EJIHPE | Free Full-Text | A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff
The World Health Organization declared an end to the COVID-19 pandemic on 5 May 2023, perceiving an increase in immunity from vaccination and infection leading to fewer deaths. In Greece, the suspension of unvaccinated health workers extended until the end of the year 2022. The timing of this study is justified by our choice to conduct the study after the end of the pandemic a few months after the unvaccinated personnel had returned back to work to measure the steady state of nurses’ vaccine beliefs and intentions after the extreme negative emotions that can blur their cognitions had subsided.
In the present study, we aimed to explore the relationships among vaccination hesitancy, trust in the healthcare system, cynical distrust, and anger in nursing staff and to test a moderated mediation model of the influence of cynical distrust on vaccination hesitancy mediated by medical mistrust and moderated by anger. The proposed hypotheses were as follows:
Cynical distrust might be positively related to vaccination hesitancy.
Medical mistrust might mediate the effect of cynical distrust on vaccination hesitancy.
Anger might moderate the indirect relationships between cynical distrust and vaccination hesitancy via medical mistrust.
Furthermore, we examined if anger as a moderator is changing the strength of the indirect effect of the above mediation. The index of moderated mediation was significant, b = −0.0025, 95% percentile CI [−0.0051, −0.0006], providing evidence for a moderated mediation. The conditional indirect effect for small values (−1 SD) of the moderator was the strongest, b = 0.0280, 95% percentile CI [0.0101, 0.0497], while it was weaker but still significant for medium values of the moderator, b = 0.0182, CI [0.0064, 0.0322], and for high values (+1 SD) of the moderator, b = 0.0084, CI [−0.0017, 0.0210], it was insignificant.
This study is subject to limitations. First is the use of self-administered questionnaires, which gave a more subjective dimension to the assessment of variables. Second, nurses who do not have easy access to the internet were excluded from the sample, as the invitation was sent through email. Third, gender disproportionality in the nursing samples may have affected generalization to other populations, and the convenience sampling method may possibly reflect selection bias.
Overall, it is very likely that anger is involved in the stated refusal of vaccination both by activating patterns of distrust toward others and in the adoption of anti-systemic views of mistrust toward the medical system. We believe that interventions of anger management and/or of enhancing communication skills and stress relief, through educational training programs, for health workers might result in the reduction of anger and anti-systemic thinking.
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