Journal of Modern Medical

Introduction
The COVID-19 pandemic has affected many aspects of people and has become an international concern. Effective vaccination against COVID-19 seems to be a long-term solution to control the pandemic. It is estimated that 75-80% of the population needs to be vaccinated to achieve herd immunity against COVID-19. Therefore, the key to control the COVID-19 pandemic is the high acceptance of vaccination by the people. A number of behavioral factors, such as people’s level of knowledge of the COVID-19 and people’s attitude towards the vaccine, influence the willingness to get vaccinated. Considering the different levels of knowledge and attitudes towards the COVID-19 pandemic and its vaccines, their evaluation is necessary in order to design educational program, better implement the policies and, as a result, prevent the transmission and spread of the disease. By being aware of people’s attitude, we can predict their health behaviors and have control over them. In order to implement the vaccination program as best as possible and achieve herd immunity and contain the corona virus epidemic as quickly as possible. To implement the vaccination program as best as possible, achieve herd immunity and control the pandemic, this study aims to investigate Iranian people’s level of knowledge and attitude towards the COVID-19 vaccines and its related factors.
Methods
This is a descriptive survey study. The study population consists of all Iranian people in online social media. The sample size was calculated 384 using Cochran’s formula and sampling was conducted using a convenience sampling method in 2020. The data collection tool was a researcher-made questionnaire that was designed in three parts. In the first part, the social and economic information of participants were surveyed. In the second part, the level of knowledge of the COVID-19 pandemic and its vaccines was surveyed based on a Likert scale (Poor, moderate, good, and very good). In the third part, the attitudes towards the safety and effectiveness of vaccination were surveyed using five items rated on a Likert scale (Negative, relatively negative, positive and relatively positive).
Of 384 questionnaires, 14 were excluded due to being incomplete and 370 questionnaires were examined. After checking the normality of data distribution using the Kolmogorov-Smirnov test, due to the abnormal distribution, Spearman’s correlation test was used for assessing the relationship between knowledge and attitude, and Kruskal-Wallis and Mann-Whitney tests were used to compare the means of knowledge and attitude towards the COVID-19 vaccine based on sociodemographic factors in SPSS v. 22 software.
Results
The mean age of participants was 35.9±10.27 years and their mean years of education was 14.3±2.3 years. It was reported that 257 people (69.5%) had relatively positive and positive attitude towards the Covid-19 vaccines. The mean knowledge of Covid-19 was 4.18±0.933 and the mean attitude towards the Covid-19 vaccines was 3.43±1.19. 123 people (33.1%) were not sure about the safety and effectiveness of the vaccines, and 100 (26.9%) were worried about the side effects of the vaccines. A positive and strong correlation was observed between knowledge of the COVID-19 and attitude towards the vaccines.
There was a significant difference between attitudes based on age (P=0.000), gender (P=0.004), income level (P=0.000), marital status (P=0.004), history of infection to covid-19 (P=0.000), and death of a relative due to covid-19 (P=0.000). There was also a significant difference between knowledge based on age (P=0.000), gender (P=0.001), income level (P=0.000), marital status (P=0.000), history of infection to COVID-19 (P=0.000), and death of a relative due to COVID-19 (P= 0.000).
Dissection
The success of the vaccination program against the Covid-19 depends on acquired immunity in a sufficient proportion of the population. A better awareness of this disease along with a positive attitude towards its vaccines can help curb this pandemic. The study showed that lack of confidence in the effectiveness of the vaccines and their side effects is one of the most important challenges in achieving herd immunity in Iran. People’s knowledge of COVID-19 was high and their attitude towards the COVID-19 vaccines was positive. There was a strong positive and significant relationship between people’s knowledge of COVID-19 and attitude towards the COVID-19 vaccines such that with the increase of knowledge, their attitude towards the vaccines can more positive. Moreover, there was a significant difference between the knowledge and attitude based on age, gender, marital status, income level, history of infection to Covid-19, and the death of a relative due to COVID-19 such that older people, men, people with higher income, married people, those who had already been infected to the COVID-19, and those who had lost a loved one due to this disease had higher knowledge and more positive attitude. Therefore, considering that the level of knowledge and attitude in Iranian people was high and positive, but they were worried about the safety of the vaccines and their side effects, extensive health related activities for increasing the confidence of people in the effectiveness of vaccines can be effective during the implementation of the vaccination program in Iran.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval at No. IR.QOM.REC.1400.014 from University of Qom.

Funding
This article is not sponsored by any institution or institution and all its financial resources were provided by the authors. This article is not a thesis.

Authors' contributions
Submitting topic, Editing paper, Data collection, Posting and tracking article; Sanaz Rahimi Kahkashi; Early Draft Writing , Editing and Modifying the Final Article: Omid Ali Adli.

Conflicts of interest
The authors say there is no conflict of interest in this article.
 

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