Effectiveness of Group and Individual Counselling Interventions on COVID-19 Vaccination Intention Among Industrial Employees in Romania

Abstract

Introduction: Vaccine hesitancy remains a critical barrier to achieving widespread vaccination, particularly in settings with limited public trust and high exposure to misinformation. This study aims to measure the level of vaccine hesitancy, identifying the factors contributing to it, and to evaluate the effectiveness of two targeted interventions-group and individual counseling-designed to address vaccine hesitancy among employees in seven industrial companies in Romania during the Coronavirus disease 2019 (COVID-19) pandemics.

Methods: A total of 256 participants were included in the study, and interventions were delivered by family physicians and occupational medicine specialists trained in motivational interviewing (MI) techniques. Data on sociodemographic factors, vaccine hesitancy, and willingness to vaccinate were collected using a questionnaire and a Visual Analogue Scale (VAS) for vaccine willingness.

Results: Both interventions led to significant increases in willingness to vaccinate, with group counseling showing a 1.4-point increase on the VAS (p-value < 0.0001) and individual counseling showing a 1.5-point increase (p-value < 0.0001), though the differences between the two approaches were not statistically significant (p-value = 0.209). Key factors correlated with higher levels of vaccine hesitancy included younger age, lower education levels, marital status (single or divorced), having children, the presence of chronic diseases, a lack of general antivaccine beliefs, and a lack of trust in the natural origin of the novel coronavirus (SARS-CoV-2).

Conclusion: This study highlights the effectiveness of dual interventions involving family doctors and occupational medicine specialists in reducing COVID-19 vaccine hesitancy among industrial workers in Romania. Key factors influencing hesitancy included demographic characteristics (age, marital status) and social determinants (education level, anti-vaccine beliefs, parenthood, and chronic illness). The findings emphasize the role of trusted healthcare professionals in addressing these concerns through targeted communication strategies, such as motivational interviewing.

Keywords: COVID-19 vaccine; Romania; motivational interview; questionnaire; vaccine hesitancy; workers.

Figure 1

Violin plots comparing COVID-19 vaccine hesitancy and the three key categories of factors between Group 1 (red – group intervention) and Group 2 (green – individual intervention) post-intervention. (A) Distribution of vaccine hesitancy scores. (B) Distribution of Factor 1, which assesses confidence in the information regarding COVID-19. (C) Distribution of Factor 2, evaluating perceptions of vaccine safety and efficacy. (D) Distribution of Factor 3, which addresses concerns about vaccination being a form of control. A significant difference is observed only in Factor 3 (p = 0.023), while no significant differences were found for the other factors. *p-value<0.05.

Figure 2

Violin plot comparing the difference between baseline and post-intervention willingness to take the COVID-19 vaccine for Group 1 (red) and Group 2 (green). The distribution of score differences shows no statistically significant difference (ns) between the two intervention groups, indicating that both interventions resulted in similar overall changes in willingness to take the vaccine.

Figure 3

Dot plots comparing the willingness to take the COVID-19 vaccine before and after interventions. In (A), the group-based intervention shows a significant increase in vaccine willingness, with the median score rising from 5.2 before the intervention to 6.6 after (p < 0.0001). In (B), the individual-based intervention also resulted in a significant increase in willingness, with the median score increasing from 4.6 before the intervention to 6.2 after (p < 0.0001). Each dot represents a participant’s score, and the lines indicate the median willingness scores. ****p-value<0.0001 (Wilcoxon matched-pairs signed rank test); Score 0, the willingness to take COVID-19 vaccine before intervention; Score 1, the willingness to take COVID-19 vaccine after intervention.