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KNOWLEDGE AND ACCEPTANCE OF COVID-19 VACCINES

AMONG NURSING STUDENTS

Jan Michael R. Remolado, RN, MN, MAN

ABSTRACT

The level of knowledge and willingness among nursing students to accept the
COVID-19 vaccine may significantly affect the vaccine acceptance of the population now
and in the future. The purpose of this descriptive-correlation and causal research study was to
assess the level of knowledge and acceptance of COVID-19 vaccines among 3 rd year nursing
students. The sample consisted of 124 nursing students both in public and private nursing
schools of Iligan City who completed an Online Survey Questionnaire consisting of
demographic profile, vaccine knowledge, and vaccine acceptance. Participants were unsure
or had lack of clarity about COVID-19 vaccines. The level of acceptance among nursing
students showed an overall mean denoting agreeing or acceptance. Participants demonstrated
a positive vaccination attitude/acceptance. Nursing students’ level of acceptance towards
COVID-19 vaccines was correlated to the level of knowledge on COVID-19 vaccines. This
study concludes that the participants were moderately agreed on the COVID-19 vaccines but
still recognized the willingness to accept the COVID-19 vaccines. It is also concludes that
knowledge is the best predictor among the variables about acceptance. The result also
demonstrates the impact of varying degrees of vaccine acceptances as a topic for future
researchers to investigate.

Key Words: Knowledge, Acceptance, Nursing Students, COVID-19 Vaccines, COIVD-19

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CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction

The COVID-19 pandemic has had a profound influence on public health worldwide.

The public interest in using the COVID-19 vaccines has increased throughout this current

epidemic. Immunization is one of the most effective strategies to prevent COVID-19,

although it depends on the population. The understanding and desire of 3 rd year nursing

students in Iligan City to get COVID-19 vaccination could greatly impact the acceptability of

COVID-19 vaccines amongst people now and in the future. The nursing students were more

likely to be vaccinated if, and only if, the potential side effects of COVID-19 vaccination

surpassed the anticipated risk and severity of the disease. The population received COVID-

19 immunizations because of its effectiveness, long-term protection, and low frequency of

adverse reactions. Hesitancy in vaccines is a threat to public health worldwide, but less is

known of COVID-19 immunizations for nursing students, our future immunizers, and

advocates of health. Nursing school was chosen for this study because the leading COVID-19

vaccines influenced the participants, and nursing students with lower vaccine knowledge

scores chose healthcare providers as a primary influence. Nursing educators would consider

delivering targeted instruction to address common vaccination misconceptions among

nursing students to positively improve students' knowledge of and acceptance of COVID-19

immunization.
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The novel Coronavirus disease (COVID-19) pandemic is a global threat wherein the

entire globe is faced. As of March 24, 2021, Corona Virus cases reached 124,799,104

globally, with death cases of 2,746,242 and 100,827,697 recovered. The increase of COVID-

19 mortality from Coronavirus is due to the non-availability of this COVID-19 vaccination.

Researchers have carried out various investigations on the creation of COVID-19 vaccines

that seek to reduce COVID-19-related morbidity and mortality. The World Health

Organization (WHO) and the European Commission developed COVAX as part of the

Access to COVID-19 Tools (ACT) effort as a global strategic approach to the COVID-19

pandemic. COVAX serves the following purposes: (1) a global campaign to ensure fair and

prompt access worldwide to COVID-19 vaccination, (2) as a feasible approach making the

COVID-19 vaccinations accessible in good time, and (3) ensuring the availability and

accessibility of COVID-19 vaccination for everybody.

Although the COVID-19 vaccines have potential benefits, many reticence aspects

have been reported regarding the proposed COVID-19 vaccination anecdotal evidence that

limits COVID-19 pandemic response efficiency (Ilesanmi, Afolabi, 2020). Mass testing,

border closure, no opening of courses, physical separation, use of face masks, hand

cleanliness, especially in public areas, and health education about the existence of COVID-19

are among the suggested safeguards. There are still many persons who refute the existence of

COVID-19, while others think of political corruption despite the public health campaigns

done by the healthcare practitioners. However still, the existence of COVID-19 is

challenging because of the large number of mortalities that have been linked to COVID-19.

The denial of the existence of COVID-19 is highly influenced by COVID-19 Vaccine

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Hesitancy (VH), wherein people lack trust in the pharmaceutical industry aside from political

and even “mark of the beast” to some religious organization beliefs. This misconception

could hinder the promising successes in achieving the prospective COVID-19 vaccine and

the entire COVID-19 outbreak response.

Unexpectedly, Vaccine Hesitancy on COVID-19 is also present among healthcare

professionals. The participation of healthcare professionals towards COVID-19 vaccination

plays a vital role in preventing the spread of viruses as they are the front liners in

understanding patients’ doubts and concerns, answers their queries, and above all explain to

them the importance and positive effect of vaccination. Unfortunately, a research study

(Paterson et al. 2016) reports low acceptance levels and high hesitancy levels on COVID-19

vaccination among healthcare professionals such as medical doctors, nurses, and others, most

of those whom provide COVID-19 vaccinations to patients. Most of these researches focused

on healthcare professionals' perspectives and concerns about insufficient knowledge,

COVID-19 vaccination efficacy and effectiveness, and potential long-term adverse effects.

Furthermore, nursing students' acceptance of COVID-19 immunization is critical since they

serve as healthcare educators to patients and will be future professionals. Since the existing

studies of COVID-19 Vaccine Hesitancy among nursing students are still rare, the

investigator aimed to explore the level of knowledge and acceptance among nursing students

towards COVID-19 vaccines. The result of this study will be used for the needed targeted

interventions to modify knowledge and acceptance and prepare the nursing students for

responsible roles in vaccination programs.

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Theoretical Framework and Conceptual Framework

Adaptation Model of Sister Callista Roy

Adaptation Model by Sister Callista Roy is derived from the meta paradigms

common to nursing theories: (1) assumptions related to the person, (2) the

environment, (3) health, and (4) nursing. The theorist emphasizes that the person is

subject to a system that includes the stimulus that generates the coping mechanisms

and results based on the response of the individual, family, and community that end up

supporting another stimulus.

Roy observed that stimulus is composed of the following: (1) focal, (2) contextual,

and (3) residual. Therefore, about the Coronavirus pandemic, the right interventions of focal

stimulus are vital, which include its clinical manifestation such as fever, dry cough, fatigue,

and even severe dyspnea.

Another type, contextual stimulus, is defined with co-morbidities (e.g., diabetes,

hypertension, pre-existing respiratory disease, immunosuppression, and a working

environment prone to transmission). About residual stimulus, internal and external factors are

considered as seen as smoking, work-related stress, stress-related to high viral transmission,

to the absence and limited access to appropriate Personal Protective Equipment.

As to coping mechanisms, it is categorized as regulators and cognates. Regulators

include the physiological mode that is direct with the individual’s physiology, revealing

facets related to the organism’s situation and performance. Within the infection by the
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COVID-19, this time is relevant because the body homeostasis is connected with the less

likelihood of worsening the clinical manifestations because of the viral infection.

 
The cognate coping mechanisms experience modes are defined as self-concept, role

function, and interdependence. The Self-concept mode defines coping as an imminent

demand to need the care of psychic integrity, attentively on psychological and spiritual

aspects. Assuredly, in the context of panic and anxiety which pandemic causes, the confront

of emotional support in this pandemic time relieves the suffering and favors the

psychological well-being.

The Role Function mode and its coping mechanism pertain to the ability of an

individual to perform his/her role within the world and with self-knowledge that enables the

individual to identify this/her role in society. In times of pandemic, this acknowledgment is

critical because the population that does not participate in essential services such as giving

supports to measures control when it fulfills social isolation, whereas within the scope of

essential services, health professionals, as an example, legitimate their functional importance

after they perform their duty with technical skills and humanization.

The coping mechanism of the interdependence mode leads to the affective demands

of everyone. In fact, with the proposal of social distancing, it is common to observe anguish

in the community, which encompasses a peculiar demand to relate for complete well-being.

However, information and communication technologies are often another mitigation to

physical distance and their respective repercussions on the population’s biopsychosocial

health.
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Still, about the interdependence mode, it is vital for health professionals to understand

this mode, specifically nurses are considered as front liners during this pandemic. As nurses,

they, check on this current situation --- since many of those health professionals do not return

to their homes, have contact with relatives and friends and constantly experience the fear of

transmission, undergo the extensive workload and, too, the precarious infrastructure of the

various health institutions. This vital context considering Roy’s assumptions which directly

interacts within this group should be addressed by health authorities.

The response of the individual's adaptive process is divided into adaptive and

ineffective. The adaptive ones promote the integrity of the individual, positively affecting

health. The ineffective response, on the choice hand, is when the individual is unable to

coping effectively, compromising his/her self-care and development. Therefore, it is through

the answers that the nurse can identify an individual’s coping mechanisms which is designed

to urge adaptive responses.

As a result, considering this present situation of world health, the nurse who delves

for significant actions directed by science, reflection, and criticality, has to consider Callista

Roy's Adaptation Theory mainly because through its premise, a view that examines the

individual in its entirety is proposed, making up a singular path, during which the science

that deals with caring can do to ensure the accuracy of their responses.

Health Belief Model

A theoretical model like health beliefs is a vital tool in understanding the factors in

decision-making through assessing what encourages and holding back the people to adopt

health-related behavior. Health Belief Model (HBM) is one of the most used models in
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examining the association of health behavior and the use of health services. This approach

explains and expects preventive health behavior in terms of belief patterns. HBM claims that

an individual may be explained through their way of life and awareness of health problems,

perceived benefits, and barriers to action and self-efficacy by their involvement (or lack of

commitment) in behavior supporting health. Action to stimulate the behavior that promotes

health is equally vital. The Health Belief Model for vaccination is frequently employed.

Based on the Health Belief Model, individual points of view on the seriousness and

susceptibility of the disease and perceived health advantages and hazards associated with the

vaccine (Carpenter, 2010).

The milieu of COVID-19, more than a few of health beliefs, is related to vaccine

acceptability. Participants who have reported greater levels of anticipated probability of

COVID-19 infection in the future and who have perceived the severity of COVID-19 were

more likely to be vaccinated. In predicting COVID-19, the perceived advantage to be

achieved within the Health Belief Model is essential.

Perceived severity entails that getting infected by COVID-19 disease has an adverse

effect both for self and others. Any person who is vulnerable to, or who recognizes, a high

risk of COVID-19 will be more likely to indicate greater intents for COVID-19 vaccination

(Betsch et al., 2015). Perceived susceptibility refers to the conviction that the disease is

highly likely to be infected. Recent research shows that people believe that if they receive a

COVID-19 vaccine, they are in danger of becoming infected with COVID-19. The

effectiveness of vaccinations COVID-19 has generally been part of the research on vaccine

hesitation (Neumann-Böhme et al., 2020). Persons at high risk of COVID-19 are less
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susceptible to vaccination by vaccinating against COVID-19 (Brewer et al., 2007). The

COVID-19 vaccine minimizes the risk of COVID-19. Finally, getting COVID-19 vaccination

is difficult due to physiological and psychosocial challenges. The perception of hurdles is

related to a reduction in the desire to get vaccinated against COVID-19.

The Health Belief Model (Champion, 2008) explains that the failure of

participation of people in COVID-19 Vaccination is considered to be salient with one-time

behaviors, like vaccination. Health Belief Model consists of six concepts: attitudes toward

the perceived threat of disease (1) perceived susceptibility and (2) perceived severity,

attitudes regarding perceived expectations of vaccination (3) perceived benefits and (4)

perceived barriers, (5) cues to action to vaccinate, and (6) self-efficacy for obtaining

vaccinations against COIVD-19. Using the framework of the Health Belief Model, the

intervention is successful because it increases the acceptance and participation of the uptake

of vaccines (Gargano et al., 2011).

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Independent Variables Dependent Variables

Demographic profile of the

nursing students:
- Age
- Gender
- Religion

Acceptance of Nursing
Students towards
COVID-19 Vaccines

Knowledge about COVID-

19 Vaccines: types, dose
and frequency, vaccine
efficacy based on Phase III
Clinical Trial (CT), and
common adverse events
reported and observed on
Phase III Clinical Trial (CT)

Figure 1. Schematic Presentation showing the interplay of the variables

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Statement of the Problem

The 3rd year nursing students’ knowledge and willingness to accept the COVID-19

vaccines may influence the vaccine acceptance of the community now and in the future. The

purpose of this study was to positively assess the level of knowledge and acceptance of

COVID-19 vaccines among 3rd year nursing students in Iligan City.

Specifically, it sought to answer the following:

1. What is the demographic profile of nursing students in terms of:

1.1. Age;

1.2. Gender;

1.3. Religion?

2. What is the nursing students’ level of knowledge about COVID-19 Vaccines?

3. What is the nursing students’ level of acceptance towards COVID-19 Vaccines?

4. Is there a significant relationship between acceptance, knowledge, and demographic

profile among nursing students towards COVID-19 vaccines?

5. Which variables best predict the acceptance of the nursing students towards COVID-

19 vaccines?

Hypothesis/Assumption
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Ho1 – There is no significant relationship between acceptance, knowledge, and

demographic profile among nursing students towards COVID-19 vaccines.

Ho2 - There are no variables that best predict the acceptance among nursing students

towards COVID-19 vaccines.

Significance of the Study

The study, on the knowledge and acceptance of COVID-19 vaccination among third-

year nursing students, is vital because it could provide valuable information on how to

increase the knowledge and acceptance level of COVID-19 vaccination. The findings of this

study will be valuable to school administrators, nursing deans and professors, nursing

students, the community, and future researchers who may be advised in expanding the

nursing idea of immunization. The study's findings will benefit nursing institutions, school

administrators, college of nursing deans and faculty, nursing students, the community, and

future researchers who want to improve their knowledge and attitude toward COVID-19

vaccination.

College Dean. Data will provide the dean with information on the level of knowledge

and acceptance of the 3rd year regular nursing students towards COVID-19 vaccines. The

results will enable the dean to formulate and improve nursing pedagogy to cope with the

demands of the nursing student learning process and help plan the advancement of nursing

education.

Nursing Faculty. The result of the study will help the clinical instructors to evaluate

the level of knowledge and acceptance of the 3rd year regular nursing students towards

COVID-19 vaccines acquired in the nursing curriculum. The results will also develop
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teaching and evaluation techniques for the clinical instructor to improve the knowledge,

skills, and attitude of nursing students over the given time frame.

3rd year Nursing Students. This study will evaluate and improve the level of

knowledge, the student nurse’s acceptance, and approach towards COVID-19 vaccines. It

will further help them understand the relevance of different COVID-19 vaccines to fight

against the COVID-19 pandemic, thus educating the community on the importance of the

said vaccines.

Future Researcher. The results of the study will give the necessary essential data for

future research and related studies.

Scope and Delimitation of the Study

This study focused on the knowledge and acceptance of COVID-19 Vaccination

among nursing students. The inclusion criteria were, the participants of this study are the 3 rd

year regular nursing students from public and private nursing schools in Iligan City, namely:

Mindanao State University – Iligan Institute of Technology (MSU-IIT), St. Michael’s

College (SMC), and Adventist Medical Center College (AMCC), and both female and male

students, religion for cultural knowledge and practices. Furthermore, the assessment for

COVID-19 vaccine knowledge among nursing students was limited in dose and frequency,

vaccine efficacy based on Clinical Trial Phase III, and adverse events reported and observed

on Clinical Trial Phase III. This study was conducted during the May-August of Academic

Year 2021-2022.
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Definition of Terms

Acceptance refers to the behavior of the nursing students in consenting to receive COVID-

19 vaccines (Pfizer BioNTech, Oxford AstraZeneca, SinovacCoronaVac, Gamaleya Sputnik

V, Bharat BioTech, Moderna, Novavax, and Janssen).

Age refers to how old or young a particular student nursing student was.

COVID-19 vaccine refers to the critical tool in the battle of COVID-19. The COVID-19

vaccines are as follows: Pfizer BioNTech, Oxford AstaZeneca, SinovacCoronaVac,

Gamaleya Sputnik V, Bharat BioTech, Moderna, Novavax, and Janssen.

Gender refers to a particular nursing student, whether he/she is a male or female.

Knowledge refers to the awareness and understanding of the nursing students towards

COVID-19 vaccines (Pfizer BioNTech, Oxford AstaZeneca, SinovacCoronaVac, Gamaleya

Sputnik V, Bharat BioTech, Moderna, Novavax, and Janssen)).

Nursing students refer to students who are officially enrolled in the program of Bachelor of

Science in Nursing. The nursing students are from Mindanao State University – Iligan

Institute of Technology, St. Michael’s College, and Adventist Medical Center College.

Religion refers to a cohesive system of ideas and practices about sacred objects set apart and

banned - beliefs and practices that come together to form a single moral society known as a

Church.
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CHAPTER 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter reviewed related literature and studies on topics about nursing students’

knowledge of and attitude towards COVID-19 vaccines, especially those that have particular

significance to this study. The review also relates to similar studies as an anchor to the

present study.

Increasing public health figures in a county and impacting on improving the quality

of human resources in the field of health, provides health instruction to communities in towns

or areas. These areas certainly require health officers to play their part by addressing

problems to characterize an increase in the quality of health and public health in society. The

high life expectancy in the community is undoubtedly closely related to healthy behaviors for

all members of the society, such as caring about the sanitation of the environment around

their residence; performing handwashing after doing work activities (Nasirin and

Wahyuningsih, 2020).

Age and Gender

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Hegar et al. (2019) state that respondents ages 18-29 are more likely knowledgeable

about COVID-19 than are other age groups. The level of acceptability to COVID 19 vaccines

was significantly affected by age and gender. Better attitudes towards the disease are most

likely held by the older people. Female participants are more likely than males to have a

favorable opinion of COVID-19.

However, according to Ferdous et al. (2020), there are no significant differences in

COVID-19 knowledge based on gender. The majority of the study participants have an

inaccurate understanding of COVID-19, with only the younger (12-20) participants having

more accurate knowledge than other participants. As regards the acceptance of the COVID-

19 vaccination, women positively believe that these suspected instances including use of the

facial mask in crowded locations. must be brought to the attention of health authorities

straight away. As for the age of the participants, older persons (>30), who are affirmative

about COVID-19, are concerned.

Another research study shows the relationship between knowledge and attitude by the

participants towards COVID-19. Based on their study, male participants are more

knowledgeable about COVID-19 transmission, which through a respiratory droplet from an

infected person (Lee et al., 2021).

In addition, women and persons who live with children were shown to be at an

elevated risk of uncertainty and refusal to get vaccinated against COVID-19. Age was not

linked to hesitation regarding the COVID-19 vaccine; nevertheless, persons over 65 were

less likely to receive COVID-19 immunization than younger adults. A 5-fold higher relative

risk of not receiving COVID-19 vaccines were negative attitudes regarding the COVID-19
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vaccines across all four domains. Strong and intermediate levels of mistrust of vaccine

benefits were associated with a five times higher relative risk of being unwilling to get a

COVID-19 vaccine. Similarly, vaccine unwillingness was predicted by worries about

unforeseen effects (Paul et al., 2020).

Furthermore, in the research study by Green et al. (2021), only a minority of the

participants indicated that they would want the COVID-19 vaccine immediately, and this was

more marked in females than males in both ethnic groups. Arab females were observed as

highest and lowest in male Jews when asked about whether they will decline the vaccine at

any stage. The responses among the participants remained almost unchanged when the same

question related to vaccine update was tantamount to the increasing number of cases is

significant. About the willingness of the participants to get involved at some stage of vaccine

clinical trials, female participants were not unwilling to participate, regardless of the ethnic

group. After controlling the age and educational status with low education, it was

significantly related to less willingness to accept the vaccine. These results are consistent

with the actual uptake of the vaccine. Despite the success of the vaccination campaign, the

acceptance in the Arab population has been much less than in the Jewish population.

Religion

Religion will also likely be assessed as a complex system of beliefs that are shared

and challenged. For both quantitative and qualitative studies, many issues arise when religion

and science are tackled. Most likely, religion is concomitant with identity, beliefs, and

practices relative to behaviors assumed or avoided in response to social distancing health

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protocols such as gathering should be avoided, wearing facemask all the time, and even

vaccine hesitancy. For instance, some people insist that wearing a face mask is no longer

effective and unnecessary, mainly because wearing it is just a manifestation of a lack of faith

and courage. This person who believes wearing a mask is vital in this pandemic bow to the

dictate of the “State” and “Science”; thus, in contrast to one’s spiritual faith and limits a

person’s God-given freedom.

According to Wilde (2018), “religion” can never be a variable quantity due to its

ongoing relationship to social life, people, and even gender. It is difficult to look at and

document how religion affects behavioral patterns associated with the transmission and

mitigation of diseases. Likewise, Margolis (2018) shows mutual and increasing relationships

between religion and partisanship, specifically within us wherein public policies and

implementation towards COVID-19 are lobbied; religion could also measure for an in-depth

understanding of social distancing actions.

However, studies show evidence that evolving those religious views are connected

with abiding by such social distancing practices. These samples are in particular linked to

gendered religion lines (Forthcoming et al., 2020). There are four aspects of religiosity

related to social distancing behaviors: (1) certainty of beliefs, (2) perceptions of

invulnerability, (3) collectivist versus individualist orientations, and (4) the centrality and

intensity of collective rituals. The inevitability and exclusivity of a conceptual framework

can associate with the distrust of authority from other institutions: science or medicine

(Baker et al. 2020). Another study gives importance to contextual consideration wherein

religion is associated with the social dynamics of the race (Yukich et al., 2020). The impact
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of the pandemic is therefore related to religiosity in ways that vary among ethnic and racial

lines.

Knowledge on COVID-19 Vaccines

A thorough understanding of the immunization COVID-19 was related to older age,

male participants, parents with a higher educational level, healthcare workers, a life science

course, and COVID-19 vaccination acceptance (Gallè et al., 2021).

In addition, a research study also shows that usage of mobile phones, education,

computer, and televisions are sources of information about COVID-19 vaccines. Computers

and mobile phones were the devices used by college students as the primary sources of

information (Jiang et al., 2021). College students play an important who can help promote

the prevention of a COVID-19. China is aggressively pursuing a universal immunization

strategy, with the government, school administration, and instructors all paying close

attention to the public. Schools provide opportunities for students to learn about COVID-19,

emphasizing its importance and integrating COVID-19-related knowledge into students' daily

lives, thereby expanding their understanding of COVID-19 vaccinations. Grade, sex, and

high school background are all important determinants of knowledge. Senior pupils and older

adults have a better ability to acquire and digest information significantly higher than

younger individuals and junior students in terms of knowledge scores (Olaimat et al., 2020).

On the other hand, female students scored higher than male students’ about to knowledge
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scores (Albaqawi et al. 2020). In order to improve student understanding about the COVID-

19 vaccine and lessen their vaccine hesitations, nursing education providers should introduce

various educational procedures according to student characteristics.

Finally, with nursing students moving on to the academic ladder, their knowledge

develops, demonstrating they have a profound comprehension of COVID-19-related material

in their theoretical topics and hospital exposures because of their exposure to high-level

learning and information on COVID-19. In order to eliminate knowledge gaps among

students at various levels, nurses should offer equal access for all students to the COVID-19

curriculum at all levels. Furthermore, a study found no difference between perceived and

actual COVID-19 knowledge; students who assessed their knowledge as high likewise

obtained high marks on the actual COVID-19 knowledge assessment (Tumala et al., 2020).

Acceptances towards COVID-19 Vaccines

To begin, Alshehry et al. (2021) investigated the predictor of nursing students'

willingness to accept the COVID-19 vaccine. Most nursing students in this study sought

vaccination. However, a minority percentage certainly did not intend to get a vaccination. It

were uncertain about their desire for the vaccine COVID-19 because of vaccine safety and

effectiveness COVID-19, immune system reaction, its side and adverse effects, and above

all, distrust. Because of the documented pandemic tiredness, which further impairs the

acceptability of the nursing students to get vaccinated, and their willingness is likely to be

negatively predisposed as the COVID-19 outbreak continues. The findings of the current
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study, which found that nursing students with a high degree of COVID-19 anxiety are more

likely to refuse the vaccine (Michie et al., 2020).

However, in contrast to the previous study, Kempe et al. 2020 found a more positive

attitude regarding COVID-19 vaccines which most likely resulted in COVID-19 vaccination.

Because most populations are based on the participants’ views on COVID-19 vaccine

effectiveness, respondents with favorable views are convinced that COVID-19 vaccines will

be efficient. Moreover, the willingness to adopt COVID-19 vaccinations is strong in

scientists' faith (Roozenbeek et al., 2020). In accepting the COVID-19 vaccine, the faith of

participants in Saudi Arabia's health professionals is critical. The health authorities and the

government of Saudi Arabia have dedicated themselves to providing full details on the

significance of vaccines COVID-19 (Gollwitzer et al. 2020). The results also supported that

acceptance towards COVID-19 vaccines is based on a positive belief in the vaccines.

Acceptance of the COVID-19 vaccinations based on the health belief model is influenced by

personal views (Sherman et al., 2021). Additional research has demonstrated that different

components of health attitudes affect people's propensity to vaccinate against COVID-19

(Zampetakis et al., 2021). Consequently, their desire to protect themselves from becoming

COVID-19 infected could impact the favorable belief of nursing students in their intention to

become vaccinated.

Healthcare students and Vaccination Program

The neighborhood desperately needs healthcare professionals who can teach people

about the importance of good health (Nasirin and Asrina, 2020). Medical physicians, nurses,
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midwives, and other educated health professionals focus on serving the community by

educating them on how to care for their health in order to prevent disease spread and so

improve the quality of life. As a result, the public health goal aims to hasten the growth of

health in order for the community, particularly those living in suburban regions, to live

healthy lives despite their limited access to health care (Nasirin et al., 2020).

Since other countries experienced the second wave of COVID-19 pandemic, increase

the level of vaccination coverage globally would be a boundless achievement in order to

realize the safety of the many. The level of healthcare students’ acceptance towards COVID-

19 is highly considered because they play a key role as future professionals in educating and

guiding the patients to the right clinical decision. The study explored the intention of nursing

students to get vaccinated for SARS-CoV-2 infection and the factors acting either as

motivators or barriers towards vaccination (Galanis et al., 2021).

The relationship between patients and healthcare providers is critical in instilling

vaccine confidence. Vaccinations of COVID-19 have shown knowledge and acceptability

among health professionals as a crucial aspect in their uptake of vaccines and in the

willingness to promote COVID-19 amongst their patients. Findings of a review on

determinants of nurses’ practices regarding vaccination indicate a relationship between

knowledge, attitudes, and vaccination practices. The higher knowledge and positive attitudes

towards vaccination were positively associated with vaccination coverage among nurses.

There was also an association between nurses’ vaccination status and their reported

promotion of vaccination to their patients (Labergue et al., 2013).

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Due to rising of vaccine hesitations, health care providers remain the most

recognized vaccination adviser and influencers. The skills are stretched, however, as they

face only a short time, heavy workloads, resource constraints, and often lack of information

and training to handle the issues and needs of parents. Healthcare practitioners generally need

to be given additional help to manage environmental vaccine concerns and public reticence

or refusal to vaccinate COVID-19. Some of the recommended measures include building

confidence in the vaccine recommendations by providing greater participation amongst

Health Providers, health authorities, and policymakers (Paterson et al., 2016).

Healthcare practitioners (e.g., nurses) have a crucial role in providing education to the

suburban community, which has a substantial impact on preventing COVID-19 transmission

to others (Linda et al., 2019). The coronavirus has a significant impact on both public health

and economic development. As a result, the role of health workers (e.g., professional nurses)

impacts the realization of economic improvement, as well as the management of health

problems by having a new healthy living expected in the community and enhanced health

quality.
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CHAPTER 3
METHODOLOGY

This chapter introduces the methodology that was employed in the study. These

include the research design, data collection procedures and instruments, and data analysis.

The methodology used was designed in such a manner that it would provide answers to the

research questions.

Research Design

This study used a descriptive-correlation and causal research design. Descriptive-

correlation research is research designed to provide a snapshot of the current state of affairs

and discovers relationships among variables, and allows the prediction of future events from

present knowledge. Causal studies focus on analyzing a situation or a specific problem to

explain relationships between variables. A study on the understanding and acceptance of

nursing students to the COVID-19 vaccine was analyzed using this research design.
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Quantitative data were collected from the online survey questionnaire sent to the 3 rd year

regular nursing students from public and private nursing schools in Iligan City. Data gathered

were organized and used in tabular forms.

Research Setting

The study was conducted within the public and private nursing schools of Iligan City.

Specifically, Mindanao State University – Iligan Institute of Technology (MSU-IIT) as the

only public nursing school in Iligan City, and two private nursing schools which were St.

Michael’s College (SMC) and Adventist Medical Center College (AMCC).

Figure 2.Map of Iligan City

Participants and Sampling Procedures

The participants of this study were 3rdyear regular nursing students both from public

and private nursing schools in Iligan City. Mindanao State University-Iligan Institute of

Technology (MSU-IIT), the only public nursing school, comprises one hundred forty-four
 Page 26
(144) 3rd-year nursing students. The private nursing schools of Iligan City with their

respective total population of 3rd year nursing students are as follows: St. Michael’s College

(SMC) with fifteen (15) nursing students, and Adventist Medical Center College (AMCC)

with twenty-one (21) nursing students, and a total population of 3 rd year nursing students

enrolled in private school is thirty-six (36).

The total population of 3rd year nursing students enrolled in both public and private

nursing schools in Iligan City is one hundred eighty (180) nursing students. Using Slovin’s

formula, the investigator gathered data from a total of one hundred twenty-four (124)

participants or one hundred (100) 3rd-year regular nursing students enrolled in a public school

and twenty-four (24) 3rd-year regular nursing students enrolled in private schools.

Data collection was through an online survey questionnaire using stratified random

sampling. Stratified sampling Random is a method that divides the population into smaller

subgroups called strata and prevents possible selection bias. In this study, the researcher

divided the population of respondents by strata/departments. Moreover, in that strata, the

names of all 3rd-year regular nursing students were entered in software, and were randomly

selected according to percentage per population.

* Number of public school – one (1)

* Number of private school – two (2)

N 180
Slovin’s Formula:n= n= 2
1+ N e 2 1+180 ( 0.05 )

n = 124

Research Instruments
 Page 27
The researcher used an “online survey questionnaire” as an instrument in gathering

the data. The online survey questionnaire was composed of three (3) parts:

Part I. Demographic profile of the 3rd year regular nursing students. This part is

composed of age, gender, and religion.

Part ll. Vaccination Knowledge Scale. This part is composed of a score scaling type of

question that will determine the knowledge of the nursing students towards the COVID-19

vaccines, which include dose and frequency, vaccine efficacy based on Clinical Trial Phase

III, and adverse events reported and observed on Clinical Trial Phase III.

Part III. Vaccines Acceptances Instrument. This part is composed of a scoring

scale of the questionnaire that will determine the nursing students’ acceptance towards

COVID-19 Vaccines, which includes long-term protection, the effectiveness of the vaccine

to stop the pandemic, safety of the vaccine, and willingness to be vaccinated.

The following are the scoring scale of the questionnaires:

Score Scale Verbal Description Interpretation

5 4.50-5.00 Strongly Agree Very Knowledgeable/Highly

Acceptable

4 3.50-4.49 Agree Knowledgeable/Acceptable

3 2.50-3.49 Moderately Agree Uncertain

2 1.50-2.49 Disagree Less Knowledgeable/Less Acceptable

1 1.00-1.49 Strongly Disagree No Knowledge at all/Unacceptable

Data Gathering Procedure

 Page 28
In this study, the general purpose is to identify the knowledge of and acceptance

among 3rd-year regular nursing students towards COVID-19 vaccines.

The investigator sought a letter of consent from the Dean of the School of Graduate

Studies to conduct research. This was followed by a letter of approval to conduct the study

by the Vice President for Research, Publication, and Extension. After the approval of the

letter to conduct research, the investigator sent a letter of consent to the School President,

Vice President of Academic Affairs, and Dean of the College of Nursing both in public and

private nursing schools of Iligan City (Mindanao State University-Iligan Institute of

Technology, St. Michael’s College, and Adventist Medical Center College) for approval. In

order to uphold and abide by research ethics, several considerations were taken into account.

The investigator got permission from school authorities upon visiting that school and

explained to the administration the value of the research and the procedures followed. The

investigator also assured the administration that the participation by participants would be

voluntary and that the informed consent forms would be given to the participants to sign

before taking part in the study. Upon approval from the school administrators, the

investigator administered the survey questionnaire to the participants online since the

institutions do not yet have their face-to-face classes. An online survey questionnaire was

used to obtain data relevant to the study’s objectives and research questions. For

confidentiality, participants’ names were not written on the questionnaires. Participants

remained anonymous and were assured that the data obtained from them would not be

disclosed to any other person. The data collection exercises were undertaken over one month

(30 working days). The actual procedure began with an online survey questionnaire being
 Page 29
distributed by the investigator to the participants as the most effective method to obtain

adequate information to reach the research objectives, and the results obtained through the

stratified random sample are used to describe the entire population of interest and after the

data, coding and entering data will be executed. The administering of survey questionnaires

was done outside class time so that the disruption of the school routine was as minimal as

possible. Thus, respect for the research site was guaranteed. Finally, the investigator took full

responsibility for the conduct of the study and its ensuing consequences.

After the production phase, it then proceeded to the post-production stage, where data

analysis and publication occurred. In this phase in the analysis of data, data should be

prepared and screened, then followed by evaluating sample, material, and procedures

statistically. Then, analyzing the research hypothesis and lastly interpreting results. The last

stage is the publication process. In this stage, the researcher should decide when to start

writing the paper and should consider as well the on how to write in APA format, how to

decide where to submit the manuscript.

Validity and Reliability of Instruments

A pilot refers to a trial run used to test a process to detect weaknesses or flaws before

full implementation. Pre-testing of an online survey questionnaire is critical to its success as

it plays a role in enhancing the reliability, validity, and practicability of the questionnaire.

Hence, piloting helps eliminate forms of ambiguity in wording, checks the ability of the

target audience to respond, checks the amount of time required to complete the questionnaire,

and whether the questionnaire is too short or too long, too easy or too difficult. In this study,
 Page 30
the pilot was carried out on 30 participants who were not included. The reliability of the

instrument was assessed using Cronbach Alpha. The following where the score of reliability

tests results: for knowledge .876 and acceptance is .956.

Statistical Techniques

For the quantitative data, an online survey questionnaire was treated statistically using

mean and standard deviation. For the retention test, on the other hand, a Pearson product-

moment correlation was used to determine how strong the correlation of the scores between

the level of knowledge and acceptance towards COVID-19 vaccination.

The demographic profile of nursing students was determined using problem 1,

frequency, and percentage. Mean and standard deviation was used in problems 2 and 3.

Problem 4: Pearson product-moment of correlation was used to find the significant

association between the variables, whereas Problem 5: Multiple regression was utilized to

determine the variables that best predict nursing students' acceptance of the COVID-19

immunization.
 Page 31

Chapter 4

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

This chapter reviews the presentation, analysis, and interpretation of the descriptive-

causal correlations research design, the compilation of the online survey questionnaire, and

the results and analysis of the study. Where appropriate, the findings are compared and

contrasted with past research findings and relevant literature to discover parallels and

differences between this study and earlier studies and literature.

Problem 1. What is the demographic profile of nursing students in terms of age, gender,

and religion?

Table 1
 Page 32

Demographic profile of the participants

Variables Indicator Frequency Percentage
Age Under 18 years old 0 0.00
18-19 years old 1 1
20-21 years old 70 56
22-23 years old 49 39
24-25 years old 2 2
26 years old and above 2 2
Total = 124 100
Sex Male 18 15
Female 106 85
Total = 124 100
Religion Roman Catholic 66 53
Pentecostal/Born Again 24 19
Seventh-day Adventist 6 5
Baptist 4 3
Iglesia ni Cristo 1 1
Islam 23 19
Total = 124 100

In this study, the majority of the participants in terms of age were from ranges

20-21 years old (70 or 56.50% of the sample), and most of them are female, which composed

of 106 (85.50 % of the sample). In terms of religion, respondents were mostly Roman

Catholics and composed of 66 participants (53.20% of the sample). Age is seen as a feature

for tracking behavior changes, forming a defining dependent variable in investigations. This

variable is determined by the function's arguments or characteristics that describe variations

in age for a definite behavioral variable. About sex, it is thought to be “the categorization as

male or female, specific reproductive organs and its functions.” Doull et al. (2021) proposed

that the methods used in systematic reviews regarding sex-based analysis be developed and

coordinated to improve the compilation, summary, and investigation of the evidence for

decision-making. In addition, Bale (2016) the most important reason to consider sex in

biomedical research is that it improves the quality of the science and the safety and efficacy
 Page 33
of treatments for human disorders. Studies show an in-depth understanding where sex

differences are identified. Likewise, according to Pargament (as cited in González, 2004),

religion is an active approach for better overcoming life challenges as a person can (1) search

for an existential purpose in any stressful situation. (4) interpreting a system of orientation

towards specific coping methods; (5) through processing, it finds meaning especially in the

maintenance and transformation of the meaning from essential events; and (6) attempting to

resolve problems through various means, which are co-existent, in terms of meanings.

Problem 2. What is the nursing students’ level of knowledge about COVID-19

Vaccines?

Table 2

Vaccine Knowledge among Nursing Students

Vaccine Knowledge Mean Standard Verbal Interpretatio
(Statement) Deviation Description n
(1) Oxford AztraZeneca is the only COVID-19 vaccine 1.44 .895 Strongly No Knowledge
that will be administered with 1 dose. Disagree at all
(2) Janseen COVID-19 vaccine will be administered 1.60 1.011 Disagree Less Knowledge
intramuscularly with 4-12 weeks apart.
(3) The vaccine efficacy of Pfizer BioNtech based on 4.18 1.013 Agree Knowledgeable
Phase III Clinical Trial (CT) is 95% against symptomatic
COVID-19.
(4) The vaccine efficacy of Oxford AztraZeneca based on 2.65 1.319 Moderately Uncertain
Phase III Clinical Trial (CT) is 100% against symptomatic Agree
COVID-19 and 70.4% against severe COVID-19.
(5) The vaccine efficacy of SinovacCoronaVac based on 2.60 1.261 Moderately Uncertain
Phase III Clinical Trial (CT) is 95% (based on Brazil, Agree
Indonesia, and Turkey Trials).
 Page 34
(6) The vaccine efficacy of Gamaleya Sputnik V based on 3.35 1.218 Moderately Uncertain
Phase III Clinical Trial (CT) is 91.6% against symptomatic Agree
COVID-19 and 100% against moderate or severe cases.
(7) The vaccine efficacy of Bharat Biotech based on Phase 3.19 1.185 Moderately Uncertain
III Clinical Trial (CT) is 80.6% against PCR-confirmed Agree
symptomatic COVID-
(8) The vaccine efficacy of Moderna based on Phase III 3.03 1.175 Moderately Uncertain
Clinical Trial (CT) is 89.5% against symptomatic COVID- Agree
19 and 95% against severe COVID-19.
(9) The vaccine efficacy of Janseen based on Phase III 3.62 1.227 Agree Knowledgeable
Clinical Trial (CT) is 66.1-66.9% against confirmed
moderate to severe/critical COVID-19.
(10) Pfizer BioNtech side effects (such as fever, chills, 3.94 .868 Agree Knowledgeable
tiredness, and headache) throughout the body were more
common after the second dose of the vaccine. Most side
effects were mild to moderate. 
(11) According to the Centers for Disease Control and 3.88 .993 Agree Knowledgeable
Prevention (CDC), and the World Health Organization
(WHO), the common side-effect of SinovacCoronaVac is
pain and tender in the injection site, fatigue, headache,
feverishness, and myalgia.
(12) Eight (8) commonly known side-effects for Oxford 3.72 1.040 Agree Knowledgeable
AztraZeneca are as follows: (1) pain and swelling in and
around the injection are, (2) fatigue, (3) fever, (4) headache,
(5) swollen lymp nodes, (6) muscle pain, (7) rashes or
itchiness, and (8) generally feeling unwell.
(13) An interim analysis of phase 3 clinical trial data, 3.53 .958 Agree Knowledgeable
published in The Lancet Trusted Source in February 2021,
reports on the efficacy and safety of the vaccine. Based on
the data, the most common side effects on Gamaleya
Sputnik V are flu-like illness, headache, fatigue, and
injection site reactions.

Table 2. Continuation
(14) A person who received Moderna COVID-19 vaccine 3.58 .964 Agree Knowledgeable
will experience tiredness, headache, muscle pain, chills,
fever, and nausea. These side effects usually start within a
day or two of getting the vaccine. Side effects might affect
your ability to do daily activities, but they should go away
in a few days.
(15) The most commonly reported side effects of Novavax 3.48 .975 Moderately Uncertain
COVID-19 vaccine were pain at the injection site, Agree
headache, fatigue, muscle aches and nausea. Most of these
side effects occurred within 1-2 days following vaccination
and were mild to moderate in severity and lasted 1-2 days.
Moderately
OVER-ALL MEAN 3.187 .5602 Agree Uncertain
Legend Score Scale Verbal Description Interpretation
5 4.50-5.00 Strongly Agree Very knowledgeable
4 3.50-4.49 Agree Knowledgeable
3 2.50-3.49 Moderately Agree Uncertain
2 1.50-2.49 Disagree Less knowledgeable
1 1.00-1.49 Strongly Disagree No knowledge at all
 Page 35

Table 2 presents the level of knowledge about COVID-19 vaccines; the result yielded

an overall mean of 3.187 and which corresponds to moderately agree or uncertain. Almost

all of them know COVID-19 vaccines. However, the outcome means they are uncertain or

unclear about COVID-19 vaccines based on the outbreak, specifically in terms of its doses

and frequency, vaccine efficacy based on Clinical Trial Phase III, and adverse events

reported and observed on Clinical Trial Phase III. Alsoufi et al. (2020) revealed that several

medical students engaged in different activities because of the lockdown and closure of

medical schools. It was observed that most of the medical students chose to relax and rest

and only less of them chose to continue their learning through self-study and even carried out

research activities. However, medical schools should take the responsibility of aiding the

medical students to help them improve their analytical abilities. In addition, university

students expressed their faith in the ineffectiveness of the vaccines. They showed their

confusion about the vaccines, which may create long-term physical problems and potential

side effects (Bsiwas et al., 2021). Finally, a study indicated that the core social media users of

nursing students gather information on COVID-19 from families, media, and government

agencies (Albaqawi et al., 2020). Nursing students should however, be responsible for

receiving factual social media information. This discovery involves developing programs for

nursing education, such as education and awareness-raising campaigns aiming to guide

students to reliance on COVID-19 information to student-centered sources. Caregivers

should help nursing students to obtain correct information sources on Vaccines under the

COVID-19 regime, provide materials and education for students and provide correct
 Page 36
information misrepresented. In training the future nurses about COVID-19 vaccinations, the

nursing education system plays a vital role, helping nurses to comprehend the value of

vaccines in protecting the people efficiently. (Jamshidi et al., 2016). Undeniably, nursing

education assures future nurses to have information and a positive response towards COVID-

19 vaccines.

Problem 3. What is the nursing students’ level of acceptance towards COVID-19

Vaccines?

Table 3

Vaccine Acceptance among Nursing Students

Vaccine Acceptance Mean Standard Verbal Interpretation
Deviation Description
(1) The COVID-19 vaccines produce protection 4.60 .796 Strongly Agree Perfectly
against the disease. Acceptable
(2) Getting vaccinated may also protect people 4.60 .719 Strongly Agree Perfectly
around you. Acceptable
(3) COVID-19 vaccines protect people especially 4.77 .491 Strongly Agree Perfectly
those at risk for severe illness from COVID-19 (e.g. Acceptable
healthcare providers, older or elderly adults, and
 Page 37
people with other medical conditions).
(4) COVID-19 Vaccines will provide a long-term 4.02 1.016 Agree Acceptable
protection.
(5) COVID-19 Vaccines is effective to stop the 4.41 .846 Agree Acceptable
pandemic.
(6) Receiving COVID-19 vaccine still increases the 2.47 1.252 Disagree Slightly
chance to be infected by COVID-19. Unacceptable
(7) I believe that if I do not get vaccinated, the 4.27 1.148 Agree Acceptable
likelihood of me getting infected with corona will
increase.
(8) I believe that if I do not get vaccinated, the 4.29 1.042 Agree Acceptable
likelihood of my family and relatives getting
infected in Corona will increase.
(9) It is impossible to reduce the incidence of 4.00 1.210 Agree Acceptable
COVID-19 without vaccination.
(10) Side effects after your second shot may be 3.37 1.265 Moderately Uncertain
more intense than the ones you experienced after Agree
your first shot.
(11) A COIVD-19 vaccine is safe to be 4.52 .631 Strongly Agree Perfectly
administered. Acceptable
(12) Some person who received COVID-19 4.15 1.049 Agree Acceptable
vaccines does not experienced severe illness and
death.
(13) Even if I get infected with COVID-19, the 4.32 .898 Agree Acceptable
likelihood of recovering from the disease is very
high.
(14) A vaccine contains dangerous ingredients. 1.89 1.006 Disagree Slightly
Unacceptable
(15) Even if I will get infected with COVID-19 I do 3.67 1.280 Agree Acceptable
not think it will cause me significant suffering or
complications.
(16) I have no issues/concerns about COVID-19 4.27 .839 Agree Acceptable
vaccines.
(17) Side-effects will not prevent me from taking a 4.48 .715 Agree Acceptable
vaccine for the prevention of COVID-19.
(18) Generally, I trust the vaccine benefits. 4.54 .630 Strongly Agree Perfectly
Acceptable
(19) The COVID-19 vaccine causes a person to get 1.90 1.185 Disagree Slightly
COVID-19. Unacceptable

Table 3. Continuation…
(20) Diseases provide better immunity than 1.82 1.044 Disagree Slightly
vaccines do. Unacceptable
(21) COVID-19 is 100% efficient. 3.37 1.239 Moderately Uncertain
Agree
(22) To protect public health, we should follow 4.71 .538 Strongly Agree Perfectly
government guidelines about vaccines. Acceptable
(23) Doctor’s recommendation is an important 4.60 .806 Strongly Agree Perfectly
factor in vaccination decision-making. Acceptable
(24) I will recommend to my family and friends to 4.70 .650 Strongly Agree Perfectly
take COVID-19 vaccines. Acceptable
(25)I am willing to take COVID-19 vaccines. 4.85 .404 Strongly Agree Perfectly
Acceptable
OVER-ALL MEAN 3.944 0.5538 Agree Acceptable
Legend Score Scale Verbal Description Interpretation
5 4.50-5.00 Strongly Agree Highly Acceptable
 Page 38
4 3.50-4.49 Agree Acceptable
3 2.50-3.49 Moderately Agree Uncertain
2 1.50-2.49 Disagree Less Unacceptable
1 1.00-1.49 Strongly Disagree Unacceptable

Table 3 presents nursing students’ level of acceptance about COVID-19 vaccines, the

result showed an overall mean of 3.944 in which denotes agreeing or acceptable. This result

implies that participants in the current study demonstrated generally positive vaccination

attitude/acceptance as measured on the Vaccine Acceptance Instrument. One of the essential

factors in controlling the COVID-19 outbreak is having a positive attitude and the

willingness to accept COVID-19 vaccines (Yang et al., 2021). The nursing students were

initially prepared for COVID-19 vaccines in the current research (Qiao et al., 2020, Sun et

al., 2020, Graupensperger et al., 2021, Di Giuseppe et al., 2021). This certain extent of

understanding of COVID-19 immunizations, their effectiveness, and safety may be based on

their will to be vaccinated among nursing school students. In addition, in the study, nursing

students significantly considered COVID-19 vaccine levels, and the majority recognized the

safety and efficiency of COVID‐19 vaccines. The overall COVID-19 vaccination acceptance

for both samples appeared to be positive (Dybsand et al., 2019). In addition, the Wei Bai et

al. research study (2021) showed that most students taking medical courses were willing to

receive vaccination equivalent to that in medical school in the USA. The number of students

taking health-related courses among university students in China was higher than in other

courses, which were especially significant in preventing disease, which provided a robust

knowledge of the need for COVID-19 vaccines.

The education of schools on COVID- 19 vaccine should therefore be strengthened,

and the need for vaccination among nursing students emphasized, which would boost the
 Page 39
vaccination process of COID-19 by adequately granting consent to COVID-19 nursing

student Vaccination. Nursing students have some discomfort with the nature, safety, and

efficacy of COVID-19 vaccinations cannot be overlooked. However, infirmer students also

need to consider that once they acquire COVID-19 infected, it will have a vast personal and

environmental impact.

Problem 4. Is there a significant relationship between acceptance, knowledge, and

demographic profile among nursing students towards COVID-19 vaccines?

Table 4

Significant relationship between Acceptance, Knowledge, and Demographic Profile among

Nursing Students

Variable Pearson Correlation P-value Interpretation

Age -.157 .081 Not significant

sex -.136 .132 Not Significant
Religion -.045 .619 Not significant
Knowledge .237** .008 Significant

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).
Pearson correlation coefficient (r) measures the degree and direction of linear

correlation between two quantitative variables (ex, acceptance, and knowledge). It ranges

from -1 to +1. Positive values imply a direct relationship; negative values are indirect.

Interpretation of strength is subjective; this is one rule of thumb by Cohen:

The Table shows that knowledge has a significant relationship to acceptance.

Therefore, the hypothesis in this portion is rejected, and however, with regards to the

demographic profile among the student nurses, a hypothesis is accepted.

 Page 40
The Pearson correlation coefficient between Acceptance and Knowledge is 0.237.

The positive value implies a direct relationship; that is, more knowledge results in greater

acceptance. However, this relationship is weak and highly significant (p-value = 0.008,

which is less than a significance level of 0.01). The result could mean that there might be

other variables that have a stronger relationship with these two. Moreover, if we were to try

to explain acceptance, knowledge will be included in the equation but will need the

contribution of other variables.

First, the nursing students’ overall vaccine knowledge and vaccine acceptance scores

were undoubtedly correlated. These findings imply that while vaccination knowledge and

acceptance are generally correlated, showing levels of vaccine knowledge alone does not

guarantee complete acceptance toward COVID-19 vaccinations, and varying degrees of

hesitancy can exist even when vaccine knowledge is accurate.

In addition, Health workers have been very supportive to the vaccination COVID-19

as non-health workers. Self-protection vaccination and a goal to protect patients, friends, and

above all, the family decided by health workers. Health workers are thoroughly aware of the

vaccines COVID‐19 and are therefore very conscious and unable to pass on COVID ‐19 to

others. It is therefore equivalent to a high level of awareness. In comparison with the non-

medical sectors, they are more inclined to take COVID-19 vaccines (Harapan et al., 2020).

In addition, students are more likely to get COVID-19 vaccines with a more profound

knowledge of COVID-19 vaccines. The danger of vaccine reluctance in health care students

is considered: immunization of medical personnel and nursing/medical students is measured

by the close relationship between high-risk patients in preventing health-care-related

 Page 41
COVID-19 infections. This is the reason why the public health information campaigns

should aim at disseminating health information to ensure the preserving of individual and

community health, including individual control measures such as vaccination against

COVID-19 (Galle et al., 2021).

Problem 5. Which variables best predict the acceptance of the nursing students towards

COVID-19 vaccines?

Table 5

Regression Analysis of the Acceptance of the Nursing Students towards COVID-19

Vaccines

Coefficientsa
Model Unstandardized Coefficients Standardized t Sig.
Coefficients
B Std. Error Beta
(Constant) 3.917 .299 13.087 .000
Age -.083 .048 -.151 -1.726 .087
1 Sex -.123 .086 -.125 -1.438 .153
Religion -.005 .016 -.028 -.322 .748
knowledge .140 .054 .226 2.583 .011
Dependent Variable: acceptance
R square: .096
F value: 3.148

In Table 5, only Knowledge can be retained as an explanatory variable for

Acceptance (since p-value = 0.011, which is significant at a 0.05 level of significance).

Equation now becomes

Acceptance=3.917+0.140 (Knowledge)

However, the coefficient of determination R squared is only 0.096 or 9.6% which

means that only 9.6% of the variation in Acceptance can be explained by its linear
 Page 42
relationship with Knowledge. Other significant variables added to the equation will improve

the explanation and prediction of a person’s Acceptance.

First, the principal factor that could increase COVID-19 vaccination acceptance

among the participants was sufficient and accurate information about the available COVID-

19 vaccines. This finding reveals the main impediment to vaccination acceptance,

represented the solution that could be quickly adopted and provided by the authorities to

maximize vaccination acceptance and coverage (Fares et al., 2021). In addition, participants

can utilize their own experience to teach their families, friends, patients in a hospital, and the

public the meaning of vaccination if they have a better knowledge of the COVID-19 vaccine.

If the nursing students have positive attitudes and behavior, they can support the

immunization of other nursing students. It is therefore vital to identify the perceptions,

attitudes, and intentions of infant students to vaccinations against COVID-19 and to look for

the associated factors that influence their readiness to get COVID-19 vaccines that can help

nursing schools to develop effective management to raise vaccination rates (Jiang et al.,

2021).

Chapter 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

This chapter presents the summary, conclusion, and recommendations of the research

study. The presentation follows the sequence based on the title of the chapter.
 Page 43

Summary

The study has established the level of knowledge and acceptance of COVID-19 vaccines

among nursing students and the best predictable variables about acceptance.

1. The knowledge and willingness of nursing students to accept the vaccines COVID-19

can have a foremost impact on population acceptance of the vaccine today and in the

future. The level of acceptability by the nursing student of COVID-19 is crucial as

they are patients and future professionals as a healthcare instructor. This trial was

done in order to determine understanding and acceptance among nursing students of

COVID-19 vaccinations.

2. The study results on the knowledge and acceptability of nursing students towards

COVID-19 vaccination were analyzed using a descriptive-correlation and causal

research design. The study was conducted on nursing students studying at public and

private schools in Iligan City. There were 124 participants in this study. An Online

Survey Questionnaire was administered to the participants. Frequency, percentage,

mean and standard deviation, person product moment of correlation, and multiple

regressions were used for statistical techniques.

3. Nursing students from public and private schools in Iligan city found 56.50% belongs

to age 20-21 years old and closely followed with the participants whose age belongs

to 22-23 years old with 39.50% responses. 85.50% were female, and 14.50% were

male. The participants were Roman Catholic with 53.20% and followed by

Pentecostal/Born Again with 19.40%.

 Page 44
4. The total mean of the result, which equates to somewhat or uncertain, was 3.187 for

nursing students' understanding of vaccines under COVID-19. The COVID-19

vaccinations were uncertain or lacking in clarity.

5. Nursing students’ level of acceptance about COVID-19 vaccines, the result showed

an overall mean of 3.944 in which denotes agreeing or acceptable. Participants in the

current study demonstrated a generally positive vaccination attitude/acceptance as

measured on the Vaccine Acceptance Instrument.

6. Nursing students’ level of acceptance towards COVID-19 vaccines was correlated to

the level of knowledge on COVID-19 vaccines.

7. Finally, Knowledge is the only explanatory variable for Acceptance that may be

preserved.

Conclusions

The participants in this study were found to have moderate agreement on the

COVID-19 vaccinations introduced in the community. However, they still expressed a

readiness to accept the vaccines, and the two scores were positively associated. It also

suggests that whereas knowledge has a considerable association with vaccination adoption,

the demographic profile of nursing students has no such relationship. In addition, the data

illustrate the impact of different levels of vaccine acceptability as a topic for further

investigation.

Recommendations
 Page 45
Considering the analyzed data and explained results, findings and conclusions, the

researcher offers the following recommendations:

1. The study's findings reveal that nursing students have a high degree of basic

understanding regarding COVID-19 vaccines; yet, it is unlikely that the majority of

nursing students would readily endorse immunizations. It is suggested that nursing

schools (college deans and nursing faculty) reassess and improve nursing instructions,

particularly about the concept of COVID-19 immunization, and develop and improve

instructional methodologies to meet the expectations on student learning.

2. Not only did the nursing students represent medical professionals, but they also

represented college students. As a result, the acceptance of COVID-19 immunization

among nursing students is critical, as they serve as healthcare educators to patients

and will be future professionals. Hence, nursing students are advised to increase their

knowledge about COVID-19 vaccinations based on new research rather than being

limited to lectures from institutions. The level of acceptance for COVID-19

vaccinations was increased because the participants understood the COVID-19

vaccination through technology.

3. The results of this study may be used as a reference to conduct new researchers or test

the results validity. Future research should quantitatively examine the impact of the

nursing school itself on COVID-19 vaccine knowledge and acceptance by measuring

knowledge and acceptance levels at baseline, improve vaccine knowledge and,

therefore, acceptance.
 Page 46

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 Page 47
Albaqawi HM, Alquwez N, Balay-odao E, Bajet JB, Alabdulaziz H, Alsolami F, Tumala RB,
Alsharari AF, Tork HMM, Felemban EM and Cruz JP. (2020). Nursing Students'
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Name (optional): ___________________________________________________________

School:
[ ] Mindanao State University – Iligan Institute of Technology (MSU-IIT)
 Page 51
[ ] St. Michael’s College (SMC)
[ ] Adventist Medical Center College (AMCC)

Part I: Demographic Profile

Age
[ ] under 18 years old
[ ] 18-19 years old
[ ] 20-21 years old
[ ] 22-23 years old
[ ] 24-25 years old
[ ] 26 years old and above

Sex
[ ] Male [ ] Female

Religion
[ ] Roman Catholic [ ] Iglesia ni Cristo
[ ] Pentecostal/Born Again Christian [ ] Islam
[ ] Seventh-day of Adventist
[ ] Baptist

Part II: Vaccination Knowledge Scale

(Source: https://doh.gov.ph/vaccines/know-your-vaccines)
 Page 52
Instruction. The following items describe statements about vaccine knowledge. Indicate your
level of knowledge (Strongly Agree to Strongly Disagree) with the following statements by
clicking your response using this scale:
5 4 3 2 1
Strongly Agree Moderately Disagree Strongly
Agree agree disagree
No. Statement 5 4 3 2 1
1 Oxford AztraZeneca is the only COVID-19 vaccine that
will be administered with 1 dose.
2 Janseen COVID-19 vaccine will be administered
intramuscularly with 4-12 weeks apart.
3 The vaccine efficacy of Pfizer BioNtech based on Phase
III Clinical Trial (CT) is 95% against symptomatic
COVID-19.
4 The vaccine efficacy of Oxford AztraZeneca based on
Phase III Clinical Trial (CT) is 100% against
symptomatic COVID-19 and 70.4% against severe
COVID-19.
5 The vaccine efficacy of SinovacCoronaVac based on
Phase III Clinical Trial (CT) is 95% (based on Brazil,
Indonesia, and Turkey Trials).
6 The vaccine efficacy of Gamaleya Sputnik V based on
Phase III Clinical Trial (CT) is 91.6% against
symptomatic COVID-19 and 100% against moderate or
severe cases.
7 The vaccine efficacy of Bharat Biotech based on Phase
III Clinical Trial (CT) is 80.6% against PCR-confirmed
symptomatic COVID-19.
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8 The vaccine efficacy of Moderna based on Phase III

Clinical Trial (CT) is 89.5% against symptomatic
COVID-19 and 95% against severe COVID-19.
9 The vaccine efficacy of Janseen based on Phase III
Clinical Trial (CT) is 66.1-66.9% against confirmed
moderate to severe/critical COVID-19.
10 Pfizer BioNtech side effects (such as fever, chills,
tiredness, and headache) throughout the body were more
common after the second dose of the vaccine. Most side
effects were mild to moderate. 
11 According to the Centers for Disease Control and
Prevention (CDC), and the World Health Organization
(WHO), the common side-effect of SinovacCoronaVac
is pain and tender in the injection site, fatigue, headache,
feverishness, and myalgia.
12 Eight (8) commonly known side-effects for Oxford
AztraZeneca are as follows: (1) pain and swelling in and
around the injection are, (2) fatigue, (3) fever, (4)
headache, (5) swollen lymp nodes, (6) muscle pain, (7)
rashes or itchiness, and (8) generally feeling unwell.
13 An interim analysis of phase 3 clinical trial data,
published in The Lancet Trusted Source in February 2021,
reports on the efficacy and safety of the vaccine. Based
on the data, the most common side effects on Gamaleya
Sputnik V are flu-like illness, headache, fatigue, and
injection site reactions.
14 A person who received Moderna COVID-19 vaccine will
experience tiredness, headache, muscle pain, chills,
fever, and nausea. These side effects usually start within
 Page 54

a day or two of getting the vaccine. Side effects might

affect your ability to do daily activities, but they should
go away in a few days.
15 The most commonly reported side effects of Novavax
COVID-19 vaccine were pain at the injection site,
headache, fatigue, muscle aches and nausea. Most of
these side effects occurred within 1-2 days following
vaccination and were mild to moderate in severity and
lasted 1-2 days.

Part II: Vaccine Acceptance

Source:
Wilpstra, Caitlyn, "Vaccine Knowledge and Vaccine Attitudes of Undergraduate Nursing Students" (2020)
Knowledge, attitudes, and practices (KAP) toward COVID-19: a cross-sectional study in South Korea, Lee et
al., 2021

Instruction. The following items describe statements about vaccine acceptance. Indicate your
agreement or disagreement with the following statements by clicking your response using this scale:
5 4 3 2 1
Strongly Agree Agree Moderately Disagree Strongly
Agree Disagree
No. Statement 5 4 3 2 1
1 The COVID-19 vaccines produce protection against the
disease.
2 Getting vaccinated may also protect people around you.
3 COVID-19 vaccines protect people especially those at
risk for severe illness from COVID-19 (e.g. healthcare
providers, older or elderly adults, and people with other
medical conditions).

4 COVID-19 Vaccines will provide a long-term

protection.
 Page 55

5 COVID-19 Vaccines is effective to stop the pandemic.

6 Receiving COVID-19 vaccine still increases the chance
to be infected by COVID-19.
7 I believe that if I do not get vaccinated, the likelihood
of me getting infected with corona will increase.
8 I believe that if I do not get vaccinated, the likelihood
of my family and relatives getting infected in Corona
will increase.
9 It is impossible to reduce the incidence of COVID-19
without vaccination.
10 Side effects after your second shot may be more intense
than the ones you experienced after your first shot.
11 A COIVD-19 vaccine is safe to be administered.
12 Some person who received COVID-19 vaccines does
not experienced severe illness and death.
13 Even if I get infected with COVID-19, the likelihood of
recovering from the disease is very high.
14 A vaccine contains dangerous ingredients.
15 Even if I will get infected with COVID-19 I do not
think it will cause me significant suffering or
complications.
16 I have no issues/concerns about COVID-19 vaccines.
17 Side-effects will not prevent me from taking a vaccine
for the prevention of COVID-19.
18 Generally, I trust the vaccine benefits.
19 The COVID-19 vaccine causes a person to get COVID-
19.
20 Diseases provide better immunity than vaccines do.
21 COVID-19 is 100% efficient.
 Page 56

22 To protect public health, we should follow government

guidelines about vaccines.
23 Doctor’s recommendation is an important factor in
vaccination decision-making.
24 I will recommend to my family and friends to take
COVID-19 vaccines.
25 I am willing to take COVID-19 vaccines.

APPENDIX D
 Page 57

CURRICULUM VITAE

Name: Jan Michael R. Remolado

Address: 0023 Blk. 16 Lot 15 Brgy. Sta. Elena Steel Town Iligan City

Email Address: jmremolado@gmail.com

ORCID Number:

Name of Father: Oscar Q. Remolado

Name of Mother: Adoracion R. Remolado

School Graduated and Honors

Elementary
St. Margaret Child Learning Center
 With Honors
High School
Iligan City National High School
College
St. Michael’s College
 Academic Excellence
 College Service Award
 Performing Artist of the Year
 Florence Nightingale Award
 Best in Community Health Nursing

Membership: Philippine Nurses Association