Page 216 - GHES-3-3

Global Health Economics and
Sustainability
COVID-19 vaccination decisions and mandate impact

Despite competing views, vaccination mandates for ensures that every individual in the target population has
HCWs have received widespread support, not only from an equal chance of being selected, making samples more
health establishments and officials but also in the peer- representative and findings more generalizable (Elfil
reviewed academic literature, especially regarding the & Negida, 2017), we chose non-probability sampling
perceived role of HCWs as the trusted sources of vaccine approaches (i.e., snowball sampling), which enables the
information (Achat et al., 2022; Dietrich et al., 2022; Evans participants to recruit other participants from their own
et al., 2022). Therefore, “vaccine hesitancy” has been, and networks (Luborsky & Rubinstein, 1995). In addition, we
continues to be, framed as a problem to be addressed also chose convenience sampling, where the individuals
through information and education, or mandatory of the target population meet certain practical criteria,
vaccination when necessary (Dietrich et al., 2022; Lee et al., such as ease of accessibility and willingness to participate
2022; Oberleitner et al., 2022). The success of the policy (Etikan et al., 2015). These sampling methods are
is operationalized as the capacity to achieve the highest widely used in health services research, where access to
possible rate of vaccine uptake (Okpani et al., 2024). probability samples is rare and where most researchers

However, in a prior literature review and critical policy rely on eligible subjects or participants who voluntarily
analysis, we identified limited exploration of HCWs’ consent to participate. A salient example is a national
experiences and perspectives on vaccination mandates, cross-sectional survey of 5,372 HCWs conducted by the
without pre-existing assumptions about the desirability Canadian polling company Ipsos for the Public Health
of vaccination (Chaufan et al., 2024). To address this Agency of Canada – the largest of its kind in the country,
gap, we conducted an exploratory cross-sectional survey to our knowledge. The participants were recruited through
in BC, Canada, to gather HCWs’ views on workplace a snowball approach and a “sample based on self-selection,
vaccination mandates and the impact of the policy on the not a probability sample” (Ipsos & Public Health Agency
capacity and quality of the healthcare system. Research of Canada [PHAC], 2023a, p. 7). While our survey was
questions included: (i) How were vaccination decisions narrower in scope and more limited in reach, we used a
made?; (ii) What were the reasons underlying COVID-19 similar approach to identify eligible participants.
vaccination decisions?; (iii) How does the decision to be Our instrument was the same questionnaire that had
vaccinated or remain unvaccinated affect social relations been previously used to survey 468 HCWs in the province
and opportunities for HCWs?; (iv) How does trust and/or of Ontario (Chaufan et al., 2025). We modified this survey
distrust impact vaccine uptake and views on vaccination by adding three additional questions upon discussing our
among HCWs?; and (v) How have vaccination mandates instrument with the HCWs in BC, including a retired
impacted patient care in healthcare settings? This study medical doctor and a currently employed laboratory
is part of a larger mixed-methods project evaluating technician. The practice of developing survey instruments
the impact of the COVID-19 policy response on HCWs in collaboration with interested parties is common in
and health systems. In addition to surveys conducted in the field, as illustrated by the survey of Canadian HCWs
selected Canadian provinces, the larger project includes
discourse analyses of expert literature, analyses of legal mentioned earlier, where researchers created their
documents, and in-depth interviews (Open Science instruments in collaboration with public health authorities
Frame Registration: https://osf.io/z5tkp). We present this (PHAC, 2023a). In contrast to that survey, ours was
article in accordance with the STROBE reporting checklist developed in collaboration with the target population
(available at https://www.strobe-statement.org/checklists/) itself, namely, HCWs in the province. We launched the
(Supplementary Material 1). survey in June 2024 and collected the responses until the
end of July 2024. Participants were recruited through social
2. Materials and Methods media platforms (e.g., X/Twitter) and were encouraged to
share the recruitment materials to other eligible peers and
We conducted an exploratory online survey of HCWs colleagues within their own networks, including on their
in BC, including those who are working in patient social media accounts. The study was further advertised
care, administrative, or maintenance services, either through the professional networks and contacts of the
currently or before the introduction of the vaccination research team. Upon the first invitation, reminders were
mandates. Participants were included regardless of gender, sent at 7-day intervals (McDonald et al., 2024).
ethnicity, racial identity, income level, employment
status, vaccination status, or any other sociodemographic The survey consisted of 91 questions, including
status. The only exclusion criteria were never having multiple-choice, short answer, and Likert scale (i.e., rank-
been employed in healthcare in BC or not having worked ordered responses). The questions were organized into
during COVID-19. Although probability sampling 15 sections including: demographics (eight questions);

Volume 3 Issue 3 (2025) 208 https://doi.org/10.36922/GHES025080014