Predicting intention to receive COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model

Assessing the determinants of influenza and COVID-19 vaccine co-administration decisions in the elderly

This research examines the low rate of co-administration of influenza and COVID-19 vaccines among seniors aged 65 and older in Korea, despite recommendations from authorities and academia worldwide. The study aimed to understand the influence of general characteristics and health beliefs on the vaccination choices of seniors, who were categorized into four groups based on their vaccination status: influenza only, COVID-19 only, both, or neither. A total of 400 participants, aged 65 and above, were selected through proportional stratified random sampling from five major Korean regions for a survey conducted between November 24th and December 15th, 2023. The results indicated no significant differences in general characteristics across these groups. However, regarding the health beliefs showed significant differences in perceived susceptibility and self-efficacy between the influenza-only and co-administration groups. Higher levels of perceived susceptibility and self-efficacy were associated with choosing co-administration. Contrary to previous studies focusing on safety concerns as a primary factor in vaccine hesitancy, this study highlights the role of individual health-related beliefs, particularly perceived susceptibility and self-efficacy, as critical in influencing the decision for co-administration among the elderly in Korea.

Expectations Versus Fantasies and Vaccine Hesitancy: How Suffering From COVID-19 Versus Suffering From Vaccines Interact

BACKGROUND

Previous research on COVID-19 vaccination highlights future thoughts associated with possible Coronavirus infection and vaccine side effects as key predictors of vaccine hesitancy. Yet, research has focused on independent contributions of such future thoughts, neglecting their interactive aspects.

PURPOSE

We examined whether thoughts about two possible COVID-related futures (suffering from COVID-19 and vaccine side effects) interactively predict vaccine hesitancy and vaccination behavior among unvaccinated and vaccinated people. Importantly, we compared two forms of future thinking: beliefs or expectations (likelihood judgments) versus fantasies (free thoughts and images describing future events).

METHODS

In Study 1, we conducted a longitudinal study with an unvaccinated group (N = 210). We assessed expectations versus fantasies about the two COVID-related futures as predictors. As outcome variables, we measured vaccine hesitancy, and 9 weeks later we assessed information seeking and vaccine uptake. Study 2 was a cross-sectional study comparing vaccine hesitancy of an unvaccinated group (N = 307) to that of a vaccinated group (N = 311).

RESULTS

Study 1 found that more negative fantasies about COVID-19 impact and less negative fantasies about vaccine side effects interactively predicted lower vaccine hesitancy and more vaccine-related behaviors among unvaccinated people; no such interaction was observed between respective expectations. Study 2 replicated these results of Study 1. Additionally, for vaccinated people, low expectations of negative COVID-19 impact and high expectations of negative vaccine impact interactively predicted higher vaccine hesitancy, whereas no such interaction was observed for respective fantasies.

CONCLUSIONS

Research on vaccine hesitancy should explore interactions between future thinking about disease and about vaccine side effects. Importantly, there is much to be gained by distinguishing expectations versus fantasies: vaccination interventions aiming to boost vaccine uptake among unvaccinated people should tap into their negative future fantasies regarding both disease and vaccine side effects.

COVID-19 Vaccine Intention Among Iranian Health Workers: Application of the HBM Model

The study aimed to determine the application of the health belief model (HBM) in the acceptance of COVID-19 vaccination among health workers in 2021. The cross-sectional study was conducted on 3600 health workers from February to March 2021. Data was collected using a researcher-made questionnaire that included the intention to receive vaccines based on the health belief model constructs. Data were analyzed using descriptive statistics indicators, Chi-square, ANOVA test, and logistic regression model at a 95% confidence level. More than 62% of the participants intended to receive the vaccine. The odds of intention to receive the vaccine among people who worked in the health center and did not have a history of hospitalization due to COVID-19 disease were 1.50 and 2.10 units more than the others. Intention to receive the vaccine in individuals with high perceived sensitivity was 1.10 units. Furthermore, in terms of perceived benefits, self-efficacy, and cue-to-action constructs were 1.15, 1.34, and 1.65 units respectively. The rate of vaccine acceptance among Iranian health care workers was relatively good and the constructs of HBM in predicting the rate of intention to receive the vaccine had good applicability.

The Willingness to Intervene Against Suicide Enhanced Questionnaire

The purpose of this study was to test the reliability and validity of the Willingness to Intervene against Suicide Enhanced (WISE) questionnaire. The WISE is a revised version of the Willingness to Intervene against Suicide (WIS) questionnaire, which was based on the theory of planned behavior, and it has consistently predicted the intention to intervene with a suicidal individual. Evaluation of the WIS showed that it was internally consistent with adequate goodness-of-fit indices for three of the four scales. The subjective norms scale did not meet the goodness-of-fit indices standard cutoff criteria. Due to this, the WIS questionnaire has been revised into the WISE. However, the dimensionality of these factors needed to be tested. College students (n = 824) completed an online survey to test the WISE. The data were analyzed using confirmatory factor analysis, reliability analysis, and multiple regression. The WISE was internally consistent, and the scales met acceptable criteria for goodness-of-fit indices. The WISE explained a range of variance in participants' intention to intervene from 12 to 40%.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19

BACKGROUND

Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake.

METHODS

The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted.

RESULTS

Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents.

CONCLUSIONS

Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

The mediating role of health literacy in the relationship between self-care and planned behavior against Covid-19

BACKGROUND

Planned behaviors and self-care against the coronavirus are two important factor in controlling its spread and self-care behaviors depend on the level of health literacy. This research was conducted to determine the mediating role of health literacy in the relationship between elements of planned behavior and self-care in dealing with the Covid-19.

METHODS

In this descriptive-analytical quantitative study, the sample size was calculated using Cochrane's formula and considering a p-value of 0.51, α = 0.05, and d = 0.05, and 313 students were selected based on stratified and random method. To gather data and assess various aspects of variables, a questionnaires were utilized, focusing on health literacy, self-car and planned behavior. The relationship between the variables was examined by SPSS version 26 and via descriptive statistics, including the mean and standard deviation, and inferential statistics such as Pearson's correlation coefficient (P = 0.05), path analysis, and determining the standard coefficients between self-care and planned behavior, mediated by the indicators of the health literacy.

RESULTS

A significant difference was found between the level of health literacy of women and men. The comparison of the mean health literacy and self-care behavior in terms of other variables did not show any significant difference. Meanwhile, the comparison of health status control behaviors, hand washing, and mask use did not show any significant difference between the two groups. A positive and significant correlation was found between self-care behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention. The relationship of health literacy and psychological variables of attitude, subjective norms, and perceived behavioral control with self-care against COVID-19 was significant.

CONCLUSION

The direct and significant impact of health literacy on individuals' self-care behaviors against the coronavirus was not observed. However, health literacy did have a significant effect on subjective norms. This finding is important because subjective norms significantly influenced individuals' behavioral intention, which in turn had a significant effect on self-care behaviors against the coronavirus. Thus, health literacy played a mediating role in this relationship. Furthermore, attitude emerged as the strongest predictor of behavioral intention, exerting a direct effect. Conversely, perceived behavioral control did not directly and significantly affect students' self-care behaviors.

Nurses' intention to care of COVID-19 patients in hospitals dedicated to infectious disease in South Korea: application of the theory of planned behavior and verification of the moderating effect of ethical nursing competence

BACKGROUND

The theory of planned behavior is a conceptual framework of recent studies to identify and explain nurses' intentions to care for patients with emerging infectious diseases. However, correlations between behavioral intentions and variables that explain them have been inconsistent in previous studies. The influence of new variables might be considered in this case. This study aimed to determine moderating effects of ethical nursing competence on nurses' intention to care for COVID-19 patients in hospitals dedicated to infectious diseases based on the theory of planned behavior.

METHODS

A cross-sectional survey was conducted. Data on intention to care for COVID-19 patients, perceived behavioral control, attitude toward the behavior, subjective norm, and ethical nursing competence were obtained from 190 nurses in three hospitals dedicated to infectious diseases in South Korea. The moderating effect of ethical nursing competence was analyzed using model I of PROCESS Macro.

ETHICAL CONSIDERATIONS

This study was approved by the Institutional Review Board of Ulsan University Hospital, South Korea. Written informed consent was obtained from each subject.

RESULTS

The ethical nursing competence was a significant moderator in the relation between perceived behavioral control and the intention to care (B = 0.36, t = 2.16, p = 0.032). Ethical nursing competence did not have a significant interaction with attitude toward behavior or subjective norm.

CONCLUSIONS

This study showed that the higher the ethical nursing competence level, the greater the effect of perceived behavioral control on nurses' intention to care for COVID-19 patients. Promoting ethical nursing competence is necessary for nurses who would take care of patients at the frontline of the infectious disease pandemic. Nursing managers should include ethical nursing competence in the assessment of nurses' competence and design educational programs to enhance ethical nursing competence for efficient nursing staffing during a pandemic.

University Students' Vaccination Intention after the Fifth Wave of the COVID-19 Outbreak in Hong Kong: Inspiration from a Health Belief Model

The fifth wave of COVID-19, driven by the Omicron variant, started to surge in Hong Kong in December 2021. Previous studies have shown that younger adults, compared to older adults, are vulnerable to increased risks of side effects after vaccination. However, little is known about the COVID-19 vaccination behavior among younger adults, especially university students, in Hong Kong. Therefore, the present online survey study aimed to investigate the predictors of COVID-19 vaccination intention among university students in Hong Kong using the Health Belief Model (HBM) as a framework. Two other potential predictors, the previous influenza vaccine uptake frequency and the Hong Kong SAR government vaccination lottery program, were also examined. The intention to receive another dose of the COVID-19 vaccine was low (36.4%). Multivariate binomial logistic regression analysis showed that, after controlling for demographic and baseline characteristics, the perceived susceptibility (OR = 2.98, CI = 1.18-7.53) and previous influenza vaccine uptake frequency (OR = 1.54, CI = 1.08-2.19) significantly and positively predicted the COVID-19 vaccination intention. However, the government vaccination lottery program (i.e., wining prizes for being vaccinated) (OR = 0.87, CI = 0.34-2.26) was not a significant motivator of COVID-19 vaccination. Future public health campaigns should focus on the individual susceptibility to COVID-19 and past influenza vaccination history to promote increased vaccination uptake among university students.

COVID-19 vaccine confidence, concerns, and uptake in children aged 5 and older in Calgary, Alberta: a longitudinal cohort study

Objectives

Beginning early in the pandemic, there was a worldwide effort to develop effective vaccines against the SARS-CoV-2 virus. Before and after the approval and implementation of vaccines, there were concerns about their need as well as their safety and rapid development. We explored child demographic characteristics and parental concerns to identify factors associated with the decision to vaccinate.

Methods

A cohort of 1035 children from Calgary was assembled in 2020 to participate in 5 visits every 6 months for survey completion and blood sampling for SARS-CoV-2 antibodies. Visits 1 to 2 occurred before approval of vaccines for children; Visits 3 to 5 occurred after vaccine approval for different age groups. We described vaccine concerns and utilized logistic regression to examine factors associated with the decision to vaccinate in children ≥5 years of age.

Results

Children ≥12 years of age, of non-white or non-black ethnicity, and who had received previous influenza vaccines had higher odds of being vaccinated against SARS-CoV-2. Children with previous SARS-CoV-2 infection had lower odds of being vaccinated. The most common concerns in early 2021 were about vaccine safety. By summer 2022, the most common concern was a belief that vaccines were not necessary. Through the study 88% of children were vaccinated.

Conclusions

Age, ethnicity, previous infections, and vaccine attitudes were associated with parental decision to vaccinate against SARS-CoV-2. For children who remained unvaccinated, parents continued to have safety concerns and questioned the necessity of the vaccine. Complacency about the need for vaccination may be more challenging to address and overcome than concerns about safety alone.

Predicting the intention to receive the COVID-19 booster vaccine based on the health belief model

COVID-19 vaccine boosters are recommended because the protection provided by previous doses eventually decreases, posing a threat to immunity. Some people, however, remain hesitant or unwilling to get vaccinated. The present study sought to investigate factors associated with the intention to receive the COVID-19 booster vaccine based on (1) the constructs of the Health Belief Model, and (2) trust in healthcare workers and science. A sample of 165 adults with two doses of the COVID-19 vaccine were recruited using convenience sampling. Data was collected using an online survey from November 2021 to January 2022. The survey included questions about participants' socio-demographic details, health beliefs, trust, history of COVID-19 vaccination, and the intention to receive a third dose of the COVID-19 vaccine. Ordinal logistic regression analysis showed that higher perceived benefits, severity, and trust in healthcare workers, and lower perceived barriers predicted higher willingness to get a third dose of the vaccine whereas perceived susceptibility and trust in science did not. Understanding the factors and health beliefs that underlie vaccine hesitancy are vital when developing effective interventions with the aim of increasing uptake of COVID-19 booster vaccines.

Factors Influencing COVID-19 Vaccination among Primary Healthcare Nurses in the Pandemic and Post-Pandemic Period: Cross-Sectional Study

The decision to vaccinate against COVID-19 is primarily a personal choice influenced by numerous factors. Vaccine acceptance and a positive attitude towards vaccination among nurses have an impact on patients' willingness to vaccinate. To assess COVID-19 vaccination coverage among primary healthcare nurses and to associate socio-demographic factors, comorbidity, self-rated health, and unhealthy lifestyle with the decision to be vaccinated, we conducted an online cross-sectional study from March to May 2023 using a self-administrated questionnaire. Probability sampling was used to select 32 health centers and nurses were invited via email. Among the 560 participants who completed survey, 78.3% and 50.8% received the primary two-dose course and at least one booster dose of COVID-19 vaccine, respectively. Primary care nurses who were ≥41 years of age, physically less active, and those who were overweight opted statistically significantly more often for the primary vaccination scheme (p = 0.00, 0.015 and 0.017, respectively). Education and the living environments of primary care nurses did not significantly influence the decision to receive two primary COVID-19 doses. Likewise, good self-rated health and comorbidity did not contribute significantly to the vaccination decision. Nurses that were vaccinated with booster doses were significantly more often overweight (p = 0.034) and ≥41 year of age (p = 0.000).

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

COVID-19 vaccination uptake among healthcare workers in Ghana: A comprehensive analysis of knowledge, attitude, perceived vaccine effectiveness, and health belief model constructs

The novel Coronavirus Disease 19 (COVID-19) caused devastating effects globally, and healthcare workers were among the most affected by the pandemic. Despite healthcare workers being prioritized in COVID-19 vaccination globally and in Ghana, hesitancy to receive the vaccines resulted in delayed control of the pandemic. In Ghana, healthcare workers had a vaccine acceptance of 39.3% before the vaccine rollout. Consequently, this study assessed the uptake of COVID-19 vaccination and associated factors among healthcare workers in Ghana in the post-vaccine roll-out period. This was an analytical cross-sectional study that used a semi-structured questionnaire to collect data on COVID-19 vaccination uptake and influencing factors. 256 healthcare workers were selected in Ayawaso West Municipality of Ghana using a stratified random sampling approach. Descriptive statistics were used to examine socio-demographic factors and Likert scale responses. Bivariable and Multivariable logistic regression were performed using IBM SPSS version 22 to identify predictors of vaccine uptake and a statistical significance was declared at p<0.05. More than three-fourths of participants 220 (85.9%) had received at least one dose of the COVID-19 vaccination, while 36 (14.9%) were hesitant. More than half 139 (54.3%) had adequate knowledge about COVID-19 vaccination and the majority 188 (73.4%) had positive perceptions about its effectiveness. Moreover, 218 (85.2%) of HCWs had a positive attitude towards COVID-19 vaccination. Positive attitude towards COVID-19 vaccination (AOR = 4.3; 95% CI: 1.4, 13.0) and high cues to action (AOR = 5.7; 95% CI: 2.2, 14.8) were the factors that significantly predicted uptake of COVID-19 vaccination among healthcare workers. COVID-19 vaccination among HCWs in Ghana is promising. However, hesitancy to receive the vaccination among a significant proportion of HCWs raises concerns. To ensure vaccination of all healthcare workers, interventions to promote vaccination should target key determinants of vaccination uptake, such as attitude towards the vaccination and cues to action.

The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale

OBJECTIVE

Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale.

METHODS

The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire.

RESULTS

The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis.

CONCLUSIONS

The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.

Examination of Predicting Factors for COVID-19 Vaccination Behaviors of University Students Utilizing the Theory of Planned Behavior

PURPOSE

This study aimed to examine the predictive factors of COVID-19 vaccination behavior by evaluating the moderating effect of perceived behavioral control on the theory of planned behavior.

METHODS

Data were collected from August 6 to August 31, 2022 from 235 college students (aged 20~29 years) across 12 universities using a structured web-based survey. Statistical analyses were conducted using the SPSS and AMOS software.

RESULTS

Attitudes toward COVID-19 vaccination, subjective norms, and intention to be vaccinated significantly influenced COVID-19 vaccination behavior. Attitudes and subjective norms indirectly affected COVID-19 vaccination behavior through intention to vaccinate, whereas intention to vaccinate had a direct effect. The moderating effect of perceived behavioral control on the relationship between subjective norms and intention to vaccinate was significant.

CONCLUSION

Interventions that foster a positive attitude toward COVID-19 vaccination and bolster subjective norms and perceived behavioral control can boost the intention to be vaccinated and facilitate the uptake of COVID-19 vaccination.

The role of trust, vaccine information exposure, and Health Belief Model variables in COVID-19 vaccination intentions: Evidence from an HBCU sample

African Americans have been disproportionately affected by COVID-19 and COVID-19 vaccines were initially met with hesitancy from the African American community. This study identified predictors of COVID-19 vaccination intentions among students attending a Historically Black College and University (HBCU) when COVID-19 vaccines first became available. Unvaccinated students (N = 224) completed a survey. Path analysis modeled relationships among exogenous variables (trust, exposure to pro- and anti-vaccine information), proposed mediators (Health Belief Model variables), and COVID-19 vaccination intentions. Students reported low trust in government officials, medical professionals, and the vaccine development process. Direct predictors of vaccination intentions included trust, perceived benefits, and perceived barriers. Students with lower trust reported lower benefits, increased concerns about side effects, and were more likely to view COVID-19 vaccination as low priority, and these factors in turn predicted intentions. Findings highlight the urgent need for theory-driven, culturally sensitive, age-relevant messaging to reduce vaccine hesitancy among Black young adults.

Effect of chronic diseases on willingness to receive the second COVID-19 vaccine booster dose among cancer patients: A multicenter cross-sectional survey in China

BACKGROUND

Cancer patients and those with chronic diseases face severe outcomes from SARS-CoV-2 infection. However, their willingness to receive a second booster dose remains low. This study identified factors affecting the willingness of cancer patients with chronic diseases (CPCD) and cancer patients without chronic diseases (non-CPCD) to receive the second COVID-19 booster vaccine dose.

METHODS

A multicenter cross-sectional study was conducted across 4 tertiary care hospitals in China. Based on the Health Belief Model, a questionnaire assessed respondents' perceptions of the second booster dose. Multivariable logistic regression analyzed factors influencing the willingness to receive a second vaccine dose.

RESULTS

Out of 171 CPCD and 722 non-CPCD, CPCD showed a higher willingness to receive the second booster dose than non-CPCD (46.8% vs 32.3%, P < .001). Factors influencing CPCD's willingness included the belief that vaccination was detrimental to cancer treatment and the perceived higher infection risk compared to healthy individuals. Fear of vaccination's negative impact on cancer treatment was the main factor affecting non-CPCD's willingness (each P < .05).

CONCLUSIONS

Different factors influenced the willingness of the 2 groups. Health education interventions should be implemented alongside vaccination, involving patients' relatives and medical staff, for both CPCD and non-CPCD populations. Additionally, health management service interventions should emphasize the benefits of vaccination for CPCD to improve their second dose coverage.

Using behavioral theory to understand partisan differences in COVID-19 vaccination and booster intentions

In 2020, the Food and Drug Administration granted emergency use authorization for two COVID-19 vaccines. Two years later, the Centers for Disease Control and Prevention estimated that more than 250 million individuals had received at least one dose of the vaccine. Despite the large numbers of individuals vaccinated against COVID-19, partisan differences surrounding the COVID-19 vaccine emerged, creating a potential challenge for health communications aimed at increasing vaccine uptake. A better understanding of partisan differences in attitudes and intentions towards vaccination may help guide public health strategies aimed at increasing vaccine uptake. To determine whether a commonly used theory of behavioral intentions used to craft public health messages explains partisan differences in intentions. Data were drawn from a national panel of US adults and collected between February 21, 2022, and March 3, 2022, using an online survey (n = 1845). Among respondents identifying as either Democrat or Republican (n = 1466), path analysis models were estimated to test whether partisan differences in vaccination or booster intentions were explained by the theoretical constructs of protection motivation theory (PMT). PMT accounted for approximately half of the covariate-adjusted mean difference in COVID-19 vaccination intentions between Democrats and Republicans, and nearly all the mean difference in booster intentions. Party affiliation indirectly affected intentions via its association with perceived susceptibility to COVID-19, vaccine/booster efficacy, and perceived costs of getting a COVID-19 vaccine or booster dose. Compared with Democrats, Republicans may be less likely to get vaccinated or receive a booster dose because of beliefs that they are less susceptible to COVID-19, that the vaccine is less effective, and that vaccination comes with disadvantages. Theories of behavioral intentions can help to identify the underlying theoretical determinants driving behavioral differences between political groups.

HIV stigma and other barriers to COVID-19 vaccine uptake among Georgian people living with HIV/AIDS: A mixed-methods study

We conducted a study in Georgia to examine behavioral insights and barriers to COVID-19 vaccine uptake among people living with HIV (PLWH). Between December 2021-July 2022, we collected quantitative data to evaluate participants' demographics, COVID-19 knowledge, attitude, perception, and HIV stigma as potential covariates for being vaccinated against COVID-19. We conducted a multivariate analysis to define the factors independently associated with COVID-19 vaccination among PLWH. We collected qualitative data to explore individual experiences of their positive or negative choices, main barriers, HIV stigma, and preferences for receiving vaccination. Of the total 85 participants of the study, 52.9% were vaccinated; 61.2% had concerns with the disclosure of HIV status at the vaccination site. Those who believed they would have a severe form of COVID-19 were more likely to be vaccinated (OR = 23.8; 95% CI: 5.1-111.7). The association stayed significant after adjusting for sex, age, education level, living area, health care providers' unfriendly attitudes, and their fear of disclosing HIV status at vaccination places. Based on the qualitative study, status disclosure was a significant barrier to receiving care; therefore, PLWH prefer to receive COVID-19 vaccination integrated in HIV services. Conclusions: In this study, around half of the participants were not vaccinated against COVID-19. The main reasons for not being vaccinated included stigma, misleading health beliefs, and low awareness about COVID-19. An integrated service delivery model may improve vaccination uptake among PLWH in Georgia.

Individual Beliefs and Experiences With Brain Health Dietary Supplements in the United States

BACKGROUND

Although the use of brain health dietary supplements (brain DS) has increased, there is limited research on safety and risk of these products. Brain DS may be beneficial for improving memory, concentration, and focus but may also carry risks.

OBJECTIVES

To assess brain DS users' utilization experiences and identify factors associated with likelihood of brain DS use among nonusers.

DESIGN

An internet-based cross-sectional survey study was conducted using a sample of middle-aged US adults. Respondents' sociodemographic characteristics and health beliefs regarding brain DS were collected. Brain DS users' utilization experiences such as negative side effects and spending were also collected.

PARTICIPANTS AND SETTING

Purposive sampling was utilized for users and nonusers sample recruitment.

MAIN OUTCOME MEASURES

Brain DS users' utilization experience and future likelihood of brain DS use among nonusers.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics on brain DS users' utilization experiences were reported. Ordinal logistic regression with sociodemographic and belief characteristics as predictors was employed to identify factors associated with the likelihood of brain DS among nonusers.

RESULTS

Five hundred twenty-five respondents (mean age = 43.8 ± 9.2 years) completed the survey. Among 260 users, primary reasons for use were enhancing memory (n = 136) and helping concentration and focus (n = 108). During the past year, 40% spent $50 to $200 (range = $0 to >$1,000) and 37% reported experiencing negative side effects. Among 265 nonusers, being female (odds ratio 2.04, 95% CI 1.21 to 3.45), perceived susceptibility to brain problems (odds ratio 1.90, 95% CI 1.28 to 2.83), recommendation from others (odds ratio 1.55, 95% CI 1.03 to 2.35) and perceived benefits of brain DS (odds ratio 2.82, 95% CI 1.60 to 4.96) were significantly associated with increased likelihood of future brain DS use.

CONCLUSIONS

Individual spending on brain DS varies and about 40% of users reported experiencing negative side effects. As individuals primarily rely on healthcare providers for recommendations, health care providers should be prepared to engage in discussions about brain DS with patients.

Influencing factors of health screening among retirees: an extended TPB approach

Background

Health screenings are promoted worldwide as they help detect and prevent overall health issues. Despite expanding coverage, the participation rate among the retired population has not significantly increased. Given the special role of health screenings in promoting health and healthy aging, understanding the behavioral intentions, and influencing factors of retirees' voluntary participation in health screenings is crucial. This study aims to explore the participation intentions in health screenings among the Chinese retired population by integrating the Theory of Planned Behavior (TPB) and Self-Efficacy (SE).

Methods

This study used a cross-sectional design to conduct an online questionnaire among 311 retirees in 2023. The questionnaire, tailored for the Chinese retired population, combines the TPB theory and Self-Efficacy theory, including demographic structure, the basic structure of TPB, and SE.

Results

A Structural Equation Modeling (SEM) approach was used to identify factors related to health screening behaviors. Of the respondents, 311 completed the survey (88.9% response rate). The most crucial determinant of health examination behavior was behavioral intention, with a correlation score of (1.524, p < 0.001). Significant correlates of behavioral intention included Subjective Norms (SN) and Self-Efficacy (SE), followed by Perceived Behavioral Control (PBC) and Attitude (AT), with correlation scores of (0.401, p < 0.001), (0.339, p < 0.001), (0.082, p < 0.001), and (0.060, p < 0.05), respectively.

Conclusion

This study provides insights for enhancing the willingness and behavior of retirees to participate in health screenings.

Utility of the Theory of Planned Behaviour for predicting parents' intentions to vaccinate their children against COVID-19

Vaccination is a crucial form of primary prevention, and it is important to understand the factors that influence parents' decisions to vaccinate their children. The current study examines the utility of the Theory of Planned Behaviour (TPB) and anticipated affect for explaining parents' intentions to vaccinate their children against COVID-19. Parents (N = 843) living in the United States completed an online survey. The TPB variables explained 65% of the variability in parents' intentions. In addition to all three of the TPB antecedents predicting vaccine intentions, both anticipated regret of not vaccinating and anticipated positive emotions of vaccinating were associated with parent intentions. Contrary to predictions, subjective norms were a stronger predictor of intentions when perceived behavioural control was lower compared to higher. These findings help further our understanding of parent-for-child vaccine decisions in the context of novel health threats and inform intervention efforts aimed at encouraging this behaviour.

COVID-19 and child education outcomes in Southern Ghana

This study analyses the effects of the COVID-19 pandemic on child education outcomes by providing evidence on the gendered dimension, determinants and coping measures of informal households in Southern Ghana. We rely on a face-to-face interview undertaken in January 2022 (i.e., approximately 2 years after the beginning of the pandemic) involving 761 students across basic and secondary schools from 10 metropolitan, municipality and district assemblies (MMDAs) in the Greater Accra region of Ghana. We document several disruptions to child education outcomes such as learning practices, school attendance, class participation and academic performance. The results also showed that per child education expenditure incurred due to the COVID-19 pandemic by the informal households was GHS305 (US$ 49). Additionally, we assess the correlates of the negative effects on academic performance and COVID-19 related education expenditure as a result of coping measures. Our results from Ordinary Least Squares (OLS) show strong association between participation in online classes, age of students, ownership of television and district of residence on COVID-19 related education expenditure. Results from Logit models show that self-reported negative effects of COVID-19 pandemic on academic performance are affected by gender and age of student, distance to market and location of residence. Interestingly, we also found considerable gendered heterogeneity for the predictors of the COVID-19 pandemic on child education outcomes. We conclude that the COVID-19 pandemic and the associated countermeasures had negative effects on child education outcomes, and that informal households incurred considerable costs in attempting to address the associated education challenges in Southern Ghana. The findings have implications on the design and implementation of educational policies and programs to address the long-term effects of the COVID-19 pandemic on child education outcomes in developing countries.

Pandemic fatigue, behavioral intention and predictors of COVID-19 vaccination among individuals living with HIV in Bench Sheko Zone, in Southern Ethiopia, application of TBP: a facility based cross sectional study

Introduction

People living with HIV often face inequalities and negative outcomes, which make them vulnerable. To protect this population and achieve herd immunity, it is crucial for COVID-19 vaccination efforts to prioritize and encourage vaccination among people living with HIV (PLWH). However, in Ethiopia, there is a lack of motivation in this regard. To tackle this issue, a study was conducted in the Bench Sheko Zone of Southwest Ethiopia. The study aimed to assess pandemic fatigue, behavioral intention to get vaccinated, and factors influencing COVID-19 vaccine acceptance among PLWH in that region.

Methods

A facility-based cross-sectional study was conducted among individuals living with HIV who were over 18 years old in Bench-Sheko Zone, located in Southwest Ethiopia. The study included a total of 590 participants from four ART healthcare facilities within the zone. The researchers utilized the Theory of Planned Behavior to examine the predictors of intention to use preconception care. Multiple linear regression analysis was employed to determine these predictors, with a p-value of less than 0.05 considered as indicative of a significant association. The final analysis of the study involved the use of linear regression analysis, and the measure of association was presented as the standardized B coefficient following a multivariable logistic regression analysis.

Result

In the conducted study, the response rate was an impressive 98%. The researchers aimed to investigate the behavioral intention toward the COVID-19 vaccine, which was found to be 55.7%. The average age of the participants in the study was 34.65 ± 6.67. The study was the assessment of pandemic fatigue, which had a mean value of 17.22 ± 5.28. During the multivariate linear regression analysis, four predictor variables were identified. Among these, three variables, namely subjective norm, pandemic fatigue, and age, positively influenced the behavioral intention toward the COVID-19 vaccine. Comprehending these factors can assist healthcare professionals and policymakers in formulating precise interventions and strategies aimed at enhancing the acceptance and adoption of vaccines.

Conclusion

The study indicates that individuals living with HIV have shown lower vaccine intention compared to previous research. The study identifies subjective norm, pandemic control measures, income, and age as predictors of individuals' intention to receive the COVID-19 vaccine.

Influence of Community Determinants on Barriers and Facilitators to COVID-19 Vaccine Uptake: Regional Stakeholders' Perspectives

Our study objective was to explore possible pathways by which neighborhood-level characteristics drive COVID-19 vaccination among communities experiencing health inequity and disparities. To do so, we conducted semi-structured qualitative interviews with stakeholders in the Finger Lakes region of New York between November 2022 through January 2023. Using a pre-developed interview guide informed by the Health Belief Model, we elicited county health commissioner, medical professional and community-health partner's perspectives regarding the impact community determinants have on shaping barriers to and facilitators of COVID-19 vaccine uptake, as well as recommended solutions for ensuring health equity in future vaccination efforts. Fifteen stakeholders were interviewed, of which 40% were county health commissioners, 27% hospital executives and 33% community-health organization partners. We identified diverse perceived and logistical barriers to COVID-19 vaccination that emerged as sub-themes including perceived risks outweighing the benefits of vaccination, concerns of vaccine safety, distrust stemming from changing scientific knowledge surrounding the vaccines, mistrust of the medical system, and challenges with transportation to and registering for vaccine appointments. Stakeholders reported these barriers were linked to the racial diversity, poverty, political conservatism, and availability of health care of the communities where they reported these were experienced. Notable solutions for improving equitable vaccination included facilitating structural access to vaccination and engaging community trusted messengers. Perceived and experienced barriers to COVID-19 vaccination may differ based upon the social, racial and economic composition of neighboring communities. Strategies for ensuring health equity in future vaccination campaigns should specifically target prevalent barriers based upon the community composition.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

The effect of perceived social support and health literacy on parental COVID-19 vaccine hesitation in preschool children: a cross-sectional study

Children are generally susceptible to COVID-19, and infection with COVID-19 may cause serious harm to children. COVID-19 vaccination is an effective way to prevent infection at present, and many factors affect children's COVID-19 vaccination. This study aimed to explore the effects of perceived social support and health literacy on hesitancy towards first and second vaccine dose. This cross-sectional study was conducted in the Minhang District of Shanghai, China, in October 2022. A total of 1150 parents of preschool children from 10 kindergartens participated. The survey encompassed four sections, capturing data on sociodemographic attributes, health literacy, perceived social support, and parental COVID-19 vaccine hesitancy. Health literacy was measured using a self-designed questionnaire consisting of four dimensions. Perceived social support was assessed using the MSPSS questionnaire. Hierarchical multiple logistic regression was used to examine the relationship between the independent variables and parental hesitancy towards the first and second doses of COVID-19 vaccine. Parental hesitancy rate for the first dose of the COVID-19 vaccine was 69.6%, and for the second dose, it was 33.1%. The final integrated model showed that parental hesitancy towards the first and the second dose of COVID-19 vaccine was associated with parental educational level, allergy in children, information decision-making and information comprehension ability, perceived social support from family and friends. Health literacy and perceived social support are influence factors for parental hesitancy towards COVID-19 vaccine for preschool children. The findings will provide insights for future intervention studies on COVID-19 vaccine hesitancy and inform the development of vaccination policies.

Factors associated with vaccine adherence among an underserved population: the adult Travellers in Nouvelle-Aquitaine, France

BACKGROUND

A measles epidemic affected the Nouvelle-Aquitaine region from November 2017 to May 2018 with clusters among Travellers. This indicates that measles vaccination rates among Travellers remain lower than in the general population. The objective of this study was to estimate the 'declarative vaccination' against measles, mumps and rubella (MMR) and to propose a conceptual framework to help identify determinants of MMR vaccination uptake among adult Travellers in Nouvelle-Aquitaine in 2019-20.

METHODS

A cross-sectional study using random sampling was performed and included 612 adult Travellers from 1 November 2019 to 31 March 2020. A conceptual framework to model vaccination adherence was tested among this underserved population by using structural equation modelling. This model included five latent variables: health literacy, attitudes toward preventive measures, stigma, accessibility to care and perceived needs and five measured variables: information received on vaccination, perception of barriers, support for administrative documents, social support and housing conditions.

RESULTS

Individuals who did not answer all the questions linked to the variables included in the model were excluded, thus 347 adults were included in the final sample. The declared vaccination rate against MMR was 74.0%, and 72.4% of the participants were favorable to vaccination. Vaccination adherence was significantly correlated with favorable attitudes toward preventive measures such as having a history of MMR vaccination and not having already refused a recommended vaccine and finally satisfactory information received on vaccination.

DISCUSSION

To improve vaccination adherence, health authorities should lean on personal history with vaccination and on transmitting information on vaccination.

Health beliefs and attitudes toward Influenza and COVID-19 vaccination in Portugal: a study using a mixed-method approach

Introduction

Vaccination is one of the most effective population strategies to prevent infectious diseases and mitigate pandemics, and it is important to understand vaccine uptake determinants since vaccine hesitancy has been increasing for the past few decades. The Health Belief Model (HBM) has been widely used for understanding vaccination behavior. The current study aimed to assess influenza vaccine (IV) non-uptake and attitudes toward COVID-19 vaccination, two important respiratory diseases with similar symptoms, and routes of transmission in the Portuguese population.

Methods

We conducted a cross-sectional study using a panel sample of randomly chosen Portuguese households. A total of 1,050 individuals aged 18 years and over responded to a telephone or online questionnaire. Through a mixed-method approach, we employed thematic content analysis to describe reasons for not taking the IV, considering the HBM dimensions, and quantitative statistical analysis to estimate IV and COVID-19 vaccine coverage.

Results

The IV uptake for the overall population was 30.7% (CI 95%: 26.5, 35.2). Susceptibility was found to be a main factor for IV non-uptake, followed by barriers, such as stock availability and fear of adverse effects. The uptake of the COVID-19 vaccine was very high in the study population (83.1%, CI 95%: 13.6%-20.9%). There was a high perception of COVID-19-associated severity and fear of the consequences. Individuals who reported IV uptake seemed to perceive a higher severity of COVID-19 and a higher benefit of taking the COVID-19 vaccine for severe complications.

Discussion

Thus, the population does not seem to consider influenza to be a health risk, as opposed to COVID-19, which is considered to be a possibly severe disease. The association between IV uptake and COVID-19 perceptions highlights that an overall attitude toward vaccination in general may be an important individual determinant.

Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo

The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.

Parental Willingness and Factors Influencing COVID-19 Vaccination for Children in Saudi Arabia

Purpose

The study aimed to examine the parents' willingness and its association with demographic factors, attitudes, and practices to vaccinate their child against COVID-19.

Patients and Methods

The study involved 2500 participants from various regions of Saudi Arabia and was conducted between July 1, 2021, and August 31, 2021. Information was gathered via an online questionnaire comprising 26 questions, distributed across social media platforms. Informed consent was obtained from all participants before the commencement of the study. A chi-square test was applied to analyze the association among variables, utilizing a subset of 2127 participants based on study inclusion criteria. A chi-square test was applied to observe the association.

Results

The willingness of parents to vaccinae their children against COVID-19 was found 61%. The main reason for taking was "Protect the child" by 1094 (51.4%%) and the main reason for refusing was "Side effects/safety concerns" by 477 (22.4%). 1846 (86.8%) participants, received the COVID-19 vaccine or were planning to receive it.

Conclusion

Our study concluded that parent's willingness to vaccinate their children against COVID-19 was relatively high in our sample as about two-thirds of them accept the vaccine for their child once it is available. The use of the health belief model demonstrated the urgent requirement for awareness and education campaigns in the private and public sectors to increase awareness of parents not only related to COVID-19 but also to cater to any unexpected or suspected pandemic of infectious disease in the future full capacity.

Mixed methods approach to understanding COVID-19 vaccine hesitancy among immigrants in the Chicago

BACKGROUND

COVID-19 vaccine hesitancy has been particularly high among immigrant populations, whose experience is shaped by a history of racism and discriminations, and distrust of the healthcare system. In this study we draw from the Theory of Planned Behavior to examine COVID-19 vaccine hesitancy among immigrants in Chicago.

METHODS

A mixed-methods approach comprising of both focus groups and a health survey was conducted from February to August 2022. Five focus groups were held (N = 35) among Black, Asian and Arab/Palestine participants to understand attitudes and beliefs around the COVID-19 vaccine. Focus groups were analyzed using a modified template approach to text analysis. Based on these findings and themes, we developed a survey that was conducted among 413 immigrants from the mentioned communities. We used hierarchical ordinal regression analyses to examine the relationship between COVID-19 vaccine hesitancy and vaccination status.

RESULTS

Qualitative analysis suggest that the major factors influencing COVID-19 vaccine hesitancy included fear of adverse reactions, misinformation around COVID-19 and the vaccine, negative social norms around vaccination, and external pressure to get vaccinated. From our quantitative analysis we found that 24% of participants were unvaccinated, 5% were partially vaccinated, 32.3% were vaccinated but not boosted, and 39% were vaccinated and boosted for COVID-19. Hierarchical regression models suggest that immigrants who hold negative attitudes and social norms around the COVID-19 vaccine are less likely to vaccinate.

CONCLUSIONS

Understanding vaccine hesitancy among immigrants allows for the creation of culturally and linguistically tailored education that can be utilized to increase vaccine confidence and uptake.

Dynamic predictors of COVID-19 vaccination uptake and their interconnections over two years in Hong Kong

The global rollout of COVID-19 vaccines faces a significant barrier in the form of vaccine hesitancy. This study adopts a dynamic and network perspective to explore the determinants of COVID-19 vaccine uptake in Hong Kong, focusing on multi-level determinants and their interconnections. Following the framework proposed by the Strategic Advisory Group of Experts (SAGE), the study used repeated cross-sectional surveys to map these determinants at multiple levels and investigates their interconnections simultaneously in a sample of 15,179 over two years. The results highlight the dynamic nature of COVID-19 vaccine hesitancy in an evolving pandemic. The findings suggest that vaccine confidence attitudes play crucial roles in vaccination uptake, with their importance shifting over time. The initial emphasis on vaccine safety gradually transitioned to heightened consideration of vaccine effectiveness at a later stage. The study also highlights the impact of chronic condition, age, COVID-19 case numbers, and non-pharmaceutical preventive behaviours on vaccine uptake. Higher educational attainment and being married were associated with primary and booster vaccine uptake and it may be possible to leverage these groups as early innovation adopters. Trust in government acts as a crucial bridging factor linking various variables in the networks with vaccine confidence attitudes, which subsequently closely linked to vaccine uptake. This study provides insights for designing future effective vaccination programmes for changing circumstances.

What influences the public's willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China

INTRODUCTION

Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it occurs in familiar or unfamiliar healthcare settings.

METHODS

Data were obtained from a validated questionnaire from 828 young and middle-aged people. McNemar's test was used to compare the public's willingness to report under the two scenarios. Chi-square tests and multiple logistic regression analysis were used to analyze the determinants of individuals' willingness to report health insurance fraud in different scenarios.

RESULTS

Young and middle-aged people were more likely to report health insurance fraud in a familiar healthcare setting than in an unfamiliar one (McNemar's χ²=26.51, P < 0.05). Their sense of responsibility for maintaining the security of the health insurance fund, the government's openness about fraud cases, and the perception of their ability to report had significant positive effects on the public's willingness to report in both settings (P < 0.05). In a familiar healthcare setting, the more satisfied the public is with government measures to protect whistleblowers, the more likely they are to report (OR = 1.44, P = 0.025). Those who perceive the consequences of health insurance fraud to be serious are more likely to report than those who perceive the consequences to be less serious (OR = 1.61, P = 0.042).

CONCLUSION

Individuals are more likely to report health insurance fraud in familiar healthcare settings than in unfamiliar ones, in which their awareness of the severity of the consequences of health insurance fraud and their perceived risk after reporting it play an important role. The government's publicizing of fraud cases and enhancing the public's sense of responsibility and ability to maintain the safety of the health insurance fund may be a way to increase their willingness to report, regardless of whether they are familiar with the healthcare setting or not.

Young adults' intention to encourage COVID-19 vaccination among their grandparents: A nationwide cross-sectional survey of college students in China

Background

During a vaccination plateau phase, traditional vaccination promotion strategies such as the mobilization of government and community appear to have limited impact on expanding the coverage. New strategies to promote vaccination are needed especially in older adults. Our study aimed to assess college students' intention to encourage coronavirus disease 2019 (COVID-19) vaccination among their grandparents and its correlates.

Methods

A cross-sectional survey was conducted in China from May to June 2022. We collected information on socio-demographics of college students and their grandparents, constructs of health belief model (HBM) and theory of planned behavior (TPB) for college students, and college students' intention to encourage COVID-19 vaccination among their grandparents. Multilevel logistic regression models were performed to assess correlates of intention.

Results

We enrolled 2681 college students who reported information for 6302 grandparents. 2272 students (84.7 %) intended to encourage COVID-19 vaccination for 4744 (75.3 %) grandparents. Intention was associated with having received a booster dose of COVID-19 vaccine (AOR 3.28, 95 % CI 1.68-6.42), having ever lived with their grandparents (2.07, 1.46-2.93), and having grandparents who regularly went outdoors (2.85, 1.70-4.76). HBM and TPB models showed that college students who had higher levels of perceived susceptibility (1.79, 1.12-2.87), perceived severity (1.52, 1.12-2.06) of COVID-19 among their grandparents, and higher levels of subjective norms (2.88, 1.61-5.15) were more likely to have the intention.

Conclusion

College students' intention to encourage COVID-19 vaccination among their grandparents was high. It may be potentially viable to engage college students in promoting COVID-19 and other routine vaccination among older adults.

Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey

Health behavior theories have been effectively used for studying populations' awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants' age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh

INTRODUCTION

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

METHODS

A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance.

RESULTS

Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy.

CONCLUSIONS

These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

Protocol to develop a framework addressing barriers to utilization of elimination of mother- to -child transmission of HIV services among pregnant women and lactating mothers in Gauteng province

Mother-to-child transmission of HIV remains the primary contributor to HIV infections in children, globally. Despite the progress made to reduce new HIV infections in children, barriers to utilization of the Elimination of Mother-to-Child Transmission service remain the bottleneck that affects the program's effectiveness. This study aims to develop a framework to address barriers to the utilization of the Elimination of Mother-to-Child Transmission of HIV services among pregnant women and lactating mothers in Gauteng province. A convergent parallel mixed methods design will be employed in phases. Phase 1(a) quantitative will be collected from pregnant women and lactating mothers to describe barriers associated with poor utilization of elimination of mother-to-child transmission services and a potential strategy to facilitate EMTCT utilization; phase 1(b) qualitative data will be collected to explore reasons for poor utilization of EMTCT services and perceived strategy to enhance women's utilization of elimination of mother-to-child transmission services. Quantitative data will be analyzed using Stata software version 14.0 and qualitative data will be analyzed thematically and then results will be integrated. Phase 2: will focus on the development of a framework; Phase 3: will validate the developed framework. The conclusion and recommendations will be based on the findings of the study.

Vaccine Hesitancy in India: Facilitators and Inhibitors

COVID-19 is yet not completely over; however, many people are hesitant to take COVID-19 vaccines despite their availability. Vaccine hesitancy is a major roadblock to attaining normalcy and controlling the spread of the COVID-19 virus. The present research used a multitheoretical framework (Health Belief Model, 3Cs framework, fatalism, and religious fatalism) to comprehend the complexity of vaccine hesitancy. Thus, the present study aimed at exploring vaccine hesitancy in India by using key components of the Health Belief Model, 3Cs framework, fatalism, religious fatalism, and some demographics as predictors. Data were collected electronically with the help of Google Forms from 639 Indian adults following snowballing and convenience sampling techniques with standardized measures (albeit some modifications to suit the context of the study). Descriptive analysis and hierarchical regression analysis were run in SPSS (V-22) to analyze the data. Results revealed that participants of the present study scored relatively high on vaccine hesitancy. Muslims as compared with Hindus and vaccination status emerged as significant predictors of vaccine hesitancy out of the demographic factors. Fear of COVID-19, vaccine convenience, and religious fatalism also significantly predicted vaccine hesitancy. Thus, a comprehensive approach is needed to strategically use these predictors to control vaccine hesitancy.

The predictors of the intention to receive Covid-19 vaccine using the health belief model and theory of planned behavior in South Khorasan province

BACKGROUND

Widespread vaccination coverage in the shortest time is one of the most effective ways for controlling the COVID-19 pandemic. Factors affecting people's intention to get the COVID-19 vaccine are of great importance. The present study aimed to investigate the predictors of the intention to receive the Covid-19 vaccine based on the constructs of the health belief model (HBM) and theory of planned behavior (TPB) in South Khorasan Province.

MATERIALS AND METHODS

In this cross-sectional-analytical study, 320 people over 18 years in South Khorasan province were randomly selected by cluster sampling method in 2021. The data was collected by a researcher-made questionnaire, including demographic information (9 questions), and the constructs of the health belief model (19 questions), and the theory of planned behavior (13 questions), using the self-report method. Finally, data were analyzed using t-test, ANOVA, linear regression, and Pearson correlation tests.

RESULTS

The mean age of the study participants was 36.57 ± 11.56 with a range of 18-66 years. In the regression model, perceived susceptibility (β = 0.247, P = 0.003), perceived severity (β = 0.247, P = 0.003) from HBM, attitude (β = 0.247, P = 0.003), and perceived behavioral control (β = 0.247, P = 0.003) from TPB were significant predictors of the intention to get the Covid-19 vaccine. The constructs of the two models were able to explain 33% of the variance of the intention to receive the Covid-19 vaccine.

CONCLUSIONS

The study findings reveal that HBM and TPB can predict factors affecting an individual's intention to receive the vaccine. The results can be utilized to design interventions with the aim of increasing vaccine uptake.

The effect of social media environmental information exposure on the intention to participate in pro-environmental behavior

With the threat of global warming, countries worldwide have enhanced their environmental campaigns on social media to increase users' willingness to take pro-environmental actions. In this study, we examined the direct and indirect effects of exposure to environmental information on Chinese young adults' (18-25 years old) intention to participate in environmental protection actions (e.g., recycling, using public transportation, involvement in an environmental group, and participation in eco-friendly events). Data were collected from a sample of 291 Chinese young adults using a web-based survey and a thoroughly designed questionnaire. The accumulated data were analyzed using SPSS version 20. Hierarchical regression and mediation analysis were performed for testing hypotheses. The results indicated that exposure to environmental information on Chinese social media platforms (WeChat and Xiaohongshu) positively affected individuals' intention to participate in pro-environmental behavior, perceived pro-environmental behavior control, pro-environmental attitude, and fear of victimization. The indirect effect demonstrated that pro-environmental behavior control and attitude mediated the relationship between exposure to environmental information on both WeChat and Xiaohongshu and the intention to participate in pro-environmental behavior. Extending the existing literature, this study provides empirical evidence on the influence of environmental information exposure on the intention to participate in environmental protection among Chinese adults. In addition, it provides valuable insights into the mediating mechanisms involving cognitive, psychological, and emotional factors in this relationship. Policy makers should implement effective pro-environmental promotions on social media to inspire individuals to engage in environmentally friendly actions. In addition, social media managers should strictly authenticate and remove misleading environmental content.

Predictors of COVID-19 vaccine uptake among persons aged 18 years and above in Ga North Municipality, Ghana using the Health Belief Model: A community-based cross-sectional study

BACKGROUND

Although the coronavirus disease 2019 (COVID-19) vaccination rollout has been accepted by the population of the Ga North Municipality, a substantial proportion has developed hesitancy to COVID-19 vaccination uptake. This study determined the predictors of COVID-19 vaccine uptake among persons aged 18 years and above in the Ga North Municipality using the Health Belief Model.

METHODS

The study used a cross-sectional study design. Structured questionnaires were used to collect data from a multistage sample of 388 respondents. Multivariable binary logistic regression was used to determine the predictors of COVID-19 vaccination uptake at the level of 0.05 and 95% confidence interval.

RESULTS

Vaccination uptake was 72.2%. The odds of COVID-19 vaccination uptake were higher among men than women [AOR = 2.02, 95% Cl: 1.13-3.20] and among singles than the married [AOR = 1.90, 95% Cl: 1.07-3.36], but lower among Muslims than Christians [AOR = 0.33, 95%Cl: 0.18-0.60]. Perceived susceptibility [AOR = 2.43, 95% Cl: 1.36-4.35], perceived barriers [AOR = 0.54, 95%Cl: 0.31-0.95], cues to action [AOR = 2.23, 95% Cl: 1.19-4.21] and self-efficacy [AOR = 3.23 95% Cl: 1.82-5.71] were the significant predictors of COVID-19 vaccination uptake.

CONCLUSION

The uptake of the COVID-19 vaccine in GA North Municipality is high. Health promotion interventions should focus on increasing perceived susceptibility to COVID-19, minimising barriers to COVID-19 vaccine uptake, and promoting cues and self-confidence for COVID-19 vaccine uptake. It should also target women, the married, and Muslims.

A planned behavior theory-based explanatory model of protective behavior against COVID-19, with an age perspective

In this study, an explanatory model of protective behaviors against COVID-19 transmission based on the theory of planned behavior is tested using a sample of 904 individuals by adding two relevant variables in the COVID-19 context: skepticism and responsibility toward COVID-19 transmission. Responsibility and the intention to behave in a protective way act as mediators in predicting protective behaviors. The model is invariant between younger and older people, although some path differences were found: the perception that individuals have about the extent to which their reference group adopts protective behaviors directly influences individual protective behavior for younger but not older people, for whom subjective social norms were only indirect predictors of such behavior. Additionally, the rates in all the variables showed that the group under 35 took more risks in the context of protective behaviors against COVID-19: they exhibited more skepticism, lower behavioral control, perceived fewer positive social norms regarding protective behaviors, felt less responsible for spreading the disease, had less intention to behave in a protective way, and finally adopted fewer protective behaviors. Developers of intervention strategies and campaigns should contemplate such variables and focus on differences according to age.

Motivation towards first trimester screening for preeclampsia among pregnant women in Denmark: A cross-sectional questionnaire study

INTRODUCTION

The aim of this cross-sectional questionnaire study was to investigate motivation to participate in a possible new screening for preeclampsia in the first trimester of pregnancy among Danish pregnant women through a questionnaire based on Theory of Planned Behavior developed for this specific purpose. The new screening combines maternal characteristics with mean arterial pressure, uterine artery pulsatility index and biochemical markers to predict the risk of preeclampsia, whereas the current Danish screening uses maternal characteristics alone.

MATERIAL AND METHODS

Participation was offered to a proportion of women attending a first or a second trimester screening scan at two University Hospitals in Copenhagen. The questionnaire was set up in REDCap® and answers were entered directly into the database, which was accessed via a QR-code.

RESULTS

We invited 772 pregnant women to participate in the questionnaire survey between November 2021 and April 2022 at Copenhagen University Hospital Rigshospitalet (study site one) (n = 238) and Copenhagen University Hospital Hvidovre (study site two) (n = 534). The response rate was 71.8% (171/238) at study site one and 33.9% (181/534) at study site two. A total of 352 women were included in the study (total participation rate 45.6%). Most women had a positive attitude towards preeclampsia screening in pregnancy, and 99.4% said they would participate in a risk assessment for preeclampsia if given the opportunity. A total of 97.4% answered "yes" to whether a first trimester preeclampsia screening should be offered to all pregnant women in Denmark. Positive motivation to participate in preeclampsia screening was correlated with having a network with a positive attitude towards preeclampsia screening.

CONCLUSIONS

The results of this study indicate that Danish pregnant women have a positive attitude towards participation in a first trimester screening for preeclampsia. This observation might be useful in relation to possible future implementation in Denmark.

Mathematical Modeling of COVID-19 Cases and Deaths and the Impact of Vaccinations during Three Years of the Pandemic in Peru

The COVID-19 pandemic has caused widespread infections, deaths, and substantial economic losses. Vaccine development efforts have led to authorized candidates reducing hospitalizations and mortality, although variant emergence remains a concern. Peru faced a significant impact due to healthcare deficiencies. This study employed logistic regression to mathematically model COVID-19's dynamics in Peru over three years and assessed the correlations between cases, deaths, and people vaccinated. We estimated the critical time (tc) for cases (627 days), deaths (389 days), and people vaccinated (268 days), which led to the maximum speed values on those days. Negative correlations were identified between people vaccinated and cases (-0.40) and between people vaccinated and deaths (-0.75), suggesting reciprocal relationships between those pairs of variables. In addition, Granger causality tests determined that the vaccinated population dynamics can be used to forecast the behavior of deaths (p-value < 0.05), evidencing the impact of vaccinations against COVID-19. Also, the coefficient of determination (R2) indicated a robust representation of the real data. Using the Peruvian context as an example case, the logistic model's projections of cases, deaths, and vaccinations provide crucial insights into the pandemic, guiding public health tactics and reaffirming the essential role of vaccinations and resource distribution for an effective fight against COVID-19.

Factors Associated with COVID-19 Vaccination Promptness after Eligibility in a North Carolina Longitudinal Cohort Study

Many studies identified factors associated with vaccination intention and hesitancy, but factors associated with vaccination promptness and the effect of vaccination intention on vaccination promptness are unknown. This study identified factors associated with COVID-19 vaccination promptness and evaluated the role of vaccination intention on vaccination promptness in 1223 participants in a community-based longitudinal cohort study (June 2020 to December 2021). Participants answered questions regarding COVID-19 vaccination intention, vaccination status, and reasons for not receiving a vaccine. The association of baseline vaccine hesitancy with vaccination was assessed by the Kaplan-Meier survival analysis. Follow-up analyses tested the importance of other variables predicting vaccination using the Cox proportional hazards model. Older age was associated with shorter time to vaccination (HR = 1.76 [1.37-2.25] 85-year-old versus 65-year-old). Lower education levels (HR = 0.80 [0.69-0.92]), household incomes (HR = 0.84 [0.72-0.98]), and baseline vaccination intention of 'No' (HR = 0.16 [0.11-0.23]) were associated with longer times to vaccination. The most common reasons for not being vaccinated (N = 58) were vaccine safety concerns (n = 33), side effects (n = 28), and vaccine effectiveness (n = 25). Vaccination campaigns that target populations prone to hesitancy and address vaccine safety and effectiveness could be helpful in future vaccination rollouts.

Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model

BACKGROUND

Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

METHODS

Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less.

RESULTS

The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530)  had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults.

CONCLUSION

The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

Assessing associations and predictors of COVID-19 vaccine uptake among college students in a university setting

Objectives: This study assessed the uptake of the COVID-19 vaccine and factors related to vaccination coverage among college students in a university setting. Methods: A cross-sectional study design included undergraduate and graduate students in a university community as study participants. Survey questions assessed the uptake of the COVID-19 vaccine and various predictor variables related to vaccination decision-making. Data analysis included descriptive statistics, correlation statistics, and binary logistic regression. Results: Of the 385 participants, most were undergraduate students. Participants who received the influenza vaccine in the past flu season were more likely to receive the COVID-19 vaccine. Participants with perceived susceptibility to COVID-19 were five times more likely to receive the COVID-19 vaccine. Conclusions: Influenza vaccination coverage and perceived susceptibility were associated with the uptake of the COVID-19 vaccine. Study findings may serve to inform behavior change interventions and educational programs for students in university communities.

Has the COVID-19 Pandemic Changed Parental Attitudes and Beliefs Regarding Vaccinating Their Children against the Flu?

BACKGROUND

This study assessed whether the COVID-19 pandemic has altered parents' attitudes toward vaccinating their children against the flu and barriers to school-based vaccination programs.

METHODS

A cross-sectional online survey was conducted with 975 parents of children aged 6 months to 11 years between 21-31 December 2022. A multivariate regression was performed to determine predictors of parents' willingness to vaccinate their children against the flu in the winter of 2023.

RESULTS

45% of parents did not plan to vaccinate their children against the flu, citing concerns about side effects and vaccine effectiveness; 39% already vaccinated their children, and 41% of them reported an increased intention to vaccinate following the pandemic. Only 37% of parents chose school-based vaccination programs, mainly due to a preference for HMO clinics and a lack of available nurses at school. The Health Belief Model variables, namely, perceived susceptibility, severity, and benefits, displayed the largest effect sizes.

CONCLUSIONS

Healthcare providers and public health officials should address parents' concerns about flu vaccine safety and efficacy to improve vaccination rates among children. Notably, the pandemic has increased vaccine receptivity among some parents. Enhancing accessibility to nursing staff in student health facilities could help boost vaccine uptake.

Updated beliefs and shaken confidence: evidence from vaccine hesitancy caused by experiencing "COVID arm"

BACKGROUND

Public health depends largely on people's knowledge, beliefs, or behaviors regarding their health and medical treatments. Although works based on the health belief model have shown that public beliefs about medical treatments affect willingness to take the treatments, little is known about the effects of changes in beliefs on attitudes toward treatment. How one's past experiences relate to one's beliefs about a given medical treatment is worth considering.

METHODS

We implemented an online panel survey in February 2021 and March 2022 in Japan before and after COVID-19 vaccines were administered to the public within the country. We exploited delayed localized hypersensitivity reactions to COVID-19 vaccines, namely, "COVID arm", as an exogenous shock to investigate the relationship between past negative experiences and current beliefs about medical treatments or science. "COVID arm" was an unexpected side effect and thus likely caused updated beliefs about the vaccine. Out of the nonprobability sample of 15,000 respondents in the first wave in February 2021, 9,668 respondents also responded to the second wave conducted in March 2022. Outcome variables were whether experiencing "COVID arm" affected the respondents' 1) confidence in vaccine safety, 2) willingness to take the next dose of COVID-19 vaccines, 3) acknowledgment of the importance of vaccination, and 4) confidence in science. We measured the impact of experience with "COVID arm" on changes in the probability that survey respondents would respond affirmatively to questions posed about the issues listed above.

RESULTS

Experiencing "COVID arm" significantly lowered confidence in the safety of vaccination by 4.3 percentage points, which was approximately 6% of the sample mean for the first wave, and lowered the probability of taking a second dose of the COVID-19 vaccine by 1.5 percentage points. These adverse impacts were observed after conditioning background characteristics and prior confidence in vaccination. Experiencing "COVID arm" affected neither the acknowledged importance of vaccination nor confidence in science in a statistically significant way.

CONCLUSIONS

An unexpected and uncomfortable shock regarding beliefs about a treatment decreases willingness to take the treatment. An appropriate public health policy should account for this effect.

TRIAL REGISTRATION

The survey was preregistered with the American Economic Association's RCT Registry (Fukai et al., 2022).