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Original Article

Assessment of healthcare workers’ knowledge and attitudes toward mpox and acceptance of its vaccine: a health belief model-based analysis in the Gulf region

Mona Gamal Mohamed1,2orcid, Eman Abdelaziz Ahmed Dabou3,4orcid, Fatma M. Ibrahim5,6orcid, Shaimaa Abdelsamad7orcid, Jibin Kunjavara8orcid, Kamaruddeen Mannethodi9orcid, Moayad Ahmad Wishah10orcid, Abdullah Y. Shihab11orcid, Khaled Mohammed Al-Sayaghi12orcid, Hammad Ali Fadlalmola13orcid, Mohammed Musaed Al-Jabri14orcid

Published online: June 25, 2025

1Adult Health Nursing, RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

2Medical Surgical Nursing Department, Faculty of Nursing Sohag University, Sohag, Egypt

3Adult Health Nursing, RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

4Medical Surgical Nursing Department, Faculty of Nursing Alexandria University, Alexandria, Egypt

5RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

6Faculty of Nursing, Mansoura University, Mansoura, Egypt

7RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

8Nursing and Midwifery Research Department, Hamad Medical Corporation, Doha, Qatar

9Nursing and Midwifery Research Department, Hamad Medical Corporation, Doha, Qatar

10Clinical Resources, Emirates Health Services, Ras Al Khaimah, United Arab Emirates

11Department of Community Health Nursing, College of Nursing, University of Baghdad, Baghdad, Iraq

12Department of Medical-Surgical Nursing, College of Nursing, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia

13Department of Community Health Nursing, College of Nursing, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia

14Nursing Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Wadi Addawasir, Saudi Arabia

Corresponding author: Mona Gamal Mohamed Adult Health Nursing, RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates E-mail: mona.mohamed2100@yahoo.com
• Received: April 13, 2025   • Revised: April 22, 2025   • Accepted: May 19, 2025

© 2025 Korea Disease Control and Prevention Agency.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • Objectives
    This study aimed to (1) assess healthcare workers’ (HCWs) knowledge and attitudes toward mpox across 3 Gulf countries, and (2) examine factors influencing their acceptance of the mpox vaccine using the health belief model (HBM). This model evaluated perceptions related to susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Additionally, the study explored the impact of prior coronavirus disease 2019 (COVID-19) vaccination history on mpox vaccine acceptance.
  • Methods
    A cross-sectional study was conducted among 764 HCWs from the United Arab Emirates (UAE), Saudi Arabia, and Qatar. Data were collected through a structured online questionnaire based on HBM constructs. Logistic regression and structural equation modeling were employed to analyze predictors of vaccine acceptance.
  • Results
    Knowledge levels varied across the countries, with the highest proportion of good knowledge reported in the UAE (59%). UAE HCWs also demonstrated higher perceived susceptibility, perceived benefits, and intention to vaccinate compared to those in Saudi Arabia and Qatar (p<0.001). Receiving 4 doses of the COVID-19 vaccine was associated with greater acceptance of the mpox vaccine. Among the HBM constructs, perceived benefits and self-efficacy were identified as the strongest predictors of vaccine acceptance. Perceived barriers, such as fear of side effects and concerns about vaccine safety, were more prominent among HCWs in Saudi Arabia and Qatar.
  • Conclusion
    The HBM effectively explains the factors influencing mpox vaccine acceptance among Gulf HCWs. Targeted interventions that improve perceived benefits, reduce barriers, and improve self-efficacy may facilitate greater vaccine uptake and preparedness for emerging infectious diseases.
  • Keywords: Attitude; Gulf region; Health belief model; Healthcare workers; Knowledge; Monkeypox vaccine; Vaccine acceptance
Healthcare workers (HCWs) play a crucial role in combating infectious disease outbreaks [1], serving as frontline defenders, educators, and influencers of public health behavior [2,3]. Their acceptance of vaccines directly influences workplace safety, patient outcomes, and community trust [4]. During the coronavirus disease 2019 (COVID-19) pandemic, HCWs’ vaccine hesitancy—driven by misinformation, safety concerns, and distrust—highlighted the necessity of addressing behavioral determinants of vaccination [5]. With the global mpox outbreak in 2022, understanding HCWs’ vaccination intentions has become urgent once again [6], particularly in high-risk regions such as the Gulf Cooperation Council (GCC), where HCWs frequently interact with transient populations and international travelers [7].
A viral zoonosis endemic to Central and West Africa, mpox re-emerged in 2022 as a multi-country outbreak, with over 87,000 cases reported globally [8]. Unlike previous outbreaks, this epidemic was characterized by sustained human-to-human transmission through close contact, sexual networks, and fomites [9]. Symptoms, including painful rashes and systemic complications [10], alongside stigma—especially among men who have sex with men (MSM)—have complicated containment efforts [11]. Although smallpox vaccines (e.g., JYNNEOS) provide protection, global disparities in vaccine access and hesitancy have impeded uptake [12]. In the Gulf, where mass religious gatherings (e.g., Hajj) and tourism hubs elevate outbreak risks, HCWs’ preparedness to manage mpox is critical [13–15].
The socio-demographic landscape of the GCC region, characterized by dense expatriate labor populations, hyper-urbanization, and global connectivity, heightens susceptibility to imported and locally transmitted pathogens [16]. For instance, Saudi Arabia hosts 2 to 3 million pilgrims annually during Hajj [17], while multicultural cities in the United Arab Emirates (UAE) attract millions of tourists [18]. These dynamics, combined with limited public awareness of zoonotic diseases and cultural sensitivities [19] regarding stigmatized transmission routes (e.g., sexual contact), create unique challenges for HCWs [20,21]. Misconceptions about mpox transmission and prevention could increase occupational exposure risks and delay outbreak responses [22,23].
Vaccine hesitancy in the Gulf region is influenced by cultural, religious, and systemic factors [24]. During the COVID-19 pandemic, concerns regarding mRNA technology’s compatibility with Islamic principles, distrust of Western pharmaceuticals, and fears related to vaccine side effects reduced vaccine uptake among HCWs [25]. For mpox, hesitancy might be further compounded by stigma toward MSM, a key affected population in conservative Gulf societies, where open discussions about sexuality are limited [26]. Additionally, hierarchical workplace cultures may discourage HCWs from voicing concerns or seeking clarification regarding vaccination policies [27].
HCWs’ ability to advocate for vaccination is dependent on their knowledge of disease transmission, prevention, and treatment. Studies have identified gaps in HCWs’ understanding of mpox, including confusion with other poxviruses and underestimation of non-sexual transmission routes [28,29]. In the Gulf region, linguistic diversity and reliance on expatriate HCWs from varied educational backgrounds could further fragment knowledge dissemination [30]. Misinformation propagated via social media, such as myths about vaccine-induced infertility, might deepen skepticism, underscoring the need for targeted training [31].
The health belief model (HBM), a psychological theory developed by Rosenstock [32], posits that health behaviors are influenced by 6 constructs: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy [33]. It has been widely applied to predict vaccine uptake, including influenza and human papilloma virus vaccinations [34]. For instance, during the COVID-19 pandemic, HCWs’ perceived susceptibility to infection and trust in institutional guidance were critical predictors of vaccine acceptance [3]. However, the model’s utility in explaining mpox vaccination behavior, particularly in contexts where cultural norms influence risk perception, remains untested.
Objectives
This study aimed to achieve 2 main objectives. First, it assessed HCWs knowledge and attitudes toward mpox across 3 Gulf countries. Second, it examined factors influencing mpox vaccine acceptance using the HBM. Specifically, the study evaluated HCWs’ perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy, and how these constructs predicted vaccine acceptance. It also explored the relationship between prior COVID-19 vaccination history and attitudes toward mpox vaccination.
Study Design and Setting
This was a multicenter, quantitative, cross-sectional study designed to assess HCWs knowledge, attitudes, and perceptions regarding mpox, as well as their intention to receive the mpox vaccine. The study was conducted across public and private hospitals in 3 Gulf countries: the UAE, the Kingdom of Saudi Arabia, and the State of Qatar. These countries were selected due to their leading roles in regional healthcare infrastructure, active public health surveillance systems, and diverse, multinational healthcare workforces, making them ideal for examining cross-country variations in vaccine perceptions and health beliefs. Data collection occurred from April 1 to October 30, 2024, through an online survey platform (Figure 1).
Participants and Sample Size
Eligible participants included HCWs (physicians, nurses, and allied health professionals) with at least 1 year of clinical experience at healthcare facilities in the Gulf region. HCWs who were in the process of resigning or unwilling to participate were excluded. A non-probability convenience sampling method was used due to logistical feasibility and the multicenter nature of the study.
The required sample size was calculated using the formula for proportions, assuming a 95% confidence level (Z=1.96), a margin of error of 5% (e=0.05), and a conservative prevalence estimate of 50% (p=0.5) for adequate mpox knowledge, due to the absence of prior regional data. This calculation yielded a minimum sample size of 384. To improve statistical power and account for incomplete responses, the target was increased. Ultimately, 764 HCWs participated, including 256 from the UAE, 187 from Saudi Arabia, and 321 from Qatar.
Participants and Sample Size
Eligible participants included HCWs (physicians, nurses, and allied health professionals) with at least 1 year of clinical experience at healthcare facilities in the Gulf region. HCWs who were in the process of resigning or unwilling to participate were excluded. A non-probability convenience sampling method was used due to logistical feasibility and the multicenter nature of the study.
The sample size was calculated using the standard formula for estimating proportions in cross-sectional studies:
n=Z2⋅p⋅(1-p)e2.
Assuming a 95% confidence level (Z=1.96), a margin of error of 5% (e=0.05), and a conservative prevalence estimate of 50% (p=0.5), the minimum required sample size was calculated to be 384. To compensate for an estimated non-response rate of 40% and a dropout rate of 10%, the final target sample size was increased to approximately 770 participants. This allowed for better representation and completeness of the data. Ultimately, 764 HCWs participated in the study: 256 from the UAE, 187 from Saudi Arabia, and 321 from Qatar.
Data Collection and Measures
Data were collected via a structured, self-administered online questionnaire, disseminated through institutional emails and internal communication systems. Department heads facilitated the survey’s distribution. Participation was voluntary, and informed consent was implied by completing the survey.
The questionnaire was divided into 3 sections.

Socio-demographic characteristics

This section collected data on participants’ age, sex, marital status, education level, country of residence, specialty, type of workplace, years of medical practice, primary sources of mpox information, and COVID-19 vaccination status (number of doses received).

HCWs’ knowledge and attitudes about mpox infection

The knowledge assessment included 16 items measuring participants’ understanding of mpox transmission, symptoms, and preventive measures. These items were adapted from previously validated tools used in similar studies among HCWs in Iraq, Saudi Arabia, Rwanda, and other international contexts [3,35,36]. Responses were rated on a 3-point Likert scale (“I know,” “Uncertain,” and “I do not know”), with a Cronbach’s alpha value of 0.76, indicating good internal consistency. Participants who correctly answered at least 70% of the knowledge items (i.e., 12 out of 16 questions) were classified as having “good knowledge,” while those scoring below this threshold were considered to have “poor knowledge.” This criterion defined satisfactory knowledge (Table S1).
The attitude assessment consisted of 5 items rated on a 5-point Likert scale (ranging from “strongly agree” to “strongly disagree”), evaluating participants’ perspectives on the seriousness and impact of mpox. These attitude items were adapted from validated instruments and systematic reviews assessing HCWs’ attitudes toward mpox [37,38]. Each item was scored from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating more positive attitudes. The total possible score ranged from 5 to 25. Participants scoring 70% or more of the total score (≥18 out of 25) were classified as having a positive attitude, while those below this threshold were considered to have a negative attitude. This section aimed to assess the depth of knowledge and attitudes among HCWs using standardized, evidence-based constructs (Tables S2, S3).

Mpox vaccine acceptance and intention based on the HBM

This section explored HCWs’ willingness to receive the mpox vaccine and recommend it to others, along with concerns about side effects and payment preferences. It incorporated 24 items structured according to the HBM, encompassing 6 dimensions: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and perceived intention to vaccinate. The items were adapted from validated instruments employed in previous HBM-based studies on vaccine hesitancy, particularly related to COVID-19 and mpox [3,39,40]. These references provided a robust theoretical and empirical foundation for measuring behavioral predictors of vaccine acceptance among HCWs.
Bias Mitigation
Efforts to minimize bias included collecting responses anonymously to reduce social desirability bias and employing a standardized online data collection method to ensure consistency across countries. Reminder emails were sent to enhance response rates and minimize non-response bias.
The content validity of the draft self-administered questionnaire was evaluated by an expert committee composed of specialists in public health, infectious diseases, and health psychology. The committee provided feedback and suggested modifications, resulting in the final version of the questionnaire. Construct validity was assessed through confirmatory factor analysis, which indicated a good model fit (Tucker-Lewis index [TLI], 0.904; root mean square error of approximation [RMSEA], 0.046; 95% confidence interval [CI], 0.040–0.051).
Following approval from respective facility authorities, invitations containing the survey link were disseminated to department heads across participating hospital facilities. The invitations included an information sheet describing the study’s objectives. Data collection took place via an online survey platform (Google Forms) between April 1 and October 30, 2024. To maximize participation, 2 follow-up reminder emails were sent. The survey employed implied consent, meaning participation was voluntary, and survey completion indicated participant consent.
Handling of Quantitative Variables
Quantitative variables such as age and years of professional experience were analyzed as continuous variables. When appropriate, categorical groupings (e.g., COVID-19 vaccination doses categorized as 0–1, 2, 3, and 4 doses) were used for subgroup analyses.

Statistical analysis

All statistical analyses were conducted using IBM SPSS ver. 26.0 (IBM Corp.) and jamovi, an R-based open software. The following statistical methods were employed.

Descriptive statistics

Categorical variables (e.g., sex, marital status, education level) were presented using frequencies (n) and percentages (%). Ordinal and continuous variables, including attitude, perception, and knowledge scores, were summarized using means and standard deviations.

Normality testing

The Shapiro-Wilk test was used to assess the normality of the distribution of continuous and ordinal variables. A significance level of p≤0.05 indicated significant deviation from a normal distribution.

Inferential statistics

The chi-square test and Fisher exact test were used to compare categorical variables across groups (e.g., HCWs from different countries). Analysis of variance was conducted to compare means of normally distributed continuous variables among multiple groups. Non-parametric tests, including the Kruskal-Wallis (H) and Mann-Whitney (U) tests, were applied to compare ordinal and continuous variables between groups when data did not meet normality assumptions.

Univariate analysis

Univariate binary logistic regression was performed to identify relationships between socio-demographic characteristics and outcome variables (knowledge, attitudes, and willingness to vaccinate). Variables with p≤0.05 in univariate analyses were considered for inclusion in subsequent multivariate models. Odds ratios (ORs) with 95% CIs were calculated for each predictor of vaccine acceptance.

Health belief model analysis

Structural equation modeling (SEM) was employed to evaluate the fit of the HBM, incorporating key constructs—perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action—hypothesized to influence HCWs’ vaccine acceptance. Model fit was assessed using standard indices, including the comparative fit index (CFI), RMSEA, and TLI.

Subgroup and interaction analysis

Subgroup analyses were conducted based on country of residence, years of professional experience, and COVID-19 vaccination status to identify differences in knowledge, attitudes, and vaccine acceptance across groups. Interaction terms were tested to evaluate whether relationships between predictors and outcomes differed among subgroups.

Handling of missing data

Missing data were addressed using multiple imputation techniques (if applicable) to preserve sample size and minimize biases associated with incomplete data. Participants with significant missing data (i.e., more than 20% missing responses within any questionnaire section) were excluded from analyses. Sensitivity analyses were conducted to evaluate the impact of data imputation on study findings.

Sensitivity analyses

Sensitivity analyses assessed the robustness of findings by testing different assumptions related to handling missing data (e.g., excluding cases with missing data versus using imputation techniques) and examining alternative analytical models (e.g., varying cutoff points for socio-demographic variables).

Statistical significance

A 2-tailed significance threshold of p≤0.05 was employed for all statistical tests. Results with p-values below this threshold were considered statistically significant.

Ethics statement

This study received ethical approval from the RAK Medical and Health Sciences University Research Committee (approval number: RAKMHSU-HEC-43-2023/24-N-F) and the Ministry of Health and Prevention (MOHAP) Research Ethics Committee (approval number: MOHAP/REC/2024/71-2024 F-N). All participants provided informed consent prior to data collection. The study was conducted in accordance with ethical guidelines outlined in the Declaration of Helsinki.
The study included a diverse group of HCWs, predominantly aged between 30 to 39 years (46.5%), followed by those aged ≥40 years (27.7%) and those aged 20 to 29 years (25.8%). Women comprised 75.5% of participants, and men 24.5%. Most participants were married (72.6%), followed by single individuals (25.7%), while a small percentage were separated, divorced, or widowed (1.7%). Participants primarily held bachelor’s degrees (73.6%), with smaller proportions holding diplomas (10.3%), master’s degrees (13.5%), and PhD/fellowships (2.6%). Most respondents were from Qatar (42.0%), followed by the UAE (33.5%) and Saudi Arabia (24.5%). The majority worked in general hospitals (83.9%), with fewer working in community healthcare (13.4%) and private hospitals (2.7%). Nurses represented the largest specialty group (93.5%), followed by physicians (3.1%), pharmacists (1.8%), and other healthcare roles (1.6%). Most participants reported 5 to 10 years of medical practice experience (54.6%). The primary sources of mpox information included HCWs (43.5%), social media (33.2%), and medical books or studies (23.3%). Most participants were vaccinated against COVID-19 (94.4%), with the largest group having received 3 doses (59.4%) (Table 1).
The data revealed significant associations between overall knowledge and several socio-demographic characteristics. Participants aged 30 to 39 had the highest proportion of good knowledge (39.5%), whereas those aged ≥40 had the lowest proportion (29.7%). Women exhibited a higher proportion of good knowledge (72.8%) compared to men (27.2%). Additionally, marital status, educational level, country of residence, type of workplace, specialty, medical practice experience, and primary source of mpox information were significantly associated with overall knowledge. For instance, participants from the UAE demonstrated the highest proportion of good knowledge (59.0%), and those holding bachelor’s degrees represented 80.5% of participants with good knowledge (Table 2).
The analysis identified significant associations between overall attitudes and several socio-demographic characteristics. Participants aged 30 to 39 had the highest proportion of positive attitudes (46.3%), while participants aged 20 to 29 had the lowest proportion of negative attitudes (22.0%). Women reported more negative attitudes (83.1%) than men (16.9%). Marital status, country of residence, and primary source of mpox information were significantly associated with overall attitudes. For example, participants from Qatar had the highest proportion of negative attitudes (50.4%) (Table 3).
The analysis also indicated significant associations between vaccine acceptance and willingness to receive the mpox vaccine with several socio-demographic characteristics. Participants aged 30 to 39 demonstrated the highest willingness to vaccinate (44.6%), whereas participants aged ≥40 showed the lowest willingness (21.7%). Women reported a higher proportion of unwillingness (80.0%) compared to men (20.0%). Marital status, country of residence, and source of mpox information were significantly associated with vaccine willingness. Specifically, participants from the UAE reported the highest proportion of willingness (52.1%), and those who received information from HCWs showed the highest proportion of willingness (39.2%) (Table 4).
The analysis further identified significant predictors of mpox vaccine perceptions among HCWs. Younger participants (aged 20–29) reported higher perceived susceptibility and greater intention to vaccinate compared to older age groups, with significant p-values of 0.041 and <0.001, respectively. Men had higher perceived susceptibility and vaccination intention than women, with significant p-values of <0.001 and 0.030, respectively. Single HCWs reported higher perceived susceptibility and vaccination intention compared to married or separated/divorced/widowed participants, with significant p-values of 0.009 and <0.001, respectively. Participants holding bachelor’s degrees reported higher perceived susceptibility and vaccination intention compared to other educational levels, with significant p-values of 0.010 and 0.003, respectively. Additionally, HCWs from the UAE showed higher perceived susceptibility, benefits, and vaccination intention compared to those from Saudi Arabia and Qatar, with significant p-values of <0.001, <0.001, and 0.001, respectively. Participants who received 4 COVID-19 vaccine doses reported higher perceived susceptibility, benefits, and vaccination intention compared to those with fewer doses, with significant p-values of <0.001, <0.001, and 0.001, respectively. These findings highlight the importance of socio-demographic-demographic factors in shaping vaccine perceptions and acceptance strategies (Table 5, Tables S4, S5).
Univariate binary logistic regression analysis identified several predictors associated with high knowledge, positive attitudes, and willingness to vaccinate against mpox. Significant predictors included age, sex, marital status, educational level, country of residence, specialty, medical practice experience, primary information source, and COVID-19 vaccination status. For example, participants aged 20 to 29 demonstrated higher odds of exhibiting positive attitudes (OR, 1.882) and willingness to vaccinate (OR, 2.149) compared to those aged ≥40. Male participants had higher odds of positive attitudes (OR, 2.554) and willingness to vaccinate (OR, 2.071) compared to female participants (Table 6).
SEM analysis indicated a good model fit, evidenced by an RMSEA of 0.111 (95% CI, 0.108–0.115), TLI of 0.986, and CFI of 0.988 (Figure 2).
The findings of this study provide valuable insights into factors influencing mpox vaccine acceptance among HCWs in the Gulf region. Utilizing the HBM, the study identified important predictors of vaccine acceptance related to knowledge, perceived risk, and attitudes toward vaccination.
The analysis revealed that overall knowledge significantly correlated with several socio-demographic-demographic factors, including marital status, educational level, country of residence, specialty, medical experience, and sources of information. Notably, HCWs from the UAE demonstrated the highest levels of good knowledge, and those holding a bachelor’s degree were more likely to exhibit good mpox knowledge.
These results align closely with a study conducted in Lebanon [41], which reported significantly better mpox knowledge and attitudes associated with postgraduate education and older age, supporting our finding that higher educational attainment is associated with greater knowledge. Similarly, another Lebanese study showed that physicians had significantly higher mpox knowledge compared to other healthcare occupations [42], supporting the broader trend observed in our research where physicians exhibited better knowledge.
Regarding mpox knowledge, recent studies have reported insufficient knowledge among Saudi Arabian HCWs [43]. Our findings similarly showed that only 30.8% of younger HCWs (aged 20–29 years) demonstrated good knowledge, compared to 39.5% among those aged 30 to 39 years. This highlights variability in knowledge across age groups, likely due to differences in professional experience.
Moreover, prior studies have demonstrated that previous vaccination behavior significantly influences vaccine uptake [44,45]. Moreover, studies have demonstrated that prior vaccination behavior is a key factor in determining vaccine uptake.
Our study’s finding that only 30.8% of younger HCWs had good mpox knowledge, compared to 39.5% among those aged 30 to 39 years, underscores a critical knowledge gap between age groups, emphasizing the need for targeted educational interventions. These findings are consistent with previous research indicating that 60.5% of Nigerian HCWs exhibited adequate knowledge [46], which is lower than the 70% rate of good knowledge reported among Jordanian HCWs [47], but higher than the 27% observed among Italian medical professionals [48]. Additionally, our study identified nurses as having lower knowledge scores than other healthcare professionals, paralleling disparities noted in global contexts.
Social media emerged as a prevalent source of health information (51.1%) among HCWs, followed by official local statements (57.6%) and international health authorities such as World Health Organization and Centers for Disease Control and Prevention (59.8%) [49]. Our study found the highest proportion of negative attitudes (35.9%) among HCWs relying on social media for information, confirming that misinformation negatively impacts vaccine perceptions.
A systematic review and meta-analysis assessing global knowledge and attitudes towards mpox among HCWs revealed that only 26.0% had good knowledge, and 34.6% had positive attitudes [37]. Our study found comparatively higher knowledge levels among Gulf HCWs, suggesting greater awareness within our study population relative to the global average. Moreover, higher knowledge among older professionals supports the notion that experience contributes significantly to better awareness.
The results indicated significant associations between overall attitudes and several socio-demographic-demographic characteristics. A recent study in Saudi Arabia reported that 74.7% of respondents were motivated by the need to protect their health, family, and friends [50]. Our study similarly found that positive attitudes were more common among HCWs with greater professional experience, reinforcing the importance of personal and professional responsibility in shaping vaccine-related attitudes. Key reasons for vaccine hesitancy included insufficient information (56.1% strongly agreed), fear of unknown side effects (45.6% strongly agreed), and doubts regarding vaccine effectiveness (46.4% strongly agreed and 26.8% agreed) [51]. In alignment with these findings, negative attitudes in our study were most frequent among those relying on social media for information (35.8%), compared to those using healthcare professionals as sources (48.9%), confirming the detrimental impact of misinformation. Furthermore, cues to action (e.g., governmental recommendations) significantly predicted vaccine acceptance, highlighting the critical role of institutional trust in shaping vaccine attitudes.
Our findings indicate that sex plays a role in shaping attitudes toward mpox vaccination. Additionally, adequate knowledge and a positive vaccine attitude significantly influenced HCWs’ willingness to recommend the vaccine to high-risk groups. This relationship between knowledge and attitude helps explain why attitudes might be more negative in contexts of lower vaccine awareness [52].
Interestingly, our study found that female HCWs had higher willingness to receive the mpox vaccine, consistent with a study from Pakistan showing higher vaccine acceptance rates among women, contrary to common global trends in vaccine hesitancy [49]. Additionally, the prevalence of chronic conditions among men (34.9%) was slightly higher than among women (31.9%), and prior research shows that individuals with chronic diseases tend to have higher vaccine hesitancy [53,54]. Our study demonstrated that perceived barriers, such as concerns about side effects, were significantly associated with chronic disease status, reinforcing the role health conditions play in vaccine perception.
Our results indicate higher vaccine willingness among Gulf HCWs, suggesting they perceive mpox as a significant health threat. In contrast, only 50% of HCWs from Kurdistan had positive attitudes, with 82.4% unwilling to vaccinate [3].
The analysis of HBM components indicated that perceived barriers, including fear of side effects and the social stigma associated with mpox, significantly deterred vaccine acceptance. These findings align with research from Egypt and Jordan, where social stigma and misinformation were major factors influencing vaccine hesitancy [28,55]. Additionally, younger HCWs and those with prior exposure to COVID-19 vaccination campaigns exhibited lower vaccine hesitancy, highlighting the positive impact of prior pandemic experiences on current vaccination behavior.
Finally, HCWs from the UAE demonstrated significantly higher perceived susceptibility, perceived benefits, and vaccination intention compared to those from Saudi Arabia and Qatar, as indicated by highly significant p-values (<0.001, <0.001, and 0.001, respectively). These differences underscore the effectiveness of the UAE’s healthcare infrastructure and public health communication strategies. Additionally, HCWs who received 4 COVID-19 vaccine doses had higher perceived susceptibility, perceived benefits, and vaccination intention compared to those with fewer doses, reflecting the influence of prior vaccination experiences in shaping positive attitudes toward future vaccines.
Study Limitations, Interpretation, and Generalizability
This study has several limitations. The cross-sectional design restricts the ability to infer causal relationships, and reliance on self-reported data may introduce recall and social desirability biases. Additionally, conducting the survey online potentially excluded HCWs with limited internet access or insufficient digital literacy.
Despite these limitations, the findings indicate moderate to high levels of mpox knowledge among HCWs in the Gulf region. Vaccine acceptance was influenced by various socio-demographic and psychological factors. Specifically, the HBM effectively identified perceived severity, perceived benefits, and cues to action as significant predictors of vaccine willingness.
While the inclusion of participants from the UAE, Saudi Arabia, and Qatar enhances the regional relevance of these findings within the Gulf, employing convenience sampling may have reduced the sample’s representativeness, particularly for rural or offline populations. Therefore, caution should be exercised when generalizing these results to other healthcare contexts or geographic regions.
This study applied the HBM to elucidate factors influencing mpox vaccine acceptance among HCWs in the Gulf region. Findings revealed that perceived susceptibility, perceived benefits, and self-efficacy were the most influential predictors of vaccine acceptance. Conversely, perceived barriers, such as fears of side effects and misinformation, impeded vaccine uptake. Notably, HCWs from the UAE demonstrated higher vaccine acceptance compared to those from Saudi Arabia and Qatar, reflecting the positive influence of prior COVID-19 vaccination experiences and the effectiveness of robust healthcare infrastructure. These results emphasize the importance of implementing targeted educational programs aimed at enhancing perceived benefits, addressing vaccine-related concerns, and strengthening self-efficacy to improve vaccine acceptance and preparedness for future infectious disease outbreaks.
• This study is the first to apply the health belief model to assess mpox vaccine acceptance among healthcare workers in the Gulf region.
• The findings emphasize the critical roles of perceived susceptibility, benefits, and self-efficacy in predicting vaccine acceptance.
• The study provides evidence-based strategies for policymakers to design culturally tailored educational interventions to reduce vaccine hesitancy and enhance public health responses to emerging infectious diseases.
• Addressing perceived barriers, including fear of side effects and social stigma, is essential for increasing vaccine uptake.
Supplementary data are available at https://doi.org/10.24171/j.phrp.2025.0113.
Table S1.
Healthcare workers’ knowledge about mpox infection (3-point Likert scale) (n=764).
j-phrp-2025-0113-Supplementary-Table-S1.pdf
Table S2.
Healthcare workers’ Attitude about mpox infection (5-point Likert scale) (n=764).
j-phrp-2025-0113-Supplementary-Table-S2.pdf
Table S3.
The willingness of healthcare workers to be vaccinated against mpox (5-point Likert scale) (n=764).
j-phrp-2025-0113-Supplementary-Table-S3.pdf
Table S4.
Mpox vaccine perceptions according to the health belief model (n=764).
j-phrp-2025-0113-Supplementary-Table-S4.pdf
Table S5.
Mpox vaccine perceptions according to the health belief model.
j-phrp-2025-0113-Supplementary-Table-S5.pdf

Ethics Approval

This study was approved by the RAK Medical and Health Sciences University Research Committee (RAKMHSU-HEC-43-2023/24-N-F) and the MOHAP Research Ethics Committee (MOHAP/REC/2024/71-2024 F-N). All participants provided informed consent prior to data collection, and the study was conducted in accordance with the guidelines set forth in the Declaration of Helsinki.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Availability of Data

The datasets are not publicly available but are available from the corresponding author upon reasonable request.

Authors’ Contributions

Conceptualization: MGM, MMAJ, MAW; Data curation: MGM, Fatma M Ibrahim, KM, SA; Formal analysis: MGM, JK, HAF; Funding acquisition: MMAJ; Investigation: MGM, EAAD, FMI, KM, SA; Methodology: MGM, EAAD, SA; Project administration: MGM; Resources: MGM; Software: MAW; Supervision: MAW, KMAS, FMI, MMAJ; Validation: MGM, KMAS; Visualization: MGM, SA; Writing–original draft: MGM, SA; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Figure 1.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flowchart.
figure
Figure 2.
Structural equation model of Gulf healthcare workers’ perceptions and acceptance of HMPXV vaccines (n=764). Structural equation modeling depicting the relationships among perceived susceptibility (Sscpt), perceived severity (Svrty), perceived benefits (Bnfts), perceived barriers (Brrrs), cues to action (CTA), perceived intention (Intnt), acceptance (Accpt), vaccine recommendation (HMPXV vaccine_R), and vaccine acceptance (HMPXV vaccine_A). The model demonstrated a good fit, with root mean square error of approximation=0.111 (95% confidence interval, 0.108–0.115), Tucker-Lewis index=0.986, and comparative fit index=0.988.
figure
Table 1.
Socio-demographic characteristics among Gulf healthcare workers (n=764)
Table 1.
Characteristic Value
Age (y)
 20–29 197 (25.8)
 30–39 355 (46.5)
 ≥40 212 (27.7)
Sex
 Female 577 (75.5)
 Male 187 (24.5)
Marital status
 Single 196 (25.7)
 Married 555 (72.6)
 Separated/divorced/widowed 13 (1.7)
Educational level
 Diploma 79 (10.3)
 Bachelor’s degree 562 (73.6)
 Postgraduate degree 123 (16.1)
Country of residence
 Saudi Arabia 187 (24.5)
 United Arab Emirates 256 (33.5)
 Qatar 321 (42.0)
Type of workplace
 General hospital 641 (83.9)
 Community health care 102 (13.4)
 Private hospital 21 (2.7)
Specialty
 Nurse 714 (93.5)
 Pharmacist 14 (1.8)
 Physician 24 (3.1)
 Others (allied health, therapist, etc.) 12 (1.6)
Medical practice experience (y)
 ≤5 608 (79.6)
 6–10 76 (9.9)
 11–15 53 (6.9)
 >15 79 (10.3)
Source of information about mpox
 Healthcare workers (peers, workshop, CDC) 332 (43.5)
 Medical books or during my studies 178 (23.3)
 Social media 254 (33.2)
COVID-19 vaccination
 Vaccinated 721 (94.4)
 Not-vaccinated 43 (5.6)
If vaccinated, number of COVID-19 vaccine doses (n=721)
 1 1 (0.1)
 2 159 (22.1)
 3 428 (59.4)
 4 133 (18.4)

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 2.
Associations between overall knowledge and socio-demographic characteristics among participants
Table 2.
Variable Good (n=195) Poor (n=569) p
Age (y) 0.060
 20–29 60 (30.8) 137 (24.1)
 30–39 77 (39.5) 278 (48.9)
 ≥40 58 (29.7) 154 (27.1)
Sex 0.335
 Female 142 (72.8) 435 (76.4)
 Male 53 (27.2) 134 (23.6)
Marital status 0.002
 Single 68 (34.9) 128 (22.5)
 Married 122 (62.6) 433 (76.1)
 Separated/divorced/widowed 5 (2.6) 8 (1.4)
Educational level 0.017
 Diploma 19 (9.7) 60 (10.5)
 Bachelor’s degree 157 (80.5) 405 (71.2)
 Postgraduate degree 19 (9.7) 104 (18.3)
Country of residence <0.001
 Saudi Arabia 25 (12.8) 162 (28.5)
 United Arab Emirates 115 (59.0) 141 (24.8)
 Qatar 55 (28.2) 266 (46.7)
Specialty 0.003
 Nurse 179 (91.8) 535 (94.0)
 Pharmacist 0 (0) 14 (2.5)
 Physician 12 (6.2) 12 (2.1)
 Others (allied health, therapist, etc.) 4 (2.1) 8 (1.4)
Medical practice experience (y) <0.001
 ≤5 60 (30.8) 133 (23.4)
 6–10 80 (41.0) 336 (59.1)
 11–15 29 (14.9) 47 (8.3)
 >15 26 (13.3) 53 (9.3)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 88 (45.1) 244 (42.9)
 Medical books or during my studies 77 (39.5) 101 (17.8)
 Social media 30 (15.4) 224 (39.4)
COVID-19 vaccination 0.305
 Vaccinated 186 (95.4) 535 (94.0)
 Not-vaccinated 9 (4.6) 34 (6.0)
If vaccinated, no. of COVID-19 vaccine doses (n=721) <0.001
 1 0 (0) 1 (0.2)
 2 41 (22) 118 (22.1)
 3 90 (48.4) 338 (63.1)
 4 55 (29.6) 78 (14.6)

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 3.
Associations between overall attitude and socio-demographic characteristics among participants
Table 3.
Variable Negative (n=427) Positive (n=337) p
Age (y) 0.007
 20–29 94 (22.0) 103 (30.6)
 30–39 199 (46.6) 156 (46.3)
 ≥40 134 (31.4) 78 (23.1)
Sex <0.001
 Female 355 (83.1) 222 (65.9)
 Male 72 (16.9) 115 (34.1)
Marital status 0.001
 Single 88 (20.6) 108 (32.0)
 Married 329 (77.0) 226 (67.1)
 Separated/divorced/widowed 10 (2.3) 3 (0.9)
Country of residence <0.001
 Saudi Arabia 96 (22.5) 91 (27.0)
 United Arab Emirates 116 (27.2) 140 (41.5)
 Qatar 215 (50.4) 106 (31.5)
Specialty 0.295
 Nurse 402 (94.1) 312 (92.5)
 Pharmacist 9 (2.1) 5 (1.5)
 Physician 9 (2.1) 15 (4.5)
 Others (allied health, therapist, etc.) 7 (1.6) 5 (1.5)
Medical practice experience (y) <0.001
 ≤5 82 (19.2) 111 (32.9)
 6–10 265 (62.1) 151 (44.8)
 11–15 40 (9.4) 36 (10.7)
 >15 40 (9.3) 39 (11.6)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 209 (48.9) 123 (36.5)
 Medical books or during my studies 65 (15.2) 113 (33.5)
 Social media 153 (35.8) 101 (30.0)
COVID-19 vaccination <0.001
 Vaccinated 403 (94.4) 318 (94.4)
 Not-vaccinated 24 (5.6) 19 (5.6)
If vaccinated, no. of COVID-19 vaccine doses (n=721) 0.003
 1 0 (0) 1 (0.3)
 2 81 (20.1) 78 (24.5)
 3 261 (64.8) 167 (52.6)
 4 61 (15.1) 72 (22.6)

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 4.
Associations between overall acceptance and willingness to receive the mpox vaccine and socio-demographic characteristics
Table 4.
Variable No (n=524) Yes (n=240) p
Age (y) 0.001
 20–29 116 (22.1) 81 (33.8)
 30–39 248 (47.4) 107 (44.6)
 ≥40 160 (30.5) 52 (21.7)
Sex <0.001
 Female 419 (80.0) 158 (65.8)
 Male 105 (20.0) 82 (34.2)
Marital status 0.001
 Single 114 (21.8) 82 (34.2)
 Married 399 (76.1) 56 (23.3)
 Separated/divorced/widowed 11 (2.1) 2 (0.8)
Country of residence <0.001
 Saudi Arabia 151 (28.8) 36 (15.0)
 United Arab Emirates 131 (25.0) 125 (52.1)
 Qatar 242 (46.2) 79 (32.9)
Specialty 0.457
 Nurse 492 (93.9) 222 (92.5)
 Pharmacist 7 (1.3) 7 (2.9)
 Physician 16 (3.1) 8 (3.3)
 Others (allied health, therapist, etc.) 9 (1.7) 3 (1.3)
Medical practice experience (y) 0.007
 ≤5 304 (58.0) 115 (21.9)
 6–10 49 (9.4) 78 (32.5)
 11–15 112 (46.7) 27 (11.3)
 >15 56 (10.7) 23 (9.6)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 238 (45.4) 94 (39.2)
 Medical books or during my studies 90 (17.2) 88 (36.7)
 Social media 196 (37.4) 58 (24.2)
COVID-19 vaccination 0.028
 Vaccinated 488 (93.1) 233 (97.1)
 Not-vaccinated 36 (6.9) 7 (2.9)
If vaccinated, no. of COVID-19 vaccine doses (n=721) <0.001
 1 0 (0) 1 (0.4)
 2 101 (20.7) 58 (24.9)
 3 318 (65.2) 110 (47.2)
 4 69 (14.1) 64 (27.5)

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 5.
Predictors of mpox vaccine perceptions according to the health belief model among healthcare workers
Table 5.
Variable Perceived susceptibility p Perceived severity p Perceived benefits p Perceived barriers p Cues to action p Perceived intention p
Age (y) 0.041 0.075 0.543 0.002 0.459 <0.001
 20–29 14.1±3.3 13.3±3.5 14.6±3.1 10.3±3.2 18±4.1 13.9±3
 30–39 13.7±3.1 13.9±3.4 14.9±3.1 11.1±2.7 17.8±3.7 13.1±3.6
 ≥40 13.3±3.3 14±3.5 14.7±3 11.2±2.8 17.5±3.5 12.3±3.9
Sex <0.001 0.057 0.402 <0.001 0.038 0.030
 Female 13.5±3.2 13.7±3.5 14.7±3.1 11.2±2.9 17.6±3.8 12.9±3.6
 Male 14.5±3.1 14.2±3.2 14.9±2.9 10.2±2.8 18.2±3.5 13.6±3.7
Marital status 0.009 0.232 0.372 0.001 0.004 <0.001
 Single 14.3±3.5 13.7±3.7 15±3.3 10.3±3.2 18.5±4.3 14±3.4
 Married 13.5±3.1 13.8±3.4 14.6±3 11.2±2.7 17.5±3.5 12.8±3.6
 Separated/divorced/widowed 13±3 12.2±3.5 15±2.1 11.1±2.6 16.3±4.3 12±4.8
Country of residence <0.001 <0.001 <0.001 <0.001 <0.001 0.001
 Saudi Arabia 13.2±3 12.8±3 13.1±2.6 10.8±2.6 16.5±3.6 13.1±2.5
 United Arab Emirates 14.5±3.2 14.4±3.5 15.8±2.8 10.3±2.9 18.9±3.5 13.7±3.6
 Qatar 13.4±3.2 13.9±3.6 14.8±3.2 11.5±2.9 17.6±3.7 12.6±4.1
Type of workplace 0.100 0.688 0.115 0.244 0.064 0.001
 General hospital 14.1±3.2 13.8±3.4 14.6±3.1 10.5±2.9 18±3.8 13.7±3.2
 Community health care 13.5±2.8 13.6±3.2 15.4±2.6 10.9±2.6 16.8±3.3 12±3.3
 Private hospital 12.5±2.1 13±0.4 14.1±1.9 9.5±1 18.3±1.8 13.2±2.1
Specialty 0.737 0.157 0.061 0.670 0.530 0.505
 Nurse 13.7±3.2 13.8±3.5 14.8±3.1 10.9±2.9 17.8±3.8 13.1±3.6
 Pharmacist 12.8±3.3 12.1±1.5 12.9±1.4 10.4±1.2 16.8±1.5 11.9±3.9
 Physician 13.6±2.7 14±2.4 14.4±2.4 11.2±2.4 18±2.4 12.5±4.4
 Others (allied health, therapist, etc.) 13.8±3.4 15.2±3 13.5±4.4 11.7±2.7 16.6±4.9 12.9±4.5
Medical practice experience (y) 0.011 0.436 0.078 0.008 0.459 0.002
 ≤5 14.3±3.1 13.4±3.2 14.2±3.1 10.4±3.1 17.7±3.9 13.9±2.9
 6–10 13.4±3.3 13.8±3.6 14.9±3.2 11.3±2.9 17.7±3.9 12.7±3.9
 11–15 13.4±3.1 14.1±3.1 14.9±3 10.7±2.5 18.1±3.3 13.1±3.8
 >15 14.5±3.2 14.2±3.9 15±2.7 10.4±2.7 18.1±3.3 13.4±3
Source of information about mpox 0.475 0.568 0.015 0.064 0.177 0.013
 Healthcare workers (peers, workshop, CDC) 13.7±3.2 13.9±3.6 15±3.1 11.1±2.7 17.8±3.8 12.8±3.9
 Medical books or during my studies 13.9±2.9 13.8±3.2 14.9±2.9 10.5±3.1 18.1±3.9 13.7±3.2
 Social media 13.6±3.3 13.6±3.4 14.3±3.2 11±3 17.5±3.6 13±3.4
COVID-19 vaccination 0.439 0.743 <0.001 0.034 0.092 0.422
 Vaccinated 13.7±3.2 13.8±3.5 14.9±3.1 10.9±3 17.8±3.8 13.1±3.6
 Not-vaccinated 14.1±2.6 13.6±2.1 12.6±1.9 11.8±1.2 16.8±3.2 12.6±3.5
If vaccinated, number of COVID-19 vaccine doses (n=721) <0.001 <0.001 <0.001 0.001 <0.001 0.001
 2 13.5±3.3 13.5±3.7 14.9±3.5 11±3 18.5±3.7 13.3±4.1
 3 13.3±3 13.4±3.4 14.4±3 11.1±2.9 17.2±3.7 12.7±3.4
 4 15.3±3.3 15.3±3.3 16.2±2.5 10.1±3.1 19±3.5 14.1±3.5

Data are presented as mean±standard deviation.

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 6.
Univariate binary logistic regression analysis of predictive factors associated with high knowledge, positive attitudes, and willingness scores regarding mpox
Table 6.
Variable Knowledge p Attitudes p Willingness p
Age (y)
 20–29 1.163 (0.758–1.784) 0.490 1.882 (1.268–2.794) 0.002 2.149 (1.408–3.278) <0.001
 30–39 0.735 (0.496–1.090) 0.126 1.347 (0.950–1.909) 0.095 1.328 (0.902–1.954) 0.151
 ≥40 Reference
Sex
 Female Reference
 Male 1.212 (0.837–1.754) 0.309 2.554 (1.820–3.585) <0.001 2.071 (1.471–2.915) <0.001
Marital status
 Single 0.850 (0.268–2.699) 0.783 4.091 (1.092–15.322) 0.037 3.956 (0.854–18.327) 0.079
 Married 0.451 (0.145–1.403) 0.169 2.290 (0.623–8.413) 0.212 2.150 (0.471–9.812) 0.323
 Separated/divorced/widowed Reference
Country of residence
 Saudi Arabia 0.746 (0.447–1.245) 0.262 1.923 (1.329–2.781) 0.001 0.730 (0.469–1.138) 0.165
 United Arab Emirates 3.945 (2.696–5.772) <0.001 2.448 (1.745–3.434) <0.001 2.923 (2.054–4.160) <0.001
 Qatar Reference
Specialty
 Nurse Reference
 Physician 2.989 (1.319–6.772) 0.009 2.147 (0.928–4.972) 0.074 1.108 (0.467–2.627) 0.816
 Others (allied health, therapist, etc.) 1.494 (0.445–5.022) 0.516 0.920 (0.289–2.927) 0.888 0.739 (0.198–2.755) 0.652
Medical practice experience (y)
 ≤5 5.323 (1.218–23.262) 0.026 3.641 (1.462–9.069) 0.006 2.812 (1.017–7.776) 0.046
 6–10 2.857 (0.662–12.339) 0.160 1.547 (0.636–3.764) 0.337 1.547 (0.570–4.202) 0.392
 11–15 7.404 (1.628–33.682) 0.010 2.443 (0.920–6.487) 0.073 2.314 (0.784–6.832) 0.129
 >15 Reference
Source of information about mpox
 Healthcare workers (peers, workshop, CDC) Reference
 Medical books or during my studies 2.114 (1.440–3.103) <0.001 2.954 (2.025–4.310) <0.001 2.476 (1.695–3.615) <0.001
 Social media 0.371 (0.236–0.584) <0.001 1.122 (0.802–1.569) 0.503 0.749 (0.513–1.093) 0.134
COVID-19 vaccination
 Yes Reference
 No 0.761 (0.358–1.617) 0.478 1.003 (0.540–1.864) 0.992 0.407 (0.179–0.929) 0.033
No. of COVID-19 vaccine doses
 2 0.493 (0.300–0.809) 0.005 0.816 (0.514–1.294) 0.387 0.619 (0.387–0.990) 0.045
 3 0.378 (0.249–0.572) <0.001 0.542 (0.366–0.803) 0.002 0.373 (0.249–0.558) <0.001
 4 Reference

Data are presented as odds ratio (95% confidence interval).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

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Assessment of healthcare workers’ knowledge and attitudes toward mpox and acceptance of its vaccine: a health belief model-based analysis in the Gulf region
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Assessment of healthcare workers’ knowledge and attitudes toward mpox and acceptance of its vaccine: a health belief model-based analysis in the Gulf region
Image Image
Figure 1. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flowchart.
Figure 2. Structural equation model of Gulf healthcare workers’ perceptions and acceptance of HMPXV vaccines (n=764). Structural equation modeling depicting the relationships among perceived susceptibility (Sscpt), perceived severity (Svrty), perceived benefits (Bnfts), perceived barriers (Brrrs), cues to action (CTA), perceived intention (Intnt), acceptance (Accpt), vaccine recommendation (HMPXV vaccine_R), and vaccine acceptance (HMPXV vaccine_A). The model demonstrated a good fit, with root mean square error of approximation=0.111 (95% confidence interval, 0.108–0.115), Tucker-Lewis index=0.986, and comparative fit index=0.988.

Figure 1.

Figure 2.

Assessment of healthcare workers’ knowledge and attitudes toward mpox and acceptance of its vaccine: a health belief model-based analysis in the Gulf region
Characteristic Value
Age (y)
 20–29 197 (25.8)
 30–39 355 (46.5)
 ≥40 212 (27.7)
Sex
 Female 577 (75.5)
 Male 187 (24.5)
Marital status
 Single 196 (25.7)
 Married 555 (72.6)
 Separated/divorced/widowed 13 (1.7)
Educational level
 Diploma 79 (10.3)
 Bachelor’s degree 562 (73.6)
 Postgraduate degree 123 (16.1)
Country of residence
 Saudi Arabia 187 (24.5)
 United Arab Emirates 256 (33.5)
 Qatar 321 (42.0)
Type of workplace
 General hospital 641 (83.9)
 Community health care 102 (13.4)
 Private hospital 21 (2.7)
Specialty
 Nurse 714 (93.5)
 Pharmacist 14 (1.8)
 Physician 24 (3.1)
 Others (allied health, therapist, etc.) 12 (1.6)
Medical practice experience (y)
 ≤5 608 (79.6)
 6–10 76 (9.9)
 11–15 53 (6.9)
 >15 79 (10.3)
Source of information about mpox
 Healthcare workers (peers, workshop, CDC) 332 (43.5)
 Medical books or during my studies 178 (23.3)
 Social media 254 (33.2)
COVID-19 vaccination
 Vaccinated 721 (94.4)
 Not-vaccinated 43 (5.6)
If vaccinated, number of COVID-19 vaccine doses (n=721)
 1 1 (0.1)
 2 159 (22.1)
 3 428 (59.4)
 4 133 (18.4)
Variable Good (n=195) Poor (n=569) p
Age (y) 0.060
 20–29 60 (30.8) 137 (24.1)
 30–39 77 (39.5) 278 (48.9)
 ≥40 58 (29.7) 154 (27.1)
Sex 0.335
 Female 142 (72.8) 435 (76.4)
 Male 53 (27.2) 134 (23.6)
Marital status 0.002
 Single 68 (34.9) 128 (22.5)
 Married 122 (62.6) 433 (76.1)
 Separated/divorced/widowed 5 (2.6) 8 (1.4)
Educational level 0.017
 Diploma 19 (9.7) 60 (10.5)
 Bachelor’s degree 157 (80.5) 405 (71.2)
 Postgraduate degree 19 (9.7) 104 (18.3)
Country of residence <0.001
 Saudi Arabia 25 (12.8) 162 (28.5)
 United Arab Emirates 115 (59.0) 141 (24.8)
 Qatar 55 (28.2) 266 (46.7)
Specialty 0.003
 Nurse 179 (91.8) 535 (94.0)
 Pharmacist 0 (0) 14 (2.5)
 Physician 12 (6.2) 12 (2.1)
 Others (allied health, therapist, etc.) 4 (2.1) 8 (1.4)
Medical practice experience (y) <0.001
 ≤5 60 (30.8) 133 (23.4)
 6–10 80 (41.0) 336 (59.1)
 11–15 29 (14.9) 47 (8.3)
 >15 26 (13.3) 53 (9.3)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 88 (45.1) 244 (42.9)
 Medical books or during my studies 77 (39.5) 101 (17.8)
 Social media 30 (15.4) 224 (39.4)
COVID-19 vaccination 0.305
 Vaccinated 186 (95.4) 535 (94.0)
 Not-vaccinated 9 (4.6) 34 (6.0)
If vaccinated, no. of COVID-19 vaccine doses (n=721) <0.001
 1 0 (0) 1 (0.2)
 2 41 (22) 118 (22.1)
 3 90 (48.4) 338 (63.1)
 4 55 (29.6) 78 (14.6)
Variable Negative (n=427) Positive (n=337) p
Age (y) 0.007
 20–29 94 (22.0) 103 (30.6)
 30–39 199 (46.6) 156 (46.3)
 ≥40 134 (31.4) 78 (23.1)
Sex <0.001
 Female 355 (83.1) 222 (65.9)
 Male 72 (16.9) 115 (34.1)
Marital status 0.001
 Single 88 (20.6) 108 (32.0)
 Married 329 (77.0) 226 (67.1)
 Separated/divorced/widowed 10 (2.3) 3 (0.9)
Country of residence <0.001
 Saudi Arabia 96 (22.5) 91 (27.0)
 United Arab Emirates 116 (27.2) 140 (41.5)
 Qatar 215 (50.4) 106 (31.5)
Specialty 0.295
 Nurse 402 (94.1) 312 (92.5)
 Pharmacist 9 (2.1) 5 (1.5)
 Physician 9 (2.1) 15 (4.5)
 Others (allied health, therapist, etc.) 7 (1.6) 5 (1.5)
Medical practice experience (y) <0.001
 ≤5 82 (19.2) 111 (32.9)
 6–10 265 (62.1) 151 (44.8)
 11–15 40 (9.4) 36 (10.7)
 >15 40 (9.3) 39 (11.6)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 209 (48.9) 123 (36.5)
 Medical books or during my studies 65 (15.2) 113 (33.5)
 Social media 153 (35.8) 101 (30.0)
COVID-19 vaccination <0.001
 Vaccinated 403 (94.4) 318 (94.4)
 Not-vaccinated 24 (5.6) 19 (5.6)
If vaccinated, no. of COVID-19 vaccine doses (n=721) 0.003
 1 0 (0) 1 (0.3)
 2 81 (20.1) 78 (24.5)
 3 261 (64.8) 167 (52.6)
 4 61 (15.1) 72 (22.6)
Variable No (n=524) Yes (n=240) p
Age (y) 0.001
 20–29 116 (22.1) 81 (33.8)
 30–39 248 (47.4) 107 (44.6)
 ≥40 160 (30.5) 52 (21.7)
Sex <0.001
 Female 419 (80.0) 158 (65.8)
 Male 105 (20.0) 82 (34.2)
Marital status 0.001
 Single 114 (21.8) 82 (34.2)
 Married 399 (76.1) 56 (23.3)
 Separated/divorced/widowed 11 (2.1) 2 (0.8)
Country of residence <0.001
 Saudi Arabia 151 (28.8) 36 (15.0)
 United Arab Emirates 131 (25.0) 125 (52.1)
 Qatar 242 (46.2) 79 (32.9)
Specialty 0.457
 Nurse 492 (93.9) 222 (92.5)
 Pharmacist 7 (1.3) 7 (2.9)
 Physician 16 (3.1) 8 (3.3)
 Others (allied health, therapist, etc.) 9 (1.7) 3 (1.3)
Medical practice experience (y) 0.007
 ≤5 304 (58.0) 115 (21.9)
 6–10 49 (9.4) 78 (32.5)
 11–15 112 (46.7) 27 (11.3)
 >15 56 (10.7) 23 (9.6)
Source of information about mpox <0.001
 Healthcare workers (peers, workshop, CDC) 238 (45.4) 94 (39.2)
 Medical books or during my studies 90 (17.2) 88 (36.7)
 Social media 196 (37.4) 58 (24.2)
COVID-19 vaccination 0.028
 Vaccinated 488 (93.1) 233 (97.1)
 Not-vaccinated 36 (6.9) 7 (2.9)
If vaccinated, no. of COVID-19 vaccine doses (n=721) <0.001
 1 0 (0) 1 (0.4)
 2 101 (20.7) 58 (24.9)
 3 318 (65.2) 110 (47.2)
 4 69 (14.1) 64 (27.5)
Variable Perceived susceptibility p Perceived severity p Perceived benefits p Perceived barriers p Cues to action p Perceived intention p
Age (y) 0.041 0.075 0.543 0.002 0.459 <0.001
 20–29 14.1±3.3 13.3±3.5 14.6±3.1 10.3±3.2 18±4.1 13.9±3
 30–39 13.7±3.1 13.9±3.4 14.9±3.1 11.1±2.7 17.8±3.7 13.1±3.6
 ≥40 13.3±3.3 14±3.5 14.7±3 11.2±2.8 17.5±3.5 12.3±3.9
Sex <0.001 0.057 0.402 <0.001 0.038 0.030
 Female 13.5±3.2 13.7±3.5 14.7±3.1 11.2±2.9 17.6±3.8 12.9±3.6
 Male 14.5±3.1 14.2±3.2 14.9±2.9 10.2±2.8 18.2±3.5 13.6±3.7
Marital status 0.009 0.232 0.372 0.001 0.004 <0.001
 Single 14.3±3.5 13.7±3.7 15±3.3 10.3±3.2 18.5±4.3 14±3.4
 Married 13.5±3.1 13.8±3.4 14.6±3 11.2±2.7 17.5±3.5 12.8±3.6
 Separated/divorced/widowed 13±3 12.2±3.5 15±2.1 11.1±2.6 16.3±4.3 12±4.8
Country of residence <0.001 <0.001 <0.001 <0.001 <0.001 0.001
 Saudi Arabia 13.2±3 12.8±3 13.1±2.6 10.8±2.6 16.5±3.6 13.1±2.5
 United Arab Emirates 14.5±3.2 14.4±3.5 15.8±2.8 10.3±2.9 18.9±3.5 13.7±3.6
 Qatar 13.4±3.2 13.9±3.6 14.8±3.2 11.5±2.9 17.6±3.7 12.6±4.1
Type of workplace 0.100 0.688 0.115 0.244 0.064 0.001
 General hospital 14.1±3.2 13.8±3.4 14.6±3.1 10.5±2.9 18±3.8 13.7±3.2
 Community health care 13.5±2.8 13.6±3.2 15.4±2.6 10.9±2.6 16.8±3.3 12±3.3
 Private hospital 12.5±2.1 13±0.4 14.1±1.9 9.5±1 18.3±1.8 13.2±2.1
Specialty 0.737 0.157 0.061 0.670 0.530 0.505
 Nurse 13.7±3.2 13.8±3.5 14.8±3.1 10.9±2.9 17.8±3.8 13.1±3.6
 Pharmacist 12.8±3.3 12.1±1.5 12.9±1.4 10.4±1.2 16.8±1.5 11.9±3.9
 Physician 13.6±2.7 14±2.4 14.4±2.4 11.2±2.4 18±2.4 12.5±4.4
 Others (allied health, therapist, etc.) 13.8±3.4 15.2±3 13.5±4.4 11.7±2.7 16.6±4.9 12.9±4.5
Medical practice experience (y) 0.011 0.436 0.078 0.008 0.459 0.002
 ≤5 14.3±3.1 13.4±3.2 14.2±3.1 10.4±3.1 17.7±3.9 13.9±2.9
 6–10 13.4±3.3 13.8±3.6 14.9±3.2 11.3±2.9 17.7±3.9 12.7±3.9
 11–15 13.4±3.1 14.1±3.1 14.9±3 10.7±2.5 18.1±3.3 13.1±3.8
 >15 14.5±3.2 14.2±3.9 15±2.7 10.4±2.7 18.1±3.3 13.4±3
Source of information about mpox 0.475 0.568 0.015 0.064 0.177 0.013
 Healthcare workers (peers, workshop, CDC) 13.7±3.2 13.9±3.6 15±3.1 11.1±2.7 17.8±3.8 12.8±3.9
 Medical books or during my studies 13.9±2.9 13.8±3.2 14.9±2.9 10.5±3.1 18.1±3.9 13.7±3.2
 Social media 13.6±3.3 13.6±3.4 14.3±3.2 11±3 17.5±3.6 13±3.4
COVID-19 vaccination 0.439 0.743 <0.001 0.034 0.092 0.422
 Vaccinated 13.7±3.2 13.8±3.5 14.9±3.1 10.9±3 17.8±3.8 13.1±3.6
 Not-vaccinated 14.1±2.6 13.6±2.1 12.6±1.9 11.8±1.2 16.8±3.2 12.6±3.5
If vaccinated, number of COVID-19 vaccine doses (n=721) <0.001 <0.001 <0.001 0.001 <0.001 0.001
 2 13.5±3.3 13.5±3.7 14.9±3.5 11±3 18.5±3.7 13.3±4.1
 3 13.3±3 13.4±3.4 14.4±3 11.1±2.9 17.2±3.7 12.7±3.4
 4 15.3±3.3 15.3±3.3 16.2±2.5 10.1±3.1 19±3.5 14.1±3.5
Variable Knowledge p Attitudes p Willingness p
Age (y)
 20–29 1.163 (0.758–1.784) 0.490 1.882 (1.268–2.794) 0.002 2.149 (1.408–3.278) <0.001
 30–39 0.735 (0.496–1.090) 0.126 1.347 (0.950–1.909) 0.095 1.328 (0.902–1.954) 0.151
 ≥40 Reference
Sex
 Female Reference
 Male 1.212 (0.837–1.754) 0.309 2.554 (1.820–3.585) <0.001 2.071 (1.471–2.915) <0.001
Marital status
 Single 0.850 (0.268–2.699) 0.783 4.091 (1.092–15.322) 0.037 3.956 (0.854–18.327) 0.079
 Married 0.451 (0.145–1.403) 0.169 2.290 (0.623–8.413) 0.212 2.150 (0.471–9.812) 0.323
 Separated/divorced/widowed Reference
Country of residence
 Saudi Arabia 0.746 (0.447–1.245) 0.262 1.923 (1.329–2.781) 0.001 0.730 (0.469–1.138) 0.165
 United Arab Emirates 3.945 (2.696–5.772) <0.001 2.448 (1.745–3.434) <0.001 2.923 (2.054–4.160) <0.001
 Qatar Reference
Specialty
 Nurse Reference
 Physician 2.989 (1.319–6.772) 0.009 2.147 (0.928–4.972) 0.074 1.108 (0.467–2.627) 0.816
 Others (allied health, therapist, etc.) 1.494 (0.445–5.022) 0.516 0.920 (0.289–2.927) 0.888 0.739 (0.198–2.755) 0.652
Medical practice experience (y)
 ≤5 5.323 (1.218–23.262) 0.026 3.641 (1.462–9.069) 0.006 2.812 (1.017–7.776) 0.046
 6–10 2.857 (0.662–12.339) 0.160 1.547 (0.636–3.764) 0.337 1.547 (0.570–4.202) 0.392
 11–15 7.404 (1.628–33.682) 0.010 2.443 (0.920–6.487) 0.073 2.314 (0.784–6.832) 0.129
 >15 Reference
Source of information about mpox
 Healthcare workers (peers, workshop, CDC) Reference
 Medical books or during my studies 2.114 (1.440–3.103) <0.001 2.954 (2.025–4.310) <0.001 2.476 (1.695–3.615) <0.001
 Social media 0.371 (0.236–0.584) <0.001 1.122 (0.802–1.569) 0.503 0.749 (0.513–1.093) 0.134
COVID-19 vaccination
 Yes Reference
 No 0.761 (0.358–1.617) 0.478 1.003 (0.540–1.864) 0.992 0.407 (0.179–0.929) 0.033
No. of COVID-19 vaccine doses
 2 0.493 (0.300–0.809) 0.005 0.816 (0.514–1.294) 0.387 0.619 (0.387–0.990) 0.045
 3 0.378 (0.249–0.572) <0.001 0.542 (0.366–0.803) 0.002 0.373 (0.249–0.558) <0.001
 4 Reference
Table 1. Socio-demographic characteristics among Gulf healthcare workers (n=764)

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 2. Associations between overall knowledge and socio-demographic characteristics among participants

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 3. Associations between overall attitude and socio-demographic characteristics among participants

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 4. Associations between overall acceptance and willingness to receive the mpox vaccine and socio-demographic characteristics

Data are presented as n (%).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 5. Predictors of mpox vaccine perceptions according to the health belief model among healthcare workers

Data are presented as mean±standard deviation.

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

Table 6. Univariate binary logistic regression analysis of predictive factors associated with high knowledge, positive attitudes, and willingness scores regarding mpox

Data are presented as odds ratio (95% confidence interval).

CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019.

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