Co esponding au ho : Micah B o he Igonieghel.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Knowledge and pe cep ion o COVID-19 accine among o sho e oil and gas wo ke s
in Nige ia
Micah B o he Igonieghel 1, * and Amanda Ezeh 2
1 Newc oss Explo a ion and P oduc ion Company Limi ed (NEPL), Nige ia.
2 Po Heal h Se ices, NAF Base, Fede al Minis y o Heal h, Nige ia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1641-1648
Publica ion his o y: Recei ed on 02 June 2025; e ised on 13 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2621
Abs ac
Backg ound: O sho e oil-and-gas ins alla ions a e high- isk, high-mobili y en i onmen s whe e in ec ious-disease
ou b eaks can apidly dis up ope a ions. E ec i e COVID-19 accina ion depends no only on accine a ailabili y bu
also on wo ke s’ knowledge o he accine and hei pe cep ions o i s sa e y and alue.
Objec i e: To assess he le el o ac ual knowledge abou , and a i udinal pe cep ions owa d, he COVID-19 accine
among o sho e oil-and-gas wo ke s in Nige ia.
Me hods: A acili y-based c oss-sec ional su ey was conduc ed among 295 o sho e oil and gas wo ke s. Da a on
knowledge and pe cep ion o he COVID-19 accine we e ob ained om modi ying he Wo ld Heal h O ganiza ion
(WHO) S a egic Ad iso y G oup o Expe s (SAGE) ool on accine hesi ancy. Knowledge o he COVID-19 accine was
assessed using se en s uc u ed i ems. A composi e knowledge sco e anging om 0 o 7 was calcula ed o each
esponden , wi h sco es o 4 o highe indica ing good knowledge. The pe cep ion o he COVID-19 accine was
measu ed using eigh s a emen s, each a ed on a i e-poin Like scale (1 = s ongly disag ee o 5 = s ongly ag ee),
wi h highe sco es indica ing mo e a o able pe cep ions. Responden s wi h mean sco es o 3.0 o highe we e
classi ied as ha ing a posi i e pe cep ion. Desc ip i e s a is ics we e used o summa ize he da a.
Resul s: The mean knowledge sco e was 4.6 ± 1.6; 55.6 % o esponden s me he h eshold o good knowledge. The
highes mean sco es we e eco ded o i ems ela ed o an ibody p oduc ion (0.76) and WHO app o al (0.73), whe eas
he ou e o adminis a ion was he leas unde s ood (0.45). The mean pe cep ion sco e was 2.89 ± 0.71; 47.1 % o
wo ke s held a posi i e pe cep ion.
Conclusion: O sho e pe sonnel demons a ed mode a e knowledge o COVID-19 accines, ye ewe han hal
exp essed posi i e pe cep ions. Ta ge ed, wo k-si e-speci ic educa ion ha cla i ies accine adminis a ion and sa e y
e idence is wa an ed o b idge his knowledge–pe cep ion gap and suppo sus ained immuniza ion up ake in he
sec o .
Keywo ds: COVID-19 Vaccine; O sho e Pe sonnel; Knowledge; Pe cep ion; Nige ia
1. In oduc ion
Vaccina ion is one o he mos signi ican public heal h achie emen s, ha ing signi ican ly educed mo ali y and
mo bidi y om in ec ious diseases. I has led o he elimina ion o poliomyeli is in he Ame icas, he wo ldwide
e adica ion o smallpox (CDC, 1999), and he ecen de ea o wild- ype polio i us in Nige ia
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(Adebisi, P isno and Nuga, 2020). Vaccina ion p og ams ely on high up ake o p o ide di ec p o ec ion o indi iduals
and indi ec p o ec ion, he d immuni y, o he b oade communi y, slowing he ansmission o accine-p e en able
diseases and p o ec ing hose who emain suscep ible (Fine, Eames and Heymann, 2011).
Vaccines con ain a weakened o inac i a ed pa o a pa hogen (whole i al accine), p o ein subuni s, nucleic acids, o
oxins (Robinson e al., 2021). Because mos i al diseases lack de ini i e cu es, scien i ic p e en ion h ough accines
emains pa amoun (Be ekaa, 2020). On he A ican con inen , e ec i e childhood accina ion p og ams ha e
signi ican ly educed mo ali y and mo bidi y, alle ia ing he inancial bu den o ea ing p e en able diseases on
households (A olabi and Ilesanmi, 2021).
The eme gence o COVID-19, a global pandemic i s epo ed in Wuhan, China, on 31 Decembe 2019, heigh ened he
u gency o accine de elopmen (Dong and Ga dne , 2020). The Wo ld Heal h O ganiza ion (WHO) decla ed COVID-
19 a Public Heal h Eme gency o In e na ional Conce n on 30 Janua y and a pandemic on 11 Ma ch 2020 (WHO, 2020).
COVID-19 has since a ec ed nea ly e e y coun y. In Nige ia, he i s case was epo ed on 26 Feb ua y 2020, wi h
o e 243,450 cases documen ed by Decembe 2021 (NCDC, 2021). In ec ion occu s h ough espi a o y d ople s,
ae osols, and con amina ed su aces, wi h mos indi iduals eco e ing wi hou hospi aliza ion; howe e , some
expe ience se e e illness (WHO, 2020).
No ably, o sho e a el o oil and gas pla o ms has con ibu ed o Nige ia’s ising case numbe s, despi e p e en i e
measu es, ad e sely a ec ing indus y demand, p oduc i i y, and disease bu den (Okeh e al., 2022). The oil and gas
sec o is a co ne s one o Nige ia’s economy, accoun ing o oughly 10% o GDP, 70% o go e nmen e enue, and o e
83% o o eign exchange ea nings. Howe e , i endu ed a s eep decline du ing he pandemic, con ibu ing jus 5.87%
o eal GDP in Q4 2020, a 19.81% d op om Q3 amid alling demand and declining p ices (Aimee and Akaoma, 2021).
In esponse, he global accine ace accele a ed, culmina ing in he ollou o he P ize –BioNTech BNT162b2 accine
in Decembe 2020 unde Eme gency Use Au ho iza ion (EUA) by he U.S. FDA. The As aZeneca/Ox o d accine
(p oduced by Se um Ins i u e o India and SKBIO) ollowed on 15 Feb ua y 2021, wi h he Janssen Ad26.The COV2.S
and Mode na accines ecei ed EUA on Ap il 30, 2021 (WHO, 2021).
In Nige ia, he Na ional P ima y Heal h Ca e De elopmen Agency (NPHCDA) led he COVID-19 accine ollou ,
suppo ed by global ini ia i es such as COVAX. Despi e hese e o s, misin o ma ion, go e nmen mis us , sa e y
conce ns, and poo isk pe cep ion ha e impeded ull popula ion co e age. These challenges a e likely ampli ied among
o sho e wo ke s due o limi ed access o heal h communica ion and cons ained accine a ailabili y in hei
occupa ional en i onmen .
This s udy aims o e alua e he knowledge o and pe cep ions owa d COVID-19 accines among o sho e oil and gas
wo ke s in Nige ia, using Po Ha cou Ci y Ai po as he ec ui men si e. By iden i ying gaps in unde s anding and
a i udes, he esea ch seeks o in o m a ge ed in e en ions ha build accine con idence and imp o e up ake among
his high- isk g oup. The indings will guide go e nmen al s a egies and indus y policies, di ec ly bene i ing o sho e
wo ke s by enhancing hei accine awa eness, and se e as a baseline o u u e esea ch on accine knowledge and
pe cep ions in occupa ional con ex s.
2. Me hodology
2.1. S udy Design and Se ing
A desc ip i e c oss-sec ional su ey was ca ied ou a a cen al ansi poin o pe sonnel emba king on o sho e
ins alla ions in he Nige Del a.
2.2. S udy Popula ion
The s udy popula ion comp ised all o sho e oil-and-gas wo ke s scheduled o helicop e o c ew-boa ans e .
2.2.1. Inclusion C i e ia
• Ac i e wo ke s on o sho e oil and gas pla o ms.
• Scheduled o c ew ans e (helicop e o boa ) du ing he s udy pe iod.
• Minimum age o 18 yea s.
• Willing o p o ide in o med consen and able o comple e he s udy ques ionnai e in English.
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2.2.2. Exclusion C i e ia
• Wo ke s who a e on lea e, aca ion, o in aining.
• Non-o sho e suppo s a , such as o ice-based adminis a i e pe sonnel.
2.3. Sample size calcula ion and Sampling
Since he ue p opo ion o accine knowledge among o sho e wo ke s was unknown, we used he conse a i e
es ima e o 50% o maximize s a is ical p ecision. Wi h a 95% con idence le el (α = 0.05) and a ma gin o e o o ±5%,
Coch an’s o mula o in ini e popula ions yields an ini ial sample size o 385. Applying a ini e popula ion co ec ion
esul ed in a inal sample size o 295, ensu ing adequa e p ecision and s a is ical powe o he s udy.
Using sys ema ic sampling, e e y i h eligible wo ke in he p e-depa u e lounge was in i ed o pa icipa e a e
p o iding w i en in o med consen , un il he desi ed sample size was achie ed.
2.4. Da a Collec ion
Da a we e ga he ed using a s uc u ed, sel -adminis e ed ques ionnai e modi ied om he Wo ld Heal h O ganiza ion
(WHO) S a egic Ad iso y G oup o Expe s (SAGE) ool on accine hesi ancy bu es ic ed o domains o knowledge
and pe cep ion (Domek e al., 2018).
The knowledge sec ion comp ised se en i ems wi h esponses o yes/no/o do no know. Co ec esponses we e
sco ed 1; inco ec o ‘do no know’ esponses sco ed 0. This yielded a maximum sco e o se en and a minimum sco e
o ze o. Responden s sco ing ou o mo e co ec answe s we e classi ied as ha ing good knowledge, while hose wi h
ewe han ou co ec answe s we e classi ied as ha ing poo knowledge.
The pe cep ion sec ion comp ised eigh i ems wi h esponses g aded on a i e-poin Like scale (1 = s ongly disag ee
o 5 = s ongly ag ee). Nega i ely wo ded s a emen s we e e e se-coded so ha highe alues uni o mly signi ied mo e
a o able a i udes. The pe cep ion composi e sco e was de e mined based on he mean o eigh Like i ems a e
e e se coding. The mean sco e o each esponden anged om 1 o 5. Mean sco e ≥ 3.0 indica ed a posi i e pe cep ion,
while sco es < 3.0 indica ed a nega i e pe cep ion. Two occupa ional heal h specialis s e iewed he d a ins umen
o con en alidi y and pilo - es ed i on 20 non-s udy o sho e wo ke s (C onbach’s α = 0.78 o pe cep ion i ems).
2.5. Da a Managemen and Analysis
Comple ed ques ionnai es we e checked o comple eness, en e ed in o SPSS e sion 25, and double- e i ied. Analysis
was limi ed o desc ip i e s a is ics: means ± s anda d de ia ions (SD) o con inuous a iables and equencies wi h
pe cen ages o ca ego ical a iables. Being a baseline s udy, he analysis was es ic ed o desc ip i e s a is ics.
2.6. E hical Conside a ions
App o al was ob ained om he Uni e si y o Po Ha cou Resea ch E hics Commi ee (Re No.
UPH-PH-SPH/2022/107). W i en pe mission was secu ed om he Po Ha cou Ci y Ai po Base Manage .
Pa icipa ion was olun a y, and anonymi y was assu ed by omi ing pe sonal iden i ie s. All ield s a adhe ed o
p e ailing COVID-19 sa e y p o ocols du ing da a collec ion.
3. Resul s
3.1. Demog aphic cha ac e is ics
The mean age o he esponden s was 37.45 yea s (SD = 8.95). Conce ning employmen s a us, 150 (50.8%) had
pe manen employmen while 145 (49.2%) we e con ac s a .
3.2. Knowledge o he COVID-19 Vaccine
Responden s' knowledge o he COVID-19 accine was assessed using se en i ems wi h bina y esponse op ions, coded
as 1 o co ec and 0 o inco ec o “don’ know.” The mean knowledge sco e was 4.6 (SD = 1.6) ou o a maximum
sco e o 7. This sugges s a mode a e le el o knowledge among he o sho e wo ke s su eyed.
As shown in Table 1, he highes -sco ing knowledge i em was “The accine s imula es an ibody p oduc ion,” wi h a
mean sco e o 0.76 (SD = 0.43), indica ing ha mos esponden s co ec ly unde s ood his undamen al unc ion o he
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accine. Simila ly high sco es we e eco ded o he i em assessing knowledge o WHO app o al o he accine (mean =
0.73, SD = 0.44), he s a emen ha accines unde go igo ous es ing be o e app o al (mean = 0.70, SD = 0.46), and
knowledge ha wo doses a e gene ally equi ed o p o ec ion (mean = 0.69, SD = 0.47).
In con as , lowe sco es we e eco ded o i ems assessing unde s anding o he accine’s composi ion and ou e o
adminis a ion. Fo example, only 45% o esponden s co ec ly indica ed ha COVID-19 accines a e no adminis e ed
o ally, as e lec ed by a mean sco e o 0.45 (SD = 0.50), he lowes among all knowledge i ems.
Based on a cu -o o 4 o mo e co ec esponses, 164 esponden s (55.6%) we e classi ied as ha ing good knowledge
o he COVID-19 accine, while he emaining 131 (44.4%) we e ca ego ized as ha ing poo knowledge.
Table 1 Knowledge o he COVID-19 Vaccine among O sho e Oil-and-Gas Wo ke s (N = 295)
I ems
Mean
SD
The accine s imula es an ibody p oduc ion.
0.76
0.43
WHO has app o ed he accine.
0.73
0.44
Two doses a e gene ally equi ed o ull p o ec ion.
0.69
0.47
Vaccines unde go igo ous es ing be o e app o al.
0.70
0.46
The accine con ains an inac i a ed i us.
0.62
0.49
The accine p o ides long- e m immuni y.
0.60
0.49
COVID-19 accines a e adminis e ed o ally
0.45
0.50
3.3. Pe cep ion o he COVID-19 Vaccine
Responden s’ pe cep ion o he COVID-19 accine was measu ed using eigh Like - ype i ems, each sco ed on a 5-poin
scale om 1 (s ongly disag ee) o 5 (s ongly ag ee). Nega i ely wo ded s a emen s we e e e se-coded so ha highe
sco es uni o mly e lec ed mo e posi i e pe cep ions.
Table 2 Pe cep ion o he COVID-19 Vaccine
I em
Mean
SD
The accine p o ec s agains se e e illness.
3.31
1.01
E e yone should ge accina ed.
3.25
1.06
I would ecommend he accine o o he s.
3.10
1.08
The accine is sa e o use.
3.11
1.09
The accine has long- e m nega i e heal h e ec s*
2.76
1.14
The accine can cause COVID-19 in ec ion*
2.62
1.17
The go e nmen is hiding he side-e ec s*
2.58
1.12
I us in o ma ion om he Minis y o Heal h.
2.89
1.03
* e e se coding
The mean composi e pe cep ion sco e was 2.89 (SD = 0.71). When ca ego ized using a h eshold o ≥3.0 o indica e
posi i e pe cep ion, 139 esponden s (47.1%) we e classi ied as ha ing a posi i e pe cep ion o he accine, while 156
esponden s (52.9%) we e classi ied as ha ing a nega i e pe cep ion.
Table 2 displays he mean esponses o each pe cep ion i em. The highes - a ed i em was “The accine p o ec s agains
se e e illness,” wi h a mean sco e o 3.31 (SD = 1.01), ollowed closely by “E e yone should ge accina ed” (mean =
3.25, SD = 1.06) and “I am willing o ecommend he accine o o he s” (mean = 3.10, SD = 1.08). These esponses sugges
ha nea ly hal o he esponden s acknowledged he public heal h alue o he accine and we e open o p omo ing i .
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Pe cep ions ela ed o sa e y and us showed mo e a iabili y and lowe sco es. Fo example, he i em “The accine
has long- e m nega i e heal h e ec s” ( e e se-coded) had a mean sco e o 2.76 (SD = 1.14), and “The accine can cause
COVID-19 in ec ion” ( e e se-coded) had a mean sco e o 2.62 (SD = 1.17). No ably, us in he Minis y o Heal h was
modes , wi h a mean sco e o 2.89 (SD = 1.03), while he e e se-coded i em “The go e nmen is hiding he side e ec s
o he accine” sco ed lowes among pe cep ion i ems a 2.58 (SD = 1.12).
4. Discussion
This s udy aimed o quan i y ac ual knowledge o , and a i udinal pe cep ions owa d, he COVID-19 accine among
o sho e oil-and-gas wo ke s in Nige ia. This c i ical wo k o ce ope a es in con ined, high-mobili y se ings whe e
ou b eaks can apidly comp omise wo ke sa e y and na ional pe oleum ou pu . Th ee p incipal indings eme ged.
Fi s , he a e age esponden answe ed oughly wo- hi ds o he knowledge i ems co ec ly, yielding a composi e mean
o 4.6 ± 1.6 ou o 7. Second, ewe han hal o he esponden s (47.1 %) displayed an unequi ocally posi i e pe cep ion
o he accine, wi h a composi e mean o 2.89 ± 0.71 on a 5-poin scale. Thi d, ma ked disc epancies we e e iden
be ween ela i ely sound knowledge in some domains (e.g., immunologic unc ion and WHO app o al) and pe sis en
misconcep ions in o he s (e.g., adminis a ion ou e), as well as be ween knowledge and pe cep ion mo e gene ally.
4.1. Knowledge in Compa a i e Con ex
The o e all knowledge sco e (66 % co ec ) aligns wi h anges epo ed in ecen Nige ian su eys o heal hca e
p o ide s (62–74 %; Amuzie e al., 2021) and communi y membe s (64 %; Adedeji-Adenola e al., 2022). Compa able
le els ha e been documen ed among heal hca e wo ke s ac oss sub-Saha an A ica (Ackah e al., 2022) and globally
(Dzieciolowska e al., 2021). High accu acy on i ems ela ing o an ibody p oduc ion and WHO app o al sugges s ha
mass-media messaging has been e ec i e in con eying he b oad accine pu pose and egula o y s a us. Con e sely,
he lowes -sco ing i em, he belie ha he accine is adminis e ed o ally, mi o s ou e-o -adminis a ion my hs
iden i ied in communi y samples h oughou Wes A ica (Olu-Abiodun e al., 2022). No ably, injec ion- ela ed anxie ies
ha e his o ically hampe ed up ake o o he accines in Nige ia (Pa e son e al., 2016); co ec ing his speci ic
misconcep ion is impe a i e.
4.2. Pe cep ion, Sa e y Conce ns, and T us De ici s
Despi e mode a e knowledge, he a i udinal p o ile was p edominan ly cau ious, i no o e ly hos ile. App oxima ely
hal o he coho exp essed ese a ions abou long- e m ad e se e ec s and he possibili y o con ac ing COVID-19
om accina ion. Simila sa e y-cen ic hesi ancy has been lagged in me a-analyses o A ican heal hca e wo ke s
(Ackah e al., 2022) and Nige ian communi y polls (Olu-Abiodun e al., 2022). Mis us o go e nmen anspa ency
sco ed lowes among pe cep ion i ems, echoing b oade Nige ian da a whe e dis us in public ins i u ions p edic s
hesi ancy mo e s ongly han misin o ma ion exposu e alone (King e al., 2021). This pa e n is consis en wi h he
“con idence” dimension o accine hesi ancy (MacDonald, 2015) and unde sco es indings ha ins i u ional us is a
c i ical de e minan o accine accep ance wo ldwide (Dubé e al., 2014; La son e al., 2016).
4.3. The Knowledge–Pe cep ion Disconnec
The coexis ence o mode a e knowledge and skep ical pe cep ion illus a es a well-documen ed knowledge–a i ude
gap in accina ion beha io (Machingaidze and Wiysonge, 2021). Heal h Beha io heo ies, such as he Heal h Belie
Model, posi ha accu a e knowledge is necessa y bu insu icien ; pe cei ed suscep ibili y, pe cei ed bene i s, and
con idence in sa e y mus con e ge o d i e up ake (Fine e al., 2011). In he p esen s udy, al hough esponden s
ecognized he accine’s p o ec i e alue (mean = 3.31 o “p o ec s agains se e e illness”), conce ns o e side-e ec s
(mean = 2.76) and in ec ion isk om he accine (mean = 2.62) dep essed o e all pe cep ion sco es, sugges ing ha
isk–bene i calcula ions emain un a o able o many wo ke s.
4.4. Occupa ional Nuances in an O sho e En i onmen
O sho e ins alla ions in oduce dis inc con ex ual ac o s ha likely ampli y sa e y conce ns. Isola ion limi s eal- ime
access o p o essional heal h counsel, and o a ional schedules impede imely accina ion oppo uni ies. Mo eo e , he
sec o ’s his o y o labo dispu es may gene alize mis us o go e nmen -led heal h ini ia i es, ein o cing skep icism.
Pee - o-pee communica ion, dominan in such se ings, can accele a e he sp ead o un e i ied umo s, consis en wi h
social-ne wo k analyses o misin o ma ion di usion in o he essen ial-wo ke g oups (K ico ian e al., 2022).
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4.5. S eng hs and Limi a ions
A chie s eng h o his s udy is i s ocus on an unde - esea ched occupa ional coho using a alida ed, SAGE-adap ed
ins umen wi h accep able in e nal consis ency (C onbach’s α = .78). Sys ema ic sampling a a signi ican ansi hub
enhances in e nal alidi y. Ne e heless, se e al limi a ions me i acknowledgmen . The c oss-sec ional design
p ecludes causal in e ence, while eliance on sel - epo in oduces po en ial social-desi abili y and ecall biases. The
single-si e sampling ame may limi gene alizabili y o all Nige ian o sho e pla o ms o o he coun ies’ o sho e
sec o s. Finally, he exclusi e use o desc ip i e s a is ics es ains explo a ion o de e minan s; u u e in e en ial
analyses could elucida e socio-demog aphic o psychosocial p edic o s o knowledge and pe cep ion.
4.6. Implica ions o P ac ice and Policy
Findings a gue o mul i ace ed, wo ksi e-adap ed in e en ions. Pee -led educa ional b ie ings should di ec ly ackle
knowledge gaps abou accine composi ion and adminis a ion, using pic o ial aids and ig-c ew e nacula o enhance
salience. T anspa en communica ion o pos -ma ke ing sa e y da a, deli e ed h ough c edible in e media ies such as
occupa ional physicians, may imp o e con idence. Pa ne ships be ween indus y and he Minis y o Heal h o hos
in e ac i e, eco ded own-hall sessions could no malize wo-way dialogue and build ins i u ional us . Finally, aligning
accina ion oppo uni ies wi h ou ine o sho e medicals o mid- ou heal h checks could mi iga e logis ical ba ie s.
4.7. Fu u e Resea ch
Longi udinal designs a e needed o ack shi s in knowledge and pe cep ion as a ge ed in e en ions a e olled ou
and new a ian s o boos e ecommenda ions eme ge. Quali a i e s udies could explo e he psychosocial mechanisms
unde pinning mis us and iden i y le e age poin s o communica ion s a egies ailo ed o o sho e subcul u es.
5. Conclusion
This s udy p o ides aluable baseline da a on he le el o COVID-19 accine knowledge and pe cep ion among Nige ian
o sho e oil-and-gas wo ke s, a c i ical bu unde ep esen ed occupa ional g oup in public heal h esea ch. While he
majo i y o esponden s demons a ed mode a e o good ac ual knowledge abou he accine, pa icula ly ega ding
i s immunologic unc ion and global app o al, key misunde s andings pe sis ed abou i s adminis a ion ou e and
o mula ion. These knowledge gaps a e signi ican gi en hei po en ial o unde mine con idence in he accine.
Pe cep ions we e mo e a ied, wi h less han hal o he esponden s exp essing posi i e a i udes owa d he accine.
Conce ns cen e ed a ound long- e m heal h e ec s, mis us o go e nmen anspa ency, and misin o ma ion abou
accine sa e y. These indings e eal a no able disconnec be ween wha wo ke s know and how hey eel abou he
accine, unde sco ing he need o mo e han jus ac ual educa ion.
To b idge his gap, a ge ed, wo ksi e-speci ic communica ion s a egies a e u gen ly needed, beyond gene al
awa eness, o add ess occupa ional eali ies, sa e y conce ns, and us de ici s. Inco po a ing pee -led educa ion,
accessible sa e y in o ma ion, and wo-way engagemen wi h c edible heal h au ho i ies could help os e mo e
a o able pe cep ions and suppo sus ained up ake. Fu u e esea ch should e alua e he e ec i eness o such
in e en ions and ack changes o e ime o in o m esponsi e and inclusi e public heal h s a egies o o sho e
popula ions.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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