{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:49:17Z","timestamp":1781714957361,"version":"3.54.5"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The coronavirus disease 2019 (COVID-19) has spread worldwide, and the vaccine remains the ultimate cornerstone to overcoming its long-term impact. Vaccine hesitancy might obstruct the effort to achieve herd immunity and eradicate the virus. We assessed Saudi Arabian individuals\u2019 willingness, beliefs, and barriers regarding the COVID-19 vaccine and their adherence to preventive measures during and after the pandemic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A self-administered electronic validated questionnaire was distributed among the five major regions in Saudi Arabia between November and December 2020. The questionnaire addressed the sociodemographic data, beliefs, potential barriers, parents\u2019 acceptance of COVID-19 vaccination for their children, and adherence to protective measures during and after the pandemic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 8,056 participants, 4,218 (52.4%) of a non-representative sample were willing to be vaccinated against COVID-19. Being a young adult, male, having less than a high school degree, being a smoker, having a chronic disease, and having a history of seasonal influenza vaccine uptake were positive predictors of COVID-19 vaccine acceptance. Hesitant participants reported concerns about vaccine side effects and safety as the main barriers to accepting the COVID-19 vaccine. Some refusers (26.1%) declared that they would reconsider vaccination only if the safety and effectiveness of the vaccine were reported by more studies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our study revealed a promising willingness to accept the vaccine among the population, with positive beliefs and attitudes toward COVID-19 vaccination. However, a considerable proportion of the population was reluctant to accept the vaccine. Thus, publicly providing information about vaccine safety and implementing health education programs is crucial for increasing the public\u2019s confidence in the vaccine.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-021-01606-6","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T01:02:18Z","timestamp":1639616538000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Willingness, beliefs, and barriers regarding the COVID-19 vaccine in Saudi Arabia: a multiregional cross-sectional study"],"prefix":"10.1186","volume":"22","author":[{"given":"Noura","family":"Altulahi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shouq","family":"AlNujaim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzam","family":"Alabdulqader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alkharashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assaf","family":"AlMalki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"AlSiari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Bashawri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Alsubaie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayel","family":"AlShahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"AlGoraini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"issue":"1","key":"1606_CR1","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12943-020-01218-1","volume":"19","author":"W Feng","year":"2020","unstructured":"W Feng W Zong F Wang S Ju 2020 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a review Mol Cancer 19 1 100 https:\/\/doi.org\/10.1186\/s12943-020-01218-1","journal-title":"Mol Cancer"},{"key":"1606_CR2","unstructured":"World Health Organization. Media statement: Knowing the risks for COVID-19. https:\/\/www.who.int\/indonesia\/news\/detail\/08-03-2020-knowing-the-risk-for-covid-19. Accessed Feb 19 2021"},{"issue":"1","key":"1606_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2991\/jegh.k.200218.003","volume":"10","author":"M Barry","year":"2020","unstructured":"M Barry M Al Amri ZA Memish 2020 COVID-19 in the shadows of MERS-CoV in the Kingdom of Saudi Arabia J Epidemiol Glob Health 10 1 1 3 https:\/\/doi.org\/10.2991\/jegh.k.200218.003","journal-title":"J Epidemiol Glob Health"},{"key":"1606_CR4","unstructured":"World Health Organization. Coronavirus disease (COVID-19) pandemic.https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019"},{"key":"1606_CR5","unstructured":"Weqaya Public Health Authority. Saudi Center for Disease Prevention; 2021"},{"issue":"18","key":"1606_CR6","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","volume":"382","author":"WJ Guan","year":"2020","unstructured":"WJ Guan  2020 Clinical characteristics of coronavirus disease 2019 in China N Engl J Med 382 18 1708 1720 https:\/\/doi.org\/10.1056\/NEJMoa2002032","journal-title":"N Engl J Med"},{"key":"1606_CR7","doi-asserted-by":"publisher","unstructured":"Anon. Why a pioneering plan to distribute COVID vaccines equitably must succeed. Nature 2021;589(7841):170. doi:https:\/\/doi.org\/10.1038\/d41586-021-00044-9","DOI":"10.1038\/d41586-021-00044-9"},{"issue":"1","key":"1606_CR8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s00103-019-03063-0","volume":"63","author":"KB Habersaat","year":"2019","unstructured":"KB Habersaat C Jackson 2019 Understanding vaccine acceptance and demand\u2014and ways to increase them Bundesgesundheitsbl 63 1 32 39 https:\/\/doi.org\/10.1007\/s00103-019-03063-0","journal-title":"Bundesgesundheitsbl"},{"issue":"8","key":"1606_CR9","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s10654-020-00675-8","volume":"35","author":"L Palamenghi","year":"2020","unstructured":"L Palamenghi S Barello S Boccia G Graffigna 2020 Mistrust in biomedical research and vaccine hesitancy: The forefront challenge in the battle against COVID-19 in Italy Eur J Epidemiol 35 8 785 788 https:\/\/doi.org\/10.1007\/s10654-020-00675-8","journal-title":"Eur J Epidemiol"},{"key":"1606_CR10","doi-asserted-by":"crossref","unstructured":"Thunstrom L. Hesitancy towards a COVID-19 vaccine and prospects for herd immunity. 2020. https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=3593098. Accessed 21 Mar 2021","DOI":"10.2139\/ssrn.3593098"},{"key":"1606_CR11","unstructured":"Lima G, et al. Public willingness to get vaccinated against COVID-19: how AI-developed vaccines can affect acceptance. 2020. https:\/\/arxiv.org\/abs\/2006.08164 Accessed 21 Mar 2021"},{"issue":"45","key":"1606_CR12","doi-asserted-by":"publisher","first-page":"7002","DOI":"10.1016\/j.vaccine.2020.09.041","volume":"38","author":"M Detoc","year":"2020","unstructured":"M Detoc S Bruel P Frappe B Tardy E Botelho-Nevers A Gagneux-Brunon 2020 Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic Vaccine 38 45 7002 7006 https:\/\/doi.org\/10.1016\/j.vaccine.2020.09.041","journal-title":"Vaccine"},{"issue":"7","key":"1606_CR13","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s10198-020-01208-6","volume":"21","author":"S Neumann-B\u00f6hme","year":"2020","unstructured":"S Neumann-B\u00f6hme  2020 Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19 Eur J Health Econ 21 7 977 982 https:\/\/doi.org\/10.1007\/s10198-020-01208-6","journal-title":"Eur J Health Econ"},{"key":"1606_CR14","doi-asserted-by":"publisher","unstructured":"Lazarus JV, et al. A global survey of potential acceptance of a COVID-19 vaccine.Nature News. https:\/\/www.nature.com\/articles\/s41591-020-1124-9. 2020. Accessed 21 Mar 2021. doi:https:\/\/doi.org\/10.1038\/s41591-020-1124-9","DOI":"10.1038\/s41591-020-1124-9"},{"issue":"10","key":"1606_CR15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.25594","volume":"3","author":"S Kreps","year":"2020","unstructured":"S Kreps S Prasad JS Brownstein Y Hswen BT Garibaldi B Zhang DL Kriner 2020 Factors associated with US adults\u2019 likelihood of accepting COVID-19 vaccination JAMA Netw Open 3 10 e2025594 https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.25594","journal-title":"JAMA Netw Open"},{"issue":"3","key":"1606_CR16","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3390\/vaccines8030482","volume":"8","author":"J Wang","year":"2020","unstructured":"J Wang  2020 Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China Vaccines 8 3 482 https:\/\/doi.org\/10.3390\/vaccines8030482","journal-title":"Vaccines"},{"key":"1606_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100495","volume":"26","author":"AA Malik","year":"2020","unstructured":"AA Malik  2020 Determinants of COVID-19 vaccine acceptance in the US EClinicalMedicine 26 100495 https:\/\/doi.org\/10.1016\/j.eclinm.2020.100495","journal-title":"EClinicalMedicine"},{"key":"1606_CR18","doi-asserted-by":"publisher","unstructured":"Fu C, et al. Acceptance and preference for COVID-19 vaccination in health-care workers (HCWs). medRxiv 2020. doi:https:\/\/doi.org\/10.1101\/2020.04.09.20060103","DOI":"10.1101\/2020.04.09.20060103"},{"key":"1606_CR19","doi-asserted-by":"publisher","unstructured":"Magadmi R, Kamel F. Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia. Res Sq. 2020. https:\/\/www.researchsquare.com\/article\/rs-48955\/v1 Accessed 21 Mar 2021. doi:https:\/\/doi.org\/10.21203\/rs.3.rs-48955\/v1","DOI":"10.21203\/rs.3.rs-48955\/v1"},{"key":"1606_CR20","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.2147\/JMDH.S276771","volume":"2020","author":"M Al-Mohaithef","year":"2020","unstructured":"M Al-Mohaithef BK Padhi 2020 Determinants of COVID-19 vaccine acceptance in Saudi Arabia: a web-based national survey: JMDH J Multi Health 2020 1657 1663 https:\/\/doi.org\/10.2147\/JMDH.S276771","journal-title":"J Multi Health"},{"key":"1606_CR21","unstructured":"The General Authority for Statistics. 2021. https:\/\/www.stats.gov.sa\/ar\/952. Accessed 5 Jul 2021"},{"issue":"6","key":"1606_CR22","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1007\/s00038-020-01404-4","volume":"65","author":"M Fadda","year":"2020","unstructured":"M Fadda E Albanese LS Suggs 2020 When a COVID-19 vaccine is ready, will we all be ready for it? Int J Public Health 65 6 711 712 https:\/\/doi.org\/10.1007\/s00038-020-01404-4","journal-title":"Int J Public Health"},{"issue":"33","key":"1606_CR23","doi-asserted-by":"publisher","first-page":"5131","DOI":"10.1016\/j.vaccine.2020.04.076","volume":"38","author":"X Xiao","year":"2020","unstructured":"X Xiao RM Wong 2020 Vaccine hesitancy and perceived behavioral control: a meta-analysis Vaccine 38 33 5131 5138 https:\/\/doi.org\/10.1016\/j.vaccine.2020.04.076","journal-title":"Vaccine"},{"issue":"1","key":"1606_CR24","doi-asserted-by":"publisher","first-page":"42","DOI":"10.3390\/vaccines9010042","volume":"9","author":"M Sallam","year":"2021","unstructured":"M Sallam  2021 High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: A study in Jordan and Kuwait among other Arab countries Vaccines 9 1 42 https:\/\/doi.org\/10.3390\/vaccines9010042","journal-title":"Vaccines"},{"key":"1606_CR25","doi-asserted-by":"publisher","unstructured":"Abdelhafiz, AS et al. Knowledge, perceptions, and attitude of Egyptians towards the novel coronavirus disease\u00a0(COVID-19). J Comm Health 2020. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7173684. Accessed 21 Mar 2021. doi:https:\/\/doi.org\/10.1007\/s10900-020-00827-7","DOI":"10.1007\/s10900-020-00827-7"},{"key":"1606_CR26","unstructured":"General Authority for Statistics Kingdom of Saudi Arabia"},{"issue":"9","key":"1606_CR27","doi-asserted-by":"publisher","first-page":"2971","DOI":"10.4103\/jfmpc.jfmpc_547_19.22","volume":"8","author":"AM Almotairy","year":"2019","unstructured":"AM Almotairy  2019 Association between knowledge of influenza vaccine and vaccination status among general population attending primary health care centers in Al-Madinah, Saudi Arabia J Fam Med Prim Care 8 9 2971 2974 https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_547_19.22","journal-title":"J Fam Med Prim Care"},{"issue":"6","key":"1606_CR28","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.jiph.2017.03.011","volume":"10","author":"AS Alqahtani","year":"2017","unstructured":"AS Alqahtani  2017 Knowledge and attitudes of Saudi populations regarding seasonal influenza vaccination J Infect Public Health 10 6 897 900 https:\/\/doi.org\/10.1016\/j.jiph.2017.03.011","journal-title":"J Infect Public Health"},{"key":"1606_CR29","unstructured":"World Health Organization. WHO coronavirus (COVID-19) dashboard.https:\/\/covid19.who.int\/. Accessed 21 Mar 2021"},{"issue":"6","key":"1606_CR30","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1080\/21645515.2020.1846397","volume":"17","author":"SM Sherman","year":"2021","unstructured":"SM Sherman LE Smith J Sim R Aml\u00f4t M Cutts H Dasch GJ Rubin N Sevdalis 2021 COVID-19 vaccination intention in the UK: results from the COVID-19 vaccination acceptability study (CoVAccS), a nationally representative cross-sectional survey Human Vaccine Immunother 17 6 1612 1621 https:\/\/doi.org\/10.1080\/21645515.2020.1846397","journal-title":"Human Vaccine Immunother"},{"issue":"1","key":"1606_CR31","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5455\/ijmsph.2015.0000201420","volume":"4","author":"M Korani","year":"2015","unstructured":"M Korani 2015 Assessment of seasonal flu immunization status among adult patients visiting al-Sharaee Primary Health Care Center in Makkah al-Mokarramah Int J Med Sci Public Health 4 1 117 https:\/\/doi.org\/10.5455\/ijmsph.2015.0000201420","journal-title":"Int J Med Sci Public Health"},{"issue":"2","key":"1606_CR32","first-page":"159","volume":"32","author":"HI Al-Khashan","year":"2011","unstructured":"HI Al-Khashan MA Selim AM Mishriky AA Binsaeed 2011 Meningitis and seasonal influenza vaccination coverage among military personnel in central Saudi Arabia Saudi Med J 32 2 159 165","journal-title":"Saudi Med J"},{"key":"1606_CR33","unstructured":"Gender and COVID-19 Vaccines. (2021, May). https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/GiHA%20Gender%20and%20COVID19%20Vaccines_140621.pdf"},{"issue":"3","key":"1606_CR35","doi-asserted-by":"publisher","first-page":"155","DOI":"10.4103\/JNSM.JNSM_29_20","volume":"3","author":"M Barry","year":"2020","unstructured":"M Barry  2020 Coronavirus disease-2019 pandemic in the Kingdom of Saudi Arabia: Mitigation measures and hospital preparedness J Nat Sci Med 3 3 155 158 https:\/\/doi.org\/10.4103\/JNSM.JNSM_29_20","journal-title":"J Nat Sci Med"},{"issue":"2","key":"1606_CR36","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.vacune.2020.10.008","volume":"21","author":"YM AlGoraini","year":"2020","unstructured":"YM AlGoraini  2020 Confidence toward vaccination as reported by parents of children admitted to a tertiary care hospital in Riyadh, Saudi Arabia: a cross sectional study Vacunas Engl Ed 21 2 95 104 https:\/\/doi.org\/10.1016\/j.vacune.2020.10.008","journal-title":"Vacunas Engl Ed"},{"issue":"1","key":"1606_CR37","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.vaccine.2017.11.050","volume":"36","author":"TM Alshammari","year":"2018","unstructured":"TM Alshammari  2018 Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: a cross sectional study Vaccine 36 1 23 28 https:\/\/doi.org\/10.1016\/j.vaccine.2017.11.050","journal-title":"Vaccine"},{"issue":"49","key":"1606_CR38","doi-asserted-by":"publisher","first-page":"7789","DOI":"10.1016\/j.vaccine.2020.10.027","volume":"38","author":"S Bell","year":"2020","unstructured":"S Bell  2020 Parents\u2019 and guardians\u2019 views on the acceptability of a future COVID-19 vaccine: a multi-methods study in England Vaccine 38 49 7789 7798 https:\/\/doi.org\/10.1016\/j.vaccine.2020.10.027","journal-title":"Vaccine"},{"issue":"1","key":"1606_CR39","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/j.1525-1446.2009.00823.x","volume":"27","author":"KE Luthy","year":"2010","unstructured":"KE Luthy RL Beckstrand LC Callister 2010 Parental hesitation in immunizing children in Utah Public Health Nurs 27 1 25 31 https:\/\/doi.org\/10.1111\/j.1525-1446.2009.00823.x","journal-title":"Public Health Nurs"},{"issue":"1","key":"1606_CR40","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.4081\/jphr.2019.1436","volume":"8","author":"A Facciol\u00e0","year":"2019","unstructured":"A Facciol\u00e0  2019 Vaccine hesitancy: an overview on parents\u2019 opinions about vaccination and possible reasons of vaccine refusal J Public Health Res 8 1 1436 https:\/\/doi.org\/10.4081\/jphr.2019.1436","journal-title":"J Public Health Res"},{"issue":"12","key":"1606_CR41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0209117","volume":"13","author":"J Ren","year":"2018","unstructured":"J Ren  2018 The demographics of vaccine hesitancy in Shanghai, China PLoS ONE 13 12 e0209117 https:\/\/doi.org\/10.1371\/journal.pone.0209117","journal-title":"PLoS ONE"},{"key":"1606_CR42","unstructured":"Benefits of getting a COVID-19 vaccine [Internet]. Centers for Disease Control and Prevention. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/vaccine-benefits.html"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01606-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-021-01606-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01606-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T01:02:26Z","timestamp":1639616546000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01606-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1606"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01606-6","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"10 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed following the ethical standards of the institutional and national research Human Ethical Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from each participant or participant\u2019s guardian after receiving approval of the study by the Institutional Research Ethics Committee in King Fahad Medical City in Riyadh, Kingdom of SA (no. IRB00010471). A written informed consent was obtained from the participants after the aims of the study were explained before the survey.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors have any competing interests to declare","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"247"}}