Study of the psychological determinants of COVID-19 vaccination among health workers in a Western Algeria


Chahrazed Kandouci
Fethi Meçabih
Ikram Bakhti
Sara Belfakroun
Salma Moueden
Imene Meçabih
Amel Sehimi
Mohamed Yacine Achouri
Ahmed Ben Abdelaziz


Context: Vaccine hesitancy is a major challenge in controlling the COVID-19 pandemic, with healthcare professionals playing a major
role in its acceptance. The objective of this study was to assess the acceptance of COVID-19 vaccines among health workers in Sidi Bel
Abbès and to identify the psychological determinants of vaccination acceptance.

Method: A descriptive cross-sectional study was conducted from December 01, 2021 to January 31, 2022 and involved health professionals in Sidi Bel Abbès, through an anonymous questionnaire. Psychological determinants were assessed using the 5C scale (15 items),
whereas the Vaccine Conspiracy Beliefs Scale (VCBS) (7 items) was used to estimate the effect of vaccine conspiracy beliefs. 5C and
VCBS scores were analyzed using the Receiver Operating Characteristic (ROC) curve.

Results: A total of 1074 health care workers were included in the final analysis: 74% were women, the median age of all participants was
31 years (IIQ: [27-39]) with a professional seniority of 7 years (IIQ: [3-12]). The overall acceptance rate for the COVID-19 vaccine was
41%. The determinants of acceptance of a COVID-19 vaccine were the median age of 33 years (ORa=1.08; CI95% [1.03-1.14]), beliefs
about the natural origin of the virus (ORa=1.68; CI95% [1.01-2.8]), collective responsibility (ORa=1.49; CI95% [1.28-1.73]), constraints
(ORa=0.69; CI95% [0.61-0.78]) and complacency (ORa=1.31; CI95% [1.16 -1.49]) . ROC analysis revealed that collective responsibility
and constraints were the main predictors of vaccination decision among health workers.

Conclusion: Targeting psychological determinants could improve the effectiveness of awareness campaigns on COVID-19 vaccines:
Insist on the sense of collectivism of health professionals in order to achieve general immunity, reduce accessibility barriers to vaccination
while paying particular attention to the elderly.


COVID-19, Vaccination refusal, Vaccination hesitancy, Health personnel, Algeria



  1. World Health Organization. Coronavirus 2020 [Available from: https://
  2. World Health Organization. Tracking SARS-CoV-2 variants 2020 [Available from:
  3. Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis. 2021;21(2):e26-e35.
  4. Koirala A, Joo YJ, Khatami A, Chiu C, Britton PN. Vaccines for COVID-19: The current state of play. Paediatr Respir Rev. 2020;35:43-9.
  5. Lounis M, Abdelhadi S, Rais MA, Bencherit D, Sallam M. Intention to get COVID-19 vaccination and its associated predictors: A cross-sectional study among the general public in Algeria. Vacunas. 2022.
  6. Our World in Data. Algeria: Coronavirus Pandemic Country Profile 2022 [Available from: coronavirus/country/algeria?fbclid=IwAR2sU7mO275IgXHxKK A3muEbrDMegUPjQ-3d5EyOQWHxgXkGC0hRIVv7z8I.
  7. Organisation mondiale de la santé (l’OMS en Afrique). L’Algérie vaccine 10 % de la population générale contre la COVID-19 2021 [Available from: fnrEZWyaloOtNF9AyBTQ7_hKUZmBQxFxGtoCMV7M.
  8. Aouissi HA. Algeria’s preparedness for Omicron variant and for the fourth wave of COVID-19. Glob Health Med. 2021;3(6):413-4.
  9. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy. Human Vaccines & Immunotherapeutics. 2013;9(8):1763-73.
  10. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.
  11. Manus J-M. Pire que l’épidémie : l’infodémie, le côté sombre des réseaux sociaux. Rev Francoph Lab. 2020;2020(527):12-3.
  12. Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al. COVID-19 Vaccine Acceptance among Health Care Workers in the United States. Vaccines. 2021;9(2):119.
  13. Kacimi SEO, Klouche-Djedid SN, Riffi O, Belaouni HA, Yasmin F, Taouza FA, et al. Determinants of SARS-CoV-2 Vaccine Engagement in Algeria: A Population-based Study with Systematic Review of Studies from Arab Countries of the MENA Region. medRxiv. 2021:2021.07.17.21260662.
  14. Kerdoun MA, Henni AH, Yamoun A, Rahmani A, Kerdoun RM, Elouar N. COVID-19 vaccine hesitancy among Algerian medical students: a cross-sectional study in five universities. medRxiv. 2021:2021.08.29.21261803.
  15. AlKetbi LMB, Elharake JA, Memari SA, Mazrouei SA, Shehhi BA, Malik AA, et al. COVID-19 vaccine acceptance among healthcare workers in the United Arab Emirates. IJID Regions (Online). 2021;1:20-6.
  16. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one. 2018;13(12):e0208601.
  17. Abd ElHafeez S, Elbarazi I, Shaaban R, ElMakhzangy R, Ossama Aly M, Alnagar A, et al. Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents. PloS one. 2021;16(8):e0254595.
  18. Abdou MS, Kheirallah KA, Aly MO, Ramadan A, Elhadi YAM, Elbarazi I, et al. The coronavirus disease 2019 (COVID-19) vaccination psychological antecedent assessment using the Arabic 5c validated tool: An online survey in 13 Arab countries. PloS one. 2021;16(11):e0260321.
  19. Jolley D, Douglas KM. The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions. PloS one. 2014;9(2):e89177.
  20. Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy beliefs scale. Papillomavirus research (Amsterdam, Netherlands). 2016;2:167-72.
  21. Sallam M, Dababseh D, Eid H, Al-Mahzoum K, Al-Haidar A, Taim D, et al. High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: a study in Jordan and Kuwait among other Arab countries. Vaccines. 2021;9(1):42.
  22. Ghazy RM, Abd ElHafeez S, Shaaban R, Elbarazi I, Abdou MS, Ramadan A, et al. Determining the Cutoff Points of the 5C Scale for Assessment of COVID-19 Vaccines Psychological Antecedents among the Arab Population: A Multinational Study. J Prim Care Community Health. 2021;12:21501327211018568.
  23. Xu B, Gao X, Zhang X, Hu Y, Yang H, Zhou Y-H. Real-World Acceptance of COVID-19 Vaccines among Healthcare Workers in Perinatal Medicine in China. Vaccines. 2021;9(7):704.
  24. Al-Sanafi M, Sallam M. Psychological Determinants of COVID-19 Vaccine Acceptance among Healthcare Workers in Kuwait: A Cross-Sectional Study Using the 5C and Vaccine Conspiracy Beliefs Scales. Vaccines. 2021;9(7):701.
  25. Dzieciolowska S, Hamel D, Gadio S, Dionne M, Gagnon D, Robitaille L, et al. Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: A multicenter survey. Am J Infect Control. 2021;49(9):1152-7.
  26. Noushad M, Nassani MZ, Alsalhani AB, Koppolu P, Niazi FH, Samran A, et al. COVID-19 Vaccine Intention among Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey. Vaccines. 2021;9(8):835.
  27. Youssef D, Abou-Abbas L, Berry A, Youssef J, Hassan H. Determinants of acceptance of Coronavirus disease-2019 (COVID-19) vaccine among Lebanese health care workers using health belief model. PloS one. 2022;17(2):e0264128.
  28. Nohl A, Afflerbach C, Lurz C, Brune B, Ohmann T, Weichert V, et al. Acceptance of COVID-19 Vaccination among Front-Line Health Care Workers: A Nationwide Survey of Emergency Medical Services Personnel from Germany. Vaccines (Basel). 2021;9(5).
  29. Zammit N, Gueder AE, Brahem A, Ayouni I, Ghammam R, Fredj SB, et al. Studying SARS-CoV-2 vaccine hesitancy among health professionals in Tunisia. BMC Health Services Research. 2022;22(1):489.
  30. El-Sokkary RH, El Seifi OS, Hassan HM, Mortada EM, Hashem MK, Gadelrab MRMA, et al. Predictors of COVID-19 vaccine hesitancy among Egyptian healthcare workers: a crosssectional study. BMC Infect Dis. 2021;21(1):762.
  31. Fares S, Elmnyer MM, Mohamed SS, Elsayed R. COVID-19 Vaccination Perception and Attitude among Healthcare Workers in Egypt. J Prim Care Community Health. 2021;12:21501327211013303.
  32. Di Gennaro F, Murri R, Segala FV, Cerruti L, Abdulle A, Saracino A, et al. Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy. Viruses. 2021;13(3):371.
  33. Qattan AMN, Alshareef N, Alsharqi O, Al Rahahleh N, Chirwa GC, Al-Hanawi MK. Acceptability of a COVID-19 Vaccine Among Healthcare Workers in the Kingdom of Saudi Arabia. Front Med (Lausanne). 2021;8:644300.
  34. Galasso V, Profeta P, Foucault M, Pons V. COVID-19 Vaccine’s Gender Paradox. medRxiv. 2021:2021.03.26.21254380.
  35. Wiysonge CS, Alobwede SM, de Marie C Katoto P, Kidzeru EB, Lumngwena EN, Cooper S, et al. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines. 2022;21(4):549-59.
  36. Yanto TA, Octavius GS, Heriyanto RS, Ienawi C, Nisa H, Pasai HE. Psychological factors affecting COVID-19 vaccine acceptance in Indonesia. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):177.
  37. Paris C, Bénézit F, Geslin M, Polard E, Baldeyrou M, Turmel V, et al. COVID-19 vaccine hesitancy among healthcare workers. Infect Dis Now. 2021;51(5):484-7.
  38. Kwok KO, Li K-K, Wei WI, Tang A, Wong SYS, Lee SS. Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey. Int J Nurs Stud. 2021;114:103854.
  39. Biswas N, Mustapha T, Khubchandani J, Price JH. The Nature and Extent of COVID-19 Vaccination Hesitancy in Healthcare Workers. J Community Health.2021;46(6):1244-51.
  40. Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775-9.
  41. Facilitating COVID-19 vaccination acceptance and uptake in the EU/EEA. 15 October 2021. Stockholm: ECDC; 2021 [Internet]. Available from: default/files/documents/Facilitating-vaccination-uptake-in-theEU-EEA-final_FR.pdf.
  42. Karlsson LC, Lewandowsky S, Antfolk J, Salo P, Lindfelt M, Oksanen T, et al. The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PloS one. 2019;14(10):e0224330.
  43. Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34(52):6700-6.
  44. Lee T, Saskin R, McArthur M, McGeer A. Beliefs and practices of Ontario midwives about influenza immunization. Vaccine. 2005;23(13):1574-8.
  45. Qunaibi E, Basheti I, Soudy M, Sultan I. Hesitancy of Arab Healthcare Workers towards COVID-19 Vaccination: A LargeScale Multinational Study. Vaccines. 2021;9(5):446.
  46. Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore. BMC Primary Care. 2022;23(1):81.
  47. Roozenbeek J, Schneider CR, Dryhurst S, Kerr J, Freeman ALJ, Recchia G, et al. Susceptibility to misinformation about COVID-19 around the world. R. Soc. Open Sci 2020;7(10):201199.
  48. Romer D, Jamieson KH. Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S. Soc Sci Med (1982). 2020;263:113356.
  49. Shahsavari S, Holur P, Wang T, Tangherlini TR, Roychowdhury V. Conspiracy in the time of corona: automatic detection of emerging COVID-19 conspiracy theories in social media and the news. J Comput Soc Sci. 2020;3(2):279-317.
  50. Fadhel FH. Vaccine hesitancy and acceptance: an examination of predictive factors in COVID-19 vaccination in Saudi Arabia. Health Promot Int. 2021.