METHODS:
Study design and population: During November 2020-February
2021, we conducted an online survey at Sydney Children’s Hospital (SCH),
Randwick. SCH is one of Australia’s leading tertiary paediatric
healthcare entities and a major teaching hospital, providing all levels
of care to a diverse population of over 70,000 children. The SCH has
respiratory clinics for children with CLDs including high risk asthma,
CF, congenital diaphragmatic hernia (CDH), tracheo-oesophageal fistula
(TOF), non-CF bronchiectasis, primary ciliary dyskinesia (PCD) and other
respiratory conditions and cares for more than 600 children with CLDs,
including children referred from other metropolitan and rural hospitals.
We reviewed the electronic medical records to collate a list of all
children with CLDs who received care from SCH during 2015-2020.
Parents/carers of all children with CLDs identified from the medical
records were eligible to participate in the study.
An email with the URL link and QR code to the online survey was sent to
all eligible participants. In circumstances where medical records did
not have a valid email address, we sent out a letter with the survey
link to the residential addresses. Flyers of the study including the URL
address and QR code were also displayed in the respiratory and
outpatient departments of the hospital.
The survey questionnaire:The survey included 14
closed-ended questions based on three major domains: (1) demographic
data, (2) factors associated with vaccine acceptance (comprised of 13
items), and (3) factors associated with vaccine refusal (comprised of 16
items). For each question around predictors for vaccine acceptance and
refusal, responses were recorded on a five-point Likert scale (strongly
agree, agree, unsure, disagree and strongly disagree). The question “If
a vaccine against COVID-19 becomes available in the future, will you get
your child vaccinated?” was utilised to determine likelihood of
vaccination. Likelihood to vaccinate was defined as yes if a response
was very likely or likely and no if a response was somewhat unlikely and
unlikely. Respondents who were
likely to vaccinated then responded to questions associated with reasons
for accepting COVID-19 vaccine for their children (Table 1). Similarly,
respondents who were unlikely to vaccinated responded to questions
associated with reasons for refusing COVID-19 vaccine for their children
(Table 2). Respondents who responded unsure to whether they would get
their child vaccinated against COVID-19 responded to both questions
around reasons for accepting the vaccine and for refusing the vaccine.
Statistical analysis: We used descriptive statistics such as
frequency and proportions where appropriate. For purpose of analysis
responses such as agree/strongly agree disagree/strongly disagree were
grouped as agree or disagree, respectively. Area-level socioeconomic
status (SES) was assessed using the Australian Bureau of Statistics
Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socioeconomic
Advantage and Disadvantage (IRSAD), based on the child’s residential
postcode. SES was according to the postcode’s NSW percentiles(6).
Ethics approval and consent: The study was approved by the
ethics committee of the Sydney Children’s Hospitals Network
(2020/ETH02556). Information about the study including nature, purpose
and duration of the study were displayed on the front page of the online
survey and included in the emails and the letters. Participants
consented by checking the ‘YES’ button in the survey.