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. 2023 Oct 29;13(11):2373-2387.
doi: 10.3390/ejihpe13110167.

A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff

Athanasios Tselebis  1 , Christos Sikaras  2 , Charalampos Milionis  3 , Eleni Paraskevi Sideri  4 , Konstantinos Fytsilis  1 , Styliani Maria Papageorgiou  1 , Ioannis Ilias  3 , Argyro Pachi  1
Affiliations

A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff

Athanasios Tselebis et al. Eur J Investig Health Psychol Educ. .

Abstract

During the pandemic, nurses experienced anger that stemmed from a sense of threat, frustration, or even a sense of injustice. The purpose of this study was to examine the relationship between vaccination hesitancy, anger, cynicism, and medical mistrust among nurses, as there are no relevant studies in the literature. This study was conducted online by completing self-report questionnaires. The Dimensions of Anger Reactions-5, the 8-item "Cynical Distrust" scale, and the Medical Mistrust Multiformat Scale were used. For vaccination hesitancy, two questions with a 5-point scale were used: one question examining hesitancy to get vaccinated with the COVID-19 vaccine, and another question examining hesitancy to get vaccinated with the influenza vaccine. In total, 387 nurses (66 men and 321 women) participated in this study. Nurses showed statistically greater hesitancy toward the COVID-19 vaccine compared to hesitancy toward the influenza vaccine. The variation in vaccine hesitancy was explained by the scores in the Medical Mistrust Multiformat Scale, the Dimensions of Anger Reactions, and the Cynical Distrust Scale. The Medical Mistrust Multiformat Scale mediated the relationship between the Cynical Distrust Scale and total vaccine hesitancy. The Dimensions of Anger Reactions Scale significantly moderated the indirect effect of the Cynical Distrust Scale on total vaccine hesitancy through the Medical Mistrust Multiformat Scale. In conclusion, it is highly likely that anger is involved in reported vaccine hesitancy both by activating schemas of distrust in others and by adopting anti-systemic views of mistrust in the medical system.

Keywords: COVID-19 pandemic; anger; cynical distrust; medical mistrust; nurses; vaccination hesitancy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mediation analysis of Medical Mistrust Multiformat Scale (MMMS) on Cynical Distrust Scale (CDS)—total vaccine hesitancy (TVH) relationship.
Figure 2
Figure 2
Moderated mediation analysis of the effect of Dimensions of Anger Reactions (DAR) on the association between Cynical Distrust Scale (CDS) and total vaccine hesitancy (TVH) through Medical Mistrust Multiformat Scale (MMMS).
Figure 3
Figure 3
Simple slopes demonstrating the interaction of the moderation analysis.
See this image and copyright information in PMC

References

    1. Chung H.-Y., Jian M.-J., Chang C.-K., Lin J.-C., Yeh K.-M., Chen C.-W., Hsieh S.-S., Hung K.-S., Tang S.-H., Perng C.-L., et al. Emergency SARS-CoV-2 Variants of Concern: Novel Multiplex Real-Time RT-PCR Assay for Rapid Detection and Surveillance. Microbiol. Spectr. 2022;10:e0251321. doi: 10.1128/spectrum.02513-21. - DOI - PMC - PubMed
    1. Mukhtar S. Psychological health during the coronavirus disease 2019 pandemic outbreak. Int. J. Soc. Psychiatry. 2020;66:512–516. doi: 10.1177/0020764020925835. - DOI - PMC - PubMed
    1. Tselebis A., Pachi A. Primary Mental Health Care in a New Era. Healthcare. 2022;10:2025. doi: 10.3390/healthcare10102025. - DOI - PMC - PubMed
    1. Sikaras C., Ilias I., Tselebis A., Pachi A., Zyga S., Tsironi M., Gil A.P.R., Panagiotou A. Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece. AIMS Public Health. 2022;9:94–105. doi: 10.3934/publichealth.2022008. - DOI - PMC - PubMed
    1. Pachi A., Sikaras C., Ilias I., Panagiotou A., Zyga S., Tsironi M., Baras S., Tsitrouli L.A., Tselebis A. Burnout, Depression and Sense of Coherence in Nurses during the Pandemic Crisis. Healthcare. 2022;10:134. doi: 10.3390/healthcare10010134. - DOI - PMC - PubMed

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