Title : Vaccine uptake and vaccine attitudes among certified nursing assistants in Illinois long-term care settings
Abstract:
Introduction/Objective: High vaccine uptake among Post-Acute And Long-Term Care (PALTC) staff is critical to protect older adults at elevated risk of severe illness (Murmann et al., 2023). Certified Nursing Assistants (CNAs) play a central role in resident care, yet vaccine uptake among healthcare workers in PALTC remains suboptimal (Pfefferle & Weinberg, 2008; Kenny et al., 2020). This study aimed to assess CNAs’ vaccine uptake and attitudes to identify key drivers of vaccine hesitancy and inform interventions that strengthen vaccine confidence.
Design/Methodology: Anonymous survey of CNAs working in PALTC facilities in Illinois (n=243). Participants were recruited through snowball sampling, direct outreach, and facility-based distribution. Survey items assessed vaccine uptake, attitudes, trust, and concerns using Likert-scale and categorical questions Data were analyzed in R using descriptive statistics, chi-square tests, nonparametric tests, and multivariable logistic regression.
Results: Overall, the majority (just under two-thirds) of CNAs reported receiving both the seasonal influenza vaccine and the COVID-19 primary series. Among CNAs who were not fully vaccinated, many expressed openness to future vaccination.Attitudes toward vaccines were moderately positive, with mean scores of 3.58 for perceived safety and 3.51 for perceived effectiveness on a five-point scale; neutral responses were common. Agreement or strong agreement with concern about side effects was reported by 40.7% of CNAs for short-term effects and 45.3% for long-term effects.Primary care clinicians were the most frequently trusted sources of vaccine information (36.7%), followed by public health agencies (22.0%), employers or supervisors (15.8%), and occupational health services (13.2%).Among the unvaccinated CNAs, it was found that willingness to be vaccinated was significantly associated with employer vaccination recommendations, trust in public health agencies, and acknowledgment that a recommendation from a supervisor would increase their likelihood to vaccinate. Differently, however, there was no observed relationship between willingness to vaccinate and ease of access to those vaccinations.In adjusted analyses, higher perceived vaccine safety was associated with lower odds of vaccine hesitancy, and the same correlation with lower hesitancy could be seen among those with greater years of CNA experience.
Conclusion/Discussion: Vaccine hesitancy among CNAs in Illinois PALTC settings appears to be driven more by confidence in vaccine safety and workplace context than by demographic characteristics or access alone. Trust in employers, supervisors, and public health agencies was strongly associated with willingness to vaccinate, suggesting these relationships may influence vaccine decisions indirectly by shaping safety perceptions. These findings are likely generalizable to similar PALTC workforce settings and support interventions that prioritize trusted communication and workplace engagement rather than access-only strategies.
