Perspectives of midwifery and nursing students on recommending the COVID-19 vaccine to women of reproductive age and factors influencing counseling competency: a cross-sectional study

Document Type : Original Article


1 Department of Public Health Nursing, Nursing Faculty, Mersin University, Mersin, Türkiye

2 Department of Midwifery, School of Health, Mersin University, Mersin, Türkiye


Background: Vaccination rates among women of reproductive age are low, and many women are hesitant to get vaccinated.
Objectives: The aim of the study was to determine the opinions of senior midwifery and nursing students regarding the recommendation of the COVID-19 vaccine to women of reproductive age and to identify the factors that affect their counseling competency.
Methods: This cross-sectional study collected data from 504 senior midwifery and nursing students using the "Individual Identification Form," "Vaccine Opinion Form," and "Scale of Attitudes Toward the COVID-19 Vaccine" in an online environment with the snowball sampling method. Various statistical methods, such as the t-test, chi-square analysis, correlation analysis, ANOVA, logistic regression, and decision tree analysis, were used to analyses the collected data.
Results: Out of all the students, 84.3% were women, 50.2% belonged to the nursing department, and 97.6% had received at least two doses of the COVID-19 vaccine. While 44.4% of the students said they would not recommend vaccination to pregnant, breastfeeding, or planning to get pregnant women, 22.6% reported that they could suggest the COVID-19 vaccine to all three groups. The students who believed they had the competency to counsel others about vaccines and had previously received a flu shot were more likely to recommend a COVID-19 vaccine. On the other hand, the students who did not consider vaccines to be safe, believed they could be harmful, and had not received adequate training on vaccines were less likely to recommend them.
Conclusions: Students who lacked knowledge about COVID-19 vaccines and counseling competency were less likely to recommend vaccination.


Main Subjects

  1. Chervenak FA, McCullough LB, Bornstein E, Johnson L, Katz A, McLeod-Sordjan R, et al. Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients. Am J Obstet Gynecol. 2021;224(5): 470-478 doi:10.1016/j.ajog.2021.01.027 PMid:33539825 PMCid:PMC7849424
  2. Giles ML, Gunatilaka A, Palmer K, Sharma K, Roach V. Alignment of national COVID-19 vaccine recommendations for pregnant and lactating women. Bull World Health Organ. 2021; 99(10):739-746. doi:10.2471/BLT.21.286644 PMid:34621092 PMCid:PMC8477428
  3. Carbone L, Di Girolamo R, Mappa I, Saccone G, Raffone A, Di Mascio D, et al. Worldwide beliefs among pregnant women on SARS-CoV-2 vaccine: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2022;268:144-164 doi:10.1016/j.ejogrb.2021.12.003 PMid:34920272 PMCid:PMC8648617
  4. Oluklu D, Goncu Ayhan S, Menekse Beser D, Hendem DU, Tokalioglu EO, Turgut E, et al. Factors affecting the acceptability of COVID-19 vaccine in the postpartum period. Hum Vaccin Immunother. 2021;17(11):4043-4047 doi:10.1080/21645515.2021.1972710 PMid:34714190 PMCid:PMC8828113
  5. Joubert E, Kekeh AC, Amin CN. COVID-19 and novel mRNA vaccines in pregnancy: an updated literature review. BJOG. 2022; 129(1):21-28. doi:10.1111/1471-0528.16973 PMid:34651406 PMCid:PMC8652509
  6. Burden S, Henshall C, Oshikanlu R. Harnessing the nursing contribution to COVID-19 mass vaccination programmes: Addressing hesitancy and promoting confidence. J Adv Nurs. 2021;77(8):e16-e20. doi:10.1111/jan.14854 PMid:33826780 PMCid:PMC8250705
  7. Bradfield Z, Wynter K, Hauck Y, Sweet L, Wilson AN, Szabo RA, et al. COVID-19 vaccination perceptions and intentions of maternity care consumers and providers in Australia. PLoS One. 2021;16(11): e0260049 doi:10.1371/journal.pone.0260049 PMid:34780555 PMCid:PMC8592457
  8. Deruelle P, Couffignal C, Sibiude J, Vicanti AJ, Anselem O, Luton D, et al. Prenatal care providers' perceptions of the SARS-Cov-2 vaccine for themselves and for pregnant women. PLoS One. 2021;16 (9): e0256080. doi:10.1371/journal.pone.0256080 PMid:34516551 PMCid:PMC8437278
  9. The International Council of Nurse. The Global Nursing Workforce and the COVID-19 Pandemic. 2022Retrieved from
  10. Manning ML, Gerolamo AM, Marino MA, Hanson-Zalot ME, Pogorzelska-Maziarz M. COVID-19 vaccination readiness among nurse faculty and student nurses. Nurs Outlook. 2021; 69(4):565-573. doi:10.1016/j.outlook.2021.01.019 PMid:33610324 PMCid:PMC7862894
  11. Yeşiltepe A, Aslan S, Bulbuloglu S. Investigation of perceived fear of COVID-19 and vaccine hesitancy in nursing students. Hum Vaccin Immunother. 2021;17(12):5030-5037. doi:10.1080/21645515.2021.2000817 PMid:34856866 PMCid:PMC8903959
  12. Geniş B, Gürhan N, Koc M, Genis C, Şirin B, Cirakoğlu OC, et al. Development of perception and attitude scales related with COVID-19 pandemia. Pearson J Social Sci-Humanities, 2020; 5(7): 306-328.
  13. Lutz CS, Carr W, Cohn A, Rodriguez L. Understanding barriers and predictors of maternal immunization: Identifying gaps through an exploratory literature review. Vaccine. 2018;36(49):7445-7455. doi:10.1016/j.vaccine.2018.10.046 PMid:30377064 PMCid:PMC10431095
  14. Castillo E, Patey A, MacDonald N. Vaccination in pregnancy: Challenges and evidence-based solutions. Best Pract Res Clin Obstet Gynaecol. 2021;76:83-95. doi:10.1016/j.bpobgyn.2021.03.008 PMid:34090801
  15. Januszek S, Siwiec N, Januszek R, Kluz M, Lebed R, Tos P, et al. Approach of Pregnant Women from Poland and the Ukraine to COVID-19 Vaccination-The Role of Medical Consultation. Vaccines (Basel). 2022;10(2):255 doi:10.3390/vaccines10020255 PMid:35214718 PMCid:PMC8880363
  16. Daskalakis G, Pergialiotis V, Antsaklis P, Theodora M, Papageorgiou D, Rodolakis A. Healthcare workers' attitudes about vaccination of pregnant women and those wishing to become pregnant. J Perinat Med. 2021;50(3):363-366. doi:10.1515/jpm-2021-0536 PMid:34881548
  17. Massot E, Epaulard O. Midwives' perceptions of vaccines and their role as vaccinators: The emergence of a new immunization corps. Vaccine. 2018;36(34):5204-5209 doi:10.1016/j.vaccine.2018.06.050 PMid:29970300
  18. Berenson AB, Hirth JM, Chang M, Kuo YF, Richard P, Jones DL. A brief educational intervention can improve nursing students' knowledge of the human papillomavirus vaccine and readiness to counsel. Hum Vaccin Immunother. 2021;17(7): 1952-1960. doi:10.1080/21645515.2020.1852871 PMid:33517843 PMCid:PMC8189062
  19. Bisset KA, Paterson P. Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review. Vaccine. 2018;36(20):2751-2759. doi:10.1016/j.vaccine.2018.04.013 PMid:29661584
  20. Vishram B, Letley L, Jan Van Hoek A, Silverton L, Donovan H, Cheryll A, et al. Vaccination in pregnancy: Attitudes of nurses, midwives and health visitors in England. Hum Vaccin Immunother. 2018;14(1):179-188 doi:10.1080/21645515.2017.1382789 PMid:29048989 PMCid:PMC5791587
  21. Chang C, Hwang G, Gau M. Promoting students' learning achievement and self‐efficacy: A mobile chatbot approach for nursing training. Br J Educational Tech. 2022;53 (1): 171-188. doi:10.1111/bjet.13158