness. There have long been claims that vaccination drives are being used for political
gain, and these stories have had an impact on vaccination drives in some nations.
(Bhattacharjee and Dotto, 2020). There is a persistent myth that key stages of clinical trials for
vaccine development were skipped because drug firms refused to pay volunteers for
unfavourable side effects they encountered. Rumours about the COVID-19 vaccine being a
messenger RNA (mRNA) vaccine that could alter people's Deoxyribonucleic Acid (DNA),
turning them into genetically edited humans, or induce cancers and infertility are the most
19
pervasive. According to some assertions, the COVID-19 vaccine was designed to decrease the
world's population. There was a report in Bangladesh that China intended to use Bangladeshi
residents as test subjects for a vaccine study. (Islam et al., 2021).
2.2.2. Awareness
The degree to which a target populace is informed about an innovation and has developed a
general understanding of what it involves is known as awareness. (Dinev and Hu, 2007). The
innovation diffusion theory, which claims that awareness, attitude development, choice,
execution, and confirmation are all parts of the decision-making process for embracing new
technologies, is where the idea of awareness first surfaced. (Rodgers, 1995). It is additionally
described as a person's active involvement and elevated curiosity in key problems. (Bickford,
2002; Greene and Kamimura, 2003). People are either unaware of or afraid of the present
vaccination program, according to one survey. (Suresh, et al., 2021). In many nations, vaccine
reluctance and false information are significant barriers to coverage and population
immunisation. (Lane et al., 2017; Larson et al., 2014). Awareness can have positive impact on
the vaccine acceptance.
In addition to one's mindset towards behaviour, one's social group's behavioural standards have
a significant impact on one's desire to behave in a particular way. (Ajzen, 1998). The
development of a social network of organisations that vehemently support policies and
programmes to lessen such issues is guided by the process of raising problem consciousness.
(Biglan and Taylor, 2000). Raising community standards about COVID-19 through the
COVID-19 vaccine and increasing knowledge among different socioeconomic groups and
communities affects immunisation through the COVID-19 vaccine.
2.2.3. Perceived Usefulness (PU).
PU is a measure of how much people believe using a system would enhance their ability to
accomplish their jobs. (Davis, 1989). The degree to which a person contemplates using
something that offers more advantages is what matters. (Davis, 1989). Attitude can be predicted
by PU. (Davis, 1989). Users can adopt an optimistic outlook because there are many advantages
to a specific action. According to Islam et al (2021), the majority of subjects had a favourable
opinion of vaccination due to its value in preventing the COVID-19 illness. Acceptance of the
COVID-19 vaccine can be predicted by perceived advantages, such as the vaccine's high
efficacy in avoiding serious illness and its consequences, as well as the risk of contracting the
illness or spreading it to others. A vaccination certificate may be necessary for recent grads to
20
apply for new jobs, higher education, and to continue their present studies and daily activities.
A positive mindset towards accepting vaccines and the COVID-19 vaccine is fostered by the
vaccine's utility. Therefore, we hypothesise that
2.2.4 Perceived ease of use (PE).
PE is a person's anticipation of how simple the intended method will be to comprehend, acquire,
and employ. (Chun and Lu, 2004). The acceptance of an invention will be hampered by the
system's complexity. (Rodgers, 1995). The operation of a system can be made simpler so that
a user can adopt a good mindset towards purpose and conduct. PE and mindset and
understanding go hand in hand. (Davis, 1989; Taylor and Todd, 1995; Ramayah et al., 2004).
Convenience in vaccination refers to how simple it is to get the vaccine, taking into account
elements like accessibility, cost, and actual availability. (MacDonald, 2015). It is crucial to take
vaccine accessibility and cost into account when examining vaccine approval. The adoption of
the COVID-19 vaccine will rise if it is more easily and widely accessible.
2.2.5 Subjective Norms
A person's view of the societal pressure to engage in or abstain from a goal action is known as
a subjective standard. (MacDonald, 2015). While desire to obey reflects how much a person
wants to abide by the intentions of the referent other, normative views reflect how a person
perceives the impact of opinion among reference groups. (Shmueli, 2021). As a result, people
frequently behave in accordance with how they believe others should behave, and those near
to them may have an impact on their desire to behave in a particular way.
Self-efficacy and subjective standards are important indicators of COVID-19 vaccination
intention. (Shmueli, 2021). Subjective standards include how peers and family members
reacted to the vaccination, which may be especially important to healthcare professionals.
People who have a positive attitude towards the COVID-19 immunisation would advocate for
it among their friends, family, and neighbours.
21
CHAPTER THREE
Methodology
3.1 Study Approach
This was a qualitative study design which is an investigation process of understanding that
investigates a social or human problem and is based on distinct methods of inquiry; the
researcher establishes a complex, holistic picture, analyses words, reports detailed views of
informants, and carries out the study in a natural setting (Creswell, 2009).
3.2 Study design
The researcher used a case study design to investigate the uniqueness and complexity of a case
while also learning about its activities and conditions (Stake, 1995). The main aspects of case
studies are summarized by Yin (2017). To begin with, case studies investigate "a contemporary
phenomenon in depth and within its real-life context, especially when the distinctions between
phenomenon and context are blurred" (Yin, 2017). The case should be portrayed as a bounded
system with clearly defined and delimited limits, despite the fact that the phenomenon and its
setting are intertwined (Merriam and Tisdell, 2015). Second, case studies draw on a variety of
sources and types of data to meet the full scope of a study issue (Yin, 2017).
A case study is ideal for addressing "why," "how," and "what" issues, according to Yin (2014).
(among question series: "who," "what," "where," "how," and "why"). For a variety of research
topics and challenges, a case study appears to be a viable technique. Because the bounded
system is the most significant condition, every research situation where the bounded system is
key is a case study candidate. A case study, for instance, in the study of a single organization,
community, or program, might be a separate research subject. Case studies are commonly used
in evaluations, such as external reviews. This technique gives respondents the freedom to
express themselves and use whichever language they like.
3.3 Study population/Target population
A population may be described as a collection of people, things, or things from whom samples
are obtained for measurement (Kombo and Tromp, 2005). The study population was Health
Care Workers of Petauke District Hospital. This study was conducted at Petauke District
Hospital. Petauke District Hospital is a 121-bed capacity government health facility located
along the on boma road off Great East Road on the way to Chipata, the Provincial headquarters
for Eastern Province. It is 420km from the country’s capital city - Lusaka and 190 kilometres
from Chipata. Petauke District Hospital is a first referral health facility serving largely the
22
district population of 256,533 for 2020. The site was selected because of its size as a district
hospital and also because it has high levels of exposure due to the high patient flow.
3.4 Sample size, sampling procedures
Purposive sampling is a non-probability sampling approach in which the items chosen for the
sample are chosen based on the researcher's judgment. Researchers typically believe that by
using sound judgment, they would be able to get a representative sample while keeping costs
down (Kombo and Tromp, 2005). To create the sample, people who do not fulfil a specified
profile are excluded, in this case, those that work in departments where there is least exposure
to patients, non-consenting HCW’s and support staff or non-clinical staff will also be excluded.
A sample is a portion of the population studied in order to derive conclusions about the entire
population. For example, according to Kothari (2004), as long as the sample is wellrepresented, the sample's results may be used to make generalizations about the entire
population.
Sandelowski, (1995) asserts that in general, qualitative research sample sizes really shouldn't
be so small that saturation is impossible to attain. In addition the sample size must not be too
huge that thorough, case-oriented analysis becomes problematic (Sandelowski,1995). When
homogenous samples are chosen in qualitative research, Kuzel (1992) indicates that 6-8 data
sources or sampling units are sometimes adequate, and that 12-20 data sources are generally
required. According to Morse (1994), qualitative researchers should utilize at least six
individuals in investigations aimed at understanding the core of experience. For ethnographies
and grounded theory research, Morse (1994) advises 30-50 interviews and/or observations.
With the preceding in mind, the sample consisted of 6 HCWs from the ART Department, 20
HCWs from Out Patient Department, 2 lab personnel and 2 HCWs from Dental Department,
the total sample size coming to 30 respondents. The respective departments have been selected
because they have high risk of exposure to COVID-19 due to having consistent contact with
patients or Recipients of Care.
23
3.5 Data collection methods
The systematic process of obtaining and analyzing measuring information on selected variables
in relation to the research questions, test hypotheses, and assess results is known as data
collection (Syed, 2016). Information will be gathered through semi-structured interviews.
Many researchers favour interviews that are semi-structured since questions may be prepared
in advance, which portrays the interviewer as being well-prepared and capable during the
interview. During interviews that are semi-structured, informants are also given the opportunity
to express themselves in their very own terms. Semi-structured interviews can yield qualitative
data that is both trustworthy and comparable (Syed, 2016). Between the interviewer and the
responders, a formal interview is held. The interviewer prepares an interview guide and uses
it. This is a list of topics and questions that must be presented in a certain order during the
presentation. When the interviewee agrees, the interviewer might deviate from the guide and
explore topic trajectories in the talk that aren't necessarily related to the advice (Syed, 2016).
Due to the COVID-19 situation, the researcher used google forms to administer the interview
via phone calls. This will be less expensive and faster to perform than face-to-face interviews
and involves fewer resources. When you just have one chance to interview someone, semistructured interviewing is the ideal option (Bernard, 1988).
3.6 Data analysis
The data was examined using thematic analysis. The most fundamental approach for assessing
qualitative data is thematic analysis (Braun and Clarke, 2006). Analysis of themes, is a method
for discovering patterns and themes of meaning within a dataset with respect to a study topic
(Braun and Clarke, 2013). NVivo will be used to import the material from each interview. The
theme analysis will be conducted using NVivo, a computer assisted qualitative analysis
software (CAQDAS) tool. The steps that the researcher followed in thematic analysis,
according to Braun and Clarke (2013), are familiarizing the data, generating initial codes,
defining and naming interpretive codes for the entire data set into themes, identifying patterns
across all data to derive themes for the data set, defining and naming themes, and concluding
analysis.
3.7 Ethical considerations
With the present study, there are certain ethical considerations. All participants are requested
to give their written consent to participate in the research by signing a Consent form and reading
the information page. The purpose is to reassure interviewees that they can opt out of the
24
research at any moment and for any reason. Furthermore, interviewees will be informed about
the study's objectives, and they will be assured that their replies will be kept private and used
only for academic reasons and the specific research. Interviewees will not be assaulted or
abused in any manner during the study, both physically and psychologically. In addition prior
to conducting the research, permission will be sought from the University of Lusaka Research
Committee (UNILUSREC) and National Health Research Authority (NHRA).
25
CHAPTER FOUR
4.0 Results
This chapter presents the results of the study as is obtaining on the ground.
4.1 Socio-demographic details of the participants
The participants comprised of 30 Health Care Workers (HCW) from 4 departments, that is; 6
from the ART Department, 2 from Laboratory, 2 from the Dental Department and 20 from Out
Patient Department (OPD). The lowest age was 19 years, highest age was 41, mean age was
26 and median age was 25. Of the 30 participants, only 2 were not vaccinated against COVID19 at the time of the interviews.





N=30
Lowest Age: 19
Highest Age: 41
Mean Age: 26
Median Age: 25
Vaccinated
against COVID-19
Sex
Male Female Total
Yes No
Total
Job Title
Nurse
Clinical Officer
Medical Doctor
Dental Therapist
10
0
0
0
14
3
1
2
24
3
1
2
22
3
1
2
2
0
0
0
24
3
1
2
ART Department
Dental Department
Laboratory
Out Patient Department (OPD)
0
0
0
10
6
2
2
10
6
2
2
20
6
2
2
18
0
0
0
2
6
2
2
20
Department
Table 4.1 Socio-demographic details of the participants
4.2 What are the experiences of Health Care Workers that have been vaccinated and
those that have not been vaccinated on the uptake of COVID-19 Vaccines at Petauke
District Hospital?
In order to capture the HCW experiences on the uptake were asked some questions (as they
appear hereon after). The responses were imported into NVIVO qualitative analysis software
version 10. Thematic analysis was then done, after coding, in which the emerging themes were
best summarised using word clouds. A Word Cloud is a collection or cluster of words depicted
in different sizes. The bigger and bolder the word appears, the more often it is selected/voted
26
for by an audience member. Word Clouds are a powerful way to visualise what your audience
really thinks about a topic. Word clouds are a great way to visualize qualitative data you have
— interviews, quotes, etc (McNaught and Lan, 2010).
4.2.1. Tell me about your concerns about acquiring COVID-19.
Figure 4.1 Word Cloud: HCW’s concerns about getting COVID-19 (Source:
NVIVO version 10)
When asked about their concerns on getting COVID-19, most of them expressed concerns, as
seen in the word cloud (figure 4.1), furthermore, most expressed having negative feelings, such
as fear, anxiety. Fear was the major feeling expressed; that is fear of getting the virus since they
work in close contact with patients who may be infected, fear of dying from the virus, fear of
it being severe and fear of passing it on to relatives, friends and patients. However, on a positive
note, some participants advocated for all people to get vaccinated which would help lessen the
spread of the virus.
27
HCW24 (Nurse): “I have concerns, what if I die, or what if it will be very severe.”
HCW16 (Clinical Officer_Vaccinated): “My concern is my life can be at risk I might
lose my life and also affect people around me.”
HCW 20 (Medical Doctor_Vaccinated): “That I might get it since I work in a high risk
area and am exposed to the virus daily.”
HCW 22 (Nurse_Vaccinated): “I am not fearful of getting the virus because I have been
vaccinated and medications exist for treatment.”
HCW 26 (Nurse_Not vaccinated): “I have mixed feelings, such as fear or anxiety
because I don't know much about how the virus reacts in the body.”
4.2.2 What are your thoughts on the COVID-19 vaccine?— Have you heard something
which makes you nervous?— Where did you get this information?
When asked about their thoughts of the COVID-19 Vaccines and whether they had heard
anything about it which made them nervous, and the source of such information; the
participants expressed different experiences, as shown in figure 4.2. The emerging themes were
that of negative information being heard in various sources, such as the community, social
media such as on Facebook, bloggers, etc. This negative information was mostly in form of
myths, which led to some HCW being nervous about getting the vaccine.
HCW 14 (Nurse_Vaccinated): “I was nervous before I got my first dose of these
vaccines, but after experiencing it now I don't have any thoughts.”
HCW 27 (Nurse_Not vaccinated): “I think the vaccines are not good, because we have
different bodies, others react while others don't react. From social media (Facebook
and opera mini and from church) that we should not get vaccinated because the
vaccines are not good for the body.”
28
Figure 4.2 Word Cloud: HCWs’ thoughts about the COVID-19 Vaccines
(Source: NVIVO version 10)
4.2.3 What are your opinions on the vaccine's safety and newness of the vaccines?
When asked about the safety of the vaccines the emerging theme as seen in figure 4.3, was that
the vaccines are safe as they are a good option from preventing COVID-19, reducing the
severity of the cases when infected and reducing the number of new cases.
HCW 30 (Nurse_Vaccinated): “Yes they are safe even though there has been many myths
surrounding that.”
HCW 13 (Nurse_Vaccinated): “I think they should continue being given [the vaccines] because
just after the coming of vaccines the number of cases reduced together with the deaths.”
29
Figure 4.3 Word Cloud: HCWs’ opinions on the safety of the COVID-19
Vaccines (Source: NVIVO version 10)
4.2.4 How much do you trust the health care person who will administer the vaccine?
Lastly on experiences, the HCW were asked, before being vaccinated whether they trusted
the HCW giving the COVID-19 vaccine. The emerging theme as seen in figure 4.4 was that
of trust, although, others had some doubts and for some the trust levels were not 100%.
However, the HCW not vaccinated expressed complete mistrust of the HCW who would
administer the vaccine.
HCW 30 (Nurse_Vaccinated): “I trusted the person 100% percent because of the way
I was welcomed and how the health care worker explained.”
HCW 29 (Nurse_Vaccinated): “I trusted the health care worker 75% because I was
not given ICE on the benefits and side effects so I had some fear.”
HCW 27 (Nurse_Not vaccinated): “I don't trust them, because I feel they add
something to the vaccine.”
30
Figure 4.4 Word Cloud: HCWs’ trust of the HCW giving the COVID-19
Vaccines (Source: NVIVO version 10)
4.3 What are the reasons why some healthcare workers have not been vaccinated yet at
Petauke District Hospital.
In order to drill down to the reasons why the HCWs are not vaccinated, their responses on some
key questions were extracted, since those not vaccinated were only 2 HCW out of the total of
30 HCW.
4.3.1 What are your thoughts on the COVID-19 vaccine?— Have you heard something
which makes you nervous?— Where did you get this information?
HCW 26 (Nurse_Not Vaccinated): “I have mixed feelings because of what people say,
that the virus is being introduced in your body that will kill me slowly—from people or
friends.”
HCW 27 (Nurse_Not Vaccinated): “I think the vaccines are not good, because we
have different bodies, others react while others don't react.—From social media
31
(Facebook and opera mini and from church) that we should not get vaccinated
because the vaccines are not good for the body.”
4.3.2 What are your opinions on the vaccine's safety and newness of the vaccines?
HCW 26 (Nurse_Not Vaccinated): “I don't know.”
HCW 27: “Yes they are safe but I still have some doubts.”
4.3.3 Have you considered being vaccinated against COVID-19? What decision did you
make? (Skip if already vaccinated).
HCW 26 (Nurse_Not Vaccinated): “Yes, I have considered it, but I don't know where
to get it.”
HCW 27 (Nurse_Not Vaccinated): “No I have not thought about getting vaccinated. I
have decided not to get vaccinated.”
4.3.4 How much do you trust the health care person who will administer the vaccine?
HCW 26 (Nurse_Not Vaccinated): “I trust the health care worker 50%, because most
of the health workers don't follow the rules of masking up, so they can transmit the
virus to me.”
HCW 27 (Nurse_Not Vaccinated): “I don't trust them, because I feel they add
something to the vaccine.”
Emerging themes from the responses as reasons for not being vaccinated are; fear/mixed
feelings/doubts/mistrust induced by wrong information from friends, the community, church
and social media platforms such as Facebook and Opera Mini News feeds. In addition, HCW
appear to have insufficient knowledge on the benefits on how the vaccines work and how they
are designed to work in any person. Lack of trust of fellow HCW administering the vaccine is
also presented as a reason for not getting vaccinated.
4.4 What are some of the experiences from the Health Care Workers that can promote
the increase in the uptake of COVID-19 vaccines at Petauke District Hospital.
Figure 4.4, summarises, the experiences of the HCWs on the uptake on COVID-19 vaccines.
The most emerging positive theme was that all but 2 HCWs were vaccinated, and gave positive
feedback on their experiences.
32
Figure 4.4 Word Cloud: HCWs’ Experiences COVID-19 Vaccines Uptake
(Source: NVIVO version 10)
4.4.1 What would make getting a COVID-19 vaccination easier for you if it was
recommended and available?
HCW 26 (Nurse_Not vaccinated): “If I am told where the vaccine is given from and
being given more information on the vaccine.”
HCW 27 (Nurse_Not vaccinated): “I need proper information on the vaccines for
example from the World Health Organisation.”
As for the HCW who were not vaccinated, when asked about their final decision whether they
will get the vaccine or not (enablers); a need for more information to be given to them on the
vaccines was expressed.
33
CHAPTER FIVE
5.0 Discussion
HCWs are an essential component of every health system in the world (WHO, 2016). The
COVID-19 pandemic's disastrous impact on healthcare delivery has brought attention back to
the crucial role that HCWs play in all health systems (WHO, 2020). In the fight against the
pandemic, HCW safety is of utmost importance.
The results showed that amongst the experiences of the HCWs, when asked about concerns on
getting the COVID-19 virus, the emerging themes where those of HCWs having negative
feelings such as fear, nervousness and anxiety at the thought of getting the virus, passing it on
to their friends and relatives, of getting severe forms of the virus or of dying from the virus.
These findings resonate with the various reports on COVID-19 infections and mortality among
frontline healthcare workers (HCW) (Erden and Lucey, 2021). For instance, the WHO African
Regional Office estimated that in 2020, the virus infected about 10,000 healthcare workers in
Africa (AFRO/WHO, 2020). Similar to this, the WHO Pan American Regional Office (PAHO)
estimated that as of September 2020, 2500 HCWs had died from COVID-19 and 570 000 had
been infected (PAHO/WHO, 2020). Such reports of death from the virus can indeed cause such
negative feelings to linger among the HCWs.
When asked about their thoughts of the COVID-19 Vaccines and whether they had heard
anything about it which made them nervous, and the source of such information; The emerging
themes were that of negative information being heard in various sources, such as the
community, social media such as on Facebook, bloggers, etc. This negative information was
mostly in form of myths. These findings tally with those of Kitonsa et al., (2021) and Valliers
et al., 2021, in their studies in which many of their participants also claimed to have heard
negative things about the COVID-19 vaccine from various sources. Negative information
concerning the COVID-19 vaccine was particularly prevalent through social interactions and
social media. It is noteworthy that more than three-quarters of respondents said they had
received unfavourable information via chatting apps. The placement of factual vaccine
information can be directed by this knowledge of the precise social media platforms spreading
harmful information. Given the link between exposure to unfavourable information and
vaccination motivation, this is particularly significant. It relates to whether the responder would
advocate for the vaccination of loved ones (Kitonsa et al., 2021; Valliers et al., 2021).
34
Because of their training in science and medicine, most survey participants agreed that the
vaccine was necessary and safe. These findings were consistent with those of Raude et al.
(2016), who asserted that HCWs had a positive attitude toward vaccinations, because of their
constant contact with patients and the need to safeguard themselves against the risk of infection.
Emerging themes from the responses as reasons for not being vaccinated are; fear/mixed
feelings/doubts/mistrust induced by wrong information from friends, the community, church
and social media platforms such as Facebook and Opera Mini News feeds. In addition, HCWs
appear to have insufficient knowledge on the benefits on how the vaccines work and how they
are designed to work in any person. Lack of trust of fellow HCW administering the vaccine is
also presented as a reason for not getting vaccinated. These findings tally somewhat with the
findings of Murphey et al., (2021) who stated that indecisive people are a group that can change
their minds if they obtain more information about the effectiveness of the vaccine, its safety,
and the fact that, if vaccinated, it protects both themselves and those who may have wanted but
could not be vaccinated against disease (Murphey et al., 2021).
In terms of overall experiences of HCWs on the uptake of the COVID-19 Vaccines, this study
discovered a very high acceptance and vaccination rate of 93% (that is 28 HCWs vaccinated
and only 2 not vaccinated), which is in contrast to the low acceptance seen in studies conducted
among HWs in Nigeria, Ghana, the Democratic Republic of the Congo, and Saudi Arabia
before the vaccine was available (Agyekum et al. 2021; Ekwebene at al, 2021; Qattan et al.,
2020; Nri-Ezedian et al., 2021; Nzaji et al., 2020). This strong acceptability can be linked to
the vaccine's accessibility in the country and the initial phase's emphasis on immunizing HCWs
(Odekunle and Odekunle, 2021).
Prior to the vaccine's introduction in Zambia, successful vaccination deployments in highly
developed countries may have also contributed to this high acceptability. According to a study
by Viswanath et al. (2021), those who believed that they were more likely to contract COVID19 and that the consequences would probably be severe were more likely to accept the
vaccinations that were offered to them and the others in their care. According to the health
belief model, people's preparedness to take action was influenced by their views of the
advantages of attempting to prevent sickness as well as their beliefs about their susceptibility
to it. It's possible that being on the front lines of the COVID-19 battle and witnessing firsthand
the catastrophic effects of the virus enhanced people's desire to receive vaccinations.
(Viswanath et al, 2021).
35
5.1 Limitations
This study has some limitations. First, the sample size is relatively small only 30 HCWs.
Second, the study was a qualitative case study and therefore causality cannot be established.
Third, this study used convenience-sampling technique, which is a non-probability sampling
technique, thus limiting the extent to which the results can be generalized to the population of
health care workers in Zambia. Fourth, it was conducted in a single Health center, however,
this hospital is a university facility that is composed of all key departments. A large number of
substantial number of HCWs work there and numerous residents gravitate for treatment to it.
Future research should be quantitative in order to establish causal relationship between uptake
of vaccines and possible barriers or factors. In addition it should be carried out at more than
one health facility in Zambia.
36
CHAPTER SIX
6.0 Conclusion and Recommendations
The uptake of the COVID-19 vaccines was determined to be high, 28 (93%) of the Health Care
Workers (HCWs) were vaccinated with only 2 not being vaccinated. A comparable study
conducted in Uganda (Katonsa et al., 2021) found that more than 70% of people accepted the
vaccine. However, this confidence needs to be maintained by ongoing, focused public health
education and HCWs sensitization seminars. In order to ensure that COVID-19 vaccine rollout
interventions for the global south are implemented successfully and effectively, these countryspecific contexts should serve as a guidance.
The results have introduced baseline empirical evidence on the need for additional follow-up
mixed methods studies to fully understand experiences and reasons for vaccine acceptance and
hesitancy among HCWs, even though the findings reported in this paper are exploratory and
may not be entirely conclusive. HCWs are a valuable resource for the general public in terms
of health information and validation, and their opinions on the COVID-19 vaccine are essential
in swaying public opinion about vaccinations in general.
Additionally, continuous engagement with HCWs by health managers and policy experts
throughout the value chain on vaccine trials and deployment will promote trust and confidence
which will likely trickle down to the general population through advocacy by HCWs on public
health benefits of vaccination. Finally, there is the need for effective stakeholder engagements
towards championing vaccinations uptake as a public health intervention. Government
agencies, Civil Society Organizations (CSOs), health professional groups should lead in
mobilizing resources for these campaigns.
6.1 Recommendations
The following are some recommendations.
1. Continued communication with HCWs about vaccines and deployment by health
managers and policy experts along the entire value chain will foster trust and
confidence, which will probably filter down to the general populace through HCW
advocacy on the public health benefits of vaccination.
2. There’s a necessity for effective stakeholder engagements to promote vaccine uptake
as a public health intervention is the final requirement. Governmental organizations,
civil society organizations (CSOs), and associations of health professionals should take
the initiative in raising money for these campaigns.
37
3. The use of more validated and verified sources and critical evaluation of health
information before making public health decisions should be taught to healthcare
professionals in more depth.
4. In order to find and equip local champions for vaccination uptake, the Ministry of
Health (MoH) and its implementing agents should work with religious organizations
and their leadership.
38
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APPENDICES
Appendix 1: Data collection tool: Qualitative Interview Guide
Interview Guide Adapted for this study using the WHO Structured Interview Guide.
Construct
General
Health worker
Please tell me about yourself.
Age, sex, other details
Tell me about your
responsibilities/designation.
Feelings and
thoughts
COVID-19 risk
perception – self
Tell me about your concerns
about acquiring COVID-19.
— What makes you feel like that?
— Do you believe it's likely?
— Do you believe it would be
severe?
HCW’s Perceived
risk to patients
What are your thoughts on the
possibility of giving COVID-19
to your patients?
COVID-19 related
stigma (social
pressures)
What is the typical treatment of a
health care professional in the
community?
- - Has there been any
difference in how you've been
treated since the COVID19 pandemic?
What are your thoughts on the
COVID-19 vaccine?
— Have you heard something
which makes you nervous?
— Where did you get this
information?
— Have you heard something
which makes you optimistic
about the vaccines under
development?
What are your thoughts on the
COVID-19 vaccine(s)?
Vaccine
information for
COVID-19
Confidence in
COVID-19 vaccine
Rationale
— Warm-up question
— Introduces the interviewer
to the circumstances of the
participant.
— Gain a better understanding
of the participant's
perceived danger from
COVID-19 (the disease, not
the vaccination)
— This will connect in with a
subsequent inquiry
regarding taking the
COVID-19 vaccine.
— Determine the HCW's
perception of the danger of
infecting others.
— Allows for probing for the
presence/experience of
stigma, which is related to
the vaccination question
below.
— Inquires about their
knowledge of the
vaccination - this allows to
probe for good or negative
information.
— Elicits participant trust in
the vaccination; probing
questions will cover a
variety of topics, including
49
— What are the impressions of
each vaccination if numerous
vaccines are available? Return
to the perceived COVID-19
danger and its importance.
— Importance of safeguarding
others
— Harmony with spiritual or
religious convictions (inquire
for all COVID-19 vaccines in
stock)
— What are your opinions on the
vaccine's safety? (Ask for all
available COVID-19
vaccinations)
— Newness of the vaccines
— Opinions as to whether it
works (inquire for all COVID19 vaccines in stock)
Motivators
Intention to get the
COVID-19 vaccine
Have you considered being
vaccinated against COVID-19?
What decision did you make?
(Why?) ….. Continue to the next
question (combine)
Getting the COVID19 vaccine –
decision making
process
Explain how you plan to or have
decided to receive a COVID-19
vaccination. Probe:
— Was anybody else engaged in
the decision-making process?
With whom did you discuss it?
— Is that anything your
boss/supervisor requires?
Getting the COVID19 vaccine –
whether it is safe to
see friends and
family
(if you've previously received the
vaccination) Has getting
vaccinated against COVID-19
altered your life? (If you haven't
had the vaccination yet) How do
you believe obtaining the
COVID-19 vaccine will affect
your life?
Examine: — Consult with family
and friends
— Making an appearance in
public
safety, significance, and so
on.
— Discovers their objectives
and choices regarding the
vaccination. The "why"
inquiry could be an
excellent spot to triangulate
their replies because it may
be repeated of the questions
answered previously.
— Addresses decision
autonomy as well as the
decision-making process in
general, with the goal of
determining what kind of
social processes are
involved.
— This covers the survey item,
but it's been broadened to
investigate for other ways a
COVID-19 vaccination
may affect people.
50
Stigma around the
COVID-19 vaccine
(If they said yes to the previous
question about stigma): Do you
believe the COVID-19
vaccination will or has assisted
with the stigma we discussed
earlier? Why?
This is only significant if the
participant mentioned any type
of stigma in the previous
question. If they don't claim
having faced or heard of it
happening, don't inquire.
COVID-19 vaccine
— Social norms
that are
descriptive
— Family norms
— Religious leader
norms
— Workplace
standards
What do you think other people
will do if a COVID-19
vaccination is suggested by health
care workers?
— Relatives and friends
— What do religious or
community leaders advise?
—
What do you expect your coworkers to do?
— Is this true for all COVID-19
vaccinations or does it depend
on which vaccine is advised if
more than one vaccine is
available?
— Finds out what they think
the social norms will be for
COVID-19 immunization
uptake.
Have you ever gotten an adult
vaccine? Have you ever had a
health care professional prescribe
one to you? So, how about your
boss?
— Begin with previous general
vaccination experiences,
including, if available,
historical service
satisfaction.
Practical
Considerations
Have you ever gone
to get vaccines
The COVID-19
vaccine –
— Vaccines
available on-site
access
— General
vaccination –
where to receive
(If you were previously
immunized as an adult):
What did you think was nice
about what transpired in the
health center when you got the
vaccine? Was there anything you
didn't like? What do you believe
you could do differently next
time?
Can you tell me how you would
go about getting a COVID-19
vaccine? Begin with the basics.
Probe:
— Would you have to seek for
permission?
— Request a narrative
outlining how they may
obtain the vaccination,
including costs, lost
workdays, transportation,
and any required permits.
— Also discuss how they
believe they can get the
vaccination more easily.
51
vaccinations —
Vaccination
availability —
General
vaccination –
cost
— Vaccines in
general –
customer
satisfaction
— Vaccines in
general
— service quality
— Would you or did you go grab
it? (Does the hospital have the
vaccine?)
— How did/would you get there?
— Would you have to complete it
on your own time (rather than
during your shift)?
— Will there be / was there a cost
to you (not just for the
vaccination, but also for things
like transportation)? — How
much do you trust the health care
person who will administer the
vaccine?
-
Closing remarks
What would make getting a
COVID-19 vaccination easier
for you if it was recommended
and available?
Is there anything else on your
Allow for unanticipated
mind?
discoveries or expansion on
previously stated ideas.
Appendix III: Consent Form
STUDY TITLE: UPTAKE OF COVID-19 VACCINES: EXPERIENCES OF
HEALTH CARE WORKERS AT PETAUKE DISTRICT HOSPITAL
I consent to take part in a study project directed by DEAN FRED LUPUPA MWENYA, a
University of Lusaka Leopards Hill Campus 4th Year BSC Public Health Student. The goal
of this paper is to spell out the conditions of my involvement in the project by way of an
interview.
1. The researcher has given me enough information on this study endeavour. The goal of my
involvement in this research as an interviewee has been stated to me and is clear.
2. I am involved in this study as an interviewee on an entirely optional basis. I have not been
no coerced to engage in, either explicitly or implicitly.
3. Being interviewed by the lead researcher is part of the participation. The interview should
last about 20 minutes. During the interview, I enable the researcher to take written notes. I
may also agree to the interview being recorded (audio).
52
4. I clearly retain the right to refuse to respond to any question I don’t feel like answering. I
can withdraw from the interview if I am made uncomfortable in any way during the
interview.
5. I have been given express assurances that the researcher would not identify me by name
or function in any reports based on material acquired from this interview if I want it, and that
my confidentiality as a participant in this study will be protected. In all situations, further
uses of records and data will be governed by the University of Lusaka's regular data usage
regulations.
6. I have received confirmation that this research study has been evaluated and authorized
by the University of Lusaka Ethics Committee.
7. I have read and comprehended all of the points and statements on this form. I have gotten
sufficient answers to all of my questions, and by signing this form, I voluntarily agree to
participate in this study.
8. I was provided a copy of this consent form, which was signed by the interviewer.
____________________________
Participant’s Signature:
________________________
Date:
____________________________
Researcher’s Signature:
________________________
Date:
Appendix IV: Work plan
TASKS
Feb- Mar- Apri22
22
22
Proposal
development
and completion
Ethical
approval
Data collection
Data analysis
Report writing
Final report
submission
May22
Jun22
Jul- Aug22
22
Sep22
Oct22
Nov22
Dec22
53
Appendix V: Budget
ITEMS
PLAIN PAPER
WRITING PADS
PENS
PRINTING
PHOTOCOPYING
TALKTIME
TRANSPORT
MISCELLANEOUS
TOTAL
COST (ZMK)
K100
K120
K30
K350
K150
K250
K500
K300
K1800
54
Appendix VI: UNILUS Letter
55
56
Appendix VII: NHRA Approval Letter
57