Background Considering medical and economic burden of the coronavirus disease 2019 (COVID-19), a high COVID-19 vaccination coverage among health care workers (HCWs) is an urgent need. Objective To estimate the intention of HCWs to accept COVID-19 vaccination and to find out related factors. Design We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this study. Data sources We searched PubMed, Medline, Scopus, Web of Science, ProQuest, CINAHL and medRxiv from January 1, 2020 to December 02, 2020. Methods The heterogeneity between results was very high and thus we applied a random effect model to estimate pooled effects. We performed subgroup and meta-regression analysis to identify possible resources of heterogeneity. Results Eleven studies, including 8847 HCWs met the inclusion criteria. The overall proportion of HCWs that intent to accept COVID-19 vaccination was 55.9% (95% CI: 43.6-67.9%) with a wide range among studies from 27.7% to 81.5%. Intention of HCWs to accept COVID-19 vaccination was higher in studies with moderate quality and in studies that were conducted in Europe. The following factors were associated with increased HCWs’ willingness to get vaccinated against COVID-19: male gender, older age, physician profession, fewer work experience, comorbidity among HCWs, seasonal influenza vaccination, stronger vaccine confidence, positive attitude towards a COVID-19 vaccine, fear about COVID-19, individual perceived risk about COVID-19, and contact with suspected or confirmed COVID-19 patients. Conclusions HCWs represent a high-risk group for SARS-CoV-2 infection. The reluctance or refusal of HCWs to vaccinate against COVID-19 could diminish the trust of individuals and trigger a ripple effect in the general public. Since vaccination is a complex behavior, understanding the way that HCWs take the decision to accept or not COVID-19 vaccination will give us the opportunity to develop the appropriate interventions to increase COVID-19 vaccination uptake. Knowledge of the factors that affect intention of HWCs to accept COVID-19 vaccination is limited and there is an urgent need for further and more valid studies.

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Intention of health care workers to accept COVID-19 vaccination and related factors: a systematic review and meta-analysis

Background: Healthcare workers (HCWs) are known to spearhead the fight against the COVID-19 pandemic As such, their knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are considered critical to the success of the current COVID-19 response efforts This study aims to determine HCWs' KAP toward COVID-19 and assesses their perception of their healthcare facilities preparedness to respond appropriately to the ongoing COVID-19 pandemic in Sierra Leone Methods: We conducted an online cross-sectional study among HCWs (n=516) between 1st May 2020 and 30th June 2020 We collected our data using a self-administered structured questionnaire via email and online social media platforms We analyzed our data using descriptive statistics and regression analysis (p < 0 05) Results: Close to three-fourth of HCWs (n=375, 72 7%) were knowledgeable regarding COVID-19 Doctors were more knowledgeable than community health workers and laboratory technicians (AOR= 2 48, 95% CI: 1 16-5 31, p=0 019) regarding COVID-19 Close to two-thirds of HCWs (n=301, 58 3%) HCWs show positive attitudes toward COVID-19 Being male (AOR=2 08, 95% CI: 1 36-3 20, p=0 001) and directly involved in COVID-19 patient care (AOR=3 21, 95% CI: 1 88-5 48, p < 0 001) were identified as predictors of positive attitude towards COVID-19 HCWs are generally adhering to COVID-19 safe practices with majority indicating that they regularly wash or sanitize their hands (n=510, 98 8%) and used facemask at point of care (n=499, 96 7%) Majority of HCWs are of the view that their healthcare facilities are ill-prepared to adequately respond to COVID-19 with majority (n= 400, 77 5%) of them stating that their facilities lack enough personal protective equipment Conclusion: HCWs in Sierra Leone showed good knowledge, positive attitude and practice regarding COVID-19 However, HCWs are of the view that their healthcare facilities are ill-prepared to respond adequately to the COVID-19 outbreak Health authorities and policymakers need to provide the necessary resources to allow HCWs to work in a safe environment

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Healthcare Workers' Knowledge, Attitude, Practice and Perceived Health Facility Preparedness Regarding COVID-19 in Sierra Leone

Key infection prevention and control measures to limit transmission of COVID-19 include social distancing, hand hygiene, use of facemasks and personal protective equipment. However, these have limited or no impact if not applied correctly through lack of knowledge, inappropriate attitude or incorrect practice. In order to maximise the impact of infection prevention and control measures on COVID-19 spread, we undertook a study to assess and improve knowledge, attitudes and practice among 119 healthcare workers and 100 general public in Thailand. The study setting was two inpatient hospitals providing COVID-19 testing and treatment. Detailed information on knowledge, attitudes and practice among the general public and healthcare workers regarding COVID-19 transmission and its prevention were obtained from a combination of questionnaires and observations. Knowledge of the main transmission routes, commonest symptoms and recommended prevention methods was mostly very high (> 80%) in both groups. There was lower awareness of aerosols, food and drink and pets as sources of transmission; of the correct duration for handwashing; recommended distance for social/physical distancing; and about recommended types of face coverings. Information sources most used and most trusted were the workplace, work colleagues, health workers and television. The results were used to produce a set of targeted educational videos which addressed many of these gaps with subsequent improvements on retesting in a number of areas. This included improvements in handwashing practice with an increase in the number of areas correctly washed in 65.5% of the public, and 57.9% of healthcare workers. The videos were then further optimized with feedback from participants followed by another round of retesting. Detailed information on gaps in knowledge, attitudes and practice among the general public and healthcare workers regarding COVID-19 transmission and its prevention were obtained from a combination of questionnaires and observations. This was used to produce targeted educational videos which addressed these gaps with subsequent improvements on retesting. The resulting videos were then disseminated as a resource to aid in efforts to fight COVID-19 in Thailand and worldwide.

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Improving knowledge, attitudes and practice to prevent COVID-19 transmission in healthcare workers and the public in Thailand.

Knowledge, attitude and practices of healthcare professionals of Riyadh, Saudi Arabia towards covid-19: A cross-sectional study.

The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction.This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations.This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs).There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations.This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO. 

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A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic

Background COVID-19 is an ongoing pandemic, for which appropriate infection prevention and control measures need to be adopted. Healthcare workers’ adherence to prevention and control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we assessed the KAP among healthcare workers towards the COVID-19 during the ongoing pandemic. Method A self-developed piloted KAP questionnaire was administered to the recruited healthcare workers involved in the COVID-19 response at the Universal College of Medical Sciences Teaching Hospital (UCMSTH), in Bhairahawa, Nepal. The knowledge questionnaire consisted of questions regarding the clinical characteristics, prevention, and management of COVID-19. Assessment on attitudes and practices towards COVID-19 included questions on behaviour and change in practices made towards COVID-19 response. Knowledge scores were calculated and compared by demographic characteristics and their attitude and practices towards COVID-19. Data were analysed using bivariate statistics. Results A total of 103 healthcare workers participated in the study. The mean age of the participants was 28.24±6.11 years (range: 20–56); 60.2% were females; 61.2% were unmarried; 60.2% had a medical degree, and 39.8% were the nursing staff. The mean knowledge score was 10.59±1.12 (range: 7–13), and it did not vary significantly when adjusted for demographic characteristics. The attitude was positive for 53.4% of the participants with a mean knowledge score of 10.35±1.19 and negative for 46.6% participants with a mean knowledge score of 10.88±0.98 (p = 0.02). The practice was good (≥3 score) for 81.5% participants with a mean knowledge score of 10.73±1.12 and poor for 18.5% participants with a mean knowledge score of 10.46±1.13 (p = 0.24). The attitude of the participants improved with increasing age (29.55±7.17, p = 0.02). Conclusion There is comparably better knowledge regarding COVID-19 among healthcare workers. Appropriate practice correlates with better knowledge and positive attitude towards COVID-19 infection is seen with increasing age. Hence, training on protection and protective measures for having a positive attitude among healthcare workers is necessary against the fight with COVID-19 infection.

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Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal

Background To control the spread of ongoing COVID-19 infection, extremely important measures need to be adopted. Healthcare worker’s adherence to prevention and control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we assessed the KAP among healthcare workers towards COVID-19 during the ongoing pandemic. Method A self-developed piloted KAP questionnaire was used among the recruited healthcare workers working for the COVID-19 response in the Universal College of Medical Sciences Teaching Hospital (UCMSTH), in Bhairahawa, Nepal. The knowledge questionnaire consisted of questions regarding the clinical characteristics, prevention and management of COVID-19. Assessment on attitudes and practices towards COVID-19 included questions on behaviour and change in practices while working during this response. Knowledge scores were calculated and compared by demographic characteristics and their attitude and practices towards COVID-19. Data were analysed using bivariate statistics. Results A total of 103 healthcare workers participated in the study. The mean age of the participants was 28.24±6.11 years (range: 20-56); 60.2% were females; 61.2% were unmarried; 60.2% had medical degree and 39.8% were nursing staff. The mean knowledge score was 10.59±1.12 (range: 7-13) and it did not vary by demographic characteristics. Attitude was positive for 53.4% participants with a mean knowledge score of 10.35±1.19 and negative for 46.6% participants with a mean knowledge score of 10.88±0.98 (p = 0.02). Practice was good (≥3 score) for 81.5% participants with a mean knowledge score of 10.73±1.12 and practice was poor for 18.5% participants with a mean knowledge score of 10.46±1.13 (p = 0.24). The attitude of the participants improved with the increasing age of the participants (29.55±7.17, p = 0.02). Conclusion There is comparably better knowledge regarding COVID-19 among healthcare workers along with appropriate practices, however attitude was less optimistic with better knowledge but more optimistic with higher age of the healthcare workers. Hence, protective measures for healthcare workers in order to improve their attitude is necessary during the pandemic response.

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Dil K. Limbu

Papers

Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal

Healthcare workers’ knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal