University students’ perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: A multi-methods study

Madeleine Mant; Asal Aslemand; Andrew Prine; Alyson Jaagumägi Holland

doi:10.1371/journal.pone.0255447

Peer Review History

Original SubmissionMarch 16, 2021
15 Jun 2021 Decision Letter - James Curtis West, Editor PONE-D-21-08664 University students’ perspectives and hesitancy regarding the COVID-19 vaccine: a multi-methods study PLOS ONE Dear Dr. Mant, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please edit your presentation of results as recommended by reviewers. Please attend to the comment on cost of vaccine per reviewer #2. Please submit your revised manuscript by Jul 30 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a copy of the interview guide used in the study, in both the original language and English, as Supporting Information, or include a citation if it has been published previously. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): Thank you for your interesting submission. Your investigation of vaccine acceptance and hesitance among university students is both timely and well executed. Please consider the following suggestions to improve. 1. Results. Please edit down your presentation of the interview data. I would recommend removing table 7 in favor of just a paragraph of general descriptives of the sample. Also, it is not necessary to identify each participant alongside the quotes. i would strongly urge you to consider placing the quotes into a table or text box organized by the themes identified in your text. 2. Results. Table 1, please clarify your label "severity." I believe this is referring to respondents' perception of the severity of COVID, but coming right after "anxiety" it gets confusing as a single word label. 3. Results. line 239. Your description of students not personally affected being 0.369 times less likely is the opposite of how it is presented in the table and the use of a fractional reduced likelihood is awkwardly worded. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study investigated the university students' willingness to receive a COVID-19 vaccine using a mixed method and then identified the concerns on efficacy and safety of COVID-19 vaccines, which is similar to other publications elsewhere. 1, The presentation of Table 4 and 5 should be revised, as usual appearance in a scientific paper. 2, I suggest the qualitative results should be revised and refined. Reviewer #2: In my opinion, this is a very interesting study assessing the perspectives and hesitancy of University students regarding the COVID-19 vaccines, as studies on this particular population regarding COVID-19 are still limited. The aim of the study, methods used, and results were presented clearly. However, there are some suggestions I'd like to give to enrich the manuscript. 1. The title of this study is "University students' perspectives and hesitancy regarding the COVID-19 vaccine: a multi-methods study," however the elaboration on hesitancy part is insufficient. Further elaboration on the issue in the study, particularly in the discussion and conclusion, is necessary to better fit the title. 2. In regards to the likeliness of university students to get COVID-19 vaccine once it's available, the authors did not include price and regulation as predictors or factors that might influence decision to get vaccinated. In fact, these two factors have been shown to be associated with vaccination uptake in previous investigations. Wether or not the COVID-19 vaccine will be available for free, and if it will be made compulsory by the government might influence the decision of this particular population to get themselves vaccinated. In my opinion, it would be great if the authors could explain why they did not include the two factors in the introduction part (it was explained briefly in the methods section, but no justification of why the two items were not included in the survey). All in all, I think the paper was well designed and suit to be published. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Yihan Lu Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0255447.r001
Revision 1
25 Jun 2021 Author Response June 25, 2021 Response to Reviewers Thank you to the Reviewers and the Academic Editor for their reviews and comments. We appreciate the time spent assessing this manuscript and hope our revisions have fully addressed the identified points. The response/actions to the comments are noted below. All four authors have approved the following changes to the manuscript. Please include a copy of the interview guide used in the study, in both the original language and English, as Supporting Information, or include a citation if it has been published previously. Response: The June and September survey questions and interview guides are included as Supporting Information. Editor Comments 1. Results. Please edit down your presentation of the interview data. I would recommend removing table 7 in favor of just a paragraph of general descriptives of the sample. Also, it is not necessary to identify each participant alongside the quotes. i would strongly urge you to consider placing the quotes into a table or text box organized by the themes identified in your text. Response: Thank you for these suggestions. All references in parentheses to specific participant numbers have been removed from the text. Table 7 has been removed and replaced with a paragraph summarizing the interview participant sample demographics. All interviewee quotations have been removed from the body text and organized into a table (new Table 7) based upon the themes identified in the Results. 2. Results. Table 1, please clarify your label "severity." I believe this is referring to respondents' perception of the severity of COVID, but coming right after "anxiety" it gets confusing as a single word label. Response: Table 1 has been adjusted so that Anxiety now reads “Self-reported Anxiety” and Severity now reads “Perception of COVID-19’s Severity” to clarify that these are separate sets of results. 3. Results. line 239. Your description of students not personally affected being 0.369 times less likely is the opposite of how it is presented in the table and the use of a fractional reduced likelihood is awkwardly worded. Response: Thank you for catching this. The text has been revised to accurately reflect what is presented in Table 5. Reviewer 1 1, The presentation of Table 4 and 5 should be revised, as usual appearance in a scientific paper. Response: Tables 4 and 5 have been revised to align with APA formatting for reporting logistic regression. 2, I suggest the qualitative results should be revised and refined. Response: Following the comments provided by the Academic Editor, and as detailed above, the references to specific participants have been removed from the main text, Table 7 was removed and replaced with a paragraph summarizing the interview participant sample demographics, and all interviewee quotations have been removed from the text and placed into a new Table 7, organized by the themes identified in the Results. Reviewer 2 1. The title of this study is "University students' perspectives and hesitancy regarding the COVID-19 vaccine: a multi-methods study," however the elaboration on hesitancy part is insufficient. Further elaboration on the issue in the study, particularly in the discussion and conclusion, is necessary to better fit the title. Response: Thank you for this point. We have adjusted the title to “University students’ perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: a multi-methods study” in order to better reflect the aims and content of the paper. The subsection “Qualitative results for vaccine uptake or resistance” has been revised to “Qualitative results for vaccine uptake or hesitancy” and the subsection “Reasons for not receiving the vaccine” was revised to “Reasons for vaccine hesitancy.” The section discussing reasons for vaccine hesitancy has been revised to explicitly state “there were vaccine hesitancy concerns raised as perceived barriers within the HBM.” The speed of development was the key fear expressed by survey participants, which is discussed and placed into the wider context of the limited existing literature. 2. In regards to the likeliness of university students to get COVID-19 vaccine once it's available, the authors did not include price and regulation as predictors or factors that might influence decision to get vaccinated. In fact, these two factors have been shown to be associated with vaccination uptake in previous investigations. Wether or not the COVID-19 vaccine will be available for free, and if it will be made compulsory by the government might influence the decision of this particular population to get themselves vaccinated. In my opinion, it would be great if the authors could explain why they did not include the two factors in the introduction part (it was explained briefly in the methods section, but no justification of why the two items were not included in the survey). Response: This is an important point that is dependent upon the national context in which this research was conducted. Regarding vaccine cost, routine vaccinations for babies, children, and adults are offered free of charge across Canada. Seasonal flu shots are free and the mass immunization program for the H1N1 pandemic in 2009 provided free vaccines for all Canadians who wanted a vaccine. We did not consider cost as a driving factor because the universal health care system in Canada covers the cost of both routine and pandemic vaccines. We also did not consider government mandating of the vaccine because there are no mandated vaccines in Canada (though two provinces have specific rules regarding vaccines for school-aged children to register in public schools, which have been noted in the text. They do, however, have medical and philosophical exemptions.) Survey participants spontaneously offered thoughts regarding making the vaccine mandatory, which has been noted in the results. We added an explanation (in the Methods section, subsection on Survey questions) as to why cost and mandatory vaccines were not considered as potential drivers of the survey participants’ answers. Three new citations have been added to the manuscript as part of this revision (#27-29). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0255447.r002
19 Jul 2021 Decision Letter - James Curtis West, Editor University students’ perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: a multi-methods study PONE-D-21-08664R1 Dear Dr. Mant, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, James Curtis West, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0255447.r003
Formally Accepted
22 Jul 2021 Acceptance Letter - James Curtis West, Editor PONE-D-21-08664R1 University students’ perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: a multi-methods study Dear Dr. Mant: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. James Curtis West Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0255447.r004

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