Integrating health behavior theories to predict American's intention to receive a COVID-19 vaccine

Message framing and COVID-19 vaccine acceptance among millennials in South India

Vaccine hesitancy and refusal remain a major concern for healthcare professionals and policymakers. Hence, it is necessary to ascertain the underlying factors that promote or hinder the uptake of vaccines. Authorities and policy makers are experimenting with vaccine promotion messages to communities using loss and gain-framed messages. However, the effectiveness of message framing in influencing the intention to be vaccinated is unclear. Based on the Theory of Planned Behaviour (TPB), this study analysed the impact of individual attitude towards COVID-19 vaccination, direct and indirect social norms, perceived behavioural control and perceived threat towards South Indian millennials' intention to get vaccinated. The study also assessed the effect of framing vaccine communication messages with gain and loss framing. Data was collected from 228 Millennials from South India during the COVID-19 pandemic from September to October 2021 and analysed using PLS path modelling and Necessary Condition Analysis (NCA). The findings reveal that attitudes towards vaccination, perceived threat and indirect social norms positively impact millennials' intention to take up vaccines in both message frames. Further, independent sample t-test between the framing groups indicate that negative (loss framed message) leads to higher vaccination intention compared to positive (gain framed message). A loss-framed message is thus recommended for message framing to promote vaccine uptake among millennials. These findings provide useful information in understanding the impact of message framing on behavioural intentions, especially in the context of vaccine uptake intentions of Millennials in South India.

Trust in Science as a Possible Mediator between Different Antecedents and COVID-19 Booster Vaccination Intention: An Integration of Health Belief Model (HBM) and Theory of Planned Behavior (TPB)

As the literature highlights, many health behavior theories try to explain both social and psychological variables influencing an individual’s health behavior. This study integrates insights relative to the antecedents of getting vaccinated from health behavior theories, particularly including the health belief model (HBM), the theory of planned behavior (TPB), and the different socio-demographic factors. Furthermore, we considered the possible mechanism of impact of distrust in science on individuals’ hesitance and resistance to taking up SARS-CoV-2 vaccination in subjects living in Italy. A correlational study of 1095 subjects enrolled when the national vaccination campaign for the third dose was launched. A questionnaire was used to measure: Italian Risk Perception; subjective norm; trust in science, trust in the vaccine; fear of COVID-19; fear of the vaccine; perceived knowledge about SARS-CoV-2; booster vaccination intention. Principal results show that: (i) the positive relationship provided by HBM theory between perceptions of SARS-CoV-2 risk (vulnerability and severity) and intention to have the vaccine, through fear of COVID-19; (ii) the positive relationship between subjective norms and both trust in science and vaccination intention; (iii) that trust in science plays a crucial role in predicting vaccination intention. Finally, the results provided indications about a positive relationship between subjective norms and fear of COVID-19, and a full mediation role of trust in science in the relationships between determinants of both TPA and HBM, fear of COVID-19, and vaccination intention. In conclusion, an individual’s intention (not) to get vaccinated requires the consideration of a plethora of socio-psychological factors. However, overall, trust in science appears to be a key determinant of vaccination intention. Additional strategies promoting healthy behavior are needed.

The dynamic evolution mechanism of public health risk perception and the choice of policy tools in the post-epidemic era: Evidence from China

Objectives

Repeated outbreaks of small-intensity epidemics are one of the important features of the post-epidemic era. After a new round of epidemics broke out in Liaoning in mid-May 2021, the Chinese government's vaccination process quickly accelerated, completing nearly 100 million doses of COVID-19 vaccination within 7 days. How is this efficient policy implementation process accomplished? What is the behavioral logic behind it?

Methods

This article constructs an analysis framework of "perception-goal-tool". Trying to study the individual's micro-psychological mechanism as a starting point, with the help of a Health Belief Model, to explore the dynamic evolution of individual health risk perception before and after the outbreak of a small-intensity epidemic and its impact on vaccination willingness. And on this basis, analyze the flexible governance process of the Chinese government in the post-epidemic period.

Results

The perceived severity is the core variable that affects the public's willingness to vaccinate. A small-intensity epidemic outbreak will aggravate the impact of the three health belief components on the public's willingness to vaccinate. In the three interactive analyses of health belief components, individuals have the highest willingness to inoculate in situations of low perceived susceptibility, low perception barriers, and high perception severity, and economic policy tools and authoritative policy tools play a key role before and after the outbreak of a small-intensity epidemic.

Conclusion

In the context of a small-intensity epidemic, the reason why the Chinese government can achieve rapid crisis management lies in the interaction between policy goals, policy tools, and public risk perception.

Determinants of COVID-19 vaccine acceptance among adults with diabetes and in the general population in Israel: A cross-sectional study

AIMS

To explore and compare key determinants of COVID-19 vaccine acceptance and willingness to get vaccinated among people with diabetes and the general population.

METHODS

A cross-sectional survey study of 807 Israeli adults with and without diabetes was conducted prior to the first vaccination campaign in Israel in December 2020. Data was analyzed by population group and gender. A multinomial logistic regression determined the association between acceptance factors and willingness to get vaccinated.

RESULTS

Diabetes patients had more anxiety about COVID-19, higher levels of confidence in vaccine safety, and greater willingness to get vaccinated than the general population. In both groups, women reported higher levels of anxiety toward COVID-19 but lower levels of confidence in vaccine safety and less willingness to get vaccinated than men. Vaccine safety had the largest contribution to diabetes patients' willingness to get vaccinated. For participants without diabetes, the perception that more than 50% of Israelis would get vaccinated had the largest contribution. Participants in both groups who had vaccinated against seasonal influenza were more likely to get vaccinated against COVID-19.

CONCLUSION

Policies aimed at improving vaccine acceptance should target vulnerable populations, particularly female diabetes patients, whose concerns must be addressed to increase their vaccination rates.

Social cognition theories and behavior change in COVID-19: A conceptual review

The COVID-19 pandemic has had unprecedented health, economic, and social consequences worldwide. Although contact reductions and wearing face coverings have reduced infection rates, and vaccines have reduced illness severity, emergence of new variants of the coronavirus that causes COVID-19, and the shift from pandemic to endemic patterns of infection, highlights the importance of ongoing preventive behavior adherence to manage future outbreaks. Research applying social cognition theories may assist in explaining variance in these behaviors and inform the development of efficacious behavior change interventions to promote adherence. In the present article, we summarize research applying these theories to identify modifiable determinants of COVID-19 preventive behaviors and the mechanisms involved, and their utility in informing interventions. We identify limitations of these applications (e.g., overreliance on correlational data, lack of long-term behavioral follow-up), and suggest how they can be addressed. We demonstrate the virtue of augmenting theories with additional constructs (e.g., moral norms, anticipated regret) and processes (e.g., multiple action phases, automatic processes) to provide comprehensive, parsimonious behavioral explanations. We also outline how the theories contribute to testing mechanisms of action of behavioral interventions. Finally, we recommend future studies applying these theories to inform and test interventions to promote COVID-19 preventive behavior adherence.

Examining the direct and indirect effects of trust in motivating COVID-19 vaccine uptake

OBJECTIVES

This study aims to investigate how trust in healthcare providers, public health agencies, politicians, and pharmaceutical companies shaped people's attitudes and behavioral intention associated with COVID-19 vaccination, directly and indirectly via the mediation of vaccine evaluation and emotions.

METHODS

A two-wave longitudinal survey (N = 534) was employed in late 2020 and early 2021 to assess the direct and indirect relationships between trust on people's attitude toward the COVID-19 vaccine, vaccination intention, and actual vaccine uptake.

RESULTS

Results show that trust was positively associated with attitude toward the COVID-19 vaccines and vaccination intention, both directly and indirectly via the mediation of vaccine evaluation, hope, and anger. Vaccination intention also mediated trust's influence on vaccine uptake.

CONCLUSION

Trust in health providers, vaccine manufacturers, and public health agencies are vital to public acceptance of the COVID-19 vaccine.

PRACTICE IMPLICATIONS

Healthcare providers and vaccine manufacturers may serve as the most effective source to communicate COVID-19 vaccine-related information. Trusted health communicators need to highlight the effectiveness and safety of the vaccine while maintaining a positive tone.

Theory of planned behavior explains males' and females' intention to receive COVID-19 vaccines differently

Uptake of COVID-19 vaccines is an important measure to curb the transmission of the coronavirus. Before the vaccines were available, numerous studies found that people had a moderate-to-high intention to receive the vaccines. Several studies have also used the theory of planned behavior (TPB) to predict people’s COVID-19 vaccination intention with three elements (i.e. attitudes, subjective norms, and perceived behavioral control) . However, the vaccination rate falters after the vaccines became available, and there were few updated data documenting people’s vaccination intention and how well TPB can explain their intention. In addition, studies investigating other outcomes found that the predictive utilities of TPB often varied across gender, but such gender differences received little consideration in the literature of COVID-19 vaccination intention. To help fill these gaps, we examined the associations between TPB elements and people’s intention to receive COVID-19 vaccines and the moderation of gender in the context of vaccination campaign. Participants were 405 Chinese citizens. They reported on the three TPB elements and intention to receive vaccines in the coming months. Descriptive results showed that participants’ vaccination intention was moderate. Results of path analysis showed that subjective norms and perceived behavioral control were positively related to vaccination intention for the whole sample. Furthermore, results of multigroup path analysis showed that attitudes were only related to males’, while subjective norms were only related to females’, intention. These findings enhance the utility of TPB in explaining people’s COVID-19 vaccination intention and inform gender-specific strategies to boost males’ and females’ vaccination intention.

COVID-19 Vaccine Uptake in the Context of the First Delta Outbreak in China During the Early Summer of 2021: The Role of Geographical Distance and Vaccine Talk

Purpose

Vaccination is essential to control the prevalence of COVID-19. However, vaccine hesitancy has been a major issue globally. Some studies have suggested that community outbreaks might boost vaccine uptake. Consistent with that idea, vaccination rates increased dramatically during the first outbreak of the COVID-19 Delta variant in Guangdong, China, in June 2021. Based on the risk perception attitude theory, this study attempted to explore the joint effect of geographical distance to the outbreak and the frequency of talking about the COVID-19 vaccine (vaccine talk) on people’s COVID-19 vaccine uptake.

Methods

An anonymous self-report online questionnaire was completed by citizens living in Guangdong Province, China, from June 6 to 11, 2021, during the Delta variant outbreak in that region. The relationship between COVID-19 vaccine uptake, geographical distance to the epicenter of the outbreak, and vaccine talk was analyzed using logistic regression analysis.

Results

Data from 350 respondents were included in the final analysis. Results showed a negative association between geographical distance and COVID-19 vaccine uptake. Furthermore, the relationship was moderated by vaccine talk. Specifically, when individuals infrequently discussed vaccine talk with others, close distance to the epicenter of the outbreak served as a motivator for getting vaccinated, whereas for people who frequently discussed the vaccine, geographical distance might have played less of a role in motivating them to get vaccinated.

Conclusion

This research highlights the joint effect of geographical distance to the outbreak of COVID-19 and vaccine talk in COVID-19 vaccine uptake. While the findings may only be a starting point for launching a public health awareness campaign, encouraging people to engage in more conversations about vaccines may be a promising solution for future health emergencies, especially among people far from the outbreak.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents’ willingness to vaccinate their adolescents and their point of view regarding adolescents’ involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16–18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents’ involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents’ involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents’ COVID-19 perceived threat and adolescent vaccination, as well as between parents’ trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents’ vaccination adherence. Considering the importance of adolescents’ involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

Influence of Information Sources on Chinese Parents Regarding COVID-19 Vaccination for Children: An Online Survey

(1) Aims: This study explored the mechanism by which exposure to different information sources on social media influences Chinese parents' intention to vaccinate their children against COVID-19. (2) Methods: We developed a research framework based on the Stimulus-Organism-Response (SOR) theory to illustrate how exposure to information sources on social media increases vaccine confidence and, as a result, parents' intentions regarding pediatric vaccination. The partial least square structural equation modeling (PLS-SEM) method was used to test the data collected through an online survey (687 valid samples). (3) Results: The government approval of vaccines fuels vaccination confidence and acts as a mediator between (a) mass media, government new media, and key opinion leaders, and (b) perceived effectiveness and side effects (safety) of vaccines. (4) Conclusions: The mass media, government new media, and key opinion leaders are crucial sources for encouraging parents to vaccinate their children since they boost the vaccination trust. The focus of COVID-19 vaccination promotion should be to strengthen parents' trust in the government, combined with publicizing the effectiveness and side effects (safety) of vaccines.

Predictors of COVID-19 actual vaccine uptake in Hong Kong: A longitudinal population-based survey

Purpose of the research

Identifying predictors of COVID-19 vaccine uptake decisions is central to the development of evidence-based strategies for promoting vaccination. This longitudinal study investigated the link between previous willingness to vaccinate and vaccine uptake decision, and examined potential predictors of vaccine uptake in Hong Kong.

Methods

A longitudinal telephone survey study was conducted using a population-based sample of Chinese adult residents (≥18 years) in Hong Kong. Data were collected at two time points: T1 (December 2020-January 2021) and T2 (June-July 2021). Primary outcome was vaccine uptake status; whilst independent variables and covariates included socio-demographic factors, COVID-19 related experiences, health beliefs, and perception, as well as vaccine related perceptions.

Results

Among the 1,003 participants, 23.7% had received a COVID-19 vaccine. Previous willingness to vaccinate did not predict vaccine uptake at later stage. Vaccine uptake by known others (aOR = 8.00), trust in authorities (aOR = 1.53), acceptability of non-pharmaceutical preventive measures (aOR = 2.96), and first-hand experience of COVID-19 (aOR = 1.32) were significant predictors of vaccine uptake after adjusting for confounding factors.

Conclusions

Future strategies to promote vaccination may focus on building public trust in government and healthcare professional, and encouraging vaccinated individuals to share their vaccine uptake status via social networking.

Correlates of COVID-19 vaccination intentions: Attitudes, institutional trust, fear, conspiracy beliefs, and vaccine skepticism

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18-74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated.

Factors associated to acceptance and willingness to pay for COVID vaccine in Nepal

Introduction

Corona virus disease (COVID-19) remains pandemic globally. Vaccination is considered one of the best means to control both morbidity and mortality of COVID-19. The study aims to find out the people's acceptance and willingness to pay for it.

Methods

The study used cross-sectional survey design. Data were collected using a survey questionnaire from 1072 respondents (age 20-60 years) from 14 districts of Nepal. Socio-demographic characteristics of the respondents were independent and acceptance of vaccine was the dependent variable.

Results

The study found that 84% of the respondents accepted the COVID vaccine. Only one out of six did not accept the COVID vaccine while 16% of the respondents stated that they would like to pay for the COVID vaccination. The average willingness to pay (WTP) for vaccination was NRs. 1053 (US$ 9) while median and mode remained the same NRs. 500. The middle age groups (30-49 years), respondents belonged to Madhesi, business people in terms of occupation and the respondents who had completed school level education had a higher acceptance rate than other categories. It was observed that place of residence in terms of provinces or districts, age group, caste/ethnicity, and educational level of the respondents were significantly associated with the acceptance of the COVID vaccine. Moreover, respondents residing from Lumbini Province, age group of 30-39 years, and having secondary or higher education were noticed as more likely to accept the COVID vaccine than the respective compared groups.

Conclusion

Appropriate information, education and communication needs to disseminate to minimize the misinformation about the COVID and lack of trust in vaccine that may lead to low acceptance and poor WTP for vaccine. These findings could be considered while making COVID and the COVID vaccine-related interventions.

Key predictors of COVID-19 vaccine hesitancy in Malaysia: An integrated framework

Background

As the vaccination drive against the coronavirus disease (COVID-19) in Malaysia progresses rapidly, the main challenge will gradually shift from procuring and distributing vaccines to ensuring the broadest possible acceptance among all population segments. Therefore, this study used the integrated framework of the health belief model (HBM) and the theory of reasoned action (TRA) to investigate the predictors of intention to receive COVID-19 vaccines in Malaysia.

Methodology

A market research company in Malaysia was engaged to collect data during June 11–20, 2021 using self-administered questionnaires via its online panel, ensuring a nationwide random sample of 804 respondents. A logistic regression was subsequently estimated to determine the significant predictors of vaccination intention.

Results

The predictors that significantly affect COVID-19 vaccine hesitancy in Malaysia are age, susceptibility, religious beliefs, attitude, subjective norms, and trust in the vaccine. In particular, those who are more inclined to get vaccinated are older individuals, have a higher perceived risk of infection and social pressure to get vaccinated, have a positive attitude, and have high levels of trust in the vaccine. Individuals’ who perceive that their religious beliefs are against vaccination are more likely to exhibit uncertainty toward it.

Conclusion

This study showed that although a large proportion of respondents indicated that they were willing to be vaccinated against COVID-19, there are concerns about religious barriers and trust in the vaccine that the relevant stakeholders should address. Campaigns should also focus on shaping the nation’s attitude toward COVID-19 vaccines, in parallel with encouraging people to use their social influence in helping those in their close circle who are unsure of vaccination to cross the line. These measures will prove to be pertinent as the nation begins to administer booster vaccines to tackle the waning effects of COVID-19 vaccines.

Acceptance of the COVID-19 vaccine based on the health belief model: a multicenter national survey among medical care workers in China

Vaccine uptake rate is crucial for herd immunity. Medical care workers (MCWs) can serve as ambassadors of COVID-19 vaccine acceptance. This study aimed to assess MCWs’ willingness to receive the COVID-19 vaccine, and to explore the factors affecting COVID-19 vaccination acceptance. A multicenter study among medical care workers was conducted in seven selected hospitals from seven geographical territories of China, and data were collected on sociodemographic characteristics, vaccine hesitancy, and health beliefs on COVID-19 vaccination among participants. Univariate and multivariate logistic regression models were performed to explore the correlations between individual factors and the acceptance of the COVID-19 vaccine. Among the 2681 subjects, 82.5% of the participants were willing to accept the COVID-19 vaccination. Multivariate regression analyses revealed that individuals with more cues to action about the vaccination, higher level of confidence about the vaccine, and higher level of trust in the recommendations of COVID-19 vaccine from the government and the healthcare system were more likely to get the COVID-19 vaccine. In contrast, subjects with higher level of perceived barriers and complacency were less likely to accept the COVID-19 vaccine. Overall, MCWs in China showed a high willingness to get the COVID-19 vaccine. The governmental recommendation is an important driver and lead of vaccination. Relevant institutions could increase MCWs’ willingness to COVID-19 vaccines by increasing MCWs’ perception of confidence about COVID-19 vaccines and cues to action through various strategies and channels. Meanwhile, it can also provide evidence in similar circumstances in the future to develop vaccine promotion strategies.

Factors Associated with COVID-19 Vaccine Acceptance in Morocco: Applying the Health Belief Model

To identify factors that influenced Moroccans’ intention to get a COVID-19 vaccine, a cross-sectional survey among a Moroccan sample was conducted based on Health Belief Model constructs. Participants’ sociodemographic characteristics, perceived susceptibility, perceived severity, perceived barriers, perceived benefits, self-efficacy, cues to action, and intention to receive vaccine data were collected and analyzed using a structural equation model (SEM). The survey was completed by 3800 individuals; 57.2% were men, 44.5% were aged 30 to 44, and 44.6% were married. After controlling for confounders, being a woman and having a chronic disease were associated with higher acceptance of the COVID-19 vaccine. The strongest predictor for the intention of receiving a vaccine was participants who were married. Most of the HBM constructs were shown to be significantly associated with vaccine acceptance. Susceptibility and Benefits were the strongest predictors of acceptance of the COVID-19 vaccine (standardized path coefficient, SPC = 0.23), followed by Severity (SPC = 0.22). Conversely, given the negative correlation between barriers and intention (SPC = −0.08), it is necessary to maintain a high level of transparency regarding the vaccines’ safety. Our study provides guidance for an implementation of vaccination strategies, intending to bolster the overall COVID-19 immunization program.

Why do Hong Kong parents have low intention to vaccinate their children against COVID-19? testing health belief model and theory of planned behavior in a large-scale survey

COVID-19 vaccines have been authorized for use in children in some societies. Parents' intention to vaccinate their children is context-specific. Drawing upon health belief model (HBM) and theory of planned behavior (TPB), this study contributed to a timely topic by examining the extent to which parents intended to vaccinate their children and its associated factors in Hong Kong, where the government announced children as young as five could take COVID-19 vaccines starting from 21 January 2022. A large-scale, online survey was conducted among 11,141 Hong Kong parents (86% mothers) of children aged 5-12 (N = 14,468, 49.5% girls). They reported on measures that assessed HBM constructs (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action), TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control), and their intention to vaccinate each of their children. Results of descriptive statistics showed that Hong Kong parents' intention to vaccinate their children was very low (1.55 out of 5.00). Multilevel regression showed that after controlling for parents' and children's demographic variables (e.g., sex and age), parents' intention to vaccinate their children was higher if parents had higher levels of perceived susceptibility, perceived benefits, positive attitudes, and subjective norms and if they had lower levels of perceived barriers. Positive attitudes were the strongest correlate of parents' intention. These findings have important implications for public health by informing which factors authorities should address in order to boost Hong Kong parents' intention to vaccinate their children.

Facilitating free and paid vaccine acceptance in Malaysia: effectiveness of vaccine and fear of COVID-19

Purpose

This study aims to examine how demographic and psychological predictors of free and paid vaccine acceptance operate within an infectious environment. The psychological predictors were derived from the protection motivation theory (PMT), including the appraised effectiveness of vaccine in containing the pandemic and the fear of COVID-19.

Design/methodology/approach

A representative data set that consists of responses from 2,850 Malaysians was used in this study. Multi-level modelling was used to analyse the data.

Findings

Results indicated that the acceptance of free and paid vaccination did not differ by region. This suggests that the effects of the included psychological predictors on vaccine acceptance are independent from the environment. Malaysians are more likely to endorse both free and paid vaccination when it is perceived as effective in controlling the pandemic. When the vaccine is deemed as an effective preventive of COVID-19, Malaysians tend to seek free vaccination. Although fear of COVID-19 did significantly predict the endorsement of vaccination, it is a weaker predictor than the perceived effectiveness of vaccine.

Originality/value

This research used a large representative data set and the PMT framework in addressing vaccine acceptance in Malaysia.

Why 'one size fits all' is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

OBJECTIVES

The present study explored public's willingness to use COVID-19 immunity certificates across six different domestic scenarios.

DESIGN

Cross-sectional online survey.

SETTING

UK representative survey conducted on 3 August 2021.

PARTICIPANTS

534 UK residents over 18 years old.

INTERVENTIONS

Participants replied to the same set of questions.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents' sociodemographic characteristics.

RESULTS

Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

CONCLUSIONS

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

Applying an extended protection motivation theory to predict Covid-19 vaccination intentions and uptake in 50-64 year olds in the UK

Objectives

To examine the correlates of Covid-19 vaccination intentions and subsequent uptake as outlined in an extended version of protection motivation theory (PMT).

Design

A two-wave online survey conducted at the start of the vaccination rollout to 50–64 year olds in the UK and three months later.

Measures

Unvaccinated UK adults (N = 438) aged 50–64 completed baseline measures from PMT (perceived vulnerability, perceived severity, maladaptive response rewards, response efficacy, self-efficacy, response costs, intention) as well as measures of injunctive and descriptive norms, demographics, Covid-19 experiences, and past influenza vaccine uptake. Self-reported uptake of a Covid-19 vaccination was assessed three months later (n = 420).

Results

The extended PMT explained 59% of the variance in Covid-19 vaccination intentions, after controlling for demographics, Covid-19 experiences, and past influenza vaccine uptake. All extended PMT variables, with the exception of perceived severity and descriptive norms, were significant independent predictors of intention. In line with national figures, 94% of the sample reported having received a Covid-19 vaccination at follow-up with intention found to be the key predictor of uptake.

Conclusions

Interventions to increase Covid-19 vaccination uptake need to increase intentions to be vaccinated by emphasizing the benefits of vaccination (e.g., in terms of reducing risk) and likely approval from others while also addressing the concerns (e.g., safety issues) and common misperceptions (e.g., natural immunity versus vaccines) that people might have about Covid-19 vaccines. Future research is needed in countries, and on groups, with lower uptake rates.

Vaccine Hesitancy Under the Magnifying Glass: A Systematic Review of the Uses and Misuses of an Increasingly Popular Construct

Resistance to vaccines has hindered attempts to contain and prevent outbreaks of infectious diseases for centuries. More recently, however, the term "vaccine hesitancy" has been used to describe not necessarily outright resistance but also a delay in acceptance or uncertainty regarding vaccines. Given concerns about hesitancy and its impact on vaccine uptake rates, researchers increasingly shifted the focus from resistance to vaccines toward vaccine hesitancy. Acknowledging the urgency to accurately assess the phenomenon, it is critical to understand the state of the literature, focusing on issues of conceptualization and operationalization. To carry out this systematic review, we collected and analyzed all published empirical articles from 2000 to 2021 that explicitly included quantitative self-report measures of vaccine hesitancy (k = 86). Using a mixed-method approach, the review demonstrates and quantifies crucial inconsistencies in the measurement of the construct, lack of clarity in regard to the determination of who should or should not be defined as hesitant, and overreliance on unrepresentative samples. Crucially, our analysis points to a potential systematic bias toward exaggerating the level of hesitancy in the population. Modeling a vaccine hesitancy co-citation network, the analysis also points to the existence of insular academic silos that make it harder to achieve a unified measurement tool. Theoretical and practical implications for academics, practitioners, and policymakers are discussed.

Understanding the influence of political orientation, social network, and economic recovery on COVID-19 vaccine uptake among Americans

The COVID-19 pandemic poses unprecedented risks to the well-being of Americans. To control the pandemic, a sufficient proportion of the population needs to be vaccinated promptly. Despite the proven efficacy and widespread availability, vaccine distribution and administration rates remain low. Thus, it is important to understand the public behavior of COVID-19 vaccination. This study aims to identify determinants at multiple levels that promote or inhibit one's vaccine uptake. We combine individual-level data from a national survey conducted in the summer of 2021 with corresponding state-level indicators. Findings of multilevel logistic regression show that political orientation, social network, and economic recovery altogether have significant influence. We articulate that individual decision to take the vaccine are a function of their personal characteristics and are also rooted in their home state's political, public health, and economic contexts. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who take/refuse the vaccine provides essential information to leverage certain factors and maximize vaccine uptake to mitigate the pandemic's devastating impact.

Continuance Intention of Online Healthcare Communities- The Mediation Mechanism of Social Interaction Ties

The purpose of this research is to evaluate the continuance usage intention on online healthcare community (OHC) platform for patients and examine the "doctor-OHC-patient" relationship. The proposed model attempted to integrate social interaction ties, shared value, trust with the indirect effects on the relationship between the determinants and continuous usage intention of the OHC platform. The empirical results showed that perceived critical mass, social identity, and para-social interaction would strengthen continuance intention via the social interaction ties. In addition, this study found that the shared values and trust increase users' willingness to continue usage of OHC. This study provides OHC platform managers with an in-depth understanding of the "doctor-OHC-patient" online social interaction. The results of this study may also help hospitals, health policy makers, and related healthcare practitioners to improve the way they use the web for advocacy and guidance, and provide insight into the intent of promoting the ongoing use of OHC platforms.

What influences tourist behaviors during and after the COVID-19 pandemic? Focusing on theories of risk, coping, and resilience

The threat of the COVID-19 pandemic poses risks and stress to travelers over the long term, impeding tourism demand recovery. This study aims to explore the behavioral consequences of potential tourists' personal perceptions of travel risks in pandemic threats. This study integrates risk communication and stress coping theory to address the research objectives and identifies interventions for psychological resilience. A sample of 1,179 potential adult travelers residing in Korea was surveyed online through quota sampling by age, gender, and region of residence, utilizing structural equation modeling to validate the proposed research model. The results showed that the two types of risk perception (personal- and societal-level) had different effects on problem-focused and emotion-focused coping strategies. It was also found that coping strategies, through psychological resilience, can change travel intentions during and after a pandemic. In particular, in terms of short-term stress relief, individuals using emotion-focused coping strategies during the COVID-19 pandemic have been shown to express a willingness to respond to negative emotions more quickly. Insightful implications for the recovery of tourism demand in response to the COVID-19 pandemic and strategies for managing crises in the tourism industry are provided.

Knowledge, attitude and practice survey towards COVID-19 vaccination: A mediation analysis

BACKGROUND AND AIM

The COVID-19 pandemic has significantly impacted human lives across the world. In a country like India, with the second highest population in the world, impact of COVID-19 has been diverse and multidimensional. Under such circumstances, vaccination against COVID-19 infection is claimed to be one of the major solutions to contain the pandemic. Understanding of Knowledge, Attitude and Practice (KAP) measures are essential prerequisites to design suitable intervention programs. This paper examines the different KAP factors in Indians towards their decision of vaccine uptake.

METHOD

An online questionnaire was administered to Indian respondents. (Pilot study: n = 100, Main study: n = 221) to assess their existing knowledge on COVID-19 infections and vaccination, attitude and intentions towards COVID-19 vaccines and their decision towards COVID-19 vaccine uptake.

RESULT

The findings highlighted that existing knowledge on COVID-19 infections and vaccination directly impacted their attitude and intention towards vaccination. The attitude and intention towards COVID-19 vaccines directly impacted their practice of undergoing COVID-19 vaccination. Further, there was a statistically significant and considerably large indirect effect of existing knowledge on COVID-19 infections and vaccination on the practice of undergoing COVID-19 vaccination through attitude and intention towards the vaccine. There was no direct effect of Knowledge (existing knowledge on COVID-19 infections and vaccination) on Practice (decision to undergo COVID-19 vaccination). Therefore, Attitude and intention towards COVID-19 vaccine is the primary mediator between Knowledge (existing knowledge on COVID-19 infections and vaccination) and Practice (decision to undergo COVID-19 vaccination).

CONCLUSION

Participants decision towards COVID-19 vaccination decisions are strongly related to their attitude and intentions that confirms the strong role of attitude towards success of COVID-19 vaccination programme. Therefore, 'person-centric' attitude based positive intervention strategies that links their prior knowledge on COVID-19 infections and vaccination must be designed for greater vaccine acceptance amongst Indians.

Effect of Information Framing on Wearing Masks During the COVID-19 Pandemic: Interaction With Social Norms and Information Credibility

Objective

The main objectives of this study were to use the effect of information framing (different expressions of the same issue, e.g., positive messages and negative messages) to explore key factors that influence the attitude of and intention of the public toward wearing masks and to understand the internal and external factors of intervention on information framing perception.

Methods

This study performed an online questionnaire survey to explore the influence of demographic characteristics, information framing, social norms, and information credibility on the attitude of the public toward masks and their intention to wear them.

Results

(1) Information framing had a significant impact on the attitudes of people toward masks and their intention to wear them, and the persuasion effect of gain-framed messages was higher than that of loss-framed messages. (2) Gender, income, occupation, educational background, and residence have no significant difference in attitude and intention to wear masks. There was a significant correlation between age and wearing of masks (p = 0.041 < 0.05). (3) Social norms affected people's perception of information framing and their attitude toward wearing masks, but only the impact of loss-framed messages on intention was significant. (4) Information framing affected people's perception of information credibility, which had a positive impact on their intention to wear masks; however, information credibility only had a significant impact on attitude toward wearing masks under the gain-framed messages and played an intermediary role.

Conclusion

The impact of information framing on the attitude of people toward masks and their intention to wear them varies. Individuals involved in the publicity of health information related to this issue should pay attention to the influence of information framing and content on the public wearing masks as a means of enhancing public health awareness.

How Does Social Media Influence People to Get Vaccinated? The Elaboration Likelihood Model of a Person's Attitude and Intention to Get COVID-19 Vaccines

The global COVID-19 mass vaccination program has created a polemic amongst pro- and anti-vaccination groups on social media. However, the working mechanism on how the shared information might influence an individual decision to be vaccinated is still limited. This study embarks on adopting the elaboration likelihood model (ELM) framework. We examined the function of central route factors (information completeness and information accuracy) as well as peripheral route factors (experience sharing and social pressure) in influencing attitudes towards vaccination and the intention to obtain the vaccine. We use a factorial design to create eight different scenarios in the form of Twitter posts to test the interaction and emulate the situation on social media. In total, 528 respondents were involved in this study. Findings from this study indicated that both the central route and peripheral route significantly influence individually perceived informativeness and perceived persuasiveness. Consequently, these two factors significantly influence attitude towards vaccination and intention to obtain the vaccine. According to the findings, it is suggested that, apart from evidence-based communication, the government or any interested parties can utilize both experience sharing and social pressure elements to increase engagement related to COVID-19 vaccines on social media, such as Twitter.

How Fear of COVID-19 Affects the Behavioral Intention of Festival Participants-A Case of the HANFU Festival

The recovery of the tourism industry is an important issue that has attracted much attention during the COVID-19 pandemic. Sustainable and safe festival tourism is considered an effective way of aiding in the recovery of the industry. A face-to-face survey of participants in the Guangzhou Hanfu Festival was conducted to examine the relationship between fears of COVID-19, perceived risks, perceptual evaluations, festival attitudes, behavioral intentions, and crowding during this difficult time. Results clarified how fear affects behavioral intentions in festival research, and the mediation role of perceived risk and the moderation role of crowding was confirmed. A timely set of recommendations was provided to festival operators and local governments.

Protection Motivation Theory and Intentions to Receive the COVID-19 Vaccine

Background. Declared a “public health threat of international concern” by the World Health Organization, the COVID-19 virus has caused the deaths of over half a million individuals in the United States in just the first 23 months after detection. The vaccine has recently been introduced to reduce this public health threat. However, due, in part, to the rapidity with which the vaccine was developed, many individuals display vaccine hesitancy. Purpose. The current study examined the utility of the Protection Motivation Theory of Health (PMT) in predicting intentions to receive the COVID-19 vaccine. Method. One hundred twenty-nine unvaccinated respondents (drawn from an initial sample of 255 participants) completed a survey assessing the components of the PMT and intentions to receive the vaccine. Respondents could also provide an open-ended response regarding any concerns they had with the vaccine. Conclusions. The PMT accounted for 76% of the variance in vaccine intentions. Vulnerability, outcome efficaciousness, and maladaptive response rewards each accounted for unique variance. Open-ended responses reflecting concerns with the vaccine fell into 8 categories, with the most common being concern with the long-term side effects of the vaccine. These results suggest that public health campaigns promoting the vaccine should focus on vulnerability to COVID-19, protective functions of the vaccine, and overcoming what people perceive as benefits of not receiving the vaccine.

Factors associated with Turkish pharmacists' intention to receive COVID-19 vaccine: an observational study

Background Pharmacists have been taking part in vaccination services during the COVID-19 pandemic. However, research identifying pharmacists' intention to get COVID-19 vaccine is limited. Aim The objective of this study was to determine the intention to receive COVID-19 vaccine and to identify the factors related to it based on the Health Belief Model framework among Turkish pharmacists. Method This is an observational study conducted between December 2020 and January 2021. The online survey was sent to all hospital and community pharmacists working in Turkey. Transtheoretical Model of Behaviour Change and Health Belief Model were used for the development of the questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with the intention to receive COVID-19 vaccine. Results Among all participants (n = 961), 74.7% had an intention to receive the COVID-19 vaccine. In model 1, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were associated with their intention to receive the COVID-19 vaccine (p < 0.05). In model 2, the intention to receive COVID-19 vaccine was associated with being male, years of experience in the professional field, not having contracted COVID-19, having a pharmacy staff who had contracted COVID-19, and having had received seasonal flu shot within the previous year (p < 0.05). Conclusion This study highlights the factors related to the intention of the pharmacists to receive COVID-19 vaccines. Health Belief Model is the strongest predictor for vaccination intention and could be used to develop behavioural change techniques to promote vaccination.

Factors influencing COVID-19 vaccination intention: The roles of vaccine knowledge, vaccine risk perception, and doctor-patient communication

OBJECTIVE

This study aims to investigate factors influencing COVID-19 vaccination intention in the United States.

METHODS

A cross-sectional survey was conducted with 800 respondents recruited from an online panel managed by a survey company. Path analysis was employed to examine the relationships between the study variables.

RESULTS

First, perceived susceptibility to COVID-19 vaccine side effects was negatively associated with vaccination intention whereas perceived severity did not show any significant impact. Second, vaccine-related knowledge was not directly related to vaccination intention, but it had an indirect and positive effect on vaccination intention via decreasing perceived susceptibility. Third, doctor-patient communication strengthened the negative effect of vaccine knowledge on perceived susceptibility and severity.

CONCLUSION

The results of this study offer insights on how to increase people's vaccination intention and reduce their psychological concerns when making COVID-19 vaccine-related decisions.

PRACTICE IMPLICATIONS

Government agencies should actively promote the effectiveness and importance of vaccination, while addressing concerns about vaccine safety in the public; Health initiatives also need to enhance the level of knowledge about COVID-19 vaccines through various media channels; Doctors can start the conversations about COVID-19 vaccination with their patients at the point of care and/or via online communication platforms.

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.

Predicting Intention to Take a COVID-19 Vaccine in the United States: Application and Extension of Theory of Planned Behavior

Purpose

This study aims to apply and extend the theory of planned behavior (TPB) to predict intention to take a COVID-19 vaccine.

Design

Cross-sectional.

Setting

Online.

Sample

Adult US residents recruited from Amazon Mechanical Turk (n = 172).

Measures

Intention to take a COVID-19 vaccine (outcome variable), demographic variables (predictors), standard TPB variables (perceived behavioral control, attitude, and subjective norm; predictors), and non-TPB variables (anticipated regret, health locus of control, and perceived community benefit; predictors).

Analysis

Hierarchical linear regression predicting intention to take a COVID-19 vaccine, with demographic, standard TPB, and non-TPB variables entered in regression models 1, 2, and 3, respectively.

Results

The extended TPB model accounted for 72.5% of the variance in vaccination intention (p < .001), with perceived behavioral control (β = .29, p < .001), attitude (β = .23, p = .043), and perceived community benefit (β = .23, p = .020) being significant unique predictors.

Conclusion

Despite the relatively small and non-representative sample, this study, conducted after COVID-19 vaccines were widely available in the USA, demonstrated that perceived behavioral control was the most robust predictor of intention to take a COVID-19 vaccine, suggesting that the TPB is a useful theoretical framework that can inform effective strategies to promote vaccine acceptance.

Predictors of the Intention to Be Vaccinated against COVID-19 in a Sample of Italian Respondents at the Start of the Immunization Campaign

COVID-19 vaccines are the most promising means of limiting the pandemic. The present study aims at determining the roles of several psychological variables in predicting vaccination intention in Italy. An online questionnaire was disseminated between 9 March and 9 May 2021. The sample included 971 participants. Results showed that most of the participants were willing to vaccinate. Acceptance rates were correlated with age, marital status, and area of residence. Intention to be vaccinated was positively correlated with perceived risk, pro-sociality, fear of COVID-19, use of preventive behaviors, and trust in government, in science, and in medical professionals. Intention to be vaccinated was negatively associated with belief in misinformation. The degree of acceptance is likely to be a result of the campaign tailored to address people’s negative attitudes towards vaccines. Trust in government and trust in science were among the strongest psychological predictors of vaccination intention. Fear of COVID-19, but not perceived risk, was associated with increased vaccine uptake, suggesting that the affective component of risk perception was more important than the cognitive component in predicting participants’ behaviors. Belief in misinformation was associated with reduced vaccination intention. Future studies will take into consideration these variables, to better understand the multifaceted process underlying vaccination intention.

Consumer Motivations for Adopting Omnichannel Retailing: A Safety-Driven Perspective in the Context of COVID-19

This study aims to understand the influence of COVID-19 on consumers' fears and self-protection motivations. Furthermore, the study seeks to understand the effects of these fears and motivations on consumers' intentions to use omnichannel retailing. A modified theoretical model is proposed by integrating protection motivation theory (PMT) and extending the extended parallel process model (E-EPPM). A total of 398 valid questionnaires are collected and used for further structural equation modeling analysis. The results suggest that the perceived severity, perceived vulnerability, and health anxiety positively impact perceived fears surrounding COVID-19. Furthermore, it is found that perceived fear, self-efficacy, and response efficacy will affect the protection motivation of consumers and ultimately contribute to their behavioral intention to use omnichannel retailing. The findings theoretically enrich the research on COVID-19, PMT, and E-EPPM and empirically provide managerial implications for omnichannel retail service providers.

The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry

In response to the COVID-19 pandemic, scientists coordinated a complex immunization effort that developed and distributed vaccines by December 2020. This study aimed to explain COVID-19 vaccination decision-making process to inform vaccine communication with patients and the public. Building on quantitative research on COVID-19 vaccine hesitancy, we conducted a grounded theory study, collecting 30 qualitative interviews with employees at a U.S. university that provided vaccine eligibility in December 2020. Analysis followed the Sort and Sift, Think and Shift method. Participants who had chosen to receive the vaccine and those who had not both described five factors that impacted their decision-making: emotional response, understanding, personal values, culture, and social norms. Across these factors, we identified three cross-cutting themes: time, trust, and communication tactics. In a time of emerging science and changing answers, the constant introduction of new information created information overload for participants. COVID-19 vaccine development was a "grand experiment globally," which required trust, not only knowledge, to overcome hesitancy. The complex information environment surrounding COVID-19 vaccination requires multi-level intervention that cannot rely on knowledge translation alone. We need to help patients build trusting relationships with experts that can create scaffolding for future information processing.

COVID-19 Vaccination Willingness and Associated Factors in Japanese Primary Care Patients: A Cross-Sectional Study

INTRODUCTION/OBJECTIVES

COVID-19 vaccination is important to stop the pandemic. It has been reported that willingness to be vaccinated is associated with system factors as well as individual attitudes and beliefs. Primary care patients include individuals at increased risk of poor outcomes after COVID-19 infection, such as elderly people and those with comorbidities. This study investigated attitudes in this population toward COVID-19 and COVID-19 vaccination, including willingness to be vaccinated and associated factors. This study was conducted in Japan, where the population has low vaccine confidence, during the initial phase of COVID-19 vaccination.

METHODS

Patients from 1 primary care clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study from March to April 2021. They were administered a self-reported questionnaire exploring factors such as willingness to undergo COVID-19 vaccination, perceived susceptibility, and perceived vaccine efficacy. Multivariable logistic regression analysis was conducted to identify factors associated with vaccination.

RESULTS

Of the 717 patients (response rate, 88.3%), 512 (70.0%) reported they were willing to be vaccinated for COVID-19. Multivariate analysis revealed that vaccination willingness was associated with older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), male gender (OR 1.95, 95% CI 1.15-3.30), influenza vaccination in in the 2020/2021 season (OR 2.54, 95% CI 1.49-4.32), recommendation from others (OR 3.11, 95% CI 1.58-6.18), high perceived susceptibility (OR 2.51, 95% CI 1.45-4.33), belief in vaccine efficacy (OR 3.83, 95% CI 1.54-9.56), high perceived susceptibility to vaccine-related adverse events (OR 0.37, 95% CI 0.22-0.64), and high espousal of social norms (OR 8.00, 95% CI 2.78-23.0).

CONCLUSIONS

COVID-19 vaccination was widely acceptable to Japanese primary care patients. In addition to factors such as vaccine efficacy, and past influenza vaccination, social norms may be important in determining COVID-19 vaccination willingness.

Predictors of Intention to Vaccinate Against COVID-19 in a Peruvian Sample

BACKGROUND

Vaccination against COVID-19 is considered one of the most effective strategies to control this global public health crisis. However, vaccine hesitancy is one of the main threats to mitigating the pandemic. The present study aimed to identify predictors of intention to vaccinate against COVID-19 in 3 geographical regions of Peru.

METHODS

An online analytical cross-sectional study was conducted. Participants were selected by non-probability convenience sampling and size was estimated using the online statistical calculator proposed by Soper. A total of 529 Peruvian nationals completed the questionnaires. Student's t-test and Fisher's F test (ANOVA) were used. A significance level of .05 was considered.

RESULTS

Face-to-face work (β = 2.037, P < .001), fear of COVID-19 (β = .461, P < .001), vaccine confidence (β = 2.881, P < .001) and trust in health care institutions (β = .432, P < .01) predict a higher intention to receive the vaccine. However, the variables perception of a worldwide conspiracy (β = -1.900, P < .001), and practice Protestant religion (β = -2.274, P < .001) predict negatively their acceptance.

CONCLUSION

Several positive predictors of intention to vaccinate against COVID-19 have been identified. However, having a perception of a global conspiracy and practice Protestant religion are shown to be risk variables for vaccine acceptance. Therefore, there is a need to develop strategies to ensure high uptake and success of COVID-19 vaccination campaigns.

Undergraduate nursing students' COVID-19 vaccine intentions: A national survey

INTRODUCTION

In December 2020, the first two COVID-19 vaccines were approved in the United States (U.S.) and recommended for distribution to front-line personnel, including nurses. Nursing students are being prepared to fill critical gaps in the health care workforce and have played important supportive roles during the current pandemic. Research has focused on vaccine intentions of current health care providers and less is known about students' intentions to vaccinate for COVID-19.

METHODS

A national sample of undergraduate nursing students were recruited across five nursing schools in five U.S. regions in December 2020. The survey measured perceived risk/threat of COVID-19, COVID-19 vaccine attitudes, perceived safety and efficacy of COVID-19 vaccines, sources for vaccine information and level of intention to become vaccinated [primary, secondary (i.e., delayed), or no intention to vaccinate].

RESULTS

The final sample consisted of 772 students. The majority (83.6%) had intentions to be vaccinated, however of those 31.1% indicated secondary intention, a delay in intention or increased hesitancy). The strongest predictors of primary intention were positive attitudes (OR = 6.86; CI = 4.39-10.72), having lower safety concerns (OR = 0.26; CI = 0.18-0.36), and consulting social media as a source of information (OR = 1.56; CI = 1.23-1.97). Asian (OR = 0.47; CI = 0.23-0.97) and Black (OR 0.26; CI = 0.08-0.80) students were more likely to indicate secondary intention as compared to primary intention. Students in the Midwest were most likely to indicate no intention as compared to secondary intention (OR = 4.6; CI = 1.32-16.11).

CONCLUSIONS

As the first two COVID-19 vaccines were approved/recommended in the U.S. nursing students had overall high intentions to vaccinate. Findings can guide development of educational interventions that reduce concerns of vaccine safety that are delivered in a way that is supportive and affirming to minoritized populations while being respectful of geo-political differences.

Influence of rapid COVID-19 vaccine development on vaccine hesitancy

INTRODUCTION

In the race to deploy vaccines to prevent COVID-19, there is a need to understand factors influencing vaccine hesitancy. Secondary risk theory is a useful framework to explain this, accounting for concerns about vaccine efficacy and safety.

METHODS

During the first week of July, 2020, participants (N = 216) evaluated one of three different hypothetical vaccine scenarios describing an FDA-approved vaccine becoming available "next week," "in one year," or "in two years." Dependent variables were perceived vaccine efficacy, self-efficacy, perceived vaccine risk, and vaccination willingness. Covariates included vaccine conspiracy beliefs, science pessimism, media dependency, and perceived COVID-19 risk. Data analysis employed multiple analysis of covariance (MANCOVA).

RESULTS

Perceived vaccine efficacy was lowest for the next-week vaccine (η2p = .045). Self-efficacy was higher for the two-year vaccine than the next-week vaccine (η2p = .029). Perceived vaccine risk was higher for the next-week vaccine than for the one-year vaccine (η2p = .032). Vaccination willingness did not differ among experimental treatments. In addition, vaccine conspiracy beliefs were negatively related to perceived vaccine efficacy (η2p = .142), self-efficacy (η2p = .031), and vaccination willingness (η2p = .143) and positively related to perceived vaccine risk (η2p = .216).

CONCLUSIONS

The rapid development of the COVID-19 vaccine may have heightened public concerns over efficacy, availability, and safety. However, the current findings showed a general willingness to take even the most rapidly developed vaccine. Nonetheless, there remains a need to communicate publicly and transparently about vaccine efficacy and safety and work to reduce vaccine conspiracy beliefs.

Relationship between attitudes toward the effectiveness of vaccine, concerns about adverse reactions, and proactively taking SARS-Cov-2 vaccine for family among medical workers in Taizhou, China

OBJECTIVES

Concerns about the safety of the SARS-CoV-2 vaccine have been a stumbling block in the promotion of vaccination uptake. Although many studies have focused on the investigation of people's intention to receive the COVID-19 vaccine, little attention has been paid to the underlying mechanism. This study explored whether concerns about the adverse reactions to the vaccine mediated the relationship between attitudes toward the effectiveness of the vaccine and proactively taking the vaccine for family.

METHODS

Questionnaires were completed by 1,673 (39.9%, 1673/4191) healthcare workers at Taizhou Hospital, Taizhou, Zhejiang, China. Among these, 1,397 (83.5%) have received two doses of the SARS-Cov-2 vaccine. Mediation analysis approach was applied in this research.

RESULTS

Attitudes toward the effectiveness of vaccines were positively correlated with proactively taking the COVID-19 vaccine for family. Additionally, concerns about the side effects to the SARS-Cov-2 vaccine mediated the relationship between attitudes toward the effectiveness of vaccines and proactively taking vaccines for family.

CONCLUSION

The findings imply inextricable relationships among attitudes toward the effectiveness of the SARS-Cov-2 vaccine, fears about side effects to vaccines, and taking vaccines for family. It further suggested that the importance of highlighting the safety of vaccine in promotion of vaccination uptake.

Perceptions towards COVID-19 Vaccines and Willingness to Vaccinate in Nepal

Vaccination is the most effective preventive measure of COVID-19 available at present, but its success depends on the global accessibility of vaccines and the willingness of people to be vaccinated. As the vaccination rollouts are increasing worldwide, it is important to assess public perception and willingness towards vaccination, so that the aim of mass vaccination will be successful. This study aimed to understand public perception towards COVID-19 vaccines and their willingness to get vaccinated in Nepal. This cross-sectional online survey was conducted among 1196 residents of Nepal in August 2021; most of the participants of this online survey were young adults (18–47 years) with university-level education. A total of 64.5% (771/1196) of the participants perceived COVID-19 vaccines to be safe and risk-free, while 68.6% (820/1196) agreed that vaccination would be efficient in the fight against this pandemic. Most of the participants (841/1196, 70.3%) disagreed that people are getting COVID-19 vaccines easily in Nepal, while they agree with the prioritization of older adults and healthcare workers for vaccination. A total of 61.1% (731/1196) of the participants had received at least one dose of the vaccine. Among the unvaccinated, 93.3% (434/465) were willing to get vaccinated when their turn came. The higher confidence of younger adults in vaccines and the vaccination process is encouraging, as that can help educate others who are hesitant or are not positive towards the idea of receiving vaccines. Dissemination of correct and current information, acquisition of enough doses of vaccines, and equitable distribution of vaccines will be required to achieve successful completion of the COVID-19 vaccination campaign in Nepal.

Behavioral intention and its predictors toward COVID-19 vaccination among people most at risk of exposure in Ethiopia: applying the theory of planned behavior model

Acceptance of a vaccine or hesitancy has great public health implications as these partly determine the extent to which people are exposed to infections that could have otherwise been prevented. There is a high need for a more updated understanding of the behavioral intention of the public toward COVID-19 vaccines and associated factors in light of the COVID-19 pandemic to give appropriate public health messages or actions. Thus, the study aimed to assess behavioral intention and its predictors toward COVID-19 vaccine among people most at risk of exposure in Ethiopia. A population-based anonymous online survey was conducted on individuals aged greater than 18 years from May 01, 2021 to June 30, 2021. The data were collected using a convenient sampling method through an online self-administered, structured questionnaire that was created onto Google survey tool (Google Forms) and disseminated to the public on different social media channels through online sharable platforms. Descriptive statistics were done. Bivariateand multivariable logistic regression was done to show the association of behavioral intention toward the COVID-19 vaccine. The associations of variables were declared with the use of 95% CI and P-value. A total of 1080 participants were included in this survey. Seven hundred one (64.9%) of the respondents had a behavioral intention to receive the COVID-19 vaccine. Males (AOR = 1.41 (95% CI = 1.004-2.53)), degree in level of education (AOR = 0.815 (95% CI = 0.254-0.916)), good knowledge (AOR = 4.21 (95% CI = 2.871-6.992)), attitude (AOR = 2.78 (95% CI = 1.654-4.102)), subjective norm (AOR = 1.214 (95% CI = 1.008-4.309)) and perceived behavioral control (AOR = 3.531 (95%CI = 1.689-5.201)) were found to be significantly associated with behavioral intention toward COVID-19 vaccine. Generally, the prevalence of behavioral intention in Ethiopia is low. Males, degree level of education, knowledge about vaccine, attitude toward vaccine subjective norm and perceived behavioral control were found to be significantly associated with intention to receive COVID-19 vaccine. Health education and communication from government sources are very crucial methods to alleviate the negative attitude, poor knowledge, and action need to improve or change the attitude and behavior of influential people within the community or organization to improve intention to take the vaccine.

Disparities in Delaware Caregiver Beliefs about the COVID-19 Vaccine for their Children

Objective

To describe sociodemographic disparities in caregiver beliefs about the COVID-19 vaccine for their children.

Methods

This was a cross-sectional study, linking caregiver-reported data to geocoded sociodemographic data from child EHRs. Caregivers of children receiving care in a Delaware pediatric healthcare system were invited to complete a survey about COVID-19 vaccine beliefs from March 19 to April 16, 2021.

Results

1499 caregivers participated (18% Black, 11% Hispanic, 32% public insurance, 12% rural). 54% of caregivers intended to vaccinate their children, while 34% were unsure and 12% would not. Caregivers of younger children (aOR 3.70, CI 2.36-5.79), Black children (aOR 2.11, CI 1.50-2.96), and from disadvantaged communities (aOR 1.59, CI 1.05-2.42) were more likely to be unsure and not vaccinate their children. Caregivers from rural communities were more likely not to vaccinate their children (aOR 2.51, CI 1.56-4.05). Fewer caregivers of younger children, Black children, and from disadvantaged communities believed in the safety or efficacy of the vaccines (p < 0.001), while fewer caregivers of younger children and from rural communities believed in their children's susceptibility to COVID-19 or risk of getting severe disease from COVID-19 (p < 0.05). While the majority (72%) of caregivers were influenced by health experts, fewer from communities of color and disadvantaged communities were (p<0.001).

Conclusions

Caregivers of younger children and from communities of color, rural communities, and disadvantaged communities in Delaware expressed more COVID-19 vaccine hesitancy.

Policy implications

This study explores beliefs of different communities in Delaware, which are important to tailoring public health messaging and strategies to increase vaccine uptake in these communities.

Predicting vaccine uptake during COVID-19 crisis: A motivational approach

The present research examined which motivational factors contribute to individuals’ intention to take a vaccine that protects against SARS-CoV-2-virus and their self-reported vaccine uptake several months later. The role of different types of motivation was investigated (i.e., autonomous and controlled regulation) as well as vaccine distrust and effort to obtain a vaccine. Across two large-scale cross-sectional (N = 8887) and longitudinal (N = 6996) studies and controlling for various covariates, autonomous motivation and distrust-based amotivation contributed positively and negatively, respectively, to a) concurrent vaccination intentions, b) self-reported vaccination and c) subsequent subscription to a waitlist to obtain a vaccine. Participants’ infection-related risk perception predicted more positive vaccination outcomes through fostering greater autonomous motivation for vaccination and lower distrust, whereas pandemic-related health concerns failed to yield such adaptive effects. The results emphasize the importance of fostering autonomous motivation for vaccination and handling distrust.

A social media microinfluencer intervention to reduce coronavirus disease 2019 vaccine hesitancy in underserved Tennessee communities: A protocol paper

Background

Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine’s adverse effects or risks.

Objective

This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies.

Methods

In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a 3-pronged, pharmacy-based COVID-19 vaccination outreach project, including (1) social media messaging (i.e., microinfluencer approach), (2) community partner collaboration, and (3) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training.

Results

Project implementation is planned for 6 months (January 2021 to June 2021) after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond).

Conclusions

Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the SEM, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders.

COVID19 vaccine intentions in South Africa: health communication strategy to address vaccine hesitancy

BACKGROUND

Vaccine hesitancy is emerging as a significant challenge in many parts of the world in the fight against the COVID19 pandemic. The continued infection amongst the unvaccinated can lead to a heightened risk of further virus mutation, exposing even those vaccinated to new virus strains. Therefore, there are social benefits in minimising vaccine hesitancy. The objective of this study is to assess the level of COVID19 vaccine hesitancy in South Africa, identify the socio-economic patterns in vaccine hesitancy and highlight insights from the national survey that can inform the development of a COVID-19 vaccination acceptance communication campaign.

METHODS

The study uses the nationally representative National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM) survey. The analysis combines univariate and bivariate statistics, as well as multivariate regression models like binomial/ordinal and multinomial logit.

RESULTS

The study finds that vaccine acceptance is lower than that of non-pharmaceutical intervention like face-mask use. Only 55% fully accept the vaccine, while a further 16% are moderately accepting of vaccines. Together, vaccine acceptance is estimated at 70.8%, and vaccine hesitancy against COVID19 is estimated at 29.2% amongst the adult South African population. The study has identified the perceived risk of infection with the mediating role of efficacy as a key predictor of vaccine intention. Higher awareness of COVID19 related information and higher household income are correlated with lower vaccine hesitancy. The non-black African population group has significantly high vaccine hesitancy compared to black Africans.

CONCLUSIONS

There are other significant differences across socio-economic and demographic variables in vaccine hesitancy. From a communication perspective, it is imperative to continue risk messaging, hand in hand with clearer information on the efficacy of the vaccines.

Racial differences in institutional trust and COVID-19 vaccine hesitancy and refusal

BACKGROUND

Previous research has indicated that demographic differences affect COVID-19 vaccination rates. Trust, in both the vaccine itself and institutional trust, is one possible factor. The present study examines racial differences in institutional trust and vaccine status among a nationally representative sample of adults in the United States.

METHODS

Data for the current study was collected as part of Wave 8 Omnibus 2000 survey conducted by RAND ALP and consisted of 2080 participants. Responses were collected through the online RAND ALP survey in March 2021.

RESULTS

Trust in the scientific community was the strongest predictor for already receiving at least one dose of the COVID-19 vaccine at the time of study. Asians had a significantly higher trust in the scientific community compared to all other groups. Results also showed a significant difference in level of trust of the government's response to the COVID-19 pandemic with Indian/Alaskan Natives reporting lower trust compared to Whites, Blacks and Asians. Asians also had a significantly higher level of trust when compared to those who identified as racial Other. Those who identify as American Indian/Alaskan Natives had the lowest levels of institutional trust. Trust in the government's response was not indicative of vaccination within the sample.

CONCLUSIONS

Strategies to increase trust of the scientific community can be employed to address vaccine hesitancy through community-based initiatives and building of partnerships between the scientific community and local community stakeholders.