Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID‐19

• Type of Material: Article
• Authors: Anica Ilic, University of Lucerne; Regine Haardoerfer, Emory University; Gisela Michel, University of Lucerne; Cam Escoffery, Emory University; Ann C. Mertens, Emory University; Jordan Gilleland Marchak, Emory University
• Language: English
• Date: 2023-11-08
• Publisher: John Wiley & Sons Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1002/cam4.6675
• Title of Journal or Parent Work: Cancer Medicine
• Volume: 12
• Issue: 23
• Start Page: 21354
• End Page: 21363
• Grant/Funding Agency: National Cancer Institute; Swiss National Science Foundation
• Grant/Funding Information: The Cancer SurvivorLink™ clinical trial (NCT03543852) was supported by the National Cancer Institute (NCI; 1R01CA218389, 5P30CA13829). The current study was supported by the Swiss National Science Foundation (SNSF; 10001C_182129/1). Anica Ilic received financial support through a mobility fellowship from the Graduate Academy of the University of Lucerne.
• Keywords: COVID-19; survivors of childhood cancer; intention; caregivers; vaccines; psychological theory; health literacy
• Subject - Topics: Cancer; COVID-19 vaccines
• Research Categories: Immunology; Oncology

Abstract

Background Vaccination against COVID‐19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5–17 years against COVID‐19 by applying the Theory of Planned Behavior. Methods Participants in this cross‐sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID‐19 health literacy, and frequency of COVID‐19 information‐seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID‐19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling. Results Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non‐Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID‐19 vaccine. Over one‐third (37.5%) of caregivers reported disagreement or indecision about future COVID‐19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID‐19 information‐seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID‐19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms. Conclusions Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID‐19 health literacy, and frequency of COVID‐19 information‐seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy.