European Journal of Cardiovascular Medicine

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to global health systems, resulting in significant morbidity, mortality, and economic disruption. Since its declaration as a global pandemic by the World Health Organization in March 2020, COVID-19 has necessitated the implementation of urgent public health strategies, among which vaccination remains the most effective intervention for controlling the spread and reducing the severity of the disease (1,2).

Vaccination campaigns have significantly reduced hospitalization rates and prevented deaths worldwide. However, vaccine acceptance is not uniform across different populations, and hesitancy remains a barrier, even among healthcare workers (3,4). Medical interns, being in the transitional phase from students to clinicians, are exposed to both clinical responsibilities and academic influences, making their perception toward vaccination particularly relevant (5). Their knowledge, attitudes, and practices (KAP) not only affect their personal health behavior but also influence patient education and public perception (6,7).

Despite the availability of vaccines and targeted awareness campaigns, previous studies have reported varying degrees of knowledge and misconceptions about COVID-19 vaccines among healthcare students and trainees (8). Attitudinal factors such as perceived vaccine efficacy, safety concerns, and trust in health authorities also contribute to vaccine acceptance (9). Understanding the KAP of medical interns is thus critical for informing tailored educational interventions and policy measures aimed at enhancing vaccine uptake and advocacy within healthcare settings.

This multi-center survey aims to evaluate the current level of knowledge, attitudes, and practices related to COVID-19 vaccination among medical interns in India, thereby identifying gaps and areas for improvement in vaccine-related education.

A cross-sectional study design was employed to assess the knowledge, attitudes, and practices (KAP) toward COVID-19 vaccination among medical interns across five tertiary care teaching hospitals in India.

Study Population and Sampling
Medical interns undergoing their compulsory rotatory internship in the selected institutions were eligible to participate. A total of 520 interns were approached using convenience sampling. After excluding incomplete responses, 476 fully completed questionnaires were included in the final analysis.

Instrument Development
A structured, self-administered questionnaire was used as the data collection tool. The questionnaire was developed based on previous KAP studies and validated guidelines from the World Health Organization and Indian Council of Medical Research. It consisted of four sections: demographic information (5 items), knowledge (10 multiple-choice questions), attitude (8 Likert-scale statements), and practice (7 behavior-based questions). The questionnaire was validated by a panel of experts for content and face validity, and a pilot test was conducted on 30 interns not included in the final analysis.

Data Collection Procedure
The questionnaire was distributed electronically via Google Forms. Participation was voluntary, and informed consent was obtained digitally before survey commencement. Anonymity and confidentiality of responses were assured throughout the study.

Scoring System
Each correct answer in the knowledge section was awarded one point, with a maximum possible score of 10. Scores ≥8 were considered high knowledge, 5–7 as moderate, and <5 as low. Attitude responses were scored on a 5-point Likert scale ranging from strongly disagree to strongly agree. Practice scores were based on positive health behaviors related to vaccination uptake and advocacy.

Statistical Analysis
Data were exported into Microsoft Excel and analyzed using IBM SPSS Statistics Version 26. Descriptive statistics such as mean, standard deviation, frequencies, and percentages were used to summarize the data. Chi-square tests were employed to assess associations between knowledge levels and practice behavior, with a significance threshold set at p<0.05.

A total of 476 medical interns participated in the study, yielding a response rate of 91.5%. The majority of participants were female (62.8%), and the mean age was 23.1 ± 0.8 years. Table 1 summarizes the demographic characteristics of the respondents.

Knowledge Regarding COVID-19 Vaccination
Out of a total score of 10, 68.5% (n=326) of interns scored in the high knowledge category (≥8), 21.4% (n=102) had moderate knowledge (5–7), and 10.1% (n=48) scored below 5. Most participants (93.3%) correctly identified that vaccination reduces the risk of severe illness, while only 62.4% were aware of the recommended gap between vaccine doses (Table 2).

Attitudes Toward Vaccination
Overall, 79.2% of interns expressed a positive attitude toward the COVID-19 vaccine. Notably, 84.7% agreed that healthcare professionals should promote vaccination, while 12.6% remained neutral, and 3.1% disagreed. A substantial proportion (77.3%) reported confidence in the vaccine’s long-term safety (Table 3).

Practices Related to Vaccination
A large majority (91.6%) of participants had completed at least two doses of the COVID-19 vaccine, and 64.5% had also received a booster dose. Furthermore, 73.5% reported that they had actively encouraged peers or family members to get vaccinated, while 58.6% had engaged in sharing vaccine-related information on social media platforms (Table 4).

Association Between Knowledge and Practice
A statistically significant association was observed between high knowledge scores and positive vaccination practices (p=0.004), as shown in Table 5. Interns with higher knowledge scores were more likely to be fully vaccinated and actively promote vaccination among others.

Table 1: Demographic Characteristics of Participants (n=476)

Table 2: Knowledge Scores and Item-Wise Correct Responses

Table 3: Attitudes Toward COVID-19 Vaccination

Table 4: Vaccination Practices Among Interns

Table 5: Association Between Knowledge Level and Practice Behavior

The present study assessed the knowledge, attitudes, and practices (KAP) regarding COVID-19 vaccination among medical interns in India. The findings indicate a generally high level of awareness and positive behavioral patterns among future healthcare professionals. This aligns with earlier studies that highlight healthcare students as informed and influential agents in public health campaigns (1,2).

Our results show that 68.5% of interns demonstrated high knowledge levels, which is slightly higher than findings reported among medical students in Egypt and Pakistan, where correct knowledge responses ranged between 60–65% (3,4). The high percentage of participants recognizing the efficacy of vaccines in reducing disease severity corroborates existing evidence emphasizing the need for accurate scientific communication in medical education (5,6).

Attitudinal analysis revealed that over 79% of respondents supported COVID-19 vaccination and believed in their role as health advocates. This finding reflects those from studies conducted in Saudi Arabia and Italy, where medical trainees expressed strong pro-vaccine sentiments (7,8). However, concerns about long-term vaccine safety, albeit in a minority, highlight the persistent challenge of misinformation, even within clinical training environments (9).

In terms of practice, 91.6% of interns had completed at least two doses of the COVID-19 vaccine, and 64.5% received a booster, indicating a commendable compliance rate. Similar vaccine uptake levels were noted in studies from Germany and the United States, where healthcare trainees reported higher adherence to immunization protocols than the general population (10,11). Importantly, over 70% of interns reported encouraging peers and family members to get vaccinated, reinforcing their role as community health influencers (12).

The significant association between higher knowledge scores and positive vaccination practices in this study is consistent with the health belief model, which suggests that accurate knowledge enhances perceived benefits and reduces barriers to preventive actions (13). These findings emphasize the critical need to integrate structured vaccine education into medical curricula to strengthen future physician advocacy and patient counselling skills (14).

Despite the encouraging findings, certain gaps remain. Nearly 30% of participants were unaware of specific vaccine schedules or contraindications, suggesting a need for focused training sessions during clinical postings. Additionally, some interns expressed neutral or negative attitudes, possibly influenced by unverified online sources or peer opinions, a phenomenon well-documented in previous behavioral studies among youth (15).

This study’s strength lies in its multi-center design and high response rate, enhancing the generalizability of findings across medical institutions. Nonetheless, limitations include reliance on self-reported data and the potential for response bias. Longitudinal studies would be beneficial to track changes in KAP over time and evaluate the long-term impact of targeted educational interventions.

The study concluded that most medical interns have good knowledge and favorable attitudes toward COVID-19 vaccination, which translated into appropriate vaccination practices. However, targeted interventions are required to address existing gaps and reinforce vaccine advocacy training among interns.

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