Effect of Implementing Virtual Educational Sessions on Nursing Students’ Knowledge, Attitude and Hesitancy Regarding COVID-19 Vaccination

Effect of Implementing Virtual Educational Sessions on Nursing Students’ Knowledge, Attitude and Hesitancy Regarding COVID-19 Vaccination | 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 Effect of Implementing Virtual Educational Sessions on Nursing Students’ Knowledge, Attitude and Hesitancy Regarding COVID-19 Vaccination Eman Fadel, Eman Alshawish, Rasha El-Shaboury, Dalia Khalil, Fatma Zaghloul, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5044444/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : COVID-19 vaccination is the hopeful savior to curb the pandemic. One of the most urgent issues facing public health officials is vaccine hesitancy. Vaccine hesitancy persists despite the availability of COVID-19 vaccinations because of ignorance and unfavorable attitudes. This study evaluated the effect of virtual educational sessions on nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 vaccination. Method: A quasi-experimental research design was used to recruit 350 undergraduate nursing students from each academic level using a convenience sampling technique. A self-administrative structured questionnaire was utilized to evaluate the nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 vaccination. Results : The mean of the total correct knowledge scores and the total negative attitudes scores regarding COVID-19 vaccination among the studied undergraduate nursing students improved from (13.82±5.08 & 36.38±7.03 respectively) pre-implementation of the virtual educational sessions to (35.59±2.62 & 17.6±5.13 respectively) post-implementation. The total vaccine hesitancy improved from (34.3% doubtful & 14.6% strongly hesitant) pre the implementation of the virtual educational sessions to (11.4% & 3.2% respectively) post-implementation. Conclusion : The educational sessions had positive effect on undergraduate nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 Vaccination. Recommendation : Integration of the virtual educational sessions regarding COVID-19 vaccination into the curricula of educational nursing institutions. Introduction The World Health Organization (WHO) classified COVID-19 as a pandemic in March 2020 [1] . Millions of COVID-19 cases and fatalities have already occurred as a result of the pandemic, affecting over 200 nations [2] . The need for the COVID-19 vaccine has become critical in every area [3] . COVID-19 vaccination is a cost-effective and reliable public health intervention for averting the catastrophic outcomes of COVID-19 infection [4] . It is an effective preventive measure to provide direct immunity for vaccinated individuals and herd immunity for non-vaccinated individuals which is thought to be between 55% and 82% [5,6] . The successful vaccination program relies on the uptake rates among the general population. Vaccine hesitancy refers to a delay in taking or refusing safe immunizations, even in the availability of vaccine services [7] . Hesitancy to get the COVID-19 vaccination can be caused by a variety of factors, including concerns about the vaccine's dangers and adverse effects, as well as ignorance of its efficacy and safety, the influence of religious beliefs, and exposure to false information that spreads online via social media. [7,8] . Additionally, there exists a wide range of attitudes and views, such as purposeful postponement of vaccination and vaccine refusal. COVID-19 vaccination hesitancy has been identified among healthcare workers (HCWs) who are important for vaccination advocacy, in many countries [10]. Since COVID-19's introduction, teaching about the virus and its related vaccine has not been included in the healthcare curriculum. [11]. Healthcare students, particularly nursing students who are not certified vaccinators, have expressed feeling unprepared to advise patients and the public on the COVID-19 vaccine or to respond to inquiries regarding its significance, efficacy, and safety.[12]. The most important strategy for Boosting nursing students' trust in the COVID-19 vaccination involves a multifaceted strategy [13]. Online education is one of the modalities today that has been popularized by the occurrence of the worldwide pandemic coronavirus [12]. The COVID-19 epidemic has led to a notable surge in the utilization of language applications, virtual education, video conferencing equipment, and online educational software.[14]. Virtual education is important to better equip nursing students’ information from reliable sources, identify adoption obstacles, and clear up misunderstandings regarding the COVID-19 vaccine [15]. The benefits of virtual education entail catering to different teaching styles, self-pacing, flexibility, and cutting expenses associated with time, travel, and the availability of trainers. [11].In this regard, the current study was conducted to evaluate the effect of virtual educational sessions on nursing students’ knowledge, attitude and hesitancy regarding COVID-19 vaccination. Significance of the study From March to May 2022, Egypt's Ministry of Health and Population (MoHP) carried out a countrywide community-based survey to ascertain the COVID-19 vaccine coverage and people's views toward immunization. According to the survey, Egypt's vaccination rates fell short of the 70% WHO target [16]. Only 31.5% of the 1,053 participants in another study [17] from six governorates in Egypt accepted the vaccination and are prepared to take it when it is available, while the remaining participants either hesitated or rejected with almost 20 million nurses globally, the nursing profession is the largest in the healthcare industry [18]. Nurses are seen as reliable providers of health data, and their increased exposure to illnesses contracted in a medical setting raises questions about their understanding of and perspectives on the COVID-19 vaccination. Additionally, nursing students were instrumental in the COVID-19 immunization efforts [19]. Because nursing students' attitudes and understanding of the COVID-19 vaccination impact those of other people, it is imperative to improve these aspects [20]. Every attempt should be made to encourage Egyptians to get vaccines and to feel confident about them. Thus, research for this study was done. Aim of the study The current study aimed to evaluate the effect of implementing virtual educational sessions on nursing students’ knowledge, attitude and hesitancy regarding COVID-19 vaccination. ‎ Research hypotheses: H1: Implementing virtual educational sessions improve nursing students’ knowledge regarding COVID-19 vaccination. H2: Implementing virtual educational sessions have a positive effect on nursing students’ attitude regarding COVID-19 vaccination. H3: Implementing virtual educational sessions decrease nursing students’ hesitancy level regarding COVID-19 vaccination. Method and subjects Study design The researchers followed a quasi-experimental research design (one group pre and posttest) to conduct the current study. In this design a single group of research participants is pretested, independent variable manipulated, and then post-tested without random assignment [21]. The Trend Checklist for non-randomized trials was followed in this research. Setting: The current study was carried out at Mansoura University's Faculty of Nursing, located in Mansoura city, Egypt. The faculty comprises four floors, each serving a different purpose. There appear to be two amphitheaters on the bottom floor, along with offices for student affairs, an activities area for student welfare, and other administrative spaces. There is an amphitheater, two computer labs, and a meeting room on the first floor. The faculty dean's and vice dean's offices, two exam control rooms, a digital library, a book library, a quality and accreditation unit, and a public health unit are all located on the second level. It appears that the vice dean for student affairs' office, the postgraduate affairs office, and nursing skill labs are located on the third level. Lastly, the vice dean of postgraduate studies' office, academic staff offices, and two language laboratories make up the fourth level. Participants: Three hundred and fifty undergraduate nursing students who were currently registered in 4 academic levels at the Faculty of Nursing - Mansoura University were enrolled in the current study. Sampling size and Sampling technique: The undergraduate nursing students from every academic level were selected by the researchers using a convenience sample technique. First and second-academic-level students were recruited from the Medical/ Surgical Nursing Department, third-academic-level students were recruited from Woman’s Health and Midwifery Department while fourth-academic level students were recruited from Community Health Nursing Department. The sample size was determined using the Steve Thompson formula, with a 5% ∞ error (95.0% significance) and a 20.0 β error (80.0% research power). Z is the matching standard class of significance, where n is the sample size, N is the total society size (3970 students), P = percentage of character and objectivity availability = (0.5), d = error percentage = 0.d d = error percentage = 1.96. 350 students were determined to be the sample size. Table (I): Distribution of the selected undergraduate nursing students from each academic level Study tool: A self-administrative structured questionnaire. The researchers distributed this tool virtually in a Google form; It was divided into the following four parts: Part 1: Demographic characteristics. It was produced by the researchers and included six items; age, sex, residence, cellphone number, and academic email and level [23]. Part 2: Knowledge regarding COVID-19 vaccination. It was developed by the researchers. Knowledge questions classified into 9 categories with total number of 42 items; mechanism of action (n=4), importance (n=2), main types (n=3), eligible population (n=9), common side effects (n=9), helpful tips to relieve common side effects (n=4) and serious adverse events (n=5) of COVID-19 vaccination, required measure before getting COVID-19 vaccination (n=4) and time to call the doctor after COVID-19 vaccination (n=2). Scoring system: Every right response received a score of one, while incorrect and unclear responses received a score of zero. The total scores for the students’ knowledge were calculated by summing all knowledge items scores which ranged from 0 to 42 marks. Overall greater scores indicated a better knowledge about COVID-19 vaccination [24, 25, 26]. Part 3: Vaccination Attitudes Examination (VAX) Scale. This scale was adapted from Martin [27]. to assess nursing students’ negative attitudes regarding COVID-19 vaccination. It consisted of 12 statements covering four subscales (1, 2, 3 = mistrust of vaccine benefit; 4, 5, 6 = worries over unforeseen future effects; 7, 8, 9 = concerns about commercial profiteering; 10, 11, 12 = preference for natural immunity). Scoring system; each statement is scored on a five-point Likert rating scale coded from 1 to 5. Each of the four subscales was grouped into three levels; low (answer 1, 2; scores from 3-6), intermediate (answer 3 or 4; scores from 7-12), or very/ high (answer 5; scores from 13-15) levels of negative attitudes towards COVID-19 vaccination. Part 4: COVID-19 Vaccine Hesitancy Scale. It’s a seven-item scale adapted from Freeman [28] to evaluate undergraduate nursing students' hesitation to get the COVID-19 vaccine. Scoring system: Response options specific to each issue, coded from 1 to 5, were employed. Additionally, there is a "Don't know" choice that is not counted toward scoring. The total scores for hesitation varied from 7 to 35, with higher scores corresponding to greater hesitancy to the COVID-19 vaccine. The total hesitancy scores were categorized into three levels; willing (answer 1 or 2; scores from 7-14), doubtful (answer 3; scores from 15-21), or strongly hesitant (answer 4 or 5; scores from 22-35) to have the COVID-19 vaccine. Validity: A panel of five experts from the Mansoura University Faculty of Nursing, with backgrounds in Medical-Surgical Nursing, Women's Health and Midwifery, and Community Health Nursing, evaluated the content validity of the developed and modified sections of the study tool based on factors such as length, overall appearance, format, wording, content, item sequence, clarity, and coverage. The third component of the study tool, the statements of mistrust on the vaccine benefit subscale of the VAX Scale, were changed from positive to negative by the researchers. In the COVID-19 Vaccine Hesitancy Scale declarations, the researchers changed a few things. The researchers made the necessary adjustments after the experts evaluated the study tool. Content reliability: The internal consistency of the study instrument was evaluated using the Cronbach's alpha coefficient test (r = 0.84, 0.99, and 0.76 for sections 2, 3, and 4, respectively). Pilot study: The researchers conducted a pilot study on 10% of the studied undergraduate students (N=35) who were excluded from the study to evaluate the study tools' clarity, feasibility and applicability, to recognize the expected obstacles which may hinder data collection. The researchers conducted a pilot study on 10% of the studied undergraduate students (N=35) who were excluded from the study to evaluate the study tools' clarity, feasibility and applicability, to recognize the expected obstacles which may hinder data collection. Procedure: Preparation of the work through: 1. Administrative approval. An approval was received to carry out the research by the researchers through the submission of an official letter from the Faculty dean to the vice dean of education and studies affairs at the Faculty of Nursing, Mansoura University. 2. Ethical considerations. The researchers obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing, Mansoura University (IRP: Ref. no. P.0518) and written informed consent from the participants. The researchers introduced themselves and explained the study’s objectives simply to the studied undergraduate nursing students. They affirmed that it was entirely optional for them to take part in the study. Confidentiality was guaranteed, and the data and answers from the students were handled anonymously and used exclusively for the study. The findings were incorporated into the essential research and used in subsequent publications. Individuals were advised that their accomplishment scores would not be impacted by their decision to quit the study whenever they want and without explanation. Study framework: The researchers collected data throughout 2 months (August and September 2021). The framework of this study was carried out throughout four phases as the following: Phase (1): Preliminary assessment phase: During the study vocation, the students attended the faculty of nursing for vaccination registration (either to confirm the vaccination appointment or to postpone for a specific reason, such as pregnancy or lactation). During registration day, the researchers had face-to-face meetings with the undergraduate nursing students. As they waited to register in the study hall, the researchers gave an overview of the goals and parameters of the ongoing investigation. Informed consent in writing, academic correspondence, phone numbers, and the consent of the participating students were obtained. The researchers created a group on What's App. A Google form included preliminary assessment data regarding students’ demographic characteristics, knowledge, attitude, and hesitancy regarding COVID-19 vaccination was sent to the group. Phase (2): Designing of the educational sessions: The researchers designed the educational sessions in the form of a printed English booklet as a simplified handout considering the preliminary assessment data and recent literature. Booklet outlines were foreground, objectives, content, and references. The booklet content was arranged in four parts; definition and types, importance and mechanism of action, eligible population, and what to expect after getting COVID-19 vaccination. The booklet content included 17 messages which supported with pictures with sharp resolution, true color, and contrast and focused on what the undergraduate nursing students need to know and do. Booklet messages were the definition and types of COVID-19 vaccination, the importance, and mechanism of action and benefits of COVID-19 vaccine, the difference between the immunity developed from getting COVID-19 infection and immunity from getting a COVID-19 vaccine, safety and effectiveness of COVID -19 vaccination, how long does protection from vaccination last? Myths and facts of vaccination, the eligible population of vaccination, what to expect when getting vaccination? Common side effects of vaccination, helpful tips to relieve common side effects of vaccination, serious and rare adverse events following vaccination, and time to call the doctor after vaccination were also included in the booklet messages. Phase (3): Implementation of the virtual educational sessions The researchers conducted two virtual educational sessions via online Microsoft Teams after a previously scheduled time suitable for undergraduate nursing students. The links were sent to the WhatsApp group. Each session included specific objectives, estimated time, and educational materials and methods. The researchers presented two parts of the study content for 2 hours meeting each session. Regarding sessions delivery, the researchers presented the content using multimodal educational methods and materials; interactive presentation, discussion, brainstorming, and booklet about COVID-19 vaccination. The researchers distributed the booklet virtually to the undergraduate nursing students, explained each point regarding COVID-19 vaccination throughout the sessions. Additionally, the booklet was sent on the WhatsApp group to be available for the students to review. Phase (4): Evaluation of the effectiveness of the virtual educational sessions: At the end of the last session and before the students attended their second appointment for vaccination, the researchers carried out the post-test as the link was sent on the WhatsApp group included the same tool used for the pre-test. Statistical analysis: Following collection, data were coded, categorized, sorted, and then moved into formats specifically created for computer feeding. The statistical program SPSS v23, which stands for Statistical Package for the Sconces, was used to conduct the statistical analysis. Descriptive statistics were used to show the data as percentages and frequencies. For continuous variables, the arithmetic mean ± standard deviation and median were employed, whereas percentages were utilized for categorical variables. To compute changes over time for qualitative variables, Monte Carlo (MC) tests and chi-square (X2) of association were employed. For quantitative variables, the Wilcoxon Sign Ranked Test and the Paired T-test were utilized to compare two paired individuals within a single group. T-test in pairs for variables with normally distributed data. For variables whose data deviated from a normal distribution, the Wilcoxon-Signed Ranks test was employed. To determine if there was a positive or negative correlation between two quantitative variables, the Pearson correlation coefficient test was utilized. If P was more than 0.05, the final results were deemed not significant and significant if P< = 0.05. Results Table 2. Reveals that 52 % of the studied undergraduate nursing students aged from 18 to less than 20 years, 68.9% of them were females and 69.4% of them lived in urban area. Graph 1. shows that 66% of the studied undergraduate nursing students got information through social media (Facebook, Instagram, and WhatsApp), followed by news from national TV/ Radio (48.9%). While discussion among friends and family, was the least source of information among 3.7% of the studied undergraduate nursing students. Table 3. presents that the mean of total correct knowledge scores was 13.82(5.08) pre implementation of the virtual educational sessions which increased to 35.59(2.62) post implementation of the virtual educational sessions. The difference was significant in the total knowledge scores of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p≤ 0.05). Table 4. indicates that regarding mistrust of COVID-19 vaccine benefit, 62% of the studied undergraduate nursing students agreed that they felt unsafe after being vaccinated pre implementation of the virtual educational sessions which decreased to only 8.6% post implementation of the virtual educational sessions. Concerning concerns about unanticipated long-term effects of the COVID-19 vaccine, 74.3% them agreed that COVID-19 vaccine can cause unforeseen problems in children pre implementation of the virtual educational sessions which decreased to 20.3% post implementation of the virtual educational sessions. Relating concerns about commercial profiteering pre-implementation of the virtual educational sessions, 40% of the studied undergraduate nursing students agreed that COVID-19 vaccine programs are a big con which decreased to 5.4% post-implementation of the virtual educational sessions. Pre implementation of the virtual educational sessions, the results displays as regards to preference for natural immunity, 34.9% of them concurred that exposure to viruses and bacteria naturally provides the best defense and that exposure to illnesses naturally is better for the immune system than exposure to the COVID-19 vaccination. This decreased to 1.7% and 2.6% post-implementation of the virtual educational sessions respectively. There was statistically significant differences in all items of the adapted VAX Scale results of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p<0.05). Graph 2. Illustrates low negative attitude regarding mistrust of vaccine benefit, worries over unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity pre-implementation of the virtual educational sessions were 13.4%, 9.1%, 26.3%, and 39.7% among of the studied undergraduate nursing students respectively. These increased to 93%, 72.9%, 90%, and 89.1% of them post-implementation of the virtual educational sessions respectively. There were statistically significant differences in all subscales of the adapted VAX Scale results of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p<0.05). Table 5. illustrates that 91.7% of the studied undergraduate nursing students showed an intermediate negative attitude scoring level regarding COVID-19 vaccination with a mean of 36.38±7.03 pre-implementation of the virtual educational sessions. While post implementation of the virtual educational sessions, only 9.4% of them showed an intermediate negative attitude scoring level with mean 17.6±5.13. There was a statistically significant difference in the total negative attitudes scores of the studied undergraduate nursing students between pre and post-implementation of the virtual educational sessions (p<0.05). Table 6. shows that 11.4% of the studied undergraduate nursing students would definitely take the approved COVID-19 vaccine if offered and if it was available at their local clinic as soon as possible pre-implementation of the virtual educational sessions compared to 54.3% and 55.1% post-implementation of the virtual educational sessions respectively. Pre-implementation of the virtual educational sessions, 11.1% of them would get the available COVID-19 vaccine as soon as possible and had a very keen attitude to receive the COVID-19 vaccine while post-implementation of the virtual educational sessions increased to 54% and 54.3% respectively. The results conveys that 12.3% of the studied undergraduate nursing students would strongly encourage their families or friends if they were thinking of getting COVID-19 vaccine and were eager to get a COVID-19 vaccine pre implementation of the virtual educational sessions compared to 55.1% post implementation of the virtual educational sessions. Moreover, 14.3% of them reported that taking a COVID-19 vaccine is really important pre implementation of the virtual educational sessions which increased to 57.1% post implementation of the virtual educational sessions. The results explain that, there was statistically significant differences in all items of the adapted Oxford COVID-19 vaccine hesitancy scale results between pre and post implementation of the virtual educational sessions (p<0.05). Graph 3. conveys that 51.1%, 34.3%, and 14.6% of the studied undergraduate nursing students were willing, doubtful, and strongly hesitant to have the COVID-19 vaccine pre-implementation of the virtual educational sessions respectively. While post implementation of the virtual educational sessions, they improved to 85.4%, 11.4%, and 3.2% respectively. Overall, there was a statistically significant difference in the COVID-19 hesitancy scoring level between pre and post-implementation of the virtual educational sessions (p<0.05). Table 7. Portrays that there were intermediate and weak negative correlations between total COVID-19 vaccination knowledge and hesitancy scores of the studied undergraduate nursing students pre and post-implementation of the virtual educational sessions (P = 0.000 and r = -0.682) and (P = 0.001 and r = -0.173) respectively. Furthermore, there were intermediate and weak positive correlations between total COVID-19 vaccination negative attitudes and hesitancy scores of the studied undergraduate nursing students pre and post-implementation of the virtual educational sessions (P = 0.000 and r = 0.381) and (P = 0.044 and r = 0.108) respectively. Discussion Nursing students, among other future healthcare professionals, are the most trustworthy source of knowledge regarding the Covid-19 vaccination. Furthermore, vaccination uptake by the general public would rise if nursing students accepted the vaccine. They are essential to the public's immunization program. [ 29 ] . Thus, the aim of the current study was to assess the effect of implementing virtual educational sessions on nursing students’ knowledge, attitude and hesitancy regarding COVID-19 vaccination.‎ The studied undergraduate nursing students had low total knowledge scores regarding COVID-19 vaccination with a mean of 13.82(5.08) pre-implementation of the virtual educational sessions in that study. This matched with the results of the electronic survey toward COVID-19 vaccines among nursing students which concluded that one fifth only of them have good knowledge levels [ 30 ] . Low knowledge scores may be due to the novelty of COVID-19 vaccination and the conduction of this study immediately after vaccination drives began in Egypt. Post implementation of the virtual educational sessions, the present study findings revealed statistical significant improvement in the total knowledge scores regarding COVID-19 vaccination with a mean 35.59(2.62). This is consistent with the findings of a researcher's investigation [ 31 ] This shows that, following the implementation of the educational intervention, the investigated sample's overall level of knowledge had significantly improved. In the current study, two-thirds of the studied undergraduate nursing students got information regarding COVID-19 vaccination through social media (Facebook, Instagram, and WhatsApp). Although many such information resources provide easy and accessible ways of getting information, they can also present COVID-19 vaccination myths and misconceptions about its safety and efficacy which postpone vaccination programs [ 32 , 33 ] . This is consistent with the findings of the present study as the majority of the studied undergraduate nursing students showed an intermediate negative attitude concerning COVID-19 vaccination pre-implementation of the virtual educational sessions. High percentages of them had concerns regarding all subscales of the adapted VAX Scale; vaccine benefits, future effects, commercial profiteering, and immunity. This is supported by Saied [ 34 ] who said that the majority of students were worried about the vaccine's side effects and safety as well as how COVID-19 could spread through the shot. . The present study finding revealed that there was a statistically significant difference in the undergraduate nursing students' total negative attitude after the implementation of virtual educational sessions than before. This is consistent with the findings of a study done by researchers [ 35 ], which showed that participants' views significantly improved after the COVID-19 instructional bag was implemented compared to before. The study conducted by Jiang [ 36 ] indicated that nursing students' professional backgrounds and level of awareness of the COVID-19 vaccine's requirement made them more likely to receive a vaccination. This is in contrast with the latest study's findings as around half of the studied undergraduate nursing students hesitated (34.3% doubtful and 14.6% strongly hesitated) regarding COVID-19 vaccination pre-implementation of the virtual educational sessions; Whereas only 11.1% of them would get the available COVID-19 vaccine as soon as possible and 41.7% of them would get it when they have time. This is supported by the conclusion of the cross-sectional descriptive [ 37 ] concluded that nursing students were largely resistant to the COVID-19 vaccination. Because they have a bad attitude about getting vaccinated, the undergraduate nursing students under study exhibit a refusal to obtain vaccinations. This is confirmed by Jiang's study's findings [ 36 ] Hesitancy to get vaccinated was one of the top 10 challenges to the success of the vaccination drive and consequently global health. For effective vaccination, the majority of people must accept and use vaccines [ 37 , 38 ] . Implementation of the intended virtual educational sessions improved COVID-19 vaccination acceptability among the studied undergraduate nursing students as only 14.6% of them were hesitated while 85.4% of them were willing to be vaccinated. The current study portrayed that Covid-19 vaccination hesitancy resulted from a lack of knowledge and negative attitudes among the studied undergraduate nursing student’s pre-implementation of the virtual educational sessions. In this regard, there is a need to implement educational sessions to increase nursing students’ awareness of COVID-19 vaccination. Most of the public universities during the COVID crisis struggled with the sudden need for virtual education after the lockdown in the Middle East region. Students and educators perceived many benefits of virtual education. Students admire the conveniences of education from home because it is more comfortable and does not involve travel [ 40 ] . In the other hand, the virtual education aids teachers in conveying information to students in order to increase their understanding and facilitates the rapid and easy sending of communications [ 41 ] . The current virtual education sessions was effective in the improvement of COVID-19 vaccination knowledge, attitude, and acceptance among the studied undergraduate nursing students. Effectiveness of the current virtual education sessions is due to usage of multimodal educational methods and materials during the delivery of the sessions. And the simplicity of the informative booklet which was delivered based on the preliminary assessment data. This is supported by a researcher [ 41 ] . who stated that multimedia usage creates interactive learning activities. Moreover, the booklet designers should consider the readers’ knowledge and needs which may be quite different from the designer's own. For individuals who have access to the right technology, virtual education can be far more successful [ 42 ] . In this study, the researchers conducted two virtual educational sessions to present 17 messages regarding Covid-19 vaccination via online Microsoft Teams for undergraduate nursing students. The links were sent to the WhatsApp group. Conclusion The current study findings concluded that about half of the studied undergraduate nursing students were hesitant toward COVID-19 vaccination due to the low mean of total correct knowledge scores and intermediate negative attitudes scoring level. The studied undergraduate nursing students had significant improvement in COVID-19 vaccination knowledge, attitude, and hesitancy post-implementation of the virtual educational sessions. Recommendations: Integration of the virtual educational sessions regarding COVID-19 vaccination into the curricula of educational nursing institutions. Dissemination of the designed booklet about COVID-19 vaccination among undergraduate nursing students. Declarations Acknowledgments: The researchers would like to express their sincere gratitude and appreciation to all authorities in the Faculty of Nursing, Mansoura University, and the undergraduate nursing students for their support, voluntary participation, and cooperation in conducting the study. Funding Nothing to report regarding funding. Conflicts of interest The authors declare that they have no conflict of interest. Clinical trial number : not applicable References WHO Coronavirus (COVID-19) Dashboard. [Cited 7 Apr 2021]. Available: https://covid19.who.int. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020; 91(1):157-160. Centers for Disease Control and Prevention. Vaccine safety and monitoring. 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html Trogen B, Pirofski LA. Understanding vaccine hesitancy in COVID-19. 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New vaccine production platforms used in developing SARS-CoV-2 vaccine candidates. Vaccine. 2021 Jan 08; 39(2):197-201. Subbarao K. The success of SARS-CoV-2 vaccines and challenges ahead. Cell Host Microbe. 2021; 29(7):1111-1123. doi:10.1016/j.chom.2021.06.016 Mullard A. COVID-19 vaccine development pipeline gears up. Lancet. 2020; 395(10239):1751-1752. doi:10.1016/S0140-6736(20)31252-6 Martin LR, Petrie KJ. Understanding the Dimensions of Anti-Vaccination Attitudes: the Vaccination Attitudes Examination (VAX) Scale. Ann Behav Med. 2017;51(5):652-660. doi:10.1007/s12160-017-9888-y Freeman D, Loe BS, Chadwick A, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022; 52(14):3127-3141. doi:10.1017/S0033291720005188 Li M, Luo Y, Watson R, et al. Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review. Postgrad Med J. 2023;99(1172):520-528. doi:10.1136/postgradmedj-2021-140195 Abd El Fatah WO, El-borie HO, & Elsayed EE. Electronic Survey for Knowledge, Attitude, and Practice toward COVID-19 Vaccines among Nursing Students. Egyptian Journal of Nursing and Health Sciences.2022; 3(2), 162-185. ‏ Mohamed NA, Mohamed HA, & Hafez SH. Nursing Educational Intervention to Control COVID-19 Vaccine Hesitancy among School Team Members at Beni-Suef City and Benha City, Egypt. Tanta Scientific Nursing Journal.2021; 23(4), 174-192. ‏ Callaghan T, Motta M, Sylvester S, Lunz Trujillo K, Blackburn CC. Parent psychology and the decision to delay childhood vaccination. Social Science & Medicine. 2019; 238. Nossier SA. Vaccine hesitancy: the greatest threat to COVID-19 vaccination programs. J Egypt Public Health Assoc. 2021; 96(1):18. Published 2021 Jul 5. doi:10.1186/s42506-021-00081-2 Saied SM, Saied EM, Kabbash IA, Abdo SAE. Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J Med Virol. 2021; 93(7):4280-4291. doi:10.1002/jmv.26910 Ibrahim Elemam Elashri N, Ahmed Mohammed Elfadawy H, & Refaat Alam R. Effect of COVID-19 Educational Bag on Knowledge, Attitude and Precautionary Practices of Institutionalized Elderly Persons. Egyptian Journal of Health Care.2021; 12(2), 176-194. ‏ Jiang N, Wei B, Lin H, Wang Y, Chai S, Liu W. Nursing students' attitudes, knowledge and willingness of to receive the coronavirus disease vaccine: A cross-sectional study. Nurse Educ Pract. 2021; 55:103148. doi:10.1016/j.nepr.2021.103148 Kim S, Lee J, Yang H, Kim H. Acceptance of and hesitancy about COVID-19 vaccination among nursing students in clinical practice. PLoS One. 2023;18(7):e0286640. Published 2023 Jul 26. doi:10.1371/journal.pone.0286640 Galagali PM, Kinikar AA, Kumar VS. Vaccine Hesitancy: Obstacles and Challenges. Curr Pediatr Rep. 2022; 10(4):241-248. doi:10.1007/s40124-022-00278-9 Ashour HA, Alhinti SF, Hawsaoi SA, Alsuwailem AA, AlFarhan A, Abdulmajeed I. Knowledge, Attitude, and Practice (KAP) of COVID-19 Vaccine Among Saudi Mothers. Cureus. 2023; 15(3):e36826. Published 2023 Mar 28. doi:10.7759/cureus.36826 Mortagy M, Abdelhameed A, Sexton P, et al. Online medical education in Egypt during the COVID-19 pandemic: a nationwide assessment of medical students' usage and perceptions. BMC Med Educ. 2022; 22(1):218. Published 2022 Mar 30. doi:10.1186/s12909-022-03249-2 Amer H & Ouhida A. Online learning on students during the COVID‐19 pandemic. Clin Med Rev Case Rep.2022; 9, 412. ‏ Abdulrahaman MD, Faruk N, Oloyede AA, et al. Multimedia tools in the teaching and learning processes: A systematic review. Heliyon. 2020;6(11):e05312. Published 2020 Nov 2. doi:10.1016/j.heliyon.2020.e05312 Suresh M, Vishnu Priya V, & Gayathri R. Effect of e-learning on academic performance of undergraduate students. Drug Invention Today. 2018; 10(9). ‏ Tables Tables 1 to 7 are available in the Supplementary Files section Graphs Graphs 1-3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.doc Graphs.doc Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5044444","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":359430577,"identity":"47544803-7464-4e07-a1f8-2b7ba55fc775","order_by":0,"name":"Eman Fadel","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"","lastName":"Fadel","suffix":""},{"id":359430578,"identity":"c92f2ce9-9e89-4e01-aa68-b270fb203b1b","order_by":1,"name":"Eman Alshawish","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYDACdgY2ICnBYMDeAKIOADkJBLQww7TwHCBNCwODgQRYJRFa+JvZnz342WZhby759uAHi5o7DPzsOQZ4tUgc5jE37G2TSNw5Oy9ZQuLYMwbJnjf4tTAc5mGT4N0mkWBwO8dAQoLtMIPBDQK2yB9mfyb5d5uEvcHNM8Y/JP4dZrAnpMXgMIOZNNAWxg03eMwkJNuAtkgQ0GJ4mMdMWvafROKGMzlmFpJ9h3kkzjwrwKtF7nj7M8k3Z+rsDY6fMb4t8e2wHH978ga8WlAAswQDAw/xykGA8QNp6kfBKBgFo2CEAADmgETbeQvJxgAAAABJRU5ErkJggg==","orcid":"","institution":"An-Najah National University","correspondingAuthor":true,"prefix":"","firstName":"Eman","middleName":"","lastName":"Alshawish","suffix":""},{"id":359430579,"identity":"2e8cfc39-a0d9-4908-861e-5e5229bc39af","order_by":2,"name":"Rasha El-Shaboury","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Rasha","middleName":"","lastName":"El-Shaboury","suffix":""},{"id":359430580,"identity":"44224b49-ed3a-4198-834a-0a095aa1b3fa","order_by":3,"name":"Dalia Khalil","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Dalia","middleName":"","lastName":"Khalil","suffix":""},{"id":359430581,"identity":"36bf69eb-627b-4d75-b7a8-0289e6ab7160","order_by":4,"name":"Fatma Zaghloul","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"","lastName":"Zaghloul","suffix":""},{"id":359430582,"identity":"9e52553d-f7e0-4bec-bf7e-434ada74a035","order_by":5,"name":"Nagwa Ibrahim EL-Feshawy","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Nagwa","middleName":"Ibrahim","lastName":"EL-Feshawy","suffix":""}],"badges":[],"createdAt":"2024-09-06 13:03:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5044444/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5044444/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66314253,"identity":"bd84edfb-0239-4866-84a0-17c2c8acdfbf","added_by":"auto","created_at":"2024-10-10 09:33:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":472951,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5044444/v1/cfded743-386b-4845-9cb0-82f3e5d792f6.pdf"},{"id":66313542,"identity":"d53d558a-ac37-4c1d-a7cd-3144b5d10ae5","added_by":"auto","created_at":"2024-10-10 09:17:42","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":235008,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.doc","url":"https://assets-eu.researchsquare.com/files/rs-5044444/v1/bd704f22df83b8f8653854ff.doc"},{"id":66313543,"identity":"e38ff203-02a7-4934-bc15-122fbc5bda51","added_by":"auto","created_at":"2024-10-10 09:17:42","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14106112,"visible":true,"origin":"","legend":"","description":"","filename":"Graphs.doc","url":"https://assets-eu.researchsquare.com/files/rs-5044444/v1/7dc9a88f5eecc9b1be324f2e.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Implementing Virtual Educational Sessions on Nursing Students’ Knowledge, Attitude and Hesitancy Regarding COVID-19 Vaccination","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) classified COVID-19 as a pandemic in March 2020\u0026nbsp;\u003csup\u003e[1]\u003c/sup\u003e.\u0026nbsp;Millions of COVID-19 cases and fatalities have already occurred as a result of the pandemic, affecting over 200 nations\u0026nbsp;\u003csup\u003e[2]\u003c/sup\u003e.\u0026nbsp;The need for the COVID-19 vaccine has become critical in every area\u0026nbsp;\u003csup\u003e[3]\u003c/sup\u003e. COVID-19 vaccination is a cost-effective and reliable public health intervention for averting the catastrophic outcomes of COVID-19 infection\u0026nbsp;\u003csup\u003e[4]\u003c/sup\u003e. It is an effective preventive measure to provide direct immunity for vaccinated individuals and herd immunity for non-vaccinated individuals which is thought to be between 55% and 82%\u0026nbsp;\u003csup\u003e[5,6]\u003c/sup\u003e. The successful vaccination program relies on the uptake rates among the general population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVaccine hesitancy refers to a delay in taking or refusing safe immunizations, even in the availability of vaccine services\u003csup\u003e\u0026nbsp;[7]\u003c/sup\u003e. Hesitancy to get the COVID-19 vaccination can be caused by a variety of factors, including concerns about the vaccine's dangers and adverse effects, as well as ignorance of its efficacy and safety, the influence of religious beliefs, and exposure to false information that spreads online via social media.\u0026nbsp;\u003csup\u003e\u0026nbsp;[7,8]\u003c/sup\u003e. Additionally, there exists a wide range of attitudes and views, such as purposeful postponement of vaccination and vaccine refusal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOVID-19 vaccination hesitancy has been identified among healthcare workers (HCWs) who are important for vaccination advocacy, in many countries [10]. Since COVID-19's introduction, teaching about the virus and its related vaccine has not been included in the healthcare curriculum. [11]. Healthcare students, particularly nursing students who are not certified vaccinators, have expressed feeling unprepared to advise patients and the public on the COVID-19 vaccine or to respond to inquiries regarding its significance, efficacy, and safety.[12].\u003c/p\u003e\n\u003cp\u003eThe most important strategy for Boosting nursing students' trust in the COVID-19 vaccination involves a multifaceted strategy [13]. Online education is one of the modalities today that has been popularized by the occurrence of the worldwide pandemic coronavirus [12]. The COVID-19 epidemic has led to a notable surge in the utilization of language applications, virtual education, video conferencing equipment, and online educational software.[14].\u003c/p\u003e\n\u003cp\u003eVirtual education is important to better equip nursing students’ information from reliable sources, identify adoption obstacles, and clear up misunderstandings regarding the COVID-19 vaccine [15]. The benefits of virtual education entail catering to different teaching styles, self-pacing, flexibility, and cutting expenses associated with time, travel, and the availability of trainers. [11].In this regard, the current study was conducted to evaluate the effect of virtual educational sessions on nursing students’ knowledge, attitude and hesitancy regarding COVID-19 vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSignificance of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom March to May 2022, Egypt's Ministry of Health and Population (MoHP) carried out a countrywide community-based survey to ascertain the COVID-19 vaccine coverage and people's views toward immunization. According to the survey, Egypt's vaccination rates fell short of the 70% WHO target [16]. Only 31.5% of the 1,053 participants in another study [17] from six governorates in Egypt accepted the vaccination and are prepared to take it when it is available, while the remaining participants either hesitated or rejected with almost 20 million nurses globally, the nursing profession is the largest in the healthcare industry [18].\u003c/p\u003e\n\u003cp\u003eNurses are seen as reliable providers of health data, and their increased exposure to illnesses contracted in a medical setting raises questions about their understanding of and perspectives on the COVID-19 vaccination. Additionally, nursing students were instrumental in the COVID-19 immunization efforts [19]. Because nursing students' attitudes and understanding of the COVID-19 vaccination impact those of other people, it is imperative to improve these aspects [20]. Every attempt should be made to encourage Egyptians to get vaccines and to feel confident about them. Thus, research for this study was done.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study aimed to evaluate the effect of implementing virtual educational sessions on nursing students’ knowledge, attitude and hesitancy regarding COVID-19 vaccination. ‎\u003c/p\u003e\n\u003cp\u003eResearch hypotheses:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH1:\u003c/strong\u003e Implementing virtual educational sessions improve nursing students’ knowledge regarding COVID-19 vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH2:\u003c/strong\u003e Implementing virtual educational sessions have a positive effect on nursing students’ attitude regarding COVID-19 vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH3:\u003c/strong\u003e Implementing virtual educational sessions decrease nursing students’ hesitancy level regarding COVID-19 vaccination.\u003c/p\u003e"},{"header":"Method and subjects ","content":"\u003cp\u003eStudy design\u003c/p\u003e\n\u003cp\u003eThe researchers followed a quasi-experimental research design (one group pre and posttest) to conduct the current study. In this design a single group of research participants is pretested, independent variable manipulated, and then post-tested without random assignment [21]. The Trend Checklist for non-randomized trials was followed in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study was carried out at Mansoura University\u0026apos;s Faculty of Nursing, located in Mansoura city, Egypt. The faculty comprises four floors, each serving a different purpose. There appear to be two amphitheaters on the bottom floor, along with offices for student affairs, an activities area for student welfare, and other administrative spaces. There is an amphitheater, two computer labs, and a meeting room on the first floor. The faculty dean\u0026apos;s and vice dean\u0026apos;s offices, two exam control rooms, a digital library, a book library, a quality and accreditation unit, and a public health unit are all located on the second level. It appears that the vice dean for student affairs\u0026apos; office, the postgraduate affairs office, and nursing skill labs are located on the third level. Lastly, the vice dean of postgraduate studies\u0026apos; office, academic staff offices, and two language laboratories make up the fourth level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree hundred and fifty undergraduate nursing students who were currently registered in 4 academic levels at the Faculty of Nursing - Mansoura University were enrolled in the current study.\u003c/p\u003e\n\u003cp\u003eSampling size and Sampling technique:\u003c/p\u003e\n\u003cp\u003eThe undergraduate nursing students from every academic level were selected by the researchers using a convenience sample technique. First and second-academic-level students were recruited from the Medical/ Surgical Nursing Department, third-academic-level students were recruited from Woman\u0026rsquo;s Health and Midwifery Department while fourth-academic level students were recruited from Community Health Nursing Department.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sample size was determined using the Steve Thompson formula, with a 5% \u0026infin; error (95.0% significance) and a 20.0 \u0026beta; error (80.0% research power).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eZ is the matching standard class of significance, where n is the sample size, N is the total society size (3970 students), P = percentage of character and objectivity availability = (0.5), d = error percentage = 0.d d = error percentage = 1.96. 350 students were determined to be the sample size.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (I): Distribution of the selected undergraduate nursing students from each academic level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eStudy tool:\u003c/strong\u003e A self-administrative structured questionnaire. The researchers distributed this tool virtually in a Google form; It was divided into the following four parts:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 1:\u003c/strong\u003e Demographic characteristics. It was produced by the researchers and included six items; age, sex, residence, cellphone number, and academic email and level [23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 2:\u003c/strong\u003e Knowledge regarding COVID-19 vaccination. It was developed by the researchers. Knowledge questions classified into 9 categories with total number of 42 items; mechanism of action (n=4), importance (n=2), main types (n=3), eligible population (n=9), common side effects (n=9), helpful tips to relieve common side effects (n=4) and serious adverse events (n=5) of COVID-19 vaccination, required measure before getting COVID-19 vaccination (n=4) and time to call the doctor after COVID-19 vaccination (n=2).\u003c/p\u003e\n\u003cp\u003eScoring system: Every right response received a score of one, while incorrect and unclear responses received a score of zero. The total scores for the students\u0026rsquo; knowledge were calculated by summing all knowledge items scores which ranged from 0 to 42 marks. Overall greater scores indicated a better knowledge about COVID-19 vaccination [24, 25, 26].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 3:\u003c/strong\u003e Vaccination Attitudes Examination (VAX) Scale. This scale was adapted from Martin [27]. to assess nursing students\u0026rsquo; negative attitudes regarding COVID-19 vaccination. It consisted of 12 statements covering four subscales (1, 2, 3 = mistrust of vaccine benefit; 4, 5, 6 = worries over unforeseen future effects; 7, 8, 9 = concerns about commercial profiteering; 10, 11, 12 = preference for natural immunity).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScoring system; each statement is scored on a five-point Likert rating scale coded from 1 to 5. Each of the four subscales was grouped into three levels; low (answer 1, 2; scores from 3-6), intermediate (answer 3 or 4; scores from 7-12), or very/ high (answer 5; scores from 13-15) levels of negative attitudes towards COVID-19 vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 4:\u003c/strong\u003e COVID-19 Vaccine Hesitancy Scale. It\u0026rsquo;s a seven-item scale adapted from Freeman [28] to evaluate undergraduate nursing students\u0026apos; hesitation to get the COVID-19 vaccine. Scoring system: Response options specific to each issue, coded from 1 to 5, were employed. Additionally, there is a \u0026quot;Don\u0026apos;t know\u0026quot; choice that is not counted toward scoring. The total scores for hesitation varied from 7 to 35, with higher scores corresponding to greater hesitancy to the COVID-19 vaccine. The total hesitancy scores were categorized into three levels; willing (answer 1 or 2; scores from 7-14), doubtful (answer 3; scores from 15-21), or strongly hesitant (answer 4 or 5; scores from 22-35) to have the COVID-19 vaccine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA panel of five experts from the Mansoura University Faculty of Nursing, with backgrounds in Medical-Surgical Nursing, Women\u0026apos;s Health and Midwifery, and Community Health Nursing, evaluated the content validity of the developed and modified sections of the study tool based on factors such as length, overall appearance, format, wording, content, item sequence, clarity, and coverage. The third component of the study tool, the statements of mistrust on the vaccine benefit subscale of the VAX Scale, were changed from positive to negative by the researchers. In the COVID-19 Vaccine Hesitancy Scale declarations, the researchers changed a few things. The researchers made the necessary adjustments after the experts evaluated the study tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent reliability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe internal consistency of the study instrument was evaluated using the Cronbach\u0026apos;s alpha coefficient test (r = 0.84, 0.99, and 0.76 for sections 2, 3, and 4, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePilot study:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers conducted a pilot study on 10% of the studied undergraduate students (N=35) who were excluded from the study to evaluate the study tools\u0026apos; clarity, feasibility and applicability, to recognize the expected obstacles which may hinder data collection. The researchers conducted a pilot study on 10% of the studied undergraduate students (N=35) who were excluded from the study to evaluate the study tools\u0026apos; clarity, feasibility and applicability, to recognize the expected obstacles which may hinder data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreparation of the work through:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Administrative approval. An approval was received to carry out the research by the researchers through the submission of an official letter from the Faculty dean to the vice dean of education and studies affairs at the Faculty of Nursing, Mansoura University.\u003c/p\u003e\n\u003cp\u003e2. Ethical considerations. The researchers obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing, Mansoura University (IRP: \u0026nbsp;Ref. no. P.0518) and written informed consent from the participants. The researchers introduced themselves and explained the study\u0026rsquo;s objectives simply to the studied undergraduate nursing students. They affirmed that it was entirely optional for them to take part in the study. Confidentiality was guaranteed, and the data and answers from the students were handled anonymously and used exclusively for the study. The findings were incorporated into the essential research and used in subsequent publications. Individuals were advised that their accomplishment scores would not be impacted by their decision to quit the study whenever they want and without explanation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy framework:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers collected data throughout 2 months (August and September 2021). The framework of this study was carried out throughout four phases as the following:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase (1):\u003c/strong\u003e Preliminary assessment phase: During the study vocation, the students attended the faculty of nursing for vaccination registration (either to confirm the vaccination appointment or to postpone for a specific reason, such as pregnancy or lactation). During registration day, the researchers had face-to-face meetings with the undergraduate nursing students. As they waited to register in the study hall, the researchers gave an overview of the goals and parameters of the ongoing investigation. Informed consent in writing, academic correspondence, phone numbers, and the consent of the participating students were obtained. The researchers created a group on What\u0026apos;s App. A Google form included preliminary assessment data regarding students\u0026rsquo; demographic characteristics, knowledge, attitude, and hesitancy regarding COVID-19 vaccination was sent to the group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase (2):\u003c/strong\u003e Designing of the educational sessions: The researchers designed the educational sessions in the form of a printed English booklet as a simplified handout considering the preliminary assessment data and recent literature. Booklet outlines were foreground, objectives, content, and references. The booklet content was arranged in four parts; definition and types, importance and mechanism of action, eligible population, and what to expect after getting COVID-19 vaccination. The booklet content included 17 messages which supported with pictures with sharp resolution, true color, and contrast and focused on what the undergraduate nursing students need to know and do.\u003c/p\u003e\n\u003cp\u003eBooklet messages were the definition and types of COVID-19 vaccination, the importance, and mechanism of action and benefits of COVID-19 vaccine, the difference between the immunity developed from getting COVID-19 infection and immunity from getting a COVID-19 vaccine, \u0026nbsp;safety and effectiveness of COVID -19 vaccination, \u0026nbsp;how long does protection from vaccination last? Myths and facts of vaccination, the eligible population of vaccination, what to expect when getting vaccination? Common side effects of vaccination, helpful tips to relieve common side effects of vaccination, serious and rare adverse events following vaccination, and time to call the doctor after vaccination were also included in the booklet messages.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase (3):\u003c/strong\u003e Implementation of the virtual educational sessions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe researchers conducted two virtual educational sessions via online Microsoft Teams after a previously scheduled time suitable for undergraduate nursing students. The links were sent to the WhatsApp group. Each session included specific objectives, estimated time, and educational materials and methods. The researchers presented two parts of the study content for 2 hours meeting each session.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding sessions delivery, the researchers presented the content using multimodal educational methods and materials; interactive presentation, discussion, brainstorming, and booklet about COVID-19 vaccination. The researchers distributed the booklet virtually to the undergraduate nursing students, explained each point regarding COVID-19 vaccination throughout the sessions. Additionally, the booklet was sent on the WhatsApp group to be available for the students to review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase (4):\u003c/strong\u003e Evaluation of the effectiveness of the virtual educational sessions: At the end of the last session and before the students attended their second appointment for vaccination, the researchers carried out the post-test as the link was sent on the WhatsApp group included the same tool used for the pre-test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing collection, data were coded, categorized, sorted, and then moved into formats specifically created for computer feeding. The statistical program SPSS v23, which stands for Statistical Package for the Sconces, was used to conduct the statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to show the data as percentages and frequencies. For continuous variables, the arithmetic mean \u0026plusmn; standard deviation and median were employed, whereas percentages were utilized for categorical variables. To compute changes over time for qualitative variables, Monte Carlo (MC) tests and chi-square (X2) of association were employed. For quantitative variables, the Wilcoxon Sign Ranked Test and the Paired T-test were utilized to compare two paired individuals within a single group. T-test in pairs for variables with normally distributed data. For variables whose data deviated from a normal distribution, the Wilcoxon-Signed Ranks test was employed. To determine if there was a positive or negative correlation between two quantitative variables, the Pearson correlation coefficient test was utilized. If P was more than 0.05, the final results were deemed not significant and significant if P\u0026lt; = 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Reveals that \u003cspan dir=\"RTL\"\u003e52\u003c/span\u003e% of the studied undergraduate nursing students aged from 18 to less than 20 years, 68.9% of them were females and 69.4% of them lived in urban area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGraph\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eshows that 66% of the studied undergraduate nursing students got information through social media (Facebook, Instagram, and WhatsApp), followed by news from national TV/ Radio (48.9%). While discussion among friends and family, was the least source of information among 3.7% of the studied undergraduate nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003epresents that the mean of total correct knowledge scores was 13.82(5.08) pre implementation of the virtual educational sessions which increased to 35.59(2.62) post implementation of the virtual educational sessions. The difference was significant in the total knowledge scores of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p\u0026le; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eindicates that regarding mistrust of COVID-19 vaccine\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ebenefit, 62% of the studied undergraduate nursing students agreed that they felt unsafe after being vaccinated pre implementation of the virtual educational sessions which decreased to only 8.6% post implementation \u003cstrong\u003eof\u003c/strong\u003e the virtual educational sessions. Concerning concerns about unanticipated long-term effects of the COVID-19 vaccine, 74.3% them agreed that COVID-19 vaccine can cause unforeseen problems in children pre implementation of the virtual educational sessions which decreased to 20.3% post implementation of the virtual educational sessions. Relating concerns about commercial profiteering pre-implementation of the virtual educational sessions, 40% of the studied undergraduate nursing students agreed that COVID-19 vaccine programs are a big con which decreased to 5.4% post-implementation of the virtual educational sessions. Pre implementation of the virtual educational sessions, the results displays as regards to preference for natural immunity, 34.9% of them concurred that exposure to viruses and bacteria naturally provides the best defense and that exposure to illnesses naturally is better for the immune system than exposure to the COVID-19 vaccination. This decreased to 1.7% and 2.6% post-implementation of the virtual educational sessions respectively. There was statistically significant differences in all items of the adapted VAX Scale results of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGraph 2.\u0026nbsp;\u003c/strong\u003eIllustrates low negative attitude regarding mistrust of vaccine benefit, worries over unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity pre-implementation of the virtual educational sessions were 13.4%, 9.1%, 26.3%, and 39.7% among of the studied undergraduate nursing students respectively. These increased to 93%, 72.9%, 90%, and 89.1% of them post-implementation of the virtual educational sessions respectively. There were statistically significant differences in all subscales of the adapted VAX Scale results of the studied undergraduate nursing students between pre and post implementation of the virtual educational sessions (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eillustrates that 91.7% of the studied undergraduate nursing students showed an intermediate negative attitude scoring level regarding COVID-19 vaccination with a mean of 36.38\u0026plusmn;7.03 pre-implementation of the virtual educational sessions. While post implementation of the virtual educational sessions, only 9.4% of them showed an intermediate negative attitude scoring level with mean 17.6\u0026plusmn;5.13. There was a statistically significant difference in the total negative attitudes scores of the studied undergraduate nursing students between pre and post-implementation of the virtual educational sessions (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eshows that 11.4% of the studied undergraduate nursing students would definitely take the approved COVID-19 vaccine if offered and if it was available at their local clinic as soon as possible pre-implementation of the virtual educational sessions compared to 54.3% and 55.1% post-implementation of the virtual educational sessions respectively. Pre-implementation of the virtual educational sessions, 11.1% of them would get the available COVID-19 vaccine as soon as possible and had a very keen attitude to receive the COVID-19 vaccine while post-implementation of the virtual educational sessions increased to 54% and 54.3% respectively. The results conveys that 12.3% of the studied undergraduate nursing students would strongly encourage their families or friends if they were thinking of getting COVID-19 vaccine and were eager to get a COVID-19 vaccine pre implementation of the virtual educational sessions compared to 55.1% post implementation of the virtual educational sessions. Moreover, 14.3% of them reported that taking a COVID-19 vaccine is really important pre implementation of the virtual educational sessions which increased to 57.1% post implementation of the virtual educational sessions. The results explain that, there was statistically significant differences in all items of the adapted Oxford COVID-19 vaccine hesitancy scale results between pre and post implementation of the virtual educational sessions (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGraph 3.\u0026nbsp;\u003c/strong\u003econveys that 51.1%, 34.3%, and 14.6% of the studied undergraduate nursing students were willing, doubtful, and strongly hesitant to have the COVID-19 vaccine pre-implementation of the virtual educational \u003cstrong\u003esessions\u003c/strong\u003e respectively. While post implementation of the virtual educational sessions, they improved to 85.4%, 11.4%, and 3.2% respectively. Overall, there was a statistically significant difference in the COVID-19 hesitancy scoring level between pre and post-implementation of the virtual educational sessions (p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7.\u003c/strong\u003e Portrays\u0026nbsp;that there were intermediate and weak negative correlations\u0026nbsp;between total COVID-19 vaccination\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eknowledge\u0026nbsp;and hesitancy\u0026nbsp;scores of the studied undergraduate nursing students\u0026nbsp;pre and post-implementation of\u0026nbsp;the\u0026nbsp;virtual educational sessions (P = 0.000 and r = -0.682) and (P = 0.001 and r = -0.173)\u0026nbsp;respectively.\u0026nbsp;Furthermore, there were intermediate and weak positive\u0026nbsp;correlations\u0026nbsp;between\u0026nbsp;total COVID-19 vaccination\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003enegative attitudes and hesitancy scores of the studied undergraduate nursing students pre and post-implementation of the virtual educational sessions (P = 0.000 and r = 0.381) and (P = 0.044 and r = 0.108) respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNursing students, among other future healthcare professionals, are the most trustworthy source of knowledge regarding the Covid-19 vaccination. Furthermore, vaccination uptake by the general public would rise if nursing students accepted the vaccine. They are essential to the public's immunization program. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Thus, the aim of the current study was to assess the effect of implementing virtual educational sessions on nursing students\u0026rsquo; knowledge, attitude and hesitancy regarding COVID-19 vaccination.\u0026lrm;\u003c/p\u003e \u003cp\u003eThe studied undergraduate nursing students had low total knowledge scores regarding COVID-19 vaccination with a mean of 13.82(5.08) pre-implementation of the virtual educational sessions in that study. This matched with the results of the electronic survey toward COVID-19 vaccines among nursing students which concluded that one fifth only of them have good knowledge levels \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Low knowledge scores may be due to the novelty of COVID-19 vaccination and the conduction of this study immediately after vaccination drives began in Egypt.\u003c/p\u003e \u003cp\u003ePost implementation of the virtual educational sessions, the present study findings revealed statistical significant improvement in the total knowledge scores regarding COVID-19 vaccination with a mean 35.59(2.62). This is consistent with the findings of a researcher's investigation \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e This shows that, following the implementation of the educational intervention, the investigated sample's overall level of knowledge had significantly improved. In the current study, two-thirds of the studied undergraduate nursing students got information regarding COVID-19 vaccination through social media (Facebook, Instagram, and WhatsApp). Although many such information resources provide easy and accessible ways of getting information, they can also present COVID-19 vaccination myths and misconceptions about its safety and efficacy which postpone vaccination programs \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. This is consistent with the findings of the present study as the majority of the studied undergraduate nursing students showed an intermediate negative attitude concerning COVID-19 vaccination pre-implementation of the virtual educational sessions. High percentages of them had concerns regarding all subscales of the adapted VAX Scale; vaccine benefits, future effects, commercial profiteering, and immunity. This is supported by Saied \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e who said that the majority of students were worried about the vaccine's side effects and safety as well as how COVID-19 could spread through the shot.\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003cp\u003eThe present study finding revealed that there was a statistically significant difference in the undergraduate nursing students' total negative attitude after the implementation of virtual educational sessions than before. This is consistent with the findings of a study done by researchers \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e35\u003c/span\u003e],\u003c/sup\u003e which showed that participants' views significantly improved after the COVID-19 instructional bag was implemented compared to before.\u003c/p\u003e \u003cp\u003eThe study conducted by Jiang \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e indicated that nursing students' professional backgrounds and level of awareness of the COVID-19 vaccine's requirement made them more likely to receive a vaccination. This is in contrast with the latest study's findings as around half of the studied undergraduate nursing students hesitated (34.3% doubtful and 14.6% strongly hesitated) regarding COVID-19 vaccination pre-implementation of the virtual educational sessions; Whereas only 11.1% of them would get the available COVID-19 vaccine as soon as possible and 41.7% of them would get it when they have time. This is supported by the conclusion of the cross-sectional descriptive \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e concluded that nursing students were largely resistant to the COVID-19 vaccination. Because they have a bad attitude about getting vaccinated, the undergraduate nursing students under study exhibit a refusal to obtain vaccinations. This is confirmed by Jiang's study's findings \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHesitancy to get vaccinated was one of the top 10 challenges to the success of the vaccination drive and consequently global health. For effective vaccination, the majority of people must accept and use vaccines \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Implementation of the intended virtual educational sessions improved COVID-19 vaccination acceptability among the studied undergraduate nursing students as only 14.6% of them were hesitated while 85.4% of them were willing to be vaccinated.\u003c/p\u003e \u003cp\u003eThe current study portrayed that Covid-19 vaccination hesitancy resulted from a lack of knowledge and negative attitudes among the studied undergraduate nursing student\u0026rsquo;s pre-implementation of the virtual educational sessions. In this regard, there is a need to implement educational sessions to increase nursing students\u0026rsquo; awareness of COVID-19 vaccination.\u003c/p\u003e \u003cp\u003eMost of the public universities during the COVID crisis struggled with the sudden need for virtual education after the lockdown in the Middle East region. Students and educators perceived many benefits of virtual education. Students admire the conveniences of education from home because it is more comfortable and does not involve travel \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. In the other hand, the virtual education aids teachers in conveying information to students in order to increase their understanding and facilitates the rapid and easy sending of communications \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. The current virtual education sessions was effective in the improvement of COVID-19 vaccination knowledge, attitude, and acceptance among the studied undergraduate nursing students.\u003c/p\u003e \u003cp\u003eEffectiveness of the current virtual education sessions is due to usage of multimodal educational methods and materials during the delivery of the sessions. And the simplicity of the informative booklet which was delivered based on the preliminary assessment data. This is supported by a researcher \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. who stated that multimedia usage creates interactive learning activities. Moreover, the booklet designers should consider the readers\u0026rsquo; knowledge and needs which may be quite different from the designer's own.\u003c/p\u003e \u003cp\u003eFor individuals who have access to the right technology, virtual education can be far more successful \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. In this study, the researchers conducted two virtual educational sessions to present 17 messages regarding Covid-19 vaccination via online Microsoft Teams for undergraduate nursing students. The links were sent to the WhatsApp group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study findings concluded that about half of the studied undergraduate nursing students were hesitant toward COVID-19 vaccination due to the low mean of total correct knowledge scores and intermediate negative attitudes scoring level. The studied\u0026nbsp;undergraduate\u0026nbsp;nursing students had significant improvement in COVID-19 vaccination knowledge, attitude, and hesitancy post-implementation of the virtual educational sessions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIntegration of the virtual educational sessions regarding COVID-19 vaccination into the curricula of educational nursing institutions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDissemination of the designed booklet about COVID-19 vaccination among undergraduate nursing students.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers would like to express their sincere gratitude and appreciation to all authorities in the Faculty of Nursing, Mansoura University, and the undergraduate nursing students for their support, voluntary participation, and cooperation in conducting the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNothing to report\u0026nbsp;regarding\u0026nbsp;funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO Coronavirus (COVID-19) Dashboard. 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Ann Behav Med. 2017;51(5):652-660. doi:10.1007/s12160-017-9888-y\u003c/li\u003e\n \u003cli\u003eFreeman D, Loe BS, Chadwick A, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022; 52(14):3127-3141. doi:10.1017/S0033291720005188\u003c/li\u003e\n \u003cli\u003eLi M, Luo Y, Watson R, et al. Healthcare workers\u0026apos; (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review. Postgrad Med J. 2023;99(1172):520-528. doi:10.1136/postgradmedj-2021-140195\u003c/li\u003e\n \u003cli\u003eAbd El Fatah WO, El-borie HO, \u0026amp; Elsayed EE. Electronic Survey for Knowledge, Attitude, and Practice toward COVID-19 Vaccines among Nursing Students. Egyptian Journal of Nursing and Health Sciences.2022; 3(2), 162-185.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eMohamed NA, Mohamed HA, \u0026amp; Hafez SH. Nursing Educational Intervention to Control COVID-19 Vaccine Hesitancy among School Team Members at Beni-Suef City and Benha City, Egypt. Tanta Scientific Nursing Journal.2021; 23(4), 174-192.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eCallaghan T, Motta M, Sylvester S, Lunz Trujillo K, Blackburn CC. Parent psychology and the decision to delay childhood vaccination. Social Science \u0026amp; Medicine. 2019; 238.\u003c/li\u003e\n \u003cli\u003eNossier SA. Vaccine hesitancy: the greatest threat to COVID-19 vaccination programs. J Egypt Public Health Assoc. 2021; 96(1):18. Published 2021 Jul 5. doi:10.1186/s42506-021-00081-2\u003c/li\u003e\n \u003cli\u003eSaied SM, Saied EM, Kabbash IA, Abdo SAE. Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J Med Virol. 2021; 93(7):4280-4291. doi:10.1002/jmv.26910\u003c/li\u003e\n \u003cli\u003eIbrahim Elemam Elashri N, Ahmed Mohammed Elfadawy H, \u0026amp; Refaat Alam R. Effect of COVID-19 Educational Bag on Knowledge, Attitude and Precautionary Practices of Institutionalized Elderly Persons. Egyptian Journal of Health Care.2021; 12(2), 176-194.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eJiang N, Wei B, Lin H, Wang Y, Chai S, Liu W. Nursing students\u0026apos; attitudes, knowledge and willingness of to receive the coronavirus disease vaccine: A cross-sectional study. Nurse Educ Pract. 2021; 55:103148. doi:10.1016/j.nepr.2021.103148\u003c/li\u003e\n \u003cli\u003eKim S, Lee J, Yang H, Kim H. Acceptance of and hesitancy about COVID-19 vaccination among nursing students in clinical practice. PLoS One. 2023;18(7):e0286640. Published 2023 Jul 26. doi:10.1371/journal.pone.0286640\u003c/li\u003e\n \u003cli\u003eGalagali PM, Kinikar AA, Kumar VS. Vaccine Hesitancy: Obstacles and Challenges. Curr Pediatr Rep. 2022; 10(4):241-248. doi:10.1007/s40124-022-00278-9\u003c/li\u003e\n \u003cli\u003eAshour HA, Alhinti SF, Hawsaoi SA, Alsuwailem AA, AlFarhan A, Abdulmajeed I. Knowledge, Attitude, and Practice (KAP) of COVID-19 Vaccine Among Saudi Mothers. Cureus. 2023; 15(3):e36826. Published 2023 Mar 28. doi:10.7759/cureus.36826\u003c/li\u003e\n \u003cli\u003eMortagy M, Abdelhameed A, Sexton P, et al. Online medical education in Egypt during the COVID-19 pandemic: a nationwide assessment of medical students\u0026apos; usage and perceptions. BMC Med Educ. 2022; 22(1):218. Published 2022 Mar 30. doi:10.1186/s12909-022-03249-2\u003c/li\u003e\n \u003cli\u003eAmer H \u0026amp; Ouhida A. Online learning on students during the COVID‐19 pandemic. Clin Med Rev Case Rep.2022; 9, 412.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eAbdulrahaman MD, Faruk N, Oloyede AA, et al. Multimedia tools in the teaching and learning processes: A systematic review. Heliyon. 2020;6(11):e05312. Published 2020 Nov 2. doi:10.1016/j.heliyon.2020.e05312\u003c/li\u003e\n \u003cli\u003eSuresh M, Vishnu Priya V, \u0026amp; Gayathri R. Effect of e-learning on academic performance of undergraduate students. Drug Invention Today. 2018; 10(9).\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 7 are available in the Supplementary Files section\u003c/p\u003e"},{"header":"Graphs ","content":"\u003cp\u003eGraphs 1-3 are available in the Supplementary Files section.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5044444/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5044444/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: COVID-19 vaccination is the hopeful savior to curb the pandemic. One of the most urgent issues facing public health officials is vaccine hesitancy. Vaccine hesitancy persists despite the availability of COVID-19 vaccinations because of ignorance and unfavorable attitudes. This study evaluated the effect of virtual educational sessions on nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA\u003cstrong\u003e \u003c/strong\u003equasi-experimental research design was used to recruit 350 undergraduate nursing students from each academic level using a convenience sampling technique. A self-administrative \u003cstrong\u003estructured\u003c/strong\u003e questionnaire was utilized to evaluate the nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The mean of the total correct knowledge scores and the total negative attitudes scores regarding COVID-19 vaccination among the studied undergraduate nursing students improved from (13.82±5.08 \u0026amp; 36.38±7.03 respectively) pre-implementation of the virtual educational sessions to (35.59±2.62 \u0026amp; 17.6±5.13 respectively) post-implementation. The total vaccine hesitancy improved from (34.3% doubtful \u0026amp; 14.6% strongly hesitant) pre the implementation of the virtual educational sessions to (11.4% \u0026amp; 3.2% respectively) post-implementation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The educational sessions had positive effect on undergraduate nursing students’ knowledge, attitude, and hesitancy regarding COVID-19 Vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e: Integration of the virtual educational sessions regarding COVID-19 vaccination into the curricula of educational nursing institutions.\u003c/p\u003e","manuscriptTitle":"Effect of Implementing Virtual Educational Sessions on Nursing Students’ Knowledge, Attitude and Hesitancy Regarding COVID-19 Vaccination","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-10 09:17:37","doi":"10.21203/rs.3.rs-5044444/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7526368-c50b-454a-8535-761071f00542","owner":[],"postedDate":"October 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-10T09:17:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-10 09:17:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5044444","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5044444","identity":"rs-5044444","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}