The role of demographic factors, mindfulness and perceived stress in resilience among nurses: A cross sectional study.

AIM: To examine the role of demographic factors, mindfulness, and perceived stress on resilience among nurses. BACKGROUND: Resilience is an important attribute in the nursing profession although factors affecting it are very diverse. Knowing these factors may help in enhancing nurses' resilience and their subsequent quality healthcare delivery. METHOD: Utilizing a cross-sectional descriptive survey, a convenience sample was recruited to answer questions assessing resilience, perceived stress, and mindfulness in Taiwan between October and November 2021. Independent t-tests, one-way analyses of variance (ANOVAs) and hierarchical regression were used to analyse the data. RESULTS: A total of 816 nurses participated in the study. Postgraduate degree nurses had lower perceived stress (p = .006) and higher resilience (p = .003) compared with their college and undergraduate counterparts. Nurses working in internal medicine had significantly higher levels of perceived stress (p = .006) and lower levels of mindfulness (p = .005) compared with those in other departments. Single nurses had significantly higher levels of mindfulness (p = .04) but lower levels of resilience (p = .049) than those who were married. Educational level, perceived stress, and mindfulness were all factors that influenced nurses' resilience. CONCLUSION: Higher educational levels, perceived stress, and mindfulness appear to influence nurses' resilience. Nurses should therefore be encouraged to upgrade themselves academically, attend refresher courses, and learn adaptive coping strategies. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital authorities should help nurses deal with stressful issues and offer career development opportunities to update, upgrade, and enhance their skillsets in the profession.

Fear of COVID-19 and workplace phobia among Pakistani doctors: A survey study.

BACKGROUND: The novel coronavirus disease-2019 (COVID-19) has seriously affected the lives of millions of people across the world. It has also heavily burdened healthcare professionals and the virus poses serious risks for their personal and professional lives. Therefore, the present study examined the associations between fear of COVID-19 and workplace phobia among doctors in Pakistan during the COVID-19 pandemic. METHODS: An online survey was conducted among 421 doctors in Pakistan between April 10 and May 25, 2020. The Workplace Phobia Scale (WPS) and the Fear of COVID-19 Scale (FCV-19S) were the main psychometric instruments used in this study. RESULTS: There was a significant positive relationship between fear of COVID-19 and workplace panic anxiety and workplace avoidance behavior. Significantly higher fear of COVID-19 was found among (i) females compared to males, (ii) doctors with 5 years or less of work experience compared to those with more than 5 years, and (iii) postgraduate trainees compared with other ranks. Two groups (doctors who were above 30 years old and postgraduate trainees) were found to have higher levels of workplace phobia compared to their counterparts. Doctors with severe levels of fear of COVID-19 had significantly higher levels of workplace panic anxiety and workplace avoidance behavior. CONCLUSIONS: Fear of COVID-19 was significantly associated with workplace phobia which may negatively affect doctors' performance. Therefore, important steps are needed to protect doctors' health by providing sufficient resources to allay their fears and anxieties which consequently help them in carrying out their frontline duties in response to the COVID-19 pandemic.

Mental health challenges in academia: comparison between students of the various educational levels in Ghana.

BACKGROUND: Students continue to face significant mental health challenges that vary in severity and type. It is, therefore, imperative that researchers and clinicians pay more attention to efforts aimed at improving the mental well-being of students. AIMS: This study examined the differences between Ghanaian students of the various educational levels on some mental health variables and the psychosocial factors of suicidal ideation. METHODS: Three hundred and fifty-seven (357) participants consisting of junior (92 students) and senior (99 students) high school students, undergraduates (86 students) and postgraduates (80 students) were involved in this cross-sectional study. RESULTS: The study revealed that high school students had higher academic stress, depression and suicidal ideation and they used more coping strategies compared to university students. Depression, age, and educational levels were the factors that facilitated suicidal ideation, with spiritual and ritual centred coping strategy and religion (Islam) serving as a buffer for suicidal ideation among students. These factors varied with different educational levels. CONCLUSIONS: High school students experienced significant mental health problems compared to university students-this has direct implications on their academic and psychosocial development. The study recommends that mental health facilities be provided and managed by professionals, especially in high schools.

Testing an app-based intervention to improve insomnia in patients with epilepsy: A randomized controlled trial.

PURPOSE: Insomnia has adverse effects on people with epilepsy. We aimed to test a novel cognitive behavioral therapy for insomnia (CBT-I) app-based intervention on insomnia symptoms and social psychological factors in people with epilepsy and to examine the possible mechanisms among the factors. METHODS: Participants were recruited from neurology clinics in Iran and comprised individuals diagnosed with epilepsy and having moderate to severe insomnia. A two-arm randomized controlled trial design was used, consisting of a treatment group (CBT-I; n = 160) and control group (patient education; n = 160). Primary outcomes were self-reported sleep quality, insomnia severity, and sleep hygiene behavior and objective sleep characteristics measured by actigraphy. Secondary outcomes were attitude, perceived behavioral control, intention, action planning, coping planning, behavioral automaticity, self-monitoring, anxiety, depression, and quality of life (QoL). All outcomes were measured at baseline, and at one, three, and six months postintervention, except objective sleep, which was assessed at baseline, and one and six months postintervention. Data were analyzed using linear mixed models. RESULTS: Current findings showed that sleep quality, insomnia severity, sleep hygiene behavior, and sleep onset latency were significantly improved in the CBT-I group compared with the patient education group at all measurement points. Also, the CBT-I group had significantly improved anxiety, depression, and QoL compared with the patient education group. Mediation analyses showed that attitude, intention, coping planning, self-monitoring, and behavioral automaticity significantly mediated the effect of the intervention on sleep outcomes. CONCLUSION: Results support the use of the CBT-I app to improve sleep outcomes among people with epilepsy.

Efficacy of a Theory-Based Cognitive Behavioral Technique App-Based Intervention for Patients With Insomnia: Randomized Controlled Trial.

BACKGROUND: Sleep hygiene is important for maintaining good sleep and reducing insomnia. OBJECTIVE: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients. METHODS: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time. RESULTS: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes. CONCLUSIONS: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03605732; https://clinicaltrials.gov/ct2/show/NCT03605732.

Parental intention on getting children COVID-19 vaccinations: Invariance evaluation across parenting roles and COVID-19-like symptoms experiences among Iranians during the pandemic period.

Countries worldwide are facing challenges with increasing the COVID-19 vaccination rates for children. This study examined associations between perceived knowledge, coping appraisal, threat appraisal, adaptive response, maladaptive response, and intention, and possible variance across parents (mother or father) and COVID-19-like symptoms experiences regarding parental intentions to vaccinate their children. A total of 836 Iranian parents with children between the ages of 6 and 12 y completed measures assessing perceived knowledge, coping appraisals, threat appraisals, intentions, adaptive responses, and maladaptive responses. Multigroup structural equation modeling revealed that perceived knowledge was positively associated with both coping and threat appraisals, coping appraisals positively associated with adaptive responses, maladaptive responses, and intentions to vaccinate, threat appraisals positively associated with adaptive and maladaptive responses, and adaptive responses positively associated with intentions to vaccinate. The invariance evaluation revealed no differences across parents or COVID-19-like symptoms experiences in parental intentions to get their children vaccinated. The findings suggest that cogent information regarding childhood COVID-19 vaccination may boost parents' knowledge influencing their appraisals, adaptive responses and intentions to vaccinate their children. Specifically, coping appraisals and adaptive responses appeared to be important mediators between knowledge and intentions to vaccinate. Furthermore, intentions to vaccinate children may not be strongly influenced by parental roles or COVID-19-like symptoms experiences. These findings may help multiple stakeholders promote COVID-19 vaccination rates among children, and countries should further examine ways of increasing rates based on their specific needs.

The Effect of COVID-19 Vaccine Acceptance, Intention, and/or Hesitancy and Its Association with Our Health and/or Important Areas of Functioning.

The emergence of coronavirus 2019 (COVID-19) has had a significant negative impact on the world, with its effect noted in various areas, such as commerce [...].

Mediating Roles of Psychological Distress, Insomnia, and Body Image Concerns in the Association Between Exercise Addiction and Eating Disorders.

Purpose: Exercising can promote good health. However, excessive exercising may have downsides. This study examined the association between exercise addiction and eating disorders and whether the identified association was mediated by psychological distress, insomnia (including sleep quality), and body image concern. Methods: A total of 2088 adolescents (mean age of 15.3 years) participated in this cross-sectional study by questions assessing exercise addiction, eating disorders, psychological distress, insomnia, sleep quality, and body image concern. Results: There were significantly positive relationships between the variables (r=0.12-0.54, p<0.01) with effect sizes from small to large. The four potential mediators (ie, insomnia, sleep quality, psychological distress, and body image concern), individually and in total, significantly mediated the association between exercise addiction and eating disorders. Conclusion: The findings suggest that exercise addiction in adolescents may influence eating disorders through multiple pathways, such as insomnia, psychological distress, and body image concerns. Future research should examine these relationships longitudinally and use gathered information to inform intervention development. Clinicians and healthcare workers are encouraged to assess exercise addiction when treating individuals with eating disorders.

The neurobiological effects of mind-body exercise: a systematic review and meta-analysis of neuroimaging studies.

The neurobiological effects of mind-body exercise on brain activation, functional neural connections and structural changes in the brain remain elusive. This systematic review and coordinate-based meta-analysis investigated the changes in resting-state and task-based brain activation, as well as structural brain changes before and after mind-body exercise compared to waitlist or active controls based on published structural or functional magnetic resonance imaging randomized controlled trials or cross-sectional studies. Electronic database search and manual search in relevant publications yielded 34 empirical studies with low-to-moderate risk of bias (assessed by Cochrane risk-of-bias tool for randomized trials or Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies) that fulfilled the inclusion criteria, with 26 studies included in the narrative synthesis and 8 studies included in the meta-analysis. Coordinate-based meta-analysis showed that, while mind-body exercise enhanced the activation of the left anterior cingulate cortex within the default mode network (DMN), it induced more deactivation in the left supramarginal gyrus within the ventral attention network (uncorrected ps < 0.05). Meta-regression with duration of mind-body practice as a factor showed that, the activation of right inferior parietal gyrus within the DMN showed a positive association with increasing years of practice (voxel-corrected p < 0.005). Although mind-body exercise is shown to selectively modulate brain functional networks supporting attentional control and self-awareness, the overall certainty of evidence is limited by small number of studies. Further investigations are needed to understand the effects of both short-term and long-term mind-body exercise on structural changes in the brain.PROSPERO registration number: CRD42021248984.

Perceived Stress Mediating the Association Between Mindfulness and Resilience Among Registered Nurses.

Purpose: Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients' healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession. Materials and Methods: Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience). Results: Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p<0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress. Conclusion: Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.

Mechanisms in Emotional Information Processing in Individuals with Major Depressive Disorder: An Event-Related Potential Study of an Information Processing Model.

Background: Individuals with major depressive disorder have a cognitive bias toward emotional stimuli, which influences the quality and speed of emotional information processing. This study aimed to understand the factors underlying this bias by identifying when it occurs during information processing using an information processing model. Methods: A total of 57 participants-19 each [ (16 (84.21%) females and 3 (15.79%) males per group)], for the first-episode MDD (FMDD), recurrent episodes MDD (RMDD), and healthy controls (HCs) - matched for sex and hand preference, completed event-related potentials (ERP) to perform psychological function and a choice response time task. Results: Results revealed that recurrent episodes major depressive disorder participants had decreased N2b and P3b amplitudes but increased contingent negative variation during the processing of happy and neutral facial stimuli, relative to their counterparts. Both recurrent episodes major depressive disorder and first-episode major depressive disorder participants used a parallel information processing strategy for happy information at P3a latency, while healthy controls used a linear information processing strategy. Conclusion: The use of a parallel processing strategy among individuals with major depressive disorder may have led to impaired "happy" information processes, possibly explaining why individuals with major depressive disorder are less efficient than healthy controls. The results suggest the possibility that biases related to the processing of "happy" information among individuals with major depressive disorder may be related to a tendency for these individuals to engage in superficial decision-making. Future research is needed to examine the processes contributing to people with major depressive disorder having challenges with inhibition-facilitation of emotional stimuli.

Psychometric properties and development of the Chinese versions of Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A).

Currently, six instruments have been developed using the 11th revision of the International Classification of Diseases (ICD-11) criteria for Gaming Disorder (GD). Two of these are the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A). The present study validated both the GDT and GADIS-A among a large sample of Chinese emerging adults. Via an online survey, 3381 participants (56.6% females; mean age = 19.56 years) completed the Chinese versions of the GDT, GADIS-A, Internet Gaming Disorder-Short Form (IGDS9-SF), and Bergen Social Media Addiction Scale (BSMAS). Confirmatory factor analysis was used to examine the factor structure of the Chinese GDT and GADIS-A. Pearson correlations were computed to examine the convergent validity (with IGDS9-SF) and divergent validity (with BSMAS) of the Chinese GDT and Chinese GADIS-A. The GDT had a unidimensional structure, which was invariant across sex and disordered gaming severity subgroups. The GADIS-A had a two-factor structure, which was also invariant across gender and gaming severity subgroups. Both the GDT and GADIS-A had significant associations with both IGDS9-SF and with BSMAS. Both the Chinese GDT and GADIS-A are valid instruments to assess GD among emerging adults in mainland China, enabling healthcare providers to adopt these tools in their efforts to prevent and examine GD severity among Chinese youth.

Neuropathways of theory of mind in schizophrenia: A systematic review and meta-analysis.

BACKGROUND: Social cognition is significantly associated with daily functioning in patients with schizophrenia. Its neural basis remains unknown. METHODS: A systematic literature search was performed. Studies using imaging to measure theory of mind (ToM) in schizophrenia were identified. Imaging data were synthesized using the seed-based d mapping approach. Potential neuropathways were hypothesized based on the identified brain regions activated during ToM tasks. RESULTS: A total of 25 studies were included in the present study. Compared with healthy people, patients with schizophrenia showed hyperactivations in superior longitudinal fasciculus II and hypoactivations in superior frontal gyrus, precuneus and cuneus, and precentral gyrus during ToM tasks. The primary brain regions involved in the potential neuropathways in schizophrenia were the middle temporal gyrus, superior and inferior frontal gyrus, and supplementary motor areas. CONCLUSION: Deactivated brain regions in schizophrenia overlapped with the default mode and salience networks. Our findings shed light on how to develop a diagnostic tool for deficits in social cognition using neuroimaging techniques and effective therapeutic interventions to rectify dysfunction in schizophrenia.

Predictors of COVID-19 Stress and COVID-19 Vaccination Acceptance among Adolescents in Ghana.

Coronavirus disease 2019 (COVID-19) continues to ravage world economies, and with its recent mutations, countries worldwide are finding ways of ramping up their vaccination programmes. This cross-sectional design study, therefore, examined the predictors of COVID-19 stress and COVID-19 vaccination acceptance among adolescents in Ghana. A total of 817 participants were conveniently selected to respond to measures on fear of COVID-19, perceived stigma from COVID-19, self-stigma from COVID-19, believing COVID-19 information, COVID-19 infection prevention behaviours, COVID-19 stress, and COVID-19 vaccination acceptance. It was found that females believed COVID-19 information and accepted COVID-19 vaccination more than males did. Moreover, there were significant relationships between the majority of the COVID-19-related variables. Furthermore, fear of COVID-19, self-stigma from COVID-19, and COVID-19 infection prevention behaviours were found to be significant predictors of COVID-19 stress. Additionally, believing COVID-19 information, danger and contamination fears (a subscale of COVID-19 stress), and traumatic stress (a subscale of COVID-19 stress) were significant predictors of COVID-19 vaccination acceptance. These findings imply that different factors influence different COVID-19 variable. Therefore, careful considerations and research should be employed by health authorities and policymakers in preparing COVID-19 information to target different age groups and for different COVID-19 purposes.

The Fear of COVID-19 Scale: Development and Initial Validation.

Background: The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases. Methods: The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties. Results: After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (α = .82) and test-retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression, r = 0.425 and anxiety, r = 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459). Conclusion: The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.

The association between fear of COVID-19 and mental health: The mediating roles of burnout and job stress among emergency nursing staff.

AIM: This current study examined the mediation roles of burnout and job stress in the association between fear of COVID-19 and mental health among emergency nurses. DESIGN: Cross-sectional survey. METHODS: A total of 516 emergency nurses with a mean age of 41.18 (SD = 8.24), mostly females (76.16%) and married (78.9%) responded to measures on fear of COVID-19, burnout, job stress and mental health between 15 September and 7 November 2020. RESULTS: There was a significantly direct effect between (a) fear of COVID-19 and mental health, (b) fear of COVID-19 and mediators (burnout and job stress) and (c) mediators (burnout and job stress) and mental health. Also, there was a significantly indirect effect between fear of COVID-19 and mental health through job stress, burnout or both. CONCLUSIONS: Fear of COVID-19 directly and indirectly influenced the mental health of emergency nurses. Therefore, hospital authorities should provide sufficient resources to allay the fears of nurses during this COVID-19 pandemic period.

Associations between vaccination and quality of life among Taiwan general population: A comparison between COVID-19 vaccines and flu vaccines.

The COVID-19 pandemic has profoundly impacted lives worldwide and has led to global vaccination against COVID-19. However, there are concerns about the adverse effects of such vaccines on individuals' health. Therefore, it is important to investigate the association between vaccination and holistic health outcome (i.e., quality of life [QoL]). The present study analyzed data from the Taiwan Social Change Survey (TSCS), a survey conducted utilizing stratified random sampling. More specifically, data (N = 1425; 47.44% males; mean age = 50.58 y) on their vaccinations (including COVID-19 and flu vaccines) and QoL (using the Short-Form 12) were used. Participants were separated into two age subgroups for analyses (those aged below 50 y, and those 50 y or above). For participants aged below 50 y, those who received COVID-19 vaccine and those who received both COVID-19 and flu vaccines had significantly better physical QoL than those who did not receive any vaccination. Mental QoL was not significantly associated with vaccinations for participants aged below 50 y. Moreover, neither mental nor physical QoL was significantly associated with vaccinations for those aged 50 y or above. The present study showed that not having COVID-19 and flu vaccinations is associated with poor QoL. This finding should be disseminated to the public to help aid vaccination promotion.

Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands: An Actor-Partner Interdependence Modelling.

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives' actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Cyberchondria, Fear of COVID-19, and Risk Perception Mediate the Association between Problematic Social Media Use and Intention to Get a COVID-19 Vaccine.

Vaccination is the most effective way to control the COVID-19 pandemic, but vaccination hesitancy threatens this effort worldwide. Consequently, there is a need to understand what influences individuals' intention to get a COVID-19 vaccine. Restriction of information gathering on societal developments to social media may influence attitudes towards COVID-19 vaccination through exposure to disinformation and imbalanced arguments. The present study examined the association between problematic social media use and intention to get the COVID-19 vaccine, taking into account the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception. In a cross-sectional survey study, a total of 10,843 residents of Qazvin City, Iran completed measures on problematic social media use, fear of COVID-19, cyberchondria, COVID-19 risk perception, and intention to get a COVID-19 vaccine. The data were analyzed using structural equation modeling (SEM). The results showed that there was no direct association between problematic social media use and intention to get a COVID-19 vaccine. Nonetheless, cyberchondria, fear of COVID-19, and COVID-19 risk perception (each or serially) mediated associations between problematic social media use and intention to get a COVID-19 vaccine. These results add to the understanding of the role of problematic social media use in COVID-19 vaccine hesitancy, i.e., it is not the quantity of social media use per se that matters. This knowledge of the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception can be used by public health experts and policymakers when planning educational interventions and other initiatives in COVID-19 vaccination programs.

The mediational role of trust in the healthcare system in the association between generalized trust and willingness to get COVID-19 vaccination in Iran.

For some individuals, there appears to be some level of unwillingness in getting a COVID-19 vaccine which may be due to trust issues. The present study used a mediation model to investigate how trust is associated with an individual's willingness to get COVID-19 vaccination among Iranians. A total of 10,843 Iranian adults were recruited in Qazvin province using a multistage stratified cluster sampling method. The survey was completed between February 19 and April 9, 2021. The findings showed that generalized trust was positively associated with trust in the healthcare system, trust in the healthcare system was positively associated with willingness to get COVID-19 vaccination, and generalized trust was positively associated with willingness to get COVID-19 vaccination. Also, trust in the healthcare system mediated the association between generalized trust and willingness to get COVID-19 vaccination. There were some significant demographic differences in COVID-19 vaccination willingness. The findings suggest that generalized trust plays a significant role in directly or indirectly influencing individuals' willingness to get COVID-19 vaccine. Therefore, government bodies and health officials may utilize these findings to appeal in a more transparent and professional manner in encouraging individuals to get a COVID-19 vaccine. However, for those with lower trust levels (in general and in the healthcare system), the focus may be to re-build and/or regain the individuals' trust through carefully planned transparent communication, information dissemination, and ethical education to help increase the uptake of COVID-19 vaccination.