Study design and setting
This study used cross-sectional survey design. The setting was Ugenya Sub-county, Siaya County, Western Kenya (Fig. 1). It is one of the six sub-counties in Siaya County. It has four administrative wards namely: West Ugenya, Ukwala, North Ugenya and East Ugenya [9]. It has a land area of 323.5 square kilometer [15]. Each of the wards have the following locations: West Ugenya 9, Ukwala ward 7, North Ugenya ward has 4 and East Ugenya with 5 locations. In this sub-county, total population from 2019 census was 134,354. Out of this population, males were 62,624 while females were 71,726. The proportion of population above 18 was 0.046. Population density in the sub-county was 415 per square kilometers [16]. Ukwala had the highest population density of 350 persons per kilometer square. Participants were recruited in November 2022 and data collected in December 2022.
This map is author-generated using publicly available shape files.
Participants
The study population were persons with physical disabilities within the community in the four wards of Ugenya Sub-county, Siaya County. The unit of observation and focus was person with physical disability. Only persons with one or more physical disabilities aged 18 years and above were recruited to take part in the study. Forms of disabilities other than physical disabilities were excluded. Those below 18 years were excluded from the study because they were not legible for COVID-19 vaccination at the time of the study. Persons who participated in this study were registered with Kenya National Council of Persons with Disabilities (KNCPWD). Washington Group Short Set (WGSS) were included in the questionnaire to gain more comprehensive view of disability. Respondents used a 4-point Likert-type scale (1 = no difficulty to 4 = cannot do at all) to indicate their difficulty “because of health problem” [1] seeing, even if wearing glasses [3] hearing, even if using a hearing aid [2] walking or climbing stairs.
Sampling procedure
Sample size and sampling procedures
Sample size was determined using Cochran formula [17]. A significance level of 0.05 and confidence level of 95% were used in the study. Proportion used in this study was (0.068) (23), a margin of error (0.05) resulting to 98 individuals. Therefore, the sample size used was 108 after adding a 10% attrition rate. Below is the formula used.
$$\rmn\, = \,{[\rmZ^2\, \times \,\rmP(1\, – \,\rmP)] \over \rme^2}$$
Where n = sample size per group, Z = the critical probability value for 95% confidence level (1.96), P = Proportion used, e = margin of error, (0.05). This formula was used because the outcome variable uptake of COVID-19 vaccine was a categorical variable.
Ugenya Sub-county was stratified into its existing four administrative wards namely: West Ugenya, East Ugenya, Ukwala and North Ugenya. In each of the four administrative wards, 27 participants were targeted. Group leaders of the respective groups of persons with disabilities were purposively identified and approached to help in identifying known persons with physical disabilities. After recruiting the first participant, the other 26 in each ward were selected by systematic sampling. Every 3rd member was recruited until the required sample size was achieved. The selected individuals were approached and their consent requested. Legally authorized representatives of the illiterate participants provided informed consent on behalf of such participants. Participants chose their responses without undue influence from the family members to address internal validity.
Sample frame used by the study
The population of Ugenya Sub-county was estimated to be 134,354 for the overall population. The population estimated to be above 18 years were 72,872. The eligible persons from the proportion of 0.068 were 4,179. Using the Cochran formula, a sample size of 108 was obtained. This sample size was obtained from 4,179-target population.
Variables of the study
The outcome variable for this study was uptake of COVID-19 vaccine. Participants were asked if they were vaccinated at least once, and the response category was dichotomized. 1 = Yes and 2 = No. “Yes” responses were considered to have COVID-19 vaccine uptake and “No” responses were considered to have no COVID-19 vaccine uptake.
Socio-demographic and economic data collected were on variables such as age gender, marital status, religion, income, education and employment status. Data collected to evaluate the physical access barriers included distance to the facility, means of transport used to reach the facility, ease of entry into the vaccination room, and willingness to get vaccinated.
Ethical approval and approval statement
This study was approved by Institutional Review Board of Jaramogi Oginga Odinga University of Science and Technology (JOOUST). Approval number was ERC 33/9/22 − 02. License was obtained from Kenya National Council for Science, Technology and Innovation (NACOSTI), NACOSTI/P/22/21,180. Participants were allowed to read the consent form. Those who could not read on their own had it read to them and interpreted in the local Luo language by the data collectors. Questions and concerns from participants were addressed. They signed the consent form to show their willingness to participate.
Data collection
The data collectors identified themselves and explained the reason for the visit. Terms of interview were explained. Concerns from the participants were addressed before, during and after the interview. Interviews were conducted in privacy using validated closed-ended questionnaires. Literate participants filled them on their own. Where a participant could not read, write or both, each question was read and interpreted where necessary into local Luo language, and the participant allowed to mark as appropriate without any external interference. Where the participant could not comprehend the questions even after it was translated, a legally authorized representative provided the required information. No identifiers were collected to safeguard privacy of the participants (see Table S1).
Data analysis and presentations
Data analysis was performed using SPSS version 23 (IBM Corporation). Data on the sociodemographic and economic variables of the study participants were analyzed using descriptive statistics. Frequency distributions and proportions were used to describe and summarize categorical nominal variables. The tests for differences in proportions across categories were performed. The results of the associations were described in terms of odds ratios and significance set at p < 0.05 (2-tailed). A binary logistic regression model was used to determine the barriers to COVID-19 vaccine uptake and to control for confounding effects of the independent variables on the outcome.
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