An Unmet Global Agenda: COVID-19 vaccine hesitancy among farmers in Northern Ghana

An Unmet Global Agenda: COVID-19 vaccine hesitancy among farmers in Northern Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An Unmet Global Agenda: COVID-19 vaccine hesitancy among farmers in Northern Ghana Prosper Mandela Amaltinga Awuni, Nancy Lightfoot, Emily Donato, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5258487/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2025 Read the published version in Discover Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Ghana became the first nation in Sub-Saharan Africa to receive the coronavirus vaccine, however, as of December 2023, only 44.3% of Ghanaians had received at least two doses of COVID-19 vaccines, with vaccine hesitancy reported at 52.2%. This research aimed to examine reasons for COVID-19 vaccine hesitancy among farmers in Northern Ghana. Methods: The study adopted a concurrent embedded mixed methods design which simultaneously collects qualitative and quantitative data. The sampling of participants was purposive, targeting five Farmer Based Organizations (FBOs). 24 participants were interviewed for 30-45 minutes. The transcripts were imported into NVIVO version 14 for analysis using Braun & Clarke's Reflexive Thematic analysis. Results: The farmers' interviews revealed six themes related to vaccine hesitancy: availability and access, misconception about the COVID-19 virus, preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences, and belief in the non-existence of COVID-19 in Northern Ghana. For the quantitative findings, farmers’ current perspectives towards the COVID-19 vaccine varied. About 37.5% would postpone receiving, and 16.7% decline COVID-19 vaccination. About, 12.5% expressed some degree of positivity towards the vaccines. Meanwhile, 58.3% of farmers stated that COVID-19 was currently unimportant. The COVID-19 vaccine uptake in northern Ghana among farmers has stalled due to a lack of information and belief that the virus no longer exists. Conclusion: To address this, it is crucial to make single-dose vaccines more available, conduct ongoing public health campaigns, and prioritize farmers as a vulnerable population during health emergencies. COVID-19 vaccines hesitancy Ghana farmers northern Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In Sub-Saharan Africa (SSA), vaccine hesitancy for COVID-19 vaccination is a significant problem. For instance, COVID-19 vaccine hesitancy prevalence in some SSA countries includes Ethiopia (29%), Burkina Faso (33%), Nigeria (34%), Ghana (42%), and Tanzania (65%) [ 1 ]. Several identified factors influencing COVID-19 vaccine hesitancy include misconceptions regarding COVID-19 vaccines, an absence of reliable sources of information about COVID-19, and the perception that vaccines are neither safe nor effective [ 1 ]. Vaccine hesitancy refers to a state of indecision regarding vaccination, which encompasses both intentions and willingness, independent of actual behavior [ 2 ]. The newly established definition by the World Health Organization characterizes hesitancy as a component of the motivational domain within the behavioral and social determinants of vaccination. On February 24, 2021, Ghana became the first nation in sub-Saharan Africa (SSA) to receive the coronavirus vaccine through the COVID-19 Vaccines Global Access (COVAX) initiative [ 3 ]. However, as of December 10, 2023, only 44.3% of Ghanaians had received at least two doses of COVID-19 vaccines [ 3 ]. In 2022, a nationwide survey noted an increasing trend in vaccine hesitancy, which rose to 52.2%. [ 4 ]. Concerns regarding efficacy and safety were the primary reasons for this hesitancy. Although the COVID-19 vaccine is available free of charge nationwide, a national survey indicated that 45.7% of Ghanaians remain unwilling to get vaccinated [ 5 ]. Numerous studies have examined COVID-19 vaccine hesitancy among urban and literate Ghanaians [ 6 – 11 ]. However, a cross-sectional study of rural participants found that 30.6% [ 4 ], 30.6% [ 12 ] and 36.8% [ 13 ] declined the COVID-19 vaccine in southern Ghana. Yet, none of these studies have specifically targeted farmers in rural and remote areas of northern Ghana, despite their significant representation in the population. Farming is crucial to the economy of northern Ghana, accounting for 73% of employment and contributing 80% to its gross domestic product [ 14 ]. However, studies on vaccine hesitancy, specifically among northern Ghanaian farmers, are limited. Given the economy's reliance on agriculture, vaccine hesitance among farmers could result in reduced productivity due to illness among those who remain unvaccinated against COVID-19. Thus, this study aimed to investigate the reasons behind vaccine hesitancy among northern Ghanaian farmers regarding the uptake of the COVID-19 vaccine. Limited information exists on vaccine hesitancy regarding COVID-19 among rural and northern populations in Ghana [ 15 ]. Most surveys have concentrated on southern Ghana, where urban areas dominate [ 16 ]. Additionally, the few national studies on vaccine hesitance were primarily conducted online, which may have excluded rural residents. Studies by [ 17 ] indicates that factors influencing vaccine hesitancy can differ significantly within a country due to geographic and economic conditions. For instance, a cross-sectional study found that vaccine acceptance among Ghanaians is location-dependent, with 58% of rural participants surveyed across multiple regions expressing opposition to the COVID-19 vaccination [ 15 ]. Furthermore, only 26.2% of the uptake of COVID-19 vaccines was observed in the northern region of Ghana [ 15 ]. The low uptake of the vaccine in these areas was attributed to factors such as poor perception (55.4%), negative attitude (59.4%), and lack of knowledge (55%) [ 15 ]. A similar survey involving participants from rural and urban areas indicated that 54% were vaccine hesitant [ 18 ]. In comparison, 63% and 50% of participants in rural and urban areas expressed skepticism towards the COVID-19 vaccine [ 18 ]. These findings are consistent with a recent survey on Ghanaian public employees, which revealed that residing in an urban environment positively influenced the acceptance of the COVID-19 vaccination [ 19 ]. These findings highlight the need for targeted interventions to address knowledge gaps, concerns, and vaccine hesitancy among farmers in both rural and urban areas of northern Ghana. The study aimed to explore the reasons for COVID-19 vaccine hesitancy in this population, addressing the questions: What factors influence COVID-19 vaccine hesitancy among farmers in northern Ghana, and what are their reasons for vaccine hesitancy? Answering these questions could help policy makers implement targeted vaccine programmes in rural and urban areas of northern Ghana. Methods Study Design: The chosen research strategy for this project was a concurrent embedded study design. As explained by Creswell & Creswell (2018), this design employs a mixed method of research techniques to understand a research problem comprehensively. It is particularly suitable when researchers aim to thoroughly comprehend a problem or investigate the interactions between variables of interest [24]. For this study, both qualitative and quantitative data were collected, analyzed, and utilized. Within the concurrent embedded mixed methods design, qualitative or quantitative data play a supportive or supplementary role [24]. Therefore, the quantitative data were embedded within the more extensive qualitative data to gain insights into the factors contributing to COVID-19 vaccine hesitancy in the study area. The concurrent embedded design was implemented in two phases: Phase One: During the initial stage of the concurrent embedded design, Quantitative and qualitative data were collected. The first part of the interview focused on gathering participants’ demographic information, followed by an in-depth interview. The second section consisted of closed-ended questions about COVID-19 vaccine hesitancy using the Oxford COVID-19 Vaccine Hesitancy Scale (OCVHS) [25]. Phase Two: In the second phase, qualitative data were collected data on the reasons for COVID-19 vaccine hesitancy among farmers in northern Ghana) Reflexive thematic analysis which involves the identification and analysis of themes [26] was conducted on the data imported into NVIVO version 14 to identify any pattern in the data set. Codes and themes were developed inductively (data-driven) to create meaning and data interpretation [27]. The qualitative data helped shed light on farmers' acceptance or rejection of COVID-19 vaccination. The findings from the analysis led to recommendations on COVID-19 vaccination acceptance and uptake. Study Setting: Northern Ghana comprises the Upper East, Upper West, Savannah, Northern, and North East Regions [28]. [16]. Roughly 97.9% of households in Northern Ghana are engaged in small-scale seasonal, rain-fed agricultural farming [18], with crop cultivation, livestock husbandry, and fish farming as the primary activities. Approximately 70% of Northern Ghana is classified as rural [28]. Recruitment Recruitment of study participants involved purposive sampling, specifically targeting five Farmer-Based Organizations (FBOs) in Northern Ghana. Information regarding farmers for the interviews and surveys was obtained from FBO executives. The researcher sampled 24 farmers (12 rural and 12 urban) from different FBOs to identify disparities and similarities in COVID-19 vaccine hesitancy between rural and urban areas in Northern Ghana. Data Collection Qualitative: Data collection involved in-depth interviews to allow participants to construct their own experiences. Semi-structured questions were formulated to explore participants’ perceptions of the COVID-19 vaccine. The interviews were conducted both in person and over the phone. Quantitative: The interview questionnaire consisted of three sections. The first section gathered demographic information. The second section comprised closed-ended questions on COVID-19 vaccine hesitancy, employing the OCVHS. This was followed by open-ended questions focused on COVID-19 vaccines, guided by the OCVHS [25]. Each interview had a duration of approximately 30-45 minutes. The OCVHS was selected by the researchers due to its connection with the Vaccine Hesitancy Scale [29], which has undergone assessment and validation by the WHO-SAGE working group, thus showcasing its robust psychometric properties. Furthermore, the OCVHS is an instrument that captures responses per-item basis, enabling direct input from participants [29]. This characteristic made it well-suited for customization and utilization among rural farmers in Northern Ghana. Data Quality: The interviews with participants were conducted between November and December 2023. In November 2022, three research assistants (RAs) from the University for Development Studies in Tamale were recruited to conduct face-to-face interviews with participants. The principal investigator ensured the accuracy of the recorded information by conducting member checking with participants, thereby enhancing the rigor of data quality. To ensure consistency and minimize errors, researchers obtained consent from participants to digitally audio-record the interviews. The principal researcher led the data coding and theme development process. JM conducted a comparative check of coding and themes. Additionally, the principal researcher and a supervisor engaged in member journaling. The principal researcher translated audio transcripts from local languages to English, leveraging his fluency in Hausa, Gurune, and Pidgin English. The principal researcher was born and lived almost 28 years in northern Ghana, and has a good command of the languages of northern Ghana. Data Analysis: The researcher transcribed all the interviews verbatim. Transcripts in local languages and Pidgin English were translated into English. The study employed reflexive thematic analysis (TA) of the data [30]. The transcripts were carefully reviewed, and the data was categorized into codes and subcodes and then grouped thematically. NVivo 14 was utilized for coding to identify common themes. The researcher worked closely with NL and JM in analyzing the collected data for themes. The phases of the reflexive thematic analysis included: (1) familiarizing oneself with the data by reading through the transcripts and listening to the audio recordings to identify any misinterpretations or missing text coding; importing all transcribed interviews into the thematic analysis software for data analysis, (2) generating initial themes through the consolidation of codes and categories, (3) reviewing themes for overlap and redundancy in categories, and (4) defining and naming themes by the principal researcher and the team, followed by the write-up of the study [30]. Moreover, the researchers employed an inductive thematic analysis approach, where the social construction theoretical framework guided their anticipation of the emerging themes [30]. Finally, the analysis and interpretation of the OCVHS were coded on a scale of 1 to 5 [29]. A score of 1 indicates low vaccine hesitancy, while a score of 5 indicates higher vaccine hesitancy. However, the “Don't Know" option was excluded from scoring without affecting the validity of the results. The themes were categorized based on issues related to barriers and facilitators of COVID-19 vaccine uptake, guided by the codes generated from the thematic analysis. Results Farmers' Characteristics The study included 24 participants. Eight were aged 30-39 and seven 20-29 respectively. An additional six participants fell in the age range of 40-49, while three participants were aged 50-59. In terms of education, the 7 participants had no education, 7 tertiary education, 6 senior school and 2 primary school. The participants were evenly distributed between 12 rural and 12 urban areas. The largest number of participants came from the Upper East Region 10, 7 from the northern region, 4 from the northeastern region, and 3 from the Upper West region. The sample included 16 males and eight females. Table 1 presents a summary of participant characteristics. Table 1. Farmers Characteristics Baseline characteristics Frequency Percentage 1 Age 20-29 7 29.2% 30-39 8 33.3% 40-49 6 25.0% 50-59 3 12.5% 2 Sex Female 8 33.3% Male 16 66.7% 3 Education No Education 7 29.2% Primary School 2 8.3% Junior High 2 8.3% Senior High 6 25.0% Tertiary 7 29.2% 4 Marital Status Single 9 37.5% Married 15 62.5% 5 Community Rural 12 50.0% Urban 12 50.0% 6 Region North East 4 16.7% Upper East 10 41.7% Northern 7 29.2% Upper West 3 12.5% Farmer Results- Themes The farmers' interviews revealed six themes for COVID-19 vaccine hesitancy among farmers in northern Ghana: availability and access to vaccines, misconception about COVID-19 virus, preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences and belief in non-existence of COVID-19 in Northern Ghana. Availability and access to COVID-19 vaccines A recurring theme in the study highlighted farmers' include limited availability and access to the COVID-19 vaccine in their communities. One farmer (interview 9) described the challenges of accessing the vaccine due to their busy work schedule and the time-consuming nature of the process. "It is not easily accessible. When you go, you have to join a long queue, and they will give you a designated time. But as a farmer, you have work to do and other obligations." Another participant (interview 1) echoed similar sentiments, saying, "In some places, you can spend two to three days waiting in line without even reaching the middle." Participants also shared their perceptions of vaccine access in rural and urban areas. A farmer (interview 10) observed, "Town people seem to have better access than those living in the village. It's challenging for us to get access because the lines are always crowded, making it difficult for us to monitor and receive help………..." Some farmers (interview 3) mentioned that initially, they went to get the vaccines, but because of scarcity, they went home and never got vaccinated. " …………. we formed a queue to take the injection and then we are not lucky and then that the thing finish at our side. So, starting from there I didn’t get the chance and go back again.” Misinformation about COVID-19 virus Participants shared their opinions about the COVID-19 virus and how it informed their decision to vaccinate or not. Some farmers believed that they know this disease and they are sceptical that it is a new one. One farmer (interview 16) stated, "You see the covid-19, it has ever occurred here in the North, it was called "Gbankogu. And they later came with its vaccine, and be vaccinating people, till those diseases perished. So those diseases do not exist again." Another farmer (interview 23) explained, " ….. the name COVID, is English, in Dagbani we have experience those kinds of diseases. Those diseases already existed… We call it "Diligu" or "Fiegfieg” (catarrh), either treat it by going to the hospital, or using medicinal herbs” This sentiment was echoed by another farmer (interview 11) who said, " For we the Dagombas here, we know the Covid-19 to be "kohanpieligu" so I would have taken some local herbs before going any other way” Another further explained that one farmer (interview 13) noted, "the way we saw the COVID-19, was that, when you are affected by it, we would have look for local herbs that treats " Yougu and kohanpieligu" that was the two kind of treatment we were prepared for in terms of the treatment, if any of my family members or I was down by the virus. we do know about the causes of that disease, the source of that disease” This point was further emphasized by another farmer (interview 15) who stated, " We are Dagombas, so when we hear there is something new coming to this land like diseases, we will look for Kpante, yougu and kohanpieligu herbs and be taking you get it ." Preference for universal vaccine brand Participants expressed a general preference for a specific vaccine over others. During the interviews, farmers highlighted their preference for a particular vaccine brand COVID-19 vaccine due to its single-dose requirement. One participant (interview 1) expressed, " I prefer the one you take it once over the one you will go for the two dosages." Another participant (interview 12) shared, "I favor the single-dose vaccine over those that require two doses because I feel that taking too much medication can burden your system." Others mentioned the convenience of the single dose vaccine since it eliminates the need for a second dose. One farmer (interview 19) mentioned, "For me…… I would have preferred the vaccine that is administered once…… People who don't feel well after the first dose might not return for the second dose. So, I would prefer a vaccine that is taken all at once." Another farmer (interview 2) echoed these sentiments, stating, " Now I learnt we have the one that you take just once and the other you take it then three months you go and take again but now I have heard there is a full dosage to take and that one is better.” Additionally, one FBO Chairman (interview 6) reflected the sentiments of all farmers when he stated, " …………. we prefer the one dose than the one you take and then repeat” Belief in non-existence of COVID-19 in Northern Ghana. During the interview, many participants believed that COVID-19 no longer posed a significant threat. This perception influenced their attitudes towards vaccination. One farmer (interview 23) remarked, "……The disease isn't even present in Ghana. I fail to understand why COVID vaccines are still being administered." Another individual (interview 21) echoed these sentiments, stating, "No, I have no intention of taking it because I haven't heard anything about it lately, and my friends feel the same, even if it were to become available." Some farmers in Northern Ghana have expressed skepticism about the existence of COVID-19. One farmer (interview 17) stated, " …. we saw covid-19 to be fake. We did not believe in it. We believe it was at the Whiteman’s land ." Another farmer also mentioned the lack of access to information about the virus in rural areas. An FBO leader (interview 10) added, " Looking at this COVID-19 as at now is recently is silent. We are not even getting more information like that, especially from the villages because of the rural area that I'm even talking about is one if I'm in my village we don't even talking about it, no information. So I don't know how can the Health Sector do so that this information will keep on going on in our communities for us to get much about it” Fear of death and negative experiences This theme identified when farmers were asked about the perspectives of their families and friends on the COVID-19 vaccine and the reasons why they took or did not take the vaccine. Some families feared that the vaccines could be fatal. One farmer disclosed (interview 12) said, “You know, my family did not support me even for the injection. According to them, people who had the vaccines all died”. Another participant (interview 13) echoed this sentiment, saying: “We have been seeing health workers carrying the vaccines around, if you want, then you go for the vaccination. They came to my house several times, but I did not go for the vaccination. The reason is that we heard the vaccine kills people and introduces new sicknesses into one’s body when you take it”. These concerns stemmed from negative experiences within the community. One participant (interview 11) shared, “Even one man in this community was vaccinated and got affected deeply, and was sent to the hospital, he was called Mohammed, and another person, MBA Imoro, also got affected badly after he was vaccinated.” Safety was another factor contributing to vaccine hesitancy. One farmer (interview 14) recounted how some community members experienced saying, “I have witnessed some people who suffered after taking the COVID-19 vaccines. Some people who took the COVID-19 vaccines were sent to the hospital for hydration, for about ten packs of water. Let me tell you something, though one will not pay for the vaccine, but later after taking the vaccine, one will go to the hospital and pay for treatment for the side effects of the vaccines”. Perceived Side Effects Some farmers expressed fear of taking the vaccine due to fear of side effects after hearing that some people had side effects from taking the vaccine. One farmer (interview 9) highlighted a fear of side effects: “ They said you feel body pains, weakness, inability to raise their hands, lying down due to the pains. So if you also hear that you become afraid and you will think if I also take I will feel these side effects” Another participant (interview 24) expressed: “ ……because of the side effects we heard from other people, we did not go for the vaccination” Some farmers (interview 17) did not take the vaccine because of the information received from health professionals about the side effects of the vaccine. “We heard on news that some of the vaccines are not correct, some doctors disapproved the vaccines.they said the reactions are not good. So that discouraged us from going for the vaccine.” Another participant (interview 23) said: “I monitored some videos on television seeing some people after taking the vaccine… I leaned the vaccine had some negative impact on the human body. that was why I did not go for the vaccination. Some people also said when you take the vaccine, you would get sick for some days”. OCVHS Results The findings from the OCVHS, a seven-item instrument depicted in Figure 1, revealed that 33.3% of farmers displayed a propensity to receive the vaccine. In comparison, 29.2% remained uncertain about their willingness to accept a COVID-19 vaccine if offered presently. Notably, 20.8% of farmers exhibited significant hesitancy towards the COVID-19 vaccine, scoring a five on the scale. Additional statistical details can be found in the accompanying figure 1 below. Figure 2 presents farmers' perspectives on vaccine acceptance. When asked if they would take the vaccine if it were available now, 37.5% said they would postpone receiving it, 33.3% expressed their willingness to accept when offered, and 16.7% indicated declining vaccination. Figure 3 illustrates farmers' current attitudes towards receiving a COVID-19 vaccine. Among respondents, 54.2% reported feeling neutral, 20.8% expressed moderate unease, and 12.5% expressed some degree of positivity towards the vaccines. Moreover, when queried about obtaining the vaccine from a local pharmacy, 33.3% stated they would delay getting it for as long as possible, 33.3% would defer it, and 20.8% would receive it when convenient. Participants were asked if they would recommend the vaccine to a friend or family member considering vaccination. Half of the participants (50%) indicated that they would not provide any feedback about the vaccine, 20.8% would encourage vaccination, and 20.8% would advise postponing it. Based on farmers' responses, 50% expressed reluctance to receive the COVID-19 vaccine, while 33.3% expressed indifference. Similarly, in figure 4 when asked about the importance of receiving the COVID-19 vaccine now, 58.3% of farmers stated that it was unimportant, 20.8% considered it neither important nor unimportant, and 8.3% considered it to be highly unimportant. Discussion Our qualitative findings indicate farmers' reasons for hesitancy such as vaccine availability and access, misinformation about COVID-19, a preference for a universal brand, perceived side effects, fear of death and negative experiences, lack of information about COVID-19, and belief in non-existence of COVID-19 in northern Ghana. Despite having a general understanding of the COVID-19 vaccine's availability in Ghana, farmers generally hold an unfavorable perception of the vaccines, expressing reluctance to receive them. If the vaccine were to become available, most farmers would actively avoid getting vaccinated and would not encourage their family members to do so. These findings align with similar studies [31] conducted in Ghana, particularly in specific regions of northern Ghana, which indicate that individuals in rural areas, northern regions, and those with lower education levels are more hesitant to receive the vaccine. A survey indicated individuals with lower education levels, including many farmers, exhibit lower acceptance of the vaccines [9]. Another recent survey [15] supports this claim, linking lower education, socioeconomic background, and residing in rural areas with higher levels of vaccine hesitancy. However, the latter study did not specify the number of participants from rural versus urban areas. A cross-sectional in rural Ghana reported a vaccine hesitancy rate of 30.6% for the COVID-19 vaccine [14]. Reasons for this hesitancy included insufficient vaccine information, concerns about side effects, and a belief that the vaccine is unnecessary. Conversely, a qualitative descriptive study of women in Kumasi and Accra identified positive factors for vaccine acceptance and uptake, with long queues and vaccine shortages acting as barriers that discouraged participants from receiving the vaccines [32]. Another investigation on the impact of media attention on COVID-19 vaccine hesitancy found that media played a significant role in influencing vaccine hesitancy in rural communities in southern Ghana [33]. The study, which included 22.9% of farmers, revealed that vaccine-hesitant individuals were more likely to be influenced by fear-inducing media messages, ultimately leading to vaccine refusal. [34] identified a fear of contracting COVID-19 and a desire to stay healthy as positive factors in encouraging acceptance of COVID-19 vaccines. The study emphasized the importance of addressing COVID-19 stressors in vaccination messages delivered by health policymakers. Further, a survey highlighted the influence of personality traits on individuals' anti-vaccine attitudes, suggesting that public health strategies should consider the psychological drivers of vaccine hesitancy to meet individual needs [35]. It is important to note that our findings differ from earlier studies. [9] studied all 16 regions to determine vaccine hesitancy and reported that the Northern and Upper West Regions had the highest willingness to receive COVID-19 vaccines. Our study findings regarding preference revealed that most participants preferred the single dose vaccine vaccine over other COVID-19 vaccines. [36] suggests that adverse effects such as headache, pain at the injection site, fatigue, malaise, fever, and chills were reasons people would not take AstraZeneca, rather than the number of doses. However, it is important to acknowledge that this study has a small sample size and cannot be generalized to the entire Ghanaian population. As highlighted by [33], 22.9% of rural dwellers were susceptible to media messages instilling fear of COVID-19 leading to vaccine refusal. Similar to our study, farmers were vaccine-hesitant due to misinformation about the COVID-19 Vaccine. Further, a recent survey found that 48.35% and 44% of journalists in Ghana rely on Facebook and WhatsApp as sources of information, respectively, exposing lax verification practices among journalists [37]. Consequently, the use of social media and the lack of stringent verification practices by Ghanaian journalists can contribute to spreading misinformation among rural individuals who rely solely on radio or television news. Based on our results and those of others, it is evident that fear of side effects among rural and urban populations in northern Ghana is common. While vaccine intentions are high at 63% [38], vaccine acceptance and uptake are only at 11% [38]. However, intentions do not necessarily translate into vaccine acceptance or uptake. Afreh et al., (2023) showed people’s fear about side effects (25.3%), while other fears were based on previous experiences of vaccine adverse effects [39] and reports of COVID-19 side effects in some countries [40]. Nonetheless, health policymakers must address COVID-19 stressors in vaccination messages [34]. Similarly, public health strategies should consider the psychological drivers of vaccine hesitancy, especially for rural dwellers and farmers [35]. The quantitative findings of our study showed about 37.5% would postpone receiving, and 16.7% declined COVID-19 vaccination. Meanwhile, 58.3% of farmers stated that the COVID-19 vaccine was unimportant now. These findings are consistent with a study which indicates that 38.6% of people globally who reported showing less concerns about COVID-19 vaccines [41]. These are signs possible signs of pandemic fatigue which is a combination of factors resulting in a reduction in adherence to protective behaviours[42]. This study aimed to examine the reasons for COVID-19 vaccine hesitancy among farmers in northern Ghana, contributing to the existing knowledge on vaccine hesitancy, which poses a significant threat to global health. Although COVID-19 is no longer classified as a pandemic or public health emergency, the insights gained from this study could be vital in promoting vaccination among rural and northern populations against the evolving SARS-CoV-2. Several recommendations can be derived from our findings. Firstly, vaccination is the most effective method for preventing the transmission of infectious diseases. Therefore, District Health Management Teams (DHMTs) must engage with communities to make single-dose vaccines more available to enhance vaccine uptake. Secondly, it is essential to continue promoting COVID-19 campaigns, even with the availability of vaccines and widespread knowledge of the disease. This is particularly important to counter vaccine apathy and fatigue, which may discourage individuals from receiving vaccinations. Health promotion campaigns and messaging should be tailored to address the specific needs of different communities, particularly those in rural and less educated populations. Lastly, farming populations should be prioritized in future health emergency interventions, given their critical role in providing food security for the entire northern region of Ghana. This ensures that food security is maintained during public emergencies. Despite the contributions of this study, there are some limitations to consider. While participants were purposively selected from the five regions of northern Ghana, not all farmer-based organizations (FBOs) were equally represented. Additionally, our study focused exclusively on farmers, and their experiences may not necessarily reflect the experiences of the broader population in northern Ghana. Most interviews were conducted over the phone, which may have influenced participants' willingness to fully express themselves. Furthermore, in-person interviews offer the interviewer the advantage of observing facial expressions, which can provide valuable insights for further exploration of the study areas. Conclusion The acceptance and uptake of the COVID-19 vaccine in northern Ghana, among farmers in both rural and urban areas, has encountered significant stagnation. In general, farmers are aware of the availability of COVID-19 vaccines. However, several factors have contributed to vaccine hesitancy, such as a preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences, and belief in the non-existence of COVID-19 in northern Ghana. To address this issue, engaging the community to make single dose vaccines more available, carrying out ongoing public health campaigns, and prioritising farmers as a vulnerable population during health emergencies is crucial. Declarations Data availability Statement All data for the study is available on request, for confidentiality purposes, the data is not publicly available. Acknowledgements We express our gratitude to the Faith-Based Organizations (FBOs) in northern Ghana who participated in the interviews. We also acknowledge the efforts of the research assistants involved in data collection. Funding This study did not receive any external funding. Contributions PMAA and NL were involved in the conceptualization of the study. PMAA, NL, MM, ED, EM, CBZ and JFM were involved in the data collection, and formal analysis. All authors were involved in writing the original draft and reviewing and editing the manuscript. All authors have read and agreed to the published version of the manuscript. Ethics Declarations Ethical approval was obtained from the Laurentian University Ethics Review Board and the Navrongo Health Research Centre Institutional Review Board (NHRCIRB554) in Ghana. Consent forms containing all necessary information were provided to participants, and verbal agreements were recorded for those unable to read and write. Consent for Publication Not applicable. Competing Interests The authors declare no competing interest. References Abubakari SW, Workneh F, Asante KP, Hemler EC, Madzorera I, Wang D, et al. Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan Africa. PLOS Global Public Health. 2023;3(7):e0000713. MacDonald & the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4. Africa CDC. Coronavirus Disease 2019 (COVID-19) Latest updates on the COVID-19 crisis from Africa CDC. Retrieved from https://africacdcorg/covid-19/. 2023;2023-12-20. Brackstone K, Atengble K, Head MG, Boateng LA. COVID-19 Vaccine Hesitancy in Ghana: The Roles of Political Allegiance, Misinformation Beliefs, and Sociodemographic Factors. 2022. Udor R, Eshun SN, Tampah-Naah AM. Factors Influencing Intentions and Acceptance of COVID-19 Vaccines in Ghana. Ghana Journal of Development Studies. 2023;20(1):252-66. Acheampong T, Akorsikumah EA, Osae-Kwapong J, Khalid M, Appiah A, Amuasi JH. Examining Vaccine Hesitancy in Sub-Saharan Africa: A Survey of the Knowledge and Attitudes among Adults to Receive COVID-19 Vaccines in Ghana. Vaccines. 2021;9(8):814. Amo-Adjei J, Nurzhynska A, Essuman R, Lohiniva A-L. Trust and willingness towards COVID-19 vaccine uptake: a mixed-method study in Ghana, 2021. 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Assessing the Prevalence and Predictors of COVID-19 Vaccine Hesitancy among Healthcare Workers in Infectious Disease Centers in Ghana. 2023. Brackstone KAE, Boateng LA, Head MG, Manyeh A, Vidzro GAA, Angwaawie P. . Examining predictors of vaccine uptake and hesitancy in three rural sub-municipalities in Nkwanta South, Oti region, Ghana. 2022. Afreh O, Angwaawie P, Attivor E, Boateng L, Brackstone K, Head M, et al. Examining confidence and hesitancy towards COVID-19 vaccines: A cross-sectional survey using in-person data collection in rural Ghana. Vaccine. 2023;41(13):2113-9. Sampene AK, Li C, Oteng Agyeman F, Brenya R. Socioeconomic and demographic characteristics influencing the hesitancy and refusal of COVID-19 vaccine in Ghana. Therapeutic Advances in Vaccines and Immunotherapy. 2023;11:251513552211493. Ministry of Food and Agriculture (MoFA). Agriculture in Ghana: Facts and Figures https://mofa.gov.gh/site/images/pdf/AGRICULTURE%20IN%20GHANA%20(Facts%20&%20Figures)%202021.pdf, editor2022. Amponsah-Tabi S, Djokoto R, Opoku S, Senu E, Boakye DK, Azanu WK, et al. Knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana: a multi-regional study. BMC Infectious Diseases. 2023;23(1). Bawa A. Agriculture and Food Security in Northern Ghana. Asian Journal of Agricultural Extension, Economics & Sociology. 2019:1-7. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon. Vaccine. 2014;32(49):6649-54. Marti M, De Cola M, Macdonald NE, Dumolard L, Duclos P. Assessments of global drivers of vaccine hesitancy in 2014—Looking beyond safety concerns. PLOS ONE. 2017;12(3):e0172310. Frimpong SO, Seidu M, Hilton SK, Ransome Y, Paintsil E, Talbert-Slagle K, et al. Development of a community-based COVID-19 intervention in rural Ghana: a document analysis. BMC Public Health. 2022;22(1). Sackey FG, Asravor R, Lamptey C. Factors influencing the perception and the willingness to take the COVID-19 vaccine among the working population in Ghana. Journal of Integrated Care. 2023;31(4):331-46. Creswell JW, & Creswell, J. D. Research design : qualitative, quantitative, and mixed methods approaches (Fifth edition.). SAGE. 2018. Freeman D, Loe BS, Yu L-M, Freeman J, Chadwick A, Vaccari C, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. The Lancet Public Health. 2021;6(6):e416-e27. Braun V, Clarke V. Thematic analysis: American Psychological Association; 2012. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health. 2019;11:589 - 97. Ghana Statistical Service (GSS). Ghana 2021 Population and Housing Census. https://census2021statsghanagovgh/gssmain/fileUpload/reportthemelist/PRINT_COPY_VERSION_FOUR%2022ND_SEPT_AT_8_30AMpdf. 2021;1. Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine. 2018;36(5):660-7. Clarke V, Braun V. Thematic Analysis. In: Teo T, editor. Encyclopedia of Critical Psychology. New York, NY: Springer New York; 2014. p. 1947-52. Akrong GB, Hiadzi RA, Donkor AB, Anafo DK. COVID-19 Vaccine Acceptance and Hesitancy in Ghana: A Systematic Review. 2023. Afrifa-Anane GF, Larbi RT, Addo B, Agyekum MW, Kyei-Arthur F, Appiah M, et al. Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: A qualitative study. PLoS One. 2022;17(8):e0272876. Zhou L, Ampon-Wireko S, Xu X, Quansah PE, Larnyo E. Media attention and Vaccine Hesitancy: Examining the mediating effects of Fear of COVID-19 and the moderating role of Trust in leadership. PLoS One. 2022;17(2):e0263610. Adjaottor ES, Addo F-M, Ahorsu FA, Chen H-P, Ahorsu DK. Predictors of COVID-19 Stress and COVID-19 Vaccination Acceptance among Adolescents in Ghana. IJERPH. 2022;19(13):1-14. Nanteer-Oteng E, Kretchy IA, Nanteer DO, Kretchy JP, Osafo J. Hesitancy towards COVID-19 vaccination: The role of personality traits, anti-vaccine attitudes and illness perception. PLOS Glob Public Health. 2022;2(12):e0001435. Boi-Dsane NAA, Dzudzor B, Alhassan Y, Aheto JMK. Prevalence of common adverse events experienced following COVID-19 vaccination and its associated factors in Ghana: Cross-sectional study design. Health Sci Rep. 2023;6(1):e1012. Gadzekpo A, Tietaah GKM, Yeboah-Banin AA, Kwame Ampofo Adjei D. Media coverage of COVID-19 vaccines: sources of information, and verification practices of journalists in Ghana. J Commun Healthc. 2023:1-15. Dubik SD. Understanding the Facilitators and Barriers to COVID-19 Vaccine Uptake Among Teachers in the Sagnarigu Municipality of Northern Ghana: A Cross-Sectional Study. Risk Manag Healthc Policy. 2022;15:311-22. Gidudu JF, Shaum A, Dodoo A, Bosomprah S, Bonsu G, Amponsa-Achiano K, et al. Barriers to healthcare workers reporting adverse events following immunization in four regions of Ghana. Vaccine. 2020;38(5):1009-14. Wise J. Covid-19: European countries suspend use of Oxford-AstraZeneca vaccine after reports of blood clots. British Medical Journal Publishing Group; 2021. Lazarus JV, Wyka K, White TM, Picchio CA, Gostin LO, Larson HJ, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Medicine. 2023;29(2):366-75. Lilleholt L, Zettler I, Betsch C, Böhm R. Development and validation of the pandemic fatigue scale. Nature Communications. 2023;14(1):6352. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2025 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 04 Nov, 2024 Reviews received at journal 04 Nov, 2024 Reviews received at journal 02 Nov, 2024 Reviewers agreed at journal 02 Nov, 2024 Reviewers agreed at journal 01 Nov, 2024 Reviews received at journal 31 Oct, 2024 Reviewers agreed at journal 31 Oct, 2024 Reviewers agreed at journal 31 Oct, 2024 Reviewers invited by journal 31 Oct, 2024 Editor assigned by journal 25 Oct, 2024 Submission checks completed at journal 24 Oct, 2024 First submitted to journal 14 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Region","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Clement","middleName":"Bomweh","lastName":"Zobazie","suffix":""},{"id":373769655,"identity":"7f9fd6c6-e744-4259-b9bd-ba262fe1ebf5","order_by":5,"name":"James Fenibe Mbinta","email":"","orcid":"","institution":"Victoria University of Wellington","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"James","middleName":"Fenibe","lastName":"Mbinta","suffix":""}],"badges":[],"createdAt":"2024-10-14 06:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5258487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5258487/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-025-00594-7","type":"published","date":"2025-04-30T15:57:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69086802,"identity":"53c706c1-08a3-4b62-82a3-113721f187a5","added_by":"auto","created_at":"2024-11-15 12:52:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCOVID-19 vaccine acceptance Status\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5258487/v1/004f9f18526d36c638819e69.png"},{"id":69086804,"identity":"adcbfea0-4227-45fd-a905-fff06aafef65","added_by":"auto","created_at":"2024-11-15 12:52:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52426,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCOVID-19 vaccine acceptability\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5258487/v1/c3bbf60be39c80987827e42a.png"},{"id":69087978,"identity":"00cdcb93-c8d0-4153-9dad-10c1ecfb3012","added_by":"auto","created_at":"2024-11-15 13:00:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":50719,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAttitude towards COVID-19 vaccine\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5258487/v1/5ee8e662144a22f6f9f7e24f.png"},{"id":69086805,"identity":"47545549-8c9e-405f-9a3e-f8a1e7e37e9c","added_by":"auto","created_at":"2024-11-15 12:52:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46106,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipants Perspectives on the Vaccine Importance\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5258487/v1/5ad1335cdcbbd41c1e5853d9.png"},{"id":81987716,"identity":"076d3a57-ea31-4a11-b1bd-4f02b3cc6215","added_by":"auto","created_at":"2025-05-05 16:05:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":974471,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5258487/v1/454f06d3-c27b-4adc-9f21-fdebbcc6e753.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Unmet Global Agenda: COVID-19 vaccine hesitancy among farmers in Northern Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Sub-Saharan Africa (SSA), vaccine hesitancy for COVID-19 vaccination is a significant problem. For instance, COVID-19 vaccine hesitancy prevalence in some SSA countries includes Ethiopia (29%), Burkina Faso (33%), Nigeria (34%), Ghana (42%), and Tanzania (65%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Several identified factors influencing COVID-19 vaccine hesitancy include misconceptions regarding COVID-19 vaccines, an absence of reliable sources of information about COVID-19, and the perception that vaccines are neither safe nor effective [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Vaccine hesitancy refers to a state of indecision regarding vaccination, which encompasses both intentions and willingness, independent of actual behavior [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The newly established definition by the World Health Organization characterizes hesitancy as a component of the motivational domain within the behavioral and social determinants of vaccination.\u003c/p\u003e \u003cp\u003eOn February 24, 2021, Ghana became the first nation in sub-Saharan Africa (SSA) to receive the coronavirus vaccine through the COVID-19 Vaccines Global Access (COVAX) initiative [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, as of December 10, 2023, only 44.3% of Ghanaians had received at least two doses of COVID-19 vaccines [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2022, a nationwide survey noted an increasing trend in vaccine hesitancy, which rose to 52.2%. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Concerns regarding efficacy and safety were the primary reasons for this hesitancy. Although the COVID-19 vaccine is available free of charge nationwide, a national survey indicated that 45.7% of Ghanaians remain unwilling to get vaccinated [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous studies have examined COVID-19 vaccine hesitancy among urban and literate Ghanaians [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, a cross-sectional study of rural participants found that 30.6% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], 30.6% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and 36.8% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] declined the COVID-19 vaccine in southern Ghana. Yet, none of these studies have specifically targeted farmers in rural and remote areas of northern Ghana, despite their significant representation in the population.\u003c/p\u003e \u003cp\u003eFarming is crucial to the economy of northern Ghana, accounting for 73% of employment and contributing 80% to its gross domestic product [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, studies on vaccine hesitancy, specifically among northern Ghanaian farmers, are limited. Given the economy's reliance on agriculture, vaccine hesitance among farmers could result in reduced productivity due to illness among those who remain unvaccinated against COVID-19. Thus, this study aimed to investigate the reasons behind vaccine hesitancy among northern Ghanaian farmers regarding the uptake of the COVID-19 vaccine.\u003c/p\u003e \u003cp\u003eLimited information exists on vaccine hesitancy regarding COVID-19 among rural and northern populations in Ghana [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Most surveys have concentrated on southern Ghana, where urban areas dominate [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, the few national studies on vaccine hesitance were primarily conducted online, which may have excluded rural residents. Studies by [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] indicates that factors influencing vaccine hesitancy can differ significantly within a country due to geographic and economic conditions. For instance, a cross-sectional study found that vaccine acceptance among Ghanaians is location-dependent, with 58% of rural participants surveyed across multiple regions expressing opposition to the COVID-19 vaccination [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, only 26.2% of the uptake of COVID-19 vaccines was observed in the northern region of Ghana [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The low uptake of the vaccine in these areas was attributed to factors such as poor perception (55.4%), negative attitude (59.4%), and lack of knowledge (55%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A similar survey involving participants from rural and urban areas indicated that 54% were vaccine hesitant [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In comparison, 63% and 50% of participants in rural and urban areas expressed skepticism towards the COVID-19 vaccine [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These findings are consistent with a recent survey on Ghanaian public employees, which revealed that residing in an urban environment positively influenced the acceptance of the COVID-19 vaccination [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings highlight the need for targeted interventions to address knowledge gaps, concerns, and vaccine hesitancy among farmers in both rural and urban areas of northern Ghana. The study aimed to explore the reasons for COVID-19 vaccine hesitancy in this population, addressing the questions: What factors influence COVID-19 vaccine hesitancy among farmers in northern Ghana, and what are their reasons for vaccine hesitancy? Answering these questions could help policy makers implement targeted vaccine programmes in rural and urban areas of northern Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe chosen research strategy for this project was a concurrent embedded study design. As explained by Creswell \u0026amp; Creswell (2018), this design employs a mixed method of research techniques to understand a research problem comprehensively. It is particularly suitable when researchers aim to thoroughly comprehend a problem or investigate the interactions between variables of interest\u0026nbsp;[24]. For this study, both qualitative and quantitative data were collected, analyzed, and utilized. Within the concurrent embedded mixed methods design, qualitative or quantitative data play a supportive or supplementary role\u0026nbsp;[24]. Therefore, the quantitative data were embedded within the more extensive qualitative data to gain insights into the factors contributing to COVID-19 vaccine hesitancy in the study area. The concurrent embedded design was implemented in two phases:\u003cbr\u003e\u003cstrong\u003ePhase One:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;During the initial stage of the concurrent embedded design,\u0026nbsp;Quantitative and qualitative\u0026nbsp;data were collected. The first part of the interview focused on gathering participants’ demographic information, followed by an in-depth interview. The second section consisted of closed-ended questions about COVID-19 vaccine hesitancy using the Oxford COVID-19 Vaccine Hesitancy Scale (OCVHS)\u0026nbsp;[25].\u003cbr\u003e\u003cstrong\u003ePhase Two:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;In the second phase, qualitative data were collected data on the reasons for COVID-19 vaccine hesitancy among farmers in northern Ghana) \u0026nbsp;Reflexive thematic analysis which involves the identification and analysis of themes\u0026nbsp;[26]\u0026nbsp;was conducted on the data imported into NVIVO version 14 to identify any pattern in the data set. Codes and themes were developed inductively (data-driven) to create meaning and data interpretation\u0026nbsp;[27]. The qualitative data helped shed light on farmers' acceptance or rejection of COVID-19 vaccination. The findings from the analysis led to recommendations on COVID-19 vaccination acceptance and uptake.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eStudy Setting:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNorthern Ghana comprises the Upper East, Upper West, Savannah, Northern, and North East Regions\u0026nbsp;[28].\u0026nbsp;[16]. Roughly 97.9% of households in Northern Ghana are engaged in small-scale seasonal, rain-fed agricultural farming\u0026nbsp;[18], with crop cultivation, livestock husbandry, and fish farming as the primary activities. Approximately 70% of Northern Ghana is classified as rural\u0026nbsp;[28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Recruitment of study participants involved purposive sampling, specifically targeting five Farmer-Based Organizations (FBOs) in Northern Ghana. Information regarding farmers for the interviews and surveys was obtained from FBO executives. The researcher sampled 24 farmers (12 rural and 12 urban) from different FBOs to identify disparities and similarities in COVID-19 vaccine hesitancy between rural and urban areas in Northern Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eQualitative:\u003c/strong\u003e Data collection involved in-depth interviews to allow participants to construct their own experiences. Semi-structured questions were formulated to explore participants’ perceptions of the COVID-19 vaccine. The interviews were conducted both in person and over the phone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative:\u003c/strong\u003e The interview questionnaire consisted of three sections. The first section gathered demographic information. The second section comprised closed-ended questions on COVID-19 vaccine hesitancy, employing the OCVHS. This was followed by open-ended questions focused on COVID-19 vaccines, guided by the OCVHS\u0026nbsp;[25].\u003c/p\u003e\n\u003cp\u003eEach interview had a duration of approximately 30-45 minutes. The OCVHS was selected by the researchers due to its connection with the Vaccine Hesitancy Scale\u0026nbsp;[29], which has undergone assessment and validation by the WHO-SAGE working group, thus showcasing its robust psychometric properties. Furthermore, the OCVHS is an instrument that captures responses per-item basis, enabling direct input from participants\u0026nbsp;[29]. This characteristic made it well-suited for customization and utilization among rural farmers in Northern Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviews with participants were conducted between November and December 2023. In November 2022, three research assistants (RAs) from the University for Development Studies in Tamale were recruited to conduct face-to-face interviews with participants. The principal investigator ensured the accuracy of the recorded information by conducting member checking with participants, thereby enhancing the rigor of data quality. To ensure consistency and minimize errors, researchers obtained consent from participants to digitally audio-record the interviews. The principal researcher led the data coding and theme development process. JM conducted a comparative check of coding and themes.\u003c/p\u003e\n\u003cp\u003eAdditionally, the principal researcher and a supervisor engaged in member journaling. The principal researcher translated audio transcripts from local languages to English, leveraging his fluency in Hausa, Gurune, and Pidgin English. The principal researcher was born and lived almost 28 years in northern Ghana, \u0026nbsp;and has a good command of the languages of northern Ghana.\u003cbr\u003e\u003cstrong\u003eData Analysis:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe researcher transcribed all the interviews verbatim. Transcripts in local languages and Pidgin English were translated into English. \u0026nbsp;The study employed reflexive thematic analysis (TA) of the data\u0026nbsp;[30]. The transcripts were carefully reviewed, and the data was categorized into codes and subcodes and then grouped thematically. NVivo 14 was utilized for coding to identify common themes. The researcher worked closely with NL and JM in analyzing the collected data for themes. The phases of the reflexive thematic analysis included: (1) familiarizing oneself with the data by reading through the transcripts and listening to the audio recordings to identify any misinterpretations or missing text coding; importing all transcribed interviews into the thematic analysis software for data analysis, (2) generating initial themes through the consolidation of codes and categories, (3) reviewing themes for overlap and redundancy in categories, and (4) defining and naming themes by the principal researcher and the team, followed by the write-up of the study\u0026nbsp;[30].\u003c/p\u003e\n\u003cp\u003eMoreover, the researchers employed an inductive thematic analysis approach, where the social construction theoretical framework guided their anticipation of the emerging themes [30]. Finally, the analysis and interpretation of the OCVHS were coded on a scale of 1 to 5 [29]. A score of 1 indicates low vaccine hesitancy, while a score of 5 indicates higher vaccine hesitancy. However, the “Don't Know\" option was excluded from scoring without affecting the validity of the results. The themes were categorized based on issues related to barriers and facilitators of COVID-19 vaccine uptake, guided by the codes generated from the thematic analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eFarmers\u0026apos; Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 24 participants. Eight were aged 30-39 and seven 20-29 respectively. An additional six participants fell in the age range of 40-49, while three participants were aged 50-59. In terms of education, the 7 participants had no education, 7 \u0026nbsp;tertiary education, 6 senior school and 2 primary school. The participants were evenly distributed between 12 rural and 12 urban areas. The largest number of participants came from the Upper East Region 10, 7 from the northern region, 4 from the northeastern region, and 3 from the Upper West region. The sample included 16 males and eight females. Table 1 presents a summary of participant characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Farmers Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e29.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eNo Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e29.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eJunior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eSenior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e29.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 564px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eNorth East\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eUpper East\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e41.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eNorthern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e29.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 263px;\"\u003e\n \u003cp\u003eUpper West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFarmer Results- Themes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe farmers\u0026apos; interviews revealed six themes for COVID-19 vaccine hesitancy among farmers in northern Ghana: availability and access to vaccines, misconception about COVID-19 virus, preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences and belief in non-existence of COVID-19 in Northern Ghana.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability and access to COVID-19 vaccines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA recurring theme in the study highlighted farmers\u0026apos; include limited availability and access to the COVID-19 vaccine in their communities. One farmer (interview 9) described the challenges of accessing the vaccine due to their busy work schedule and the time-consuming nature of the process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;It is not easily accessible. When you go, you have to join a long queue, and they will give you a designated time. But as a farmer, you have work to do and other obligations.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant (interview 1) echoed similar sentiments, saying,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;In some places, you can spend two to three days waiting in line without even reaching the middle.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants also shared their perceptions of vaccine access in rural and urban areas. A farmer (interview 10) observed,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Town people seem to have better access than those living in the village. It\u0026apos;s challenging for us to get access because the lines are always crowded, making it difficult for us to monitor and receive help\u0026hellip;\u0026hellip;\u0026hellip;...\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome farmers (interview 3) mentioned that initially, they went to get the vaccines, but because of scarcity, they went home and never got vaccinated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003cem\u003ewe formed a queue to take the injection and then we are not lucky and then that the thing finish at our side. So, starting from there I didn\u0026rsquo;t get the chance and go back again.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMisinformation about COVID-19 virus\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants shared their opinions about the COVID-19 virus and how it informed their decision to vaccinate or not. Some farmers believed that\u0026nbsp;they know this disease and they are sceptical that it is a new one.\u0026nbsp;One farmer (interview 16) stated,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;You see the covid-19, it has ever occurred here in the North, it was called \u0026quot;Gbankogu. And they later came with its vaccine, and be vaccinating people, till those diseases perished. So those diseases do not exist again.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother farmer (interview 23) explained,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e\u0026hellip;..\u0026nbsp;\u003cem\u003ethe name COVID, is English, in Dagbani we have experience those kinds of diseases. Those diseases already existed\u0026hellip; We call it \u0026quot;Diligu\u0026quot; or \u0026quot;Fiegfieg\u0026rdquo; (catarrh), either treat it by going to the hospital, or using medicinal herbs\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis sentiment was echoed by another farmer (interview 11) who said,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u003cem\u003eFor we the Dagombas here, we know the Covid-19 to be \u0026quot;kohanpieligu\u0026quot; so I would have taken some local herbs before going any other way\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother further explained that one farmer (interview 13) noted,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;the way we saw the COVID-19, was that, when you are affected by it, \u0026nbsp;we would have look for local herbs that treats \u0026quot; Yougu and kohanpieligu\u0026quot; that was the two kind of treatment we were prepared for in terms of the treatment, if any of my family members or I was down by the virus. we do know about the causes of that disease, the source of that disease\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis point was further emphasized by another farmer (interview 15) who stated,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u003cem\u003eWe are Dagombas, so when we hear there is something new coming to this land like diseases, we will look for Kpante, yougu and kohanpieligu herbs and be taking you get it\u003c/em\u003e\u003cem\u003e.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreference for universal vaccine brand\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants expressed a general preference for a specific vaccine over others. During the interviews, farmers highlighted their preference for a particular vaccine brand COVID-19 vaccine due to its single-dose requirement. One participant (interview 1) expressed,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u003cem\u003eI\u003c/em\u003e \u003cem\u003eprefer the one you take it once over the one you will go for the two dosages.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant (interview 12) shared,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I favor the single-dose vaccine over those that require two doses because I feel that taking too much medication can burden your system.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOthers mentioned the convenience of the single dose vaccine since it eliminates the need for a second dose. One farmer (interview 19) mentioned,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;For me\u0026hellip;\u0026hellip; I would have preferred the vaccine that is administered once\u0026hellip;\u0026hellip; People who don\u0026apos;t feel well after the first dose might not return for the second dose. So, I would prefer a vaccine that is taken all at once.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother farmer (interview 2) echoed these sentiments, stating,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u003cem\u003eNow I learnt we have the one that you take just once and the other you take it then three months you go and take again but now I have heard there is a full dosage to take and that one is better.\u0026rdquo; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, one FBO Chairman (interview 6) reflected the sentiments of all farmers when he stated,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003cem\u003ewe prefer the one dose than the one you take and then repeat\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBelief in non-existence of COVID-19 in Northern Ghana.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the interview, many participants believed that COVID-19 no longer posed a significant threat. This perception influenced their attitudes towards vaccination. One farmer (interview 23) remarked,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u0026hellip;\u0026hellip;The disease isn\u0026apos;t even present in Ghana. I fail to understand why COVID vaccines are still being administered.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother individual (interview 21) echoed these sentiments, stating,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;No, I have no intention of taking it because I haven\u0026apos;t heard anything about it lately, and my friends feel the same, even if it were to become available.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome farmers in Northern Ghana have expressed skepticism about the existence of COVID-19. One farmer (interview 17) stated,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e\u0026hellip;.\u003cem\u003ewe saw covid-19 to be fake. We did not believe in it. We believe it was at the Whiteman\u0026rsquo;s land\u003c/em\u003e\u003cem\u003e.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother farmer also mentioned the lack of access to information about the virus in rural areas. An FBO leader (interview 10) added,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e\u003cem\u003eLooking at this COVID-19 as at now is recently is silent. We are not even getting more information like that, especially from the villages because of the rural area that I\u0026apos;m even talking about is one if I\u0026apos;m in my village we don\u0026apos;t even talking about it, no information. So I don\u0026apos;t know how can the Health Sector do so that this information will keep on going on in our communities for us \u0026nbsp;to get much about it\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear of death and negative experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme identified when farmers were asked about\u0026nbsp;the perspectives of their families and friends on the COVID-19 vaccine and the reasons why they took or did not take the vaccine. Some families feared that the vaccines could be fatal. \u0026nbsp;One farmer disclosed (interview 12) said,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You know, my family did not support me even for the injection. According to them, people who had the vaccines all died\u0026rdquo;.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant (interview 13) echoed this sentiment, saying:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have been seeing health workers carrying the vaccines around, if you want, then you go for the vaccination. They came to my house several times, but I did not go for the vaccination. The reason is that we heard the vaccine kills people and introduces new sicknesses into one\u0026rsquo;s body when you take it\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThese concerns stemmed from negative experiences within the community. One participant (interview 11) shared,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Even one man in this community was vaccinated and got affected deeply, and was sent to the hospital, he was called Mohammed, and another person, MBA Imoro, also got affected badly after he was vaccinated.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSafety was another factor contributing to vaccine hesitancy. One farmer (interview 14) recounted how some community members experienced saying,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I have witnessed some people who suffered after taking the COVID-19 vaccines. Some people who took the COVID-19 vaccines were sent to the hospital for hydration, for about ten packs of water. Let me tell you something, though one will not pay for the vaccine, but later after taking the vaccine, one will go to the hospital and pay for treatment for the side effects of the vaccines\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Side Effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome farmers expressed fear of taking the vaccine due to fear of side effects after hearing that some people had side effects from taking the vaccine. One farmer (interview 9) highlighted a fear of side effects:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eThey said you feel body pains, weakness, inability to raise their hands, lying down due to the pains. So if you also hear that you become afraid and you will think if I also take I will feel these side effects\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant (interview 24) expressed:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003e\u0026hellip;\u0026hellip;because of the side effects we heard from other people, we did not go for the vaccination\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome farmers (interview 17) did not take the vaccine because of the information received from health professionals about the side effects of the vaccine.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We heard on news that some of the vaccines are not correct, some doctors disapproved the vaccines.they said the reactions are not good. So that discouraged us from going for the vaccine.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant (interview 23) said:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I monitored some videos on television seeing some people after taking the vaccine\u0026hellip; I leaned the vaccine had some negative impact on the human body. that was why I did not go for the vaccination. Some people also said when you take the vaccine, you would get sick for some days\u0026rdquo;.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOCVHS Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from the OCVHS, a seven-item instrument depicted in Figure 1, revealed that 33.3% of farmers displayed a propensity to receive the vaccine. In comparison, 29.2% remained uncertain about their willingness to accept a COVID-19 vaccine if offered presently. Notably, 20.8% of farmers exhibited significant hesitancy towards the COVID-19 vaccine, scoring a five on the scale. Additional statistical details can be found in the accompanying figure 1 below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 2 presents farmers\u0026apos; perspectives on vaccine acceptance. When asked if they would take the vaccine if it were available now, 37.5% said they would postpone receiving it, 33.3% expressed their willingness to accept when offered, and 16.7% indicated declining vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 3 illustrates farmers\u0026apos; current attitudes towards receiving a COVID-19 vaccine. Among respondents, 54.2% reported feeling neutral, 20.8% expressed moderate unease, and 12.5% expressed some degree of positivity towards the vaccines. Moreover, when queried about obtaining the vaccine from a local pharmacy, 33.3% stated they would delay getting it for as long as possible, 33.3% would defer it, and 20.8% would receive it when convenient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were asked if they would recommend the vaccine to a friend or family member considering vaccination. Half of the participants (50%) indicated that they would not provide any feedback about the vaccine, 20.8% would encourage vaccination, and 20.8% would advise postponing it. Based on farmers\u0026apos; responses, 50% expressed reluctance to receive the COVID-19 vaccine, while 33.3% expressed indifference. Similarly, in figure 4 when asked about the importance of receiving the COVID-19 vaccine now, 58.3% of farmers stated that it was unimportant, 20.8% considered it neither important nor unimportant, and 8.3% considered it to be highly unimportant.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur qualitative findings indicate farmers' reasons for hesitancy such as vaccine availability and access, misinformation about COVID-19, a\u0026nbsp;preference for a universal brand, perceived side effects, fear of death and negative experiences, lack of information about COVID-19, and belief in non-existence of COVID-19 in northern Ghana.\u003c/p\u003e\n\u003cp\u003eDespite having a general understanding of the COVID-19 vaccine's availability in Ghana, farmers generally hold an unfavorable perception of the vaccines, expressing reluctance to receive them. If the vaccine were to become available, most farmers would actively avoid getting vaccinated and would not encourage their family members to do so. These findings align with similar studies\u0026nbsp;[31]\u0026nbsp;conducted in Ghana, particularly in specific regions of northern Ghana, which indicate that individuals in rural areas, northern regions, and those with lower education levels are more hesitant to receive the vaccine.\u003c/p\u003e\n\u003cp\u003eA survey indicated individuals with lower education levels, including many farmers, exhibit lower acceptance of the vaccines\u0026nbsp;[9]. Another recent survey\u0026nbsp;[15]\u0026nbsp;supports this claim, linking lower education, socioeconomic background, and residing in rural areas with higher levels of vaccine hesitancy. However, the latter study did not specify the number of participants from rural versus urban areas.\u003c/p\u003e\n\u003cp\u003eA cross-sectional in rural Ghana reported a vaccine hesitancy rate of 30.6% for the COVID-19 vaccine\u0026nbsp;[14]. Reasons for this hesitancy included insufficient vaccine information, concerns about side effects, and a belief that the vaccine is unnecessary. Conversely, a\u0026nbsp;qualitative descriptive\u0026nbsp;study of women in Kumasi and Accra identified positive factors for vaccine acceptance and uptake, with long queues and vaccine shortages acting as barriers that discouraged participants from receiving the vaccines\u0026nbsp;[32].\u003c/p\u003e\n\u003cp\u003eAnother investigation on the impact of media attention on COVID-19 vaccine hesitancy found that media played a significant role in influencing vaccine hesitancy in rural communities in southern Ghana\u0026nbsp;[33]. The study, which included 22.9% of farmers, revealed that vaccine-hesitant individuals were more likely to be influenced by fear-inducing media messages, ultimately leading to vaccine refusal.\u0026nbsp;[34]\u0026nbsp;identified a fear of contracting COVID-19 and a desire to stay healthy as positive factors in encouraging acceptance of COVID-19 vaccines. The study emphasized the importance of addressing COVID-19 stressors in vaccination messages delivered by health policymakers.\u003c/p\u003e\n\u003cp\u003eFurther, a survey highlighted the influence of personality traits on individuals' anti-vaccine attitudes, suggesting that public health strategies should consider the psychological drivers of vaccine hesitancy to meet individual needs\u0026nbsp;[35]. It is important to note that our findings differ from earlier studies.\u0026nbsp;[9]\u0026nbsp;studied all 16 regions to determine vaccine hesitancy and reported that the Northern and Upper West Regions had the highest willingness to receive COVID-19 vaccines. Our study findings regarding preference revealed that most participants preferred the single dose vaccine vaccine over other COVID-19 vaccines.\u0026nbsp;[36]\u0026nbsp;suggests that adverse effects such as headache, pain at the injection site, fatigue, malaise, fever, and chills were reasons people would not take AstraZeneca, rather than the number of doses. However, it is important to acknowledge that this study has a small sample size and cannot be generalized to the entire Ghanaian population.\u003c/p\u003e\n\u003cp\u003eAs highlighted by\u0026nbsp;[33], \u0026nbsp;22.9% of rural dwellers were susceptible to media messages instilling fear of COVID-19 leading to vaccine refusal. Similar to our study, farmers were vaccine-hesitant due to misinformation about the COVID-19 Vaccine. Further, a recent survey found that 48.35% and 44% of journalists in Ghana rely on Facebook and WhatsApp as sources of information, respectively, exposing lax verification practices among journalists\u0026nbsp;[37]. Consequently, the use of social media and the lack of stringent verification practices by Ghanaian journalists can contribute to spreading misinformation among rural individuals who rely solely on radio or television news.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on our results and those of others, it is evident that fear of side effects among rural and urban populations in northern Ghana is common. While vaccine intentions are high at 63%\u0026nbsp;[38], vaccine acceptance and uptake are only at 11%\u0026nbsp;[38]. However, intentions do not necessarily translate into vaccine acceptance or uptake. Afreh et al., (2023) showed people’s fear about side effects (25.3%), while other fears were based on\u0026nbsp;previous experiences of vaccine adverse effects\u0026nbsp;[39]\u0026nbsp;and reports of COVID-19 side effects in some countries\u0026nbsp;[40]. Nonetheless, health policymakers must address COVID-19 stressors in vaccination messages\u0026nbsp;[34]. Similarly, public health strategies should consider the psychological drivers of vaccine hesitancy, especially for rural dwellers and farmers\u0026nbsp;[35].\u003c/p\u003e\n\u003cp\u003eThe quantitative findings of our study showed about\u0026nbsp;37.5% would postpone receiving, and\u0026nbsp;16.7% declined COVID-19 vaccination.\u0026nbsp;Meanwhile,\u0026nbsp;58.3% of farmers stated that the COVID-19 vaccine was unimportant now. These findings are consistent with a study which indicates that 38.6% of people globally who reported showing less concerns about COVID-19 vaccines\u0026nbsp;[41]. These are signs possible signs of pandemic fatigue which is a combination of factors resulting in a reduction in adherence to protective behaviours[42]. This study aimed to examine the reasons for COVID-19 vaccine hesitancy among farmers in northern Ghana, contributing to the existing knowledge on vaccine hesitancy, which poses a significant threat to global health. Although COVID-19 is no longer classified as a pandemic or public health emergency, the insights gained from this study could be vital in promoting vaccination among rural and northern populations against the evolving SARS-CoV-2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral recommendations can be derived from our findings. Firstly, vaccination is the most effective method for preventing the transmission of infectious diseases. Therefore, District Health Management Teams (DHMTs) must engage with communities to make single-dose vaccines more available to enhance vaccine uptake. Secondly, it is essential to continue promoting COVID-19 campaigns, even with the availability of vaccines and widespread knowledge of the disease. This is particularly important to counter vaccine apathy and fatigue, which may discourage individuals from receiving vaccinations. Health promotion campaigns and messaging should be tailored to address the specific needs of different communities, particularly those in rural and less educated populations. Lastly, farming populations should be prioritized in future health emergency interventions, given their critical role in providing food security for the entire northern region of Ghana. This ensures that food security is maintained during public emergencies.\u003c/p\u003e\n\u003cp\u003eDespite the contributions of this study, there are some limitations to consider. While participants were purposively selected from the five regions of northern Ghana, not all farmer-based organizations (FBOs) were equally represented. Additionally, our study focused exclusively on farmers, and their experiences may not necessarily reflect the experiences of the broader population in northern Ghana. Most interviews were conducted over the phone, which may have influenced participants' willingness to fully express themselves. Furthermore, in-person interviews offer the interviewer the advantage of observing facial expressions, which can provide valuable insights for further exploration of the study areas.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe acceptance and uptake of the COVID-19 vaccine in northern Ghana, among farmers in both rural and urban areas, has encountered significant stagnation. In general, farmers are aware of the availability of COVID-19 vaccines. However, several factors have contributed to vaccine hesitancy, such as a preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences, and belief in the non-existence of COVID-19 in northern Ghana. To address this issue, engaging the community to make single dose vaccines more available, carrying out ongoing public health campaigns, and prioritising farmers as a vulnerable population during health emergencies is crucial.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data for the study is available on request, for confidentiality purposes, the data is not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to the Faith-Based Organizations (FBOs) in northern Ghana who participated in the interviews. We also acknowledge the efforts of the research assistants involved in data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePMAA and NL were involved in the conceptualization of the study. PMAA, NL, MM, ED, EM, CBZ and JFM were involved in the data collection, and formal analysis. All authors were involved in writing the original draft and reviewing and editing the manuscript. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Laurentian University Ethics Review Board and the Navrongo Health Research Centre Institutional Review Board (NHRCIRB554) in Ghana. Consent forms containing all necessary information were provided to participants, and verbal agreements were recorded for those unable to read and write.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbubakari SW, Workneh F, Asante KP, Hemler EC, Madzorera I, Wang D, et al. Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan Africa. PLOS Global Public Health. 2023;3(7):e0000713.\u003c/li\u003e\n \u003cli\u003eMacDonald \u0026amp; the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.\u003c/li\u003e\n \u003cli\u003eAfrica CDC. Coronavirus Disease 2019 (COVID-19) Latest updates on the COVID-19 crisis from Africa CDC. Retrieved from https://africacdcorg/covid-19/. 2023;2023-12-20.\u003c/li\u003e\n \u003cli\u003eBrackstone K, Atengble K, Head MG, Boateng LA. COVID-19 Vaccine Hesitancy in Ghana: The Roles of Political Allegiance, Misinformation Beliefs, and Sociodemographic Factors. 2022.\u003c/li\u003e\n \u003cli\u003eUdor R, Eshun SN, Tampah-Naah AM. Factors Influencing Intentions and Acceptance of COVID-19 Vaccines in Ghana. Ghana Journal of Development Studies. 2023;20(1):252-66.\u003c/li\u003e\n \u003cli\u003eAcheampong T, Akorsikumah EA, Osae-Kwapong J, Khalid M, Appiah A, Amuasi JH. Examining Vaccine Hesitancy in Sub-Saharan Africa: A Survey of the Knowledge and Attitudes among Adults to Receive COVID-19 Vaccines in Ghana. Vaccines. 2021;9(8):814.\u003c/li\u003e\n \u003cli\u003eAmo-Adjei J, Nurzhynska A, Essuman R, Lohiniva A-L. 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COVID-19 vaccine hesitancy concerns: Findings from a Ghana clinical radiography workforce survey. Radiography. 2022;28(2):537-44.\u003c/li\u003e\n \u003cli\u003eDadzie G, Bawua SA. Assessing the Prevalence and Predictors of COVID-19 Vaccine Hesitancy among Healthcare Workers in Infectious Disease Centers in Ghana. 2023.\u003c/li\u003e\n \u003cli\u003eBrackstone KAE, Boateng LA, Head MG, Manyeh A, Vidzro GAA, Angwaawie P. . Examining predictors of vaccine uptake and hesitancy in three rural sub-municipalities in Nkwanta South, Oti region, Ghana. 2022.\u003c/li\u003e\n \u003cli\u003eAfreh O, Angwaawie P, Attivor E, Boateng L, Brackstone K, Head M, et al. Examining confidence and hesitancy towards COVID-19 vaccines: A cross-sectional survey using in-person data collection in rural Ghana. Vaccine. 2023;41(13):2113-9.\u003c/li\u003e\n \u003cli\u003eSampene AK, Li C, Oteng Agyeman F, Brenya R. Socioeconomic and demographic characteristics influencing the hesitancy and refusal of COVID-19 vaccine in Ghana. Therapeutic Advances in Vaccines and Immunotherapy. 2023;11:251513552211493.\u003c/li\u003e\n \u003cli\u003eMinistry of Food and Agriculture (MoFA). Agriculture in Ghana: Facts and Figures https://mofa.gov.gh/site/images/pdf/AGRICULTURE%20IN%20GHANA%20(Facts%20\u0026amp;%20Figures)%202021.pdf, editor2022.\u003c/li\u003e\n \u003cli\u003eAmponsah-Tabi S, Djokoto R, Opoku S, Senu E, Boakye DK, Azanu WK, et al. Knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana: a multi-regional study. BMC Infectious Diseases. 2023;23(1).\u003c/li\u003e\n \u003cli\u003eBawa A. Agriculture and Food Security in Northern Ghana. Asian Journal of Agricultural Extension, Economics \u0026amp; Sociology. 2019:1-7.\u003c/li\u003e\n \u003cli\u003eMacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.\u003c/li\u003e\n \u003cli\u003eDub\u0026eacute; E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy\u0026mdash;Country-specific characteristics of a global phenomenon. Vaccine. 2014;32(49):6649-54.\u003c/li\u003e\n \u003cli\u003eMarti M, De Cola M, Macdonald NE, Dumolard L, Duclos P. Assessments of global drivers of vaccine hesitancy in 2014\u0026mdash;Looking beyond safety concerns. PLOS ONE. 2017;12(3):e0172310.\u003c/li\u003e\n \u003cli\u003eFrimpong SO, Seidu M, Hilton SK, Ransome Y, Paintsil E, Talbert-Slagle K, et al. Development of a community-based COVID-19 intervention in rural Ghana: a document analysis. BMC Public Health. 2022;22(1).\u003c/li\u003e\n \u003cli\u003eSackey FG, Asravor R, Lamptey C. Factors influencing the perception and the willingness to take the COVID-19 vaccine among the working population in Ghana. Journal of Integrated Care. 2023;31(4):331-46.\u003c/li\u003e\n \u003cli\u003eCreswell JW, \u0026amp; Creswell, J. D. Research design : qualitative, quantitative, and mixed methods approaches (Fifth edition.). SAGE. 2018.\u003c/li\u003e\n \u003cli\u003eFreeman D, Loe BS, Yu L-M, Freeman J, Chadwick A, Vaccari C, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. The Lancet Public Health. 2021;6(6):e416-e27.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Thematic analysis: American Psychological Association; 2012.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health. 2019;11:589 - 97.\u003c/li\u003e\n \u003cli\u003eGhana Statistical Service (GSS). Ghana 2021 Population and Housing Census. https://census2021statsghanagovgh/gssmain/fileUpload/reportthemelist/PRINT_COPY_VERSION_FOUR%2022ND_SEPT_AT_8_30AMpdf. 2021;1.\u003c/li\u003e\n \u003cli\u003eShapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine. 2018;36(5):660-7.\u003c/li\u003e\n \u003cli\u003eClarke V, Braun V. Thematic Analysis. In: Teo T, editor. Encyclopedia of Critical Psychology. New York, NY: Springer New York; 2014. p. 1947-52.\u003c/li\u003e\n \u003cli\u003eAkrong GB, Hiadzi RA, Donkor AB, Anafo DK. COVID-19 Vaccine Acceptance and Hesitancy in Ghana: A Systematic Review. 2023.\u003c/li\u003e\n \u003cli\u003eAfrifa-Anane GF, Larbi RT, Addo B, Agyekum MW, Kyei-Arthur F, Appiah M, et al. Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: A qualitative study. PLoS One. 2022;17(8):e0272876.\u003c/li\u003e\n \u003cli\u003eZhou L, Ampon-Wireko S, Xu X, Quansah PE, Larnyo E. Media attention and Vaccine Hesitancy: Examining the mediating effects of Fear of COVID-19 and the moderating role of Trust in leadership. PLoS One. 2022;17(2):e0263610.\u003c/li\u003e\n \u003cli\u003eAdjaottor ES, Addo F-M, Ahorsu FA, Chen H-P, Ahorsu DK. Predictors of COVID-19 Stress and COVID-19 Vaccination Acceptance among Adolescents in Ghana. IJERPH. 2022;19(13):1-14.\u003c/li\u003e\n \u003cli\u003eNanteer-Oteng E, Kretchy IA, Nanteer DO, Kretchy JP, Osafo J. Hesitancy towards COVID-19 vaccination: The role of personality traits, anti-vaccine attitudes and illness perception. PLOS Glob Public Health. 2022;2(12):e0001435.\u003c/li\u003e\n \u003cli\u003eBoi-Dsane NAA, Dzudzor B, Alhassan Y, Aheto JMK. Prevalence of common adverse events experienced following COVID-19 vaccination and its associated factors in Ghana: Cross-sectional study design. Health Sci Rep. 2023;6(1):e1012.\u003c/li\u003e\n \u003cli\u003eGadzekpo A, Tietaah GKM, Yeboah-Banin AA, Kwame Ampofo Adjei D. Media coverage of COVID-19 vaccines: sources of information, and verification practices of journalists in Ghana. J Commun Healthc. 2023:1-15.\u003c/li\u003e\n \u003cli\u003eDubik SD. Understanding the Facilitators and Barriers to COVID-19 Vaccine Uptake Among Teachers in the Sagnarigu Municipality of Northern Ghana: A Cross-Sectional Study. Risk Manag Healthc Policy. 2022;15:311-22.\u003c/li\u003e\n \u003cli\u003eGidudu JF, Shaum A, Dodoo A, Bosomprah S, Bonsu G, Amponsa-Achiano K, et al. Barriers to healthcare workers reporting adverse events following immunization in four regions of Ghana. Vaccine. 2020;38(5):1009-14.\u003c/li\u003e\n \u003cli\u003eWise J. Covid-19: European countries suspend use of Oxford-AstraZeneca vaccine after reports of blood clots. British Medical Journal Publishing Group; 2021.\u003c/li\u003e\n \u003cli\u003eLazarus JV, Wyka K, White TM, Picchio CA, Gostin LO, Larson HJ, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Medicine. 2023;29(2):366-75.\u003c/li\u003e\n \u003cli\u003eLilleholt L, Zettler I, Betsch C, B\u0026ouml;hm R. Development and validation of the pandemic fatigue scale. Nature Communications. 2023;14(1):6352.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, vaccines, hesitancy, Ghana, farmers, northern","lastPublishedDoi":"10.21203/rs.3.rs-5258487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5258487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Ghana became the first nation in Sub-Saharan Africa to receive the coronavirus vaccine, however, as of December 2023, only 44.3% of Ghanaians had received at least two doses of COVID-19 vaccines, with vaccine hesitancy reported at 52.2%. This research aimed to examine reasons for COVID-19 vaccine hesitancy among farmers in Northern Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The study adopted a concurrent embedded mixed methods design which simultaneously collects qualitative and quantitative data. The sampling of participants was purposive, targeting five Farmer Based Organizations (FBOs). 24 participants were interviewed for 30-45 minutes. The transcripts were imported into NVIVO version 14 for analysis using Braun \u0026amp; Clarke's Reflexive Thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The farmers' interviews revealed six themes related to vaccine hesitancy: availability and access, misconception about the COVID-19 virus, preference for a universal vaccine brand, perceived side effects, fear of death and negative experiences, and belief in the non-existence of COVID-19 in Northern Ghana. For the quantitative findings, farmers’ current perspectives towards the COVID-19 vaccine varied. About 37.5% would postpone receiving, and 16.7% decline COVID-19 vaccination. About, 12.5% expressed some degree of positivity towards the vaccines. Meanwhile, 58.3% of farmers stated that COVID-19 was currently unimportant. The COVID-19 vaccine uptake in northern Ghana among farmers has stalled due to a lack of information and belief that the virus no longer exists.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e To address this, it is crucial to make single-dose vaccines more available, conduct ongoing public health campaigns, and prioritize farmers as a vulnerable population during health emergencies.\u003c/p\u003e","manuscriptTitle":"An Unmet Global Agenda: COVID-19 vaccine hesitancy among farmers in Northern Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 12:52:40","doi":"10.21203/rs.3.rs-5258487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-04T10:02:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T10:02:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-02T20:23:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105264025860684219029524257413418685112","date":"2024-11-02T05:08:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318665883862017505163013964988453266198","date":"2024-11-01T04:10:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-31T12:37:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72040910935715867150068919879680319208","date":"2024-10-31T11:52:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96633820701160331698021164543195753754","date":"2024-10-31T07:53:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-31T05:06:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T06:50:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T03:55:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-10-14T06:08:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"686081b9-1982-48d3-969f-4688a491efb9","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:00:39+00:00","versionOfRecord":{"articleIdentity":"rs-5258487","link":"https://doi.org/10.1186/s12982-025-00594-7","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-04-30 15:57:06","publishedOnDateReadable":"April 30th, 2025"},"versionCreatedAt":"2024-11-15 12:52:40","video":"","vorDoi":"10.1186/s12982-025-00594-7","vorDoiUrl":"https://doi.org/10.1186/s12982-025-00594-7","workflowStages":[]},"version":"v1","identity":"rs-5258487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5258487","identity":"rs-5258487","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}