HCW knew the name of the virus, modes of transmission and vaccine type correctly with the rates of 93.0%, 91.0% and 52.7%, respectively. It can be said that knowledge of HCW in this matter is good.
Most of the participants expressed that they found the vaccine neither protective nor safe. Similarly, in another study in Hong Kong, 61% of the participants believed that the vaccine wasn't protective, and 63% of them believed that the vaccine was unsafe as clinical experiments were not performed. Evidence about safety and efficacy is critical in determining the prevalence of uptake of vaccination . Thus, HCW and the general public have to be convinced about the vaccine's efficacy and safety.
In this study, only 12.7% of HCW got vaccinated. Although a majority of the participants considered the swine flu outbreak as serious, described it as a fatal disease and had a high level of knowledge about the disease, vaccination rate was very low. Similarly, it was determined that the vaccination rates of HCW were very low in Greece, Germany and Italy [16–18].
In terms of order of importance "Being in risk group", "Declarations of the Ministry of Health" and "Death news in the media" became influential in participants' vaccination. Results of the study of Chor et al. (2009) on HCW are parallel to this study and the most common reasons to uptake the vaccine were stated as "protection demand" and "advice of health authorities" . Based on these studies, we can say that health authorities' announcements and publications made through the media and similar ways have a positive effect on vaccination.
Reasons like "side effects of the vaccine" and "not believing in the protectiveness of the vaccine" "The Prime Minister's personal refusal of getting vaccinated" and "negative news about vaccine in the media" are influential factors in HCW' refusal to get vaccinated. The most important obstacles defined in the study of Chor et al. (2009) were "being anxious about the side effects" and "suspicions about the vaccine's safety". In another study, reasons to refuse the vaccine were expressed as anxiety about the vaccine's safety and efficiency . It was determined that there was anxiety about the safety, efficiency and necessity of the vaccine. In the study of Rachiotis et al. (2010), the main reason to refuse the vaccine was fear of side effects, which was stronger in those who received information on the safety of the vaccine mainly from mass media . Also, in our study, state anxiety levels of people who did not rely on the vaccine were found to be significantly higher than those who relied on the vaccine. However, these people's trait anxiety levels were not detected a significant high level. According to the results of this study, it is important to overcome this anxiety and to enable safety in order to convince people to get vaccinated in vaccination campaigns. In our study the Prime Minister's refusal of vaccine had a negative impact, while the advice of health authorities had a positive effect on vaccination. In this case we can say that different attitudes of the Prime Minister and the Ministry of Health affected the vaccination process negatively. Although we do not have certain data on this matter these different attitudes can be said to increase anxiety levels as to this situation. Consistent attitude of the government in vaccination campaigns can contribute a decrease in public anxiety, and an increase in trust.
In professional terms, doctors knew modes of transmission and type of the vaccine correctly at the highest rate, and allied health workers knew these correctly at the lowest rate. Doctors believed in the vaccine's protectiveness and safety more than the others. Also, in comparison with others, doctors gave permission to their children to get vaccinated at a higher level. In this matter, it can be recommended to give importance to inform allied health workers in vaccination campaigns.
In terms of anxiety levels, a significant difference was not detected between those who were vaccinated and those who were not vaccinated.
Strengths and weaknesses of this study
To our knowledge, this is the first study conducted to assess vaccination rate and factors associated with vaccine acceptance and their relations with anxiety levels of HCW in literature. It provides some new important information on obstacles in vaccination. This study was conducted only in a city center, and had relatively low number of respondents for a social study.