Does the Fear of Needles Influence Jamaicans’ Willingness to be Vaccinated against COVID-19?

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Introduction: As of November 21, 2021, the vaccination rate in the world is 55% (fully vaccinated, 43%) compared to 22% in Jamaica (17% fully vaccinated), 70% in the United States and Canada, 66% in Latin America, Asia-Pacific (64%), Europe (62%), Middle East (45%), and 9.7% in Africa. A variable proportion of each country’s population is delaying or avoiding vaccination, which may hamper the success of vaccination programmes. The frequency of needle injections averaged from 2-11 per person each year in 10 major regions globally in a study conducted by the World Health Organization [1-10].
Aim: To explore whether the fear of needles influences Jamaicans’ willingness to be vaccinated?”
Methods and materials: The study used an explanatory web-based cross-sectional design. A standardized questionnaire instrument consisting of fifteen closed-ended questions was disseminated via WhatsApp, Facebook, and face-to-face interaction in the fourteen parishes. The Statistical Packages for the Social Sciences (SPSS) 25 for Windows 27.0 provided data analysis (Table 1).

Table 1: Demographic characteristics of the sampled respondents, n=1,080.

Findings: Most of the respondents were females living in Clarendon who were hesitant to take the vaccine due to trypanophobia. Of the total respondents, 62.6% (n=676) avoided medication requiring administration through needles. The majority of the respondents (31.2%, n=337) was three on a scale of 1-5 (with 5 being the highest level of fear). Most respondents (43.6%, n=471) answered “Yes” when asked, “If the needles were shorter would you take the vaccine?” When asked if the following statement referred to the: “My heart races when I think about getting an injection”, most of the respondents (31.9%, n=344) agreed. Age, fear of needles, and willingness to accept oral vaccination accounted for 21.6% (i.e., Nagelkerke R2) of the variance in vaccination status (-2Ll=744.023; Omnibus test of Model coefficients: χ2(8)=117.109, P < 0.001; Hosmer and Lemeshow test: χ2(8)=10.750, P-value = 0.216) [11-13].
Conclusion: The influence of trypanophobia on COVID-19 vaccination rates in Jamaica must be considered when formulating future public media strategies, policymakers’ approach, and civic responsibility in reducing vaccine hesitancy among the population. Therapeutic healthcare provider and patient interactions are pivotal in increasing the patient’s confidence, willingness toward treatment, and the strength to overcome trypanophobia (Table 2).

Table 2:Respondent’s views on needles/injections, n=1,080.

Keywords: COVID-19; Fear of needles; Injection; Needle; Needle phobia; Trypanophobia; Vaccine acceptance; Vaccine hesitancy

The initial report of the Coronavirus 2019 (COVID-19) by the World Health Organization (WHO) occurred on December 31, 2019, following pneumonia cases of unknown origins in Wuhan city, China (World Health Organization (WHO). The virus was declared a global health emergency on January 30, 2020 (WHO). Holder of the New York Times indicated that as of November 21, 2021, the vaccination rate in the world is 55% (fully vaccinated, 43%) compared to 22% in Jamaica (17% fully vaccinated), 70% in the United States and Canada, 66% in Latin America, Asia-Pacific (64%), Europe (62%), Middle East (45%), and 9.7% in Africa. These statistics indicate that a variable proportion of the population in each country are delaying or avoiding vaccination, which may hamper the success of vaccination programmes [13-21].

A significant number of persons continue to be diagnosed with the COVID-19 virus. A more substantial number of individuals died from the COVID-19 due to the initial lack of knowledge of how to treat such a virus, making vaccines more critical. The fear of getting vaccinated may be hindering the current uptake in Jamaica [21-26]. A renowned medical doctor, Professor Denise Eldemire Shearer, postulated that trypanophobia (i.e., the fear of needles or needle phobia) is accounting for some per cent of COVID-19 vaccine hesitancy among the Jamaican population, which is also the case across the globe, and this extends to children (Table 3). A search of the literature revealed no empirical support for the perspective of Eldemire, and this means that the society continue to operate and plan in ignorance for the pandemic. Hence, this study seeks to answer the following research questions:
A. What are the reasons for Jamaicans current unvaccinated status?
B. Is the vaccination process delayed due to the fear of needles? and
C. What is the profile of those who fear needles in the vaccination process?

Table 3:Issues on COVID-19 Vaccines, n=1,080.

H0: No statistical relationship exists between the fear of needles and considering taking the COVID-19 vaccine.

To contextualize the current study and answer the research question, a theoretical framework (i.e., Theory of Reasoned Action and the Theory of Planned Behavior) was developed to guide and better understand COVID-19 hesitancy as a result of trypanophobia in Jamaica [26-39].

Theoretical framework

Globally, varying views exist on the vaccination process and the COVID-19 virus, leading to world leaders implementing additional measures. Social distancing, frequent hand washing, and education were some of those measures (Table 4). Despite the plethora of current information, individuals still have mixed feelings about vaccination. These feelings range from fear of needles to misunderstanding of information. A theoretical framework that addresses the study constructs is warranted to explore further the “fear needles” and their influence on vaccinations. This current study uses a theoretical framework reflecting the Theory of Reasoned Action and the Theory of Planned Behavior that aided the researchers in better assessing these phenomena (Figure 1).

Table 4:A cross-tabulation between the fear of needles and considering taking the COVID-19 Vaccine, n=1,080.

H0: There is no statistical association between considering being vaccinated against COVID-19 and preferring oral vaccines.

Figure 1:Reason action theory/theory of planned behaviour.

According to Rural Health Information Hub (2018), the Theory of Reasoned Action and the Theory of Planned Behavior explain the association of beliefs and behaviour and implies that a person’s health behaviour is determined by their intention to perform a behaviour. Attitude, subjective norms, and perceived behavioural control collectively influences an individual’s behavioural intentions. An individual’s attitude toward the behaviour and the subjective norms affects their intention to perform a behaviour. However, subjective norms result from the social and environmental surroundings and an individual’s perceived control over the behaviour (Table 5). Generally, a positive attitude and positive subjective norms result in greater perceived control and increase the likelihood of intentions governing changes in behaviour. The theory clarifies health behaviours, planning, implementing health promotion and disease prevention programs [39-44].

Table 5:A cross-tabulation of considering being vaccinated against COVID-19 and prefer oral Vaccines, n=1,080.

Furthermore, subjective norms describe the behaviours of healthcare providers, patients, care providers, and others in the community. Therefore, these theories provide a framework for answering this current study’s research question, “Does the fear of needles influences Jamaican’s willingness to be vaccinated?” An individual’s decision depends on their attitude towards a particular situation, whether positive, negative, or neutral Tables 6-8. Using the theoretical framework (Figure 1) to address the research question, we anticipate that individuals will consider the vaccination process negative or positive. Furthermore, if individuals believe that the outcome of taking the vaccine is beneficial, they will have a positive attitude. If they believe the vaccine is not essential and has undesirable effects, they will react negatively.

Table 6:A Cross-tabulation between the fear of needles and Gender, n=1,080.

H0: Older respondents are less likely to fear needles than younger respondents.

Table 7:A cross-tabulation of rating the fear of needles and age Cohort, n=1,080.

Table 8:Binary logistic regression of vaccination status of Jamaica by selected explanatory Variables.

OR denotes the odds ratio.

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