EXPLORING THE COVID-19 VACCINATION HESISTANCY OF ELDERLY

PEOPLE

Kristel Cumpio,* Grace Arriane K. Torceno. Justine Paul V. Custodio, and Jian
Lou D. Lerios
Biliran Province State University, Brgy. P.I, Garcia, Naval, Biliran

Abstract

In the fight against viral pandemics and epidemics, vaccines are dependable

and successful public health measures. However, there is a widespread reluctance

among elderly people to use the COVID-19 vaccination to prevent Coronavirus

illness. This study is anchored on the Theory of Planned Behavior. and aims to

investigate the reasons of hesitancy among elderly people of Naval towards the

COVID-19 vaccination.

The researchers will utilize the qualitative research method using a descriptive

qualitative study and conduct an unstructured interview with a guide questionnaire.

This study focused on investigating the reasons for hesitancy among eight (8) elderly

people towards the COVID-19 vaccination.

Keywords – Vaccine Hesitancy, Elderly People

Introduction

Nature and Importance of the Study

Elderly people are among the first people to be vaccinated because research

shows that older people are more likely to become very ill and die as a result of the

virus (McSpadden, 2021). People are hesitant to receive the COVID-19 vaccine for a

variety of reasons, ranging from personal beliefs and anxieties to logistical issues

travelling to vaccine sites. However, delaying vaccination permits the coronavirus to

continue circulating in the community, resulting in the emergence of new variations.

Severe COVID-19 can be extremely hazardous; the sooner you get immunized, the

better (Golden, 2021).

Vaccine hesitation is influenced by issues such as complacency, convenience,

confidence, and sociodemographic settings, and is caused by complex, context-

specific factors that change over time, place, and different vaccines (The BMJ,

2021). Vaccine acceptance is mostly explained by a desire to protect oneself against

COVID-19, while worries regarding side effects are the most common reasons for

hesitancy, and health professionals are the most trusted sources of information on

COVID-19 vaccines. It is worth noting, though, that stated intentions don't

necessarily equate to vaccine uptake. Vaccine hesitancy is a global problem

(Machingaidze & Wiysonge, 2021).

The most basic rationale is that they have been particularly susceptible to illness

and mortality as a group. Ageism in our society has been exposed more than usual

during this outbreak. Many older adults face the decision of whether to receive a

vaccine with ease: they choose to get all recommended vaccines, or they refuse

vaccines entirely. Others, however, find the decision more complex and make it on a
case-by-case basis. Experts consider this middle group of adults, who selectively

choose which vaccines to accept, to be “vaccine hesitant (The BMJ, 2021).

A study conducted by Amit, Pepito, Sumpaico-Tanchanco, Dayrit (2022),

investigated vaccination narratives and problems faced and witnessed by Filipinos

during the early immunization period in the article. In the paper, the Filipinos during

the early vaccination period. Individual, interpersonal, and/or structural barriers to

COVID-19 immunization may interact to impact decisions. Individual views play a

significant influence in the choice to vaccinate, and these beliefs are modified by

media, community, and health-care system exposure to (mis)information.

Due to quick transmission through social media and sensationalism in

conventional media, vaccination brand hesitation and misinformation are common in

the Philippines. There is a need to research best practices in vaccine distribution in

order to put in place mechanisms that are both efficient and inclusive so that we can

vaccinate as many people as possible against COVID-19 (Amit, Pepito, Sumpaico-

Tanchanco, & Dayrit, 2022).

The literature review, on the other hand, does not intend to portray all scenarios

and conditions and focuses on participants from different regions in the Philippines,

various age groups, socio-economic classes, and vaccination status and attitudes

but also may fail to include low-resource households (Amit, Pepito, Sumpaico-

Tanchanco, & Dayrit, 2022). The research gap in this study is the knowledge gap

because no one has done a study on COVID-19 vaccination hesitancy in Naval,

Biliran and that focuses on elderly people, specifically 60 years and older.

Therefore, the researchers want to conduct this study because there is no

existing study in Naval, Biliran about COVID-19 vaccine hesitancy and that mostly
focuses on elderly people, and there is a dearth in literature. The researchers want

to fill this gap by conducting this study.

Objectives

The study aims to understand the reasons of hesitancy among elderly Navalenos

towards the COVID-19 vaccination through descriptive qualitative research design.

Theoretical Framework

The research is anchored on Theory of Planned Behavior by Ajzen (1991) which

suggests that behavior is determined by intentions, attitudes (beliefs about a

behavior), and subjective norms (beliefs about others' attitudes toward a behavior).

The Theory of Planned Behavior (TPB) posits that health behaviors can be predicted

by intentions to perform them (Ajzen, 1991).

In Theory of Planned Behavior intentions are determined by three variables. One

is how we feel about a Personal Attitude. It encompasses all the knowledge,

attitudes, and prejudices. When we consider behavior, we consider both positive and

negative aspects. This would mean that people would consider their knowledge

about the vaccine from the people around them and used to make their decision on

hesitating to be vaccinated. Second is Subjective Norms, this considers how we

perceive other people's views on a given conduct, such as vaccination. It is our

perception of others' attitudes, not what they think. Some elders might be influenced

by their family towards their attitude towards vaccines. Third and lastly, Perceived

Behavioral Control. This is how much we feel we have control over our actions.

According to the idea, our perception of behavioral control has two effects: it

influences our intentions to behave in each manner, that is the more control we
believe we have over our conduct, the greater our intention to do it. It also has a

direct impact on our conduct; if we believe we have a high amount of control, we will

work harder and longer to achieve our goals. The more hesitant they are, the more

they are not willing to be vaccinated (Brookes, 2021).

TPB is yet another theoretical model for predicting a person's vaccination

intent. As a successor to the Theory of Reasoned Action, Icek Ajzen proposed the

model. According to the TPB model, vaccination intention is influenced by several

factors, including vaccine attitudes, subjective vaccination norms, and vaccination

perception of behavioral control (PBC). Because it has been proven that a distinction

must be made between perception of control of behavior and self-efficacy, another

predictor was added to the original model: self-efficacy for vaccination. The strongest

predictor of health behavioral intention was found to be self-efficacy (Shmueli, 2021).

Methodology

This research is a descriptive qualitative on which the researchers conducted a

unstructured interview to eight (8) selected elderly people participants that ages from

60 years and older. This study is purposive because of the set of criteria that the

researchers provide and only needs limited participants. The participants were

chosen randomly that were hesitant towards COVID-19 vaccination.

Research Design and Sampling

This study is anchored to a descriptive qualitative research design. Qualitative

descriptive research generates data that describe the ‘who, what, and where of

events or experiences from a subjective perspective (Kim et al., 2017, p. 23). In

descriptive research, researchers are motivated to comprehend each person’s

experience within a specific setting. Descriptive qualitative research has also been

aligned with pragmatism (Neergaard, Olesen, Andersen, & Sondergaard , 2009)

where decisions are made about how the research should be conducted based on

the aims or objectives and context of the study (Ritchie, Lewis, Nicholls, & Ormston,

2013).

The researchers will use a Qualitative Descriptive as our research approach to

dig further into the progression of a certain event or scenario, in this case, the

individual's hesitancy, across time.

Furthermore, purposive sampling will be used in this study. A non-probability

sample is chosen depending on population characteristics and the study's goal.

Purposive sampling, which is distinct from convenience sampling, is often referred to

as judgmental, selective, or subjective sampling. When you need to reach a specific

sample rapidly and proportionality isn't a major concern, this sort of sampling can be

very effective (Crossman, 2020). It is an outstanding tool for research in

phenomenology. For several helpful studies and much qualitative research-work,

purposive sampling is desirable in any of several forms. “In purposive sampling, the

researcher selects sampling units based on his or her judgment of what units will

facilitate an investigation” (Adler & Clark, 2008).

Samples are chosen based on preset criteria, one of which is that the subject

must be an elderly Naval resident. For the age requirement, we will be using the

Philippines Age Structure. Its emphasizes that 60 years and over are elderly.

According to the Philippine Statistics Authority, elderly people or elderly people are

individuals that belong to the age group of 60 years and over (Philippine Statistics
Authority, n.d.). With this source, our participants are going to be 60 years and older.

Finally, for the Qualitative Descriptive, round them up to 5–10 participants.

Data Collection Procedure

The researchers seek to interview elderly people in Naval who are

hesitating toward COVID-19 vaccination. The researchers will begin the interview

with a permit from the authorities of Biliran Province State University before

interviewing research participants.

Researchers will work on the research questionnaire that will be validated by

the research adviser after obtaining an approved letter of request. After the request

is approved, the interview of participants will begin while adhering to the health

guidelines and protocols. Interviews shall be conducted carefully to create reliable

results.

For proper health protocol on conducting this research, the researchers will

practice social distance while gathering data because intimate person-to-person

contact appears to be the major source of transmission, and social separation

remains a critical approach to limit spread. Maintaining a 6-foot gap between yourself

and others in public areas or everywhere you go. This space will enable us avoid

coming into close touch with respiratory droplets from coughing or sneezing (CDC,

2021). The researchers will also use face masks all the time in order to prevent

catching COVID-19. Those who conceal their faces in public places, especially since

studies have revealed that people infected with the new coronavirus may be

asymptomatic or presymptomatic. And being a fully vaccinated researcher is crucial

for preventing or protecting against symptomatic and acute COVID-19 (The

University of Southern Mississippi, 2022)

 The researchers will interview 5-10 elderly people in an unstructured interview

using open questions. This includes people aged 60 years and older, that identifies

as elderly people according to the PSA, who live in Naval (Philippine Statistics

Authority, n.d.). This helps the respondent to speak more freely, using their own

language, and to put the respondents at ease with the interviewer. This will also

assist the researcher in gaining a true understanding of a person's perspective on a

topic.

The interviewers will take handwritten notes or voice recordings for future

references. After conducting the interview, the researchers will compile the

information and be able to summarize the findings of the data collection.

Data Analysis

Thematic analysis is a simple and conceptually flexible interpretive technique

to qualitative data analysis that makes it easier to find and analyze patterns and

themes in a data set (Braun & Clarke, 2012).

Phase 1: Data familiarization. The search for patterns and significance begins

by immersing oneself in the data to grasp the depth and breadth of the

information.

Phase 2: Initial code generation. Creating basic codes to arrange the data,

giving each data item equal priority.

Phase 3: Generating (initial) themes. Sorting codes into basic themes and

determining the significance and links between them.

 Phase 4: Theme review. Identifying consistent patterns at the coded data

level, as well as reviewing the complete data collection.

Phase 5: Theme defining and naming. Identifying and fitting the overall story

of the data set to react to the research questions.

Phase 6: Report production. Presentation provides a clear and engaging

explanation of the data's story, both within and across topics.

Therefore, the researchers will prepare the gathered data. With the first phase,

researchers will transcribe the audio files and read and reread them, data set and

taking notes. The replies will then be labelled and data elements will be grouped into

relevant groupings. Then there's diagramming or mapping out writing topics and their

identifying characteristics. Following that, we'll check to see whether there's enough

data to support a theme, collapse overlapping themes, and rework and refine codes

and themes. Next, in order to arrange the tale, cycle between the facts and the

discovered themes. Finally, writing a persuasive argument that addresses the

research questions, as well as writing more than a straightforward explanation of the

ideas (Campbell, Orr, Durepos, Nguyen, & Li, 2021).

Ethical Consideration

As the initial stage in the interview process, the researcher will remind

participants of the study's purpose, research protocols, anticipated benefits, their

right to withdraw from the study at any time, and confidentiality security. The

researcher will also inquire whether the participants have any reservations regarding

the research study or the research method. In order to communicate successfully

and acquire their confidence, the researcher will also offer personal details (Patton,
1980). The researchers shall ask for the participant’s consent with the use of

Informed Consent. Its goal is for human participants to engage in research freely

(voluntarily), with full knowledge of what it entails for them to participate, and to

provide their agreement before doing so. The privacy of research participants is

safeguarded during the study, and suitable confidentiality is offered. The dignity of

study participants will be respected. There will be no misrepresentation or

exaggeration about the research's goals and objectives. Individuals taking part in this

study will remain anonymous. Any communication relating to this study will be

conducted in an entirely honest and transparent manner. We avoid giving misleading

information and portraying main data results in a biased way. Offensive,

discriminatory, or other improper language is avoided while creating a questionnaire

or interview. Finally, the researchers will request data validation from the participants

at the conclusion of the study.

RESULTS AND DISCUSSION

The focus of this research was to understand the reasons of hesitancy among

elderly people towards the COVID-19 vaccination. During the interviews,

respondents expressed their opinions and feelings about their views on the COVID-

19 vaccination.

The information gleamed from the elderly people participants’ statements was

based on their emphasis, which indicated the relevance of each factor mentioned.

The elderly people in this study indicate their perceptions of their views of COVID-19

vaccination, including distrust of experts, health risk, unmotivated, and trauma.

THEME 1: PASSION
 The elderly people who think they’re more informed than the experts are the

people who are not trusting health experts. They are not used to going to a doctor

when they are sick because of fear, denial, thriftiness, and discomfort. They have

their own beliefs on what will be the effect of the covid vaccines to an individual.

That's why they are hesitant to take covid vaccine.

“Wa lang ko maruyag, pagpa vaccine daghan mn daw nag pavaccine kay kung mga

mangamatay tong na vaccinan ma apil pud tag kamatay. Kay gikan pagkagamay

nako wako nag padoctor og wa pa pud ko natupukan og injection. Wa pako katilaw

og doctor, di gani ko mag padoctor nga nagkasakit ko.” (P1; Page ; Line 1;

Transcript 1)

“Mahadlok lang ko kay naa rabay uban nga way sakit nga nagkasakit.” (P5; Page ;

Line 2; Transcript 5)

According to the elderly people’s responses, elderly people are not

accustomed to visiting a doctor when they are ill. They each hold their own opinions

regarding the effects that the COVID-19 vaccines will have on an individual.

THEME 2: HEALTH RISK

Almost all the vaccine-hesitant and vaccine-refusing participants were

concerned about vaccine safety. Some of them believed they were unsuitable for

vaccination due to the most common concern, which was their health. Despite the

fact that some of them thought they were unsuitable for COVID-19 vaccination. This
was due in part to pre-existing chronic conditions, while others believed they were

unsuitable for vaccination due to their age.

“Kanang pag tan aw nakos vaccination murag limitado akong kaugalingon ana sa

vaccination. Nganong karon paman magsuroy og vaccination, damo na mga sakit na

muabot.” (P1; Page ; Line 2; Transcript 1)

“Wa, di ko kay lain naman ni akong lawas.” (P2; Page ; Line 1; Transcript 2)

“Ang akong lawas, kay kanang may hubak man ko. Kanang maot sa ako, kay kuan

man kanang naa man koy sakit. Mahadlok lang kog mag pabakuna kay naa man

koy gipaminaw.” (P3; Page ; Line 1-3; Transcript 3)

“Di gad ko mahadlok ang ako lang gi kuanan, kanang ako lagi hubak.” (P3; Page ;

Line 5; Transcript 3)

“Akong potassium kay ubos man kaayo pud. Naa koy sakit sa kidney. Mahadlok

man ko kay naa koy sakit.” (P5; Page ; Line 1 & 5; Transcript 5)

“Kanang daghan man koy sakit, akong mga tiil manghubag. Nya naa pud koy hubag

sa kong tiyan. Akong gamay nga tinae naay bukol duha kabook, mura nag itlog

kadako. Aw okay ragad ang vaccine, kay akong mga anak gani, ako galing

gipavaccinan. Ako lang wa kay naa pa man koy gipaminaw nga sakit. Mahadlok lang

pud kong mokuan sa kong sakit ba.” (P6; Page ; Line 1-3; Transcript 6)
“Kanang tungod sa akong gi paminaw sa akong lawas. Ang kaayohan sa tanan man

to. Pero akong lawas di naman kasugakod.” (P7; Page ; Line 1-2; Transcript 7)

“Dili lang, kay luya akong lawas.” (P8; Page ; Line 1; Transcript 8)

The study concludes that the elderly people are afraid of getting their health in

risk. The most common concept that occurs to them is that they don’t want to

endanger their health further me considering they are already sick.

P1 mentioned that they were too old to get vaccinations. It also indicates that

why would vaccines being given out when they already experienced several

diseases.

P2 mentioned that their body cannot oblige and they were too old to received

vaccination.

P3 mentioned that they afraid in taking vaccination because of its pre-existing

chronic conditions.

P5 also mentioned that they have pre-existing chronic conditions that's why

they don't get vaccinated.

P6 mentioned that they have a lot of illness that's why they are hesitant to get

vaccinated.

P7 mentioned that there is something wrong with their body or was caused by

pre-existing chronic conditions.

P8 mentioned that their body is weak or too old to take vaccination.

THEME 3: UNMOTIVATED
 The COVID-19 vaccine is widely available to adolescents in the Philippines;

however, vaccine hesitancy poses a threat to full coverage. In spite of a growing

number of safe and effective vaccines, they represent an important tool, in

combination with other measures, to protect people against this epidemic, save lives

and reduce wide-scale social disruption. However, even with sufficient efficacy and

vaccine supplies, high vaccination coverage resulting from high participation rates is

essential for the global society to be able to manage the pandemic. Knowing the

underlying motivation for getting vaccinated is important, specifically for all elderly

people. Basically, perceived risk distinctly plays a key role in vaccine motivation.

“Wa ko mahadlok oyy. wa ko mahadlok og injection. Wa ko mahadlok og

vaccination. Di lang ko magpa vaccine lagi kay maayo untag vaccinan ko gi examine

sa kong dugo og makamasibo ba ang vaccine o dili. Unya og di makasibo sa kong

dugo mao ranay akong kamatyan. Mao na dihang akong gidilian. Kay og gi examine

pa ang akong dugo diha og makasibo ang vaccine, magpa vaccine ko. Mao rana

akong gidilian nga di ko mag pa vaccine.” (P1; Page ; Line 3; Transcript 1)

“Wa lang, kay wa man pud namugos dira. Kung may vaccine mag pavaccine pud ko.

Wa man ko mahadlok, wa lang may mi pugos diri.” (P4; Page ; Line 1 & 3;

Transcript 4)

“Wa koy gikahadlukan, di lang ko magpa vaccine.” (P8; Page ; Line 3; Transcript 8)
 Based on the elderly people’s responses during the interview, they are not

forced by the government and not obligatory on their area. They show no action of

being vaccinated.

THEME 4: TRAUMA

Despite the apparent relationship between past experiences and subsequent

vaccination decisions, the role of traumatic events has been overlooked when

understanding vaccination intention and behavior, especially the elderly people.

Aside from a safe, efficacious, and cost-effective vaccine being available, past

experiences are an influential factor in the decision to vaccinate. More generally, an

individual’s thoughts and behavior can be affected by their experience of a traumatic

event.

“Mahadlok kog injection.” (P2; Page ; Line 3; Transcript 2)

“Kanang tulo man ko kasemana gi trangkaso.” (P5; Page ; Line 3; Transcript 5)

This research also found that elderly people have fear of injections and are

afraid of getting sick after being injected. They are traumatized by the during and

after the action of being vaccinated.

CONCLUSION

Data was collected after interviewing the eight participants. As mentioned in

the introduction, this research paper will help to understand the reasons of hesitancy
among elderly Navalenos towards the COVID-19 vaccination through descriptive

qualitative research design.

The statements of the participants can be used to infer conclusions.

According to the findings, the majority of elderly people are vaccine-hesitant due to

health risk. Even if they want to be vaccinated or they consider vaccine as a long-

lasting solution, they are not considering to be vaccinated because they care for their

health the most. They are afraid that their illnesses may trigger while being injected

for the vaccine. it is significant in their capacity as someone who values both their

own life and the lives of others. Most of them were unmotivated to get vaccinated

because they were not forced and not obligatory for them to get vaccinated. Some of

them distrust experts; they became traumatized as they talked about their hesitation

towards COVID-19 vaccine. All of the participants described their views on COVID-

19 vaccination. They expressed various reasons for why they are vaccine-hesitant,

such as distrust of experts, health risk, unmotivated, and trauma.

RECOMMENDATIONS

Following are some recommendations to consider based on the study's

findings and conclusion:

1. Future researchers who are interested in this study should investigate the

various psychological effects of elderly people on the COVID-19 epidemic in

order to fully comprehend elderly people's perspectives and behaviors. Be

able to expand on the study's information and provide a more thorough

explanation.

2. More research should be done to discover more about the perspectives and
 behaviors of adults, young adults, and teenagers to see if they have similar or

different perspectives on the pandemic. The researchers feel that because the

study is limited to elderly people, there would be many differences in their

findings.

ACKNOWLEDGEMENT

The researcher is thankful to the people who helped and extended their time

in conducting the study.

To Mr. Ralph Arvic T. Arcenal, our Instructor and research adviser who gave

us the golden opportunity to do this wonderful project on the topic “EXPLORING

THE COVID-19 VACCINATION HESITANCY OF ELDERLY PEOPLE,” which also

helped us a lot of research and we came to know about so many new things. To Mr.

Rhene D. Saul for also guiding us throughout our research paper. And, to Dr. Juvy

Dia Saniel for validating our research interview guide questions used during our

entire data gathering.

To our parents, grandparents and friends who helped us a lot in finalizing this

project within the limited time frame and who always understand, support us morally,

financially and gave us encouragement who serves as the constant source of

strength and inspiration.

 And to our Almighty God for the gift of life, wisdom, knowledge and guidance

for the completion of this study.

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