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.