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

"Cultural and conceptual knowledge": Reformulation and conceptual analysis of a key component of the health literacy model

Extensive evidence of health disparities and systemic racism has prompted scholars to examine constructs that may account for differences in the burden of disease. One such construct is health literacy, which has been posited to have four components: print literacy, oral literacy, numeracy, and cultural and conceptual knowledge. Consistent with historical trends related to culturally based constructs, the latter component has garnered the least attention in the published literature, despite its pervasive influence on health care outcomes. We engage in a reformulation and conceptual analysis of cultural and conceptual knowledge, defined as the filter through which individuals obtain, process, and understand health information and options for diagnosis and treatment. We propose the construct of cultural schema, and operationalize the construct as having cognitive (knowledge, beliefs) and affective (attitudes, emotions) components. As we strive to achieve a more complex understanding of influences on behavioral outcomes, a greater focus on these culturally based factors is essential. In this article, we present a conceptual analysis that seeks to advance the field by: (a) providing distinct definitions for each component that can be applied across fields of study and theoretical frameworks, (b) offering measurement considerations consistent with their conceptualizations, and (c) making recommendations for future theory, research, and practice. We hope that with greater conceptual and measurement clarity of cultural schema, more consistent results will be obtained, constructs and processes that affect health outcomes will be identified, and more personalized intervention will be possible, optimizing the limited resources available for health promotion efforts.

Understanding hepatitis E vaccination intention among women of childbearing-age: A theory-based cross-sectional study

OBJECTIVES

The purpose of this study was to investigate the HEV vaccination intention, its determinants, and overall influence mechanisms among childbearing-age women.

METHOD

The current study was cross-sectional and conducted online from June 25, 2023 to September 25, 2023 in Nanjing, China. Logistic regression models were constructed to identify the intention-associated background factors. Technology Acceptance Model (TAM) and Theory of Planned Behavior (TPB) were integrated and expanded as TAM-TPB model to further investigate the determinants and overall influence mechanism of HEV vaccination intention among this population using structural equation modeling.

RESULTS

A total of 423 eligible participants were included in this study. High general HEV knowledge was independently associated with an increased intention to get HEV vaccination (OR = 1.97, 95 % CI: 1.11-3.58, P = 0.023). All the hypotheses proposed in the theoretical TAM-TPB model were supported, with perceived ease of use, perceived usefulness, attitude, subjective norm, and perceived behavioral control positively affecting the intention of HEV vaccination (all P values <0.05), while perceived risk (P = 0.003) exhibited an inverse association with HEV vaccination intention. The model achieved an acceptable fit, and the total explained variance of HEV vaccination intention was as high as 86.20 %. Moreover, no significant common method bias was observed.

CONCLUSION

This is the first theory-based study that explored the HEV vaccination intention, its determinants, and overall influence mechanism among childbearing-age women. The results of the current study are of great importance for improving the understanding of the HEV vaccination intention among females of childbearing age.

Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index

BACKGROUND

County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine.

METHODS

This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups.

RESULTS

Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05).

CONCLUSIONS

Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

Acceptance of AI in Health Care for Short- and Long-Term Treatments: Pilot Development Study of an Integrated Theoretical Model

BACKGROUND

As digital technologies and especially artificial intelligence (AI) become increasingly important in health care, it is essential to determine whether and why potential users intend to use related health information systems (HIS). Several theories exist, but they focus mainly on aspects of health care or information systems, in addition to general psychological theories, and hence provide a small number of variables to explain future behavior. Thus, research that provides a larger number of variables by combining several theories from health care, information systems, and psychology is necessary.

OBJECTIVE

This study aims to investigate the intention to use new HIS for decisions concerning short- and long-term medical treatments using an integrated approach with several variables to explain future behavior.

METHODS

We developed an integrated theoretical model based on theories from health care, information systems, and psychology that allowed us to analyze the duality approach of adaptive and nonadaptive appraisals and their influence on the intention to use HIS. We applied the integrated theoretical model to the short-term treatment using AI-based HIS for surgery and the long-term treatment of diabetes tracking using survey data with structured equation modeling. To differentiate between certain levels of AI involvement, we used several scenarios that include treatments by physicians only, physicians with AI support, and AI only to understand how individuals perceive the influence of AI.

RESULTS

Our results showed that for short- and long-term treatments, the variables perceived threats, fear (disease), perceived efficacy, attitude (HIS), and perceived norms are important to consider when determining the intention to use AI-based HIS. Furthermore, the results revealed that perceived efficacy and attitude (HIS) are the most important variables to determine intention to use for all treatments and scenarios. In contrast, abilities (HIS) were important for short-term treatments only. For our 9 scenarios, adaptive and nonadaptive appraisals were both important to determine intention to use, depending on whether the treatment is known. Furthermore, we determined R² values that varied between 57.9% and 81.7% for our scenarios, which showed that the explanation power of our model is medium to good.

CONCLUSIONS

We contribute to HIS literature by highlighting the importance of integrating disease- and technology-related factors and by providing an integrated theoretical model. As such, we show how adaptive and nonadaptive appraisals should be arranged to report on medical decisions in the future, especially in the short and long terms. Physicians and HIS developers can use our insights to identify promising rationale for HIS adoption concerning short- and long-term treatments and adapt and develop HIS accordingly. Specifically, HIS developers should ensure that future HIS act in terms of HIS functions, as our study shows that efficient HIS lead to a positive attitude toward the HIS and ultimately to a higher intention to use.

Determinants of Intention to Uptake COVID-19 Vaccination Among Saudi Adults: Application of the Health Belief Model

Introduction

The pandemic caused by COVID-19 has had a profound effect on global health. Due to its potential impact on the efficacy of pandemic control measures, vaccine hesitancy (VH) in relation to COVID-19 has emerged as a significant concern. The attainment of herd immunity is contingent on the rate of COVID-19 vaccine adoption. Despite this, there have been reports of reluctance toward the COVID-19 vaccine. This study seeks to investigate the effect of constructs that influence adults' intentions to receive COVID-19 vaccination using the Health Belief Model (HBM).

Methods

A cross-sectional study was conducted by recruiting Saudi Arabian adults as participants. Using Structural Equation Modeling (SEM), the proposed HBM model was evaluated. A total of 505 individuals replied to the survey.

Results

The suggested HBM model explained 68% of the variation in intention to get COVID-19 immunization. I found all HBM variables namely perceived susceptibility, greater levels of perceived behavioral control, severity, benefits, and barriers to be significant predictors of vaccination intentions. Among demographic variables, only married status had a significant relationship with the intention to obtain COVID-19 immunization.

Discussion

The findings of this study indicate that the HBM can be utilized effectively to obtain insight into the factors that influence COVID-19 prevention measure adherence. Understanding and recognizing individuals' perceived health beliefs and practices is essential for the development of effective COVID-19 intervention strategies.

Beyond fight or flight: The protective role of pre-pandemic meditation practice against anxiety and perceived stress

The COVID-19 pandemic generated distinct mental health challenges, characterised by stress and anxiety due to its unpredictable duration and continuous threat. This study examined the role of meditation practice on anxiety symptoms and perceived stress, considering co-variables such as self-compassion, acceptance, awareness, brooding, lockdown duration, and sociodemographic characteristics. The study used a longitudinal design and data were collected through online surveys from April 2020 to January 2021 (at four different time points) and included 238 participants from Portugal (165 had prior experience with meditation practices, 73 were non-meditators) with a mean age of 43.08 years (SD = 10.96). Linear mixed models revealed that over time, during the lockdown, the non-meditators group demonstrated a greater increase of anxiety symptoms (β = -0.226, SE = 0.06, p = 0.006) and perceived stress (β = -0.20, SE = 0.06, p = 0.004), whereas the meditators group showed non-significant (p > 0.05) variations in anxiety and stress symptoms during the same period of time. The effect of meditation on anxiety symptoms was moderated by sex, days of lockdown, self-compassion, and acceptance. The effect of meditation on perceived stress was moderated by sex, years of education, days of lockdown, and levels of awareness. Additionally, the study explored the potential predictive effect of different meditation session lengths, indicating that longer meditation practices offered greater protection against an increase in anxiety symptoms. These findings highlight the importance of cultivating self-regulation skills and investing in preventive mental health strategies to promote well-being and autonomy. Mental health professionals should prioritise educating communities on evidence-based practices like meditation and compassion exercises to enhance overall health.

Effects of User Experience in Automated Information Processing on Perceived Usefulness of Digital Contact-Tracing Apps: Cross-Sectional Survey Study

BACKGROUND

In pandemic situations, digital contact tracing (DCT) can be an effective way to assess one's risk of infection and inform others in case of infection. DCT apps can support the information gathering and analysis processes of users aiming to trace contacts. However, users' use intention and use of DCT information may depend on the perceived benefits of contact tracing. While existing research has examined acceptance in DCT, automation-related user experience factors have been overlooked.

OBJECTIVE

We pursued three goals: (1) to analyze how automation-related user experience (ie, perceived trustworthiness, traceability, and usefulness) relates to user behavior toward a DCT app, (2) to contextualize these effects with health behavior factors (ie, threat appraisal and moral obligation), and (3) to collect qualitative data on user demands for improved DCT communication.

METHODS

Survey data were collected from 317 users of a nationwide-distributed DCT app during the COVID-19 pandemic after it had been in app stores for >1 year using a web-based convenience sample. We assessed automation-related user experience. In addition, we assessed threat appraisal and moral obligation regarding DCT use to estimate a partial least squares structural equation model predicting use intention. To provide practical steps to improve the user experience, we surveyed users' needs for improved communication of information via the app and analyzed their responses using thematic analysis.

RESULTS

Data validity and perceived usefulness showed a significant correlation of r=0.38 (P<.001), goal congruity and perceived usefulness correlated at r=0.47 (P<.001), and result diagnosticity and perceived usefulness had a strong correlation of r=0.56 (P<.001). In addition, a correlation of r=0.35 (P<.001) was observed between Subjective Information Processing Awareness and perceived usefulness, suggesting that automation-related changes might influence the perceived utility of DCT. Finally, a moderate positive correlation of r=0.47 (P<.001) was found between perceived usefulness and use intention, highlighting the connection between user experience variables and use intention. Partial least squares structural equation modeling explained 55.6% of the variance in use intention, with the strongest direct predictor being perceived trustworthiness (β=.54; P<.001) followed by moral obligation (β=.22; P<.001). Based on the qualitative data, users mainly demanded more detailed information about contacts (eg, place and time of contact). They also wanted to share information (eg, whether they wore a mask) to improve the accuracy and diagnosticity of risk calculation.

CONCLUSIONS

The perceived result diagnosticity of DCT apps is crucial for perceived trustworthiness and use intention. By designing for high diagnosticity for the user, DCT apps could improve their support in the action regulation of users, resulting in higher perceived trustworthiness and use in pandemic situations. In general, automation-related user experience has greater importance for use intention than general health behavior or experience.

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.

Evaluation of willingness to obtain of Covid 19 vaccine in patients with multiple sclerosis

INTRODUCTION

Assessing vaccine willingness and understanding sources of vaccine hesitancy in individuals with multiple sclerosis (MS) helps healthcare providers approach patients more effectively while respecting their autonomy to encourage coronavirus disease 2019 (COVID-19) vaccination.

MATERIALS AND METHODS

A descriptive-analytical cross-sectional study using a researcher-made checklist was conducted on MS patients referred to Neshat Clinic of Hamadan during the years 2020-2021. The checklist contained questions about demographic information, MS phenotype, duration of illness, expanded disability status scale (EDSS) score, and COVID-19 vaccination status. The expanded disability status scale (EDSS) is the most commonly used instrument for measuring disability in patients with multiple sclerosis (MS). The EDSS scale ranges from 0 to 10 in increments of 0.5 units, denoting advanced points of disability.

RESULTS

Based on the results, 20 individuals (10%) were in the vaccine non-acceptance group, while 181 individuals (90%) were in the vaccine acceptance group. A significant number of relapsing and remitting (RR) type MS patients (90.7%) and all primary progressive (PP) type MS patients (100%) accepted the vaccine. In comparison, vaccine non-acceptance in the secondary progressive (SP) group was relatively higher (20.7%) compared to other types of MS, and this difference was significant (P < 0.05). Additionally, there was a statistically significant relationship between the history of COVID-19 and vaccine acceptance (P < 0.05).

CONCLUSION

The study results demonstrated a high rate of COVID-19 vaccine acceptance among MS patients. MS phenotype, previous infection experiences, and other influences allow for COVID-19 vaccine acceptance among MS patients. This information can improve health programs and communication strategies for COVID-19 and future possible infectious disease vaccination in individuals with MS.

Exploring COVID-19 Vaccine Intentions, Perceptions, and Uptake Among the Saudi Population

Background The widespread hesitancy, delays in acceptance, or outright refusal to receive vaccinations, even when readily available, present a notable global challenge. This is particularly pertinent in the context of COVID-19 vaccine hesitancy, where research shows considerable variability in hesitancy rates worldwide. The primary aim of this study is to investigate COVID-19 vaccine intentions among the Saudi population using behavioral theories as a framework. Methodology A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia from January 2022 to December 2022. An online self-administered survey was distributed via social media to reach the targeted participants. Both men and women aged >18 years were included, while non-Saudi individuals and people who are less than 18 years old were excluded. A total of 1,139 participants were included. Results The study found that about 96% of respondents were willing to receive a COVID-19 vaccination. Analyzing sociodemographic and COVID-19-related factors with vaccine intention showed that those previously diagnosed with COVID-19 were less likely to refuse vaccination (P = 0.015). Univariate analyses revealed significant differences in the health belief model (HBM) and theory of planned behavior (TPB) dimensions between willing and unwilling participants. Willing individuals perceived greater infection severity (P = 0.543), higher vaccination benefits (P < 0.01), fewer barriers (P < 0.01), more cues to action (P < 0.01), and lower infection prevention self-efficacy (P < 0.01) compared to the unwilling group. TPB dimensions also differed, with willing individuals having more favorable vaccine attitudes (P < 0.01) and stronger vaccination social norms (P < 0.01). A multivariate logistic regression indicated that having COVID-19 increased vaccine willingness likelihood (odds ratio [OR] = 2.11, 95% confidence interval [CI] 1.14-3.91). Perceived barriers (OR = 0.61, 95% CI 0.44-0.85), self-efficacy (OR = 1.96, 95% CI 1.16-3.32) from HBM, and favorable vaccine attitudes (OR = 1.55, 95% CI 1.02-2.35) from TPB were significant predictors of vaccine willingness. Conclusions The TPB highlighted the importance of attitudes and perceived norms in vaccination acceptance, suggesting their value in vaccination promotion strategies. However, further research, including prospective and interventional studies drawing from a wider array of psychological theories, is needed to develop effective interventions for promoting vaccination.

Validating part of the social media infodemic listening conceptual framework using structural equation modelling

Background

The literature has identified various factors that promote or hinder people's intentions towards COVID-19 vaccination, and structural equation modelling (SEM) is a common approach to validate these associations. We propose a conceptual framework called social media infodemic listening (SoMeIL) for public health behaviours. Hypothesizing parameters retrieved from social media platforms can be used to infer people's intentions towards vaccination behaviours. This study preliminarily validates several components of the SoMeIL conceptual framework using SEM and Twitter data and examines the feasibility of using Twitter data in SEM research.

Methods

A total of 2420 English tweets in Toronto or Ottawa, Ontario, Canada, were collected from March 8 to June 30, 2021. Confirmatory factor analysis and SEM were applied to validate the SoMeIL conceptual framework in this cross-sectional study.

Findings

The results showed that sentiment scores, the log-numbers of favourites and retweets of a tweet, and the log-numbers of a user's favourites, followers, and public lists had significant direct associations with COVID-19 vaccination intention. The sentiment score of a tweet had the strongest relationship, whereas a user's number of followers had the weakest relationship with the intention of COVID-19 vaccine uptake.

Interpretation

The findings preliminarily validate several components of the SoMeIL conceptual framework by testing associations between self-reported COVID-19 vaccination intention and sentiment scores and the log-numbers of a tweet's favourites and retweets as well as users' favourites, followers, and public lists. This study also demonstrates the feasibility of using Twitter data in SEM research. Importantly, this study preliminarily validates the use of these six components as online reaction behaviours in the SoMeIL framework to infer the self-reported COVID-19 vaccination intentions of Canadian Twitter users in two cities.

Funding

This study was supported by the 2023-24 Ontario Graduate Scholarship.

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.

The impact of health beliefs and trust in health information sources on SARS-CoV-2 vaccine uptake

Background

Health beliefs may mediate the relationship between trust and vaccination decisions, as confidence in online health information has expanded quickly. However, little is known about how health attitudes and trust in health information affect COVID-19 vaccine intention. This study aimed to assess the effect of health beliefs and trust in information sources on the willingness to receive a COVID-19 vaccine among the general public in Saudi Arabia.

Methods

This study was designed and carried out at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Selected items were extracted from the Saudi Residents' Intention to Get Vaccinated Against COVID-19 (SRIGVAC) survey. They were categorized and validated into constructs of a health belief model (the perceived threat of COVID-19, vaccine-related benefits, barriers, and safety concerns) and trust in health information (from online platforms and health authorities/providers). Regression analysis and parallel mediation were used to assess the predictors of vaccination intentions.

Results

Based on the responses of 3,091 participants, vaccine-related barriers and safety concerns negatively influenced vaccination intention, whereas vaccine benefits and the perceived threat of COVID-19 were positively correlated with vaccination intention. Trust in online health information had a direct relationship with intentions (β = 0.09, p < 0.0001) as well as indirect relationships through the perceived benefits (β = 0.095), the perceived barriers (β = -0.029), and the perceived safety concerns toward the vaccine (β = -0.010). The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs, with indirect coefficients of 0.004, 0.310, -0.134, and -0.031 for the perceived threat, vaccine benefits, barriers, and safety concerns, respectively.

Conclusion

The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs. Vaccine coverage in Saudi Arabia can be optimized by targeting the health beliefs of the general public.

The application of behavioral change theories in addressing vaccine hesitancy: A Literature Review

Vaccination is vital in combating infectious diseases, including COVID-19. Nevertheless, vaccine hesitancy poses a substantial obstacle to achieving high vaccination rates. This study investigated the determinants of vaccine hesitancy using behavioral change theories and proposes a comprehensive conceptual framework to address this challenge.The paper conducted a review of several behavior change theories relevant to understanding vaccine hesitancy. The health belief model (HBM) highlighted the importance of individuals' perceptions of the effectiveness of health behaviors and their perceived susceptibility to illness. The social cognitive model (SCT) underscored the role of personal experiences, environmental factors, and social support in shaping health behaviors. The theory of reasoned action and planned behavior (TRA) suggested that attitudes and subjective norms are crucial in determining behavioral intentions. The transtheoretical model (TTM) outlined stages of behavior change, while the socio-ecological model (SEM) considered factors at individual, relationship, community, and societal levels. Comprehending vaccine hesitancy is essential for developing effective strategies to promote vaccine acceptance. This study, which examined vaccine hesitancy through various behavior change theories, sought to shed light on the factors influencing vaccine hesitancy among Filipinos. The resulting conceptual framework offers guidance for future interventions aimed at addressing vaccine hesitancy and ultimately improving vaccination rates.

The politics of vaccination: a closer look at the beliefs, social norms, and prevention behaviors related to COVID-19 vaccine uptake within two US political parties

COVID-19 vaccine hesitancy and suboptimal vaccine uptake rates are pressing public health challenges. Vaccine hesitancy has been observed for different vaccines. For COVID-19 vaccines, multiple factors influence vaccine uptake in the U.S. including political ideology. A more nuanced understanding of the factors influencing COVID-19 vaccine uptake within political parties is needed. This study assesses the relationship between known vaccine hesitancy factors and vaccine uptake within two major political parties. Data from 804 U.S. participants in an online survey from June 2021 was used to assess the association between COVID-19 vaccine uptake (no dose vs. any dose) and categories of factors thought to influence vaccine uptake (sociodemographic variables, COVID-19 disease and vaccine belief variables, belief in COVID-19 prevention behavior variables, and social network features variables) for Republicans and Democrats using bivariate and multivariate regression. 65.4% of the sample reported having received at least one dose of the COVID-19 vaccine (22.6% Republican and 52.1% Democrat). In the total sample bivariate model, Democrat participants had significantly greater odds of having received a dose of the vaccine as compared to Republican participants (OR = 2.51, 95%CI = 1.73-3.64). In adjusted models, the speed of vaccine development was negatively associated with vaccine uptake for both Republicans (aOR = 0.18, 95%CI = 0.06-0.57) and Democrats (aOR = 0.40, 95%CI = 0.19-0.86), as was concern about side effects from the vaccine (Republicans: aOR = 0.15; 95%CI = 0.05-0.47; Democrats: aOR = 0.14, 95%CI = 0.06-0.31). COVID-19 vaccine uptake among Republicans, but not Democrats, was associated with belief that the vaccine prevents COVID-19 (aOR = 3.29, 95%CI = 1.29-8.37) and belief about friends' vaccine intentions (aOR = 6.19, 95%CI = 2.39-16.05). There were no significant factors unique to Democrats. Concerns about aspects of COVID-19 vaccine safety for both political groups suggest that vaccine advocacy interventions should universally address these factors. However, Republican beliefs in vaccine efficacy and in friends' vaccine intentions suggest a need for Republican-specific messaging.

Surname order and revaccination intentions during the COVID-19 pandemic

Teachers in Japanese schools employ alphabetical surname lists that call students sooner, with surnames appearing early on these lists. We conducted Internet surveys nearly every month from March 2020 to September 2022 with the same participants, wherein we asked participants where the alphabetical columns of their childhood and adult surnames were located. We aimed to identify how surname order is important for the formation of noncognitive skills. During the data collection period, the COVID-19 vaccines became available; Japanese people could receive their third dose starting in December 2021. The 19th wave of the survey was conducted in January 2022. Therefore, to examine how a surname's alphabetical order could influence intention to revaccinate, we used a subsample of data from December 2021 to September 2022. The major findings were as follows. Women with early surnames had an approximately 4% stronger likelihood of having such intentions than men with early surnames. Early name order was more strongly correlated with revaccination intention among women than among men. The surname effect for women was larger when a mixed-gender list was used compared with when it was not used. This effect was only observed for childhood surnames and not for adult surnames.

A study on the factors influencing the intention to receive booster shots of the COVID-19 vaccine in China based on the information frame effect

Introduction

In the response to and prevention and control of the Novel coronavirus pneumonia, the COVID-19 vaccine does not provide lifelong immunity, and it is therefore important to increase the rate of booster shots of the COVID-19 vaccine. In the field of information health science, research has found that information frames have an impact in changing individual attitudes and health behaviors.

Objective

This study focuses on the effects of different influencing factors on the public's willingness to receive the booster shots of the COVID-19 vaccine under two information frameworks.

Methods

An online questionnaire was conducted to explore the effects of demographic characteristics, personal awareness, social relationships, risk disclosure, perceived booster vaccination protection rate, and duration of protection under the assumption of an information framework. T test and one-way analysis were used to testing the effect of variables.

Results

(1) The persuasion effect under the gain frame is higher than that under the loss frame (B = 0.863 vs. B = 0.746); (2) There was no significant difference in subjects' intention of booster vaccination in terms of gender, age, income, occupation, educational background and place of residence. Whether family members received booster vaccination was strongly correlated with their intention of vaccination under the loss framework (p = 0.017, M = 4.63, SD = 0.664). (3) The higher the understanding of COVID-19, the higher the degree of compliance with the government's COVID-19 prevention and control measures, and the higher the willingness to strengthen vaccination; (4) Risk disclosure has a significant impact on people's willingness to receive COVID-19 booster shots (M = 2.48, under the loss framework; M = 2.44, under the gain framework); (5) Vaccine protection rate and duration of protection have an impact on people's willingness to vaccinate. Increased willingness to vaccinate when the protection rate of booster vaccine approaches 90% (M = 4.76, under the loss framework; M = 4.68, under the gain framework). When the vaccine protection period is 2 years, people are more willing to receive a booster vaccine; and the willingness to receive a booster shot is stronger under the loss framework (M = 4.60, SD = 0.721, p = 0.879).

Conclusion

The impact of the information framework on COVID-19 vaccination intentions is different, and the disclosure of relevant health information should focus on the impact of the information framework and content on the public's behavior toward strengthening vaccination. Therefore, in the face of public health emergencies, public health departments, healthcare institutions, and other sectors can consider adopting the Gainful Information Framework tool to disseminate health information to achieve better persuasion and promote public health behavior change enhancing public health awareness, and promoting universal vaccination.

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.

Understanding the role of risk preferences and perceptions in vaccination decisions and post-vaccination behaviors among U.S. households

COVID-19 vaccines play a critical role in protecting against infection and transmission of the virus. Therefore, understanding public perceptions of COVID-19 vaccines is essential for successful vaccine promotion. Previous literature reported strong associations between vaccination decisions and several sociodemographic variables. However, knowledge about how behavioral factors, including risk perceptions and preferences, impact individuals' attitudes towards receiving COVID-19 vaccination is currently lacking. Using data from a nationally representative survey of 1050 US adults, this study investigates the correlation between individuals' decisions to receive COVID-19 vaccination and both their risk perceptions and preferences. Additionally, we investigate post-vaccination behavior by measuring individuals' participation in three different groups of activities that vary by their degree of social exposure. We find strong correlations between vaccination decisions and four measures of risk preference and risk perception. We also find associations between the four risk measures and individuals' behaviors post-vaccination. We shed light on the main factors discouraging the uptake of COVID-19 vaccines, as well as public opinions regarding the performance of different organizations in addressing the COVID-19 pandemic, and grocery store policies to prevent COVID-19 infections. Our study provides critical information that can help policymakers communicate more effectively with the public and promote vaccine uptake among population groups and geographic areas with higher anti-vaccine sentiments.

Are interactive and tailored data visualizations effective in promoting flu vaccination among the elderly? Evidence from a randomized experiment

OBJECTIVE

Although interactive data visualizations are increasingly popular for health communication, it remains to be seen what design features improve psychological and behavioral targets. This study experimentally tested how interactivity and descriptive titles may influence perceived susceptibility to the flu, intention to vaccinate, and information recall, particularly among older adults.

MATERIALS AND METHODS

We created data visualization dashboards on flu vaccinations, tested in a 2 (explanatory text vs none) × 3 (interactive + tailored, static + tailored, static + nontailored) + questionnaire-only control randomized between-participant online experiment (N   = 1378).

RESULTS

The flu dashboards significantly increased perceived susceptibility to the flu compared to the control: static+nontailored dashboard, b = 0.14, P = .049; static-tailored, b = 0.16, P = .028; and interactive+tailored, b = 0.15, P = .039. Interactive dashboards potentially decreased recall particularly among the elderly (moderation by age: b = -0.03, P = .073). The benefits of descriptive text on recall were larger among the elderly (interaction effects: b = 0.03, P = .025).

DISCUSSION

Interactive dashboards with complex statistics and limited textual information are widely used in health and public health but may be suboptimal for older individuals. We experimentally showed that adding explanatory text on visualizations can increase information recall particularly for older populations.

CONCLUSION

We did not find evidence to support the effectiveness of interactivity in data visualizations on flu vaccination intentions or on information recall. Future research should examine what types of explanatory text can best support improved health outcomes and intentions in other contexts. Practitioners should consider whether interactivity is optimal in data visualization dashboards for their populations.

Message Fatigue and COVID-19 Vaccine Booster Uptake in the United States

Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.

Behavioral Beliefs Predict Recommended Behaviors, Especially When Trust in Public Health Sources is Low: Evidence from a Longitudinal Study of Three COVID-19 Prevention Behaviors Among U.S. Adults

Public distrust in official sources of health information and uncertainty about novel guidelines may discourage engagement in recommended disease prevention practices. The current study tests the hypothesis that building confidence in positive behavioral outcomes may support recommendation following even in the context of low trust in recommendation sources. This set of longitudinal studies examines the main and interaction effects of trust in official sources and behavioral beliefs in their prediction of recommended COVID-19 prevention behaviors (facemask wearing, social distancing, vaccination). Repeated measurement data were collected from a nationally representative sample of U.S. adults in May/June 2020 (T1; n = 1074), July 2020 (T2; n = 889), and April/June 2021 (T3; n = 750). All five tests, using lagged linear regression, found negative interactions between trust and behavioral beliefs, as hypothesized; three were significant (T1-T2: facemask wearing B=-0.10, SE = 0.04; T1-T3: social distancing B=-0.20, SE = 0.06; T2-T3 vaccination B=-0.27, SE = 0.10) and two were consistent albeit not significant (T1-T3: social distancing B=-0.13, SE = 0.08; T1-T3: facemask wearing B=-0.11, SE = 0.06). Supporting hypotheses, trust in recommendation sources predicted behavior most among those who were less certain about behavioral outcomes and confidence in behavioral benefits predicted behavior most among those with low trust in recommendation sources. Theoretical and practical implications are discussed.

Original Research: Predictors of COVID-19 Vaccine Hesitancy Among Asian Indians in the United States: A Cross-Sectional Descriptive Study

BACKGROUND

Although COVID-19 is a highly infectious disease, vaccine hesitancy remains a primary barrier to attaining full population inoculation. Numerous factors related to vaccine hesitancy have been identified. The aim of this study was to explore associations between select demographic variables and COVID-19 vaccine hesitancy among Asian Indians in the United States.

METHODS

The study used a cross-sectional, descriptive, correlational design. The sample consisted of 363 Asian Indians living in the United States who were 18 years of age or older and were literate in English. Vaccine hesitancy was assessed using an online survey. Both descriptive and inferential statistical analyses were conducted. Inferential tests included t tests, regression analyses, and analysis of variance (ANOVA) tests.

RESULTS

As participant age increased, there was a statistically significant proportionate increase in the total vaccine hesitancy score ( P = 0.01). There were also statistically significant differences in the vaccine hesitancy scores of participants with no more than a high school degree compared to those with associate or bachelor's degrees, although this finding was based on just six participants. Although most participants had already been vaccinated, many identified reasons for feeling some degree of vaccine hesitancy.

CONCLUSIONS

The reasons for vaccine hesitancy vary by individual and are often complex. The results of this study will help guide public health agencies and health care personnel in developing vaccination strategies tailored to the specific requirements of Asian Indians in the United States, which could reduce vaccine hesitancy in this population.

Hyperlocal lessons from the COVID-19 pandemic: Toward an equity-centered implementation science approach

COVID-19 vaccination campaigns across the US were implemented to mitigate the disproportionate hospitalizations and unnecessary deaths across many communities that experienced unequal gaps in initial vaccine distribution rollout and uptake. In parallel, the COVID-19 pandemic created declines in routine vaccination coverage for adults, adolescents, and children; particularly, in communities experiencing overlapping social disadvantage. Community-based efforts offer a solution to narrow immunization gaps but have not been replicated consistently nor demonstrated widespread success during the pandemic as evidenced by prevailing disparities in immunization uptake. We offer an equity centered implementation science approach that involves co-designing, co-implementing, and co-evaluating solutions with the community and all partners investing in the shared goal of sustainable improvement in health outcomes.

Longitudinal study of theory-based predictors of COVID-19 vaccination

Efforts to mitigate the impact of COVID-19 now focus primarily on encouraging vaccination. These efforts have been hampered, however, by vaccine hesitancy. A better understanding of the factors associated with vaccination may help identify those most likely to experience hesitancy and inform the content of public health outreach efforts. The aims of this study were to evaluate whether two theory-based factors (perceived vaccine efficacy and vaccination intention) and political party affiliation were associated with vaccination in the United States (US) and to provide descriptive analysis of factors shaping vaccination decisions. A longitudinal online survey was conducted with 108 adults in the US. Participants completed surveys in July 2020 (Time 1) and October 2021 (Time 2). As hypothesized, greater vaccination intention and perceived vaccine efficacy were significant predictors of vaccine uptake. The second hypothesis was also supported as political party affiliation was associated with vaccination (i.e. Democrats were more likely to vaccinate than Republicans). Descriptive data indicated that vaccinated participants (including those reluctant to vaccinate at Time 1) had been motivated by a desire to protect themselves and others from COVID-19. Participants who had chosen not to vaccinate were influenced by a variety of factors including concerns about vaccine safety and efficacy. Understanding the predictors of vaccination is critical to identifying those unlikely to vaccinate and creating effective interventions to encourage the uptake of this essential public health strategy. Messaging should emphasize the efficacy of COVID-19 vaccines and be delivered by those seen as trustworthy in communities prone to vaccine hesitancy.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Intention to receive the monkeypox vaccine and its psychological and sociodemographic predictors: a cross-sectional survey in the general population of Peru

OBJECTIVE

The objective of this study was to identify predictors of intention to be vaccinated against Monkeypox (Mpox) in a sample of Peruvian citizens.  METHODS: A set of sociodemographic and psychological predictors were used, such as sex, sexual orientation, educational level, previous diagnosis of COVID-19, marital status, complete vaccination against COVID-19, employment status, living with vulnerable people, presence of chronic disease, area of residence, perceived usefulness of COVID-19 vaccines, fear of Mpox, conspiracy beliefs about Mpox, among others. A total of 472 Peruvian adults participated, selected by non-probabilistic snowball convenience sampling. A sociodemographic survey, the Mpox Fear Scale, was used. Conspiracy Beliefs about Mpox was assessed using three questions created specifically for this study. For inferential purposes, simple ordinal regressions ("crude models") were performed between each factor and the outcome.  RESULTS: Regarding their intention to be vaccinated against Mpox, more than 60% expressed clear approval. Being non-heterosexual, having greater emotional fear of Mpox, and perceiving some potential for this disease to become the next pandemic were related to greater intention to vaccinate. On the other hand, being older, having low perceived usefulness of COVID-19 vaccines, and having higher conspiracy beliefs about Mpox were associated with lower intention to vaccinate.  CONCLUSION: The study provides initial information for future research seeking to better analyze Mpox vaccination intention. In addition, cross-sectional data are provided that can be used to develop public health policies that target subgroups with low prevalence of intention to vaccinate against Mpox.

Chinese Americans' Information Sources on, Preferred Types of, and Satisfaction with COVID-19 Vaccination

According to the Centers for Disease Control and Prevention (CDC), about 87% of Asian Americans had received at least one dose of the COVID-19 vaccine as of July 2023. The purpose of this study is to identify the sources of information, preferred vaccine types, and levels of satisfaction related to COVID-19 vaccination among Chinese Americans, the largest subgroup of Asian immigrants living in the U.S. Our survey data were collected from 241 Chinese American early adopters of the COVID-19 vaccine, who completed at least one dose of the COVID-19 vaccine in June 2021. Our results indicated that their major information sources regarding COVID-19 vaccination included health officials and authorities, local news, family/friends/co-workers, social media platforms, and healthcare professionals. More than half of the participants expressed a preference for the Pfizer-BioNTech (New York, U.S.) vaccine based on the primary considerations of safety, efficacy, credibility of the developer, and availability. A majority of the participants felt satisfied with their experience of receiving the COVID-19 vaccination. Participants with higher levels of self-efficacy and subjective norms related to receiving the COVID-19 vaccine were more likely to express satisfaction with the vaccination. These findings provide valuable insights into Chinese Americans' information sources, vaccine preferences, and satisfaction levels regarding COVID-19 vaccination. This knowledge can help guide future vaccination interventions and campaigns.

Motivators and Barriers to COVID-19 Research Participation at the Onset of the COVID-19 Pandemic in Black Communities in the USA: an Exploratory Study

INTRODUCTION

Black individuals in the USA continue to be underrepresented in clinical trials with low participation rates in COVID-19 research studies. Identifying participation barriers is necessary as we develop more vaccines and other treatments to address SARS-CoV-2 and associated sequelae. The purpose of this explorative, qualitative study is to apply the theory of planned behavior to understand motivators and barriers to COVID-19 research participation at the early stages of the COVID-19 pandemic. Understanding these factors is important to ultimately lead to increased vaccination rates among Black individuals, especially in strategies that increase preparedness in response to public health emergencies.

METHODS

A phenomenological qualitative study design was conducted between May and September 2020 among 62 Black participants. The participants were purposefully selected from vulnerable subgroups of the Black population: essential workers, young adults, parents, and individuals with underlying medical conditions. An inductive-deductive content analysis approach was used to analyze the interview data.

RESULTS

Majority (54.8%) reported willingness to participate in COVID-19 research. The following themes emerged from the interviews: (1) positivity toward research exists yet fear and distrust remain; (2) views toward COVID-19 research vary; (3) motivators to COVID-19 research participation; (4) barriers to COVID-19 research participation; and (5) potential strategies to increase COVID-19 research participation.

CONCLUSIONS

Based on our findings, majority of the participants reported willingness to participate in research with observational research being the most commonly cited type of research. Providing data on the attitudes and perspectives of Black individuals and their intentions for COVID-19 research participation using TPB informs intervention targets for healthcare providers and policy makers for an equitable emergency response. Our results suggest improved communication on the research process, research opportunities, and participant testimonial through trusted sources could increase the likelihood of participation. This is especially important as we continue through the pandemic and new treatments for COVID-19 vaccines become readily available.

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.

Measuring Motivation for COVID-19 Vaccination: An Application of the Transtheoretical Model

PURPOSE

In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination.

DESIGN

Cross-sectional measurement development.

SETTING

Online survey.

SAMPLE

528 US adults ages 18-75.

MEASURES

Demographics, stage of change (SOC), DCBL, SE, myths, and barriers.

ANALYSIS

The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs.

RESULTS

For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) (n1 = 8, α = .97; n2 = 5, α = .93; n3 = 4, α = .84). For SE, two correlated factors were revealed (n1 = 12, α = .96; n2 = 3, α = .89). Single-factor solutions for Myths (n = 13, α = .94) and Barriers (n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers.

CONCLUSION

This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.

What motivates food workers to adhere with WHO guidelines to combat the COVID-19? A social cognitive theory perspective

Background

COVID-19 has become a public health emergency and pandemic of global concern, and the hundreds of millions of foodborne illnesses that occur each year also wreak havoc on human lives, society and the economy. Promoting workers in food service establishments to adhere to the hygiene practices in the WHO guidelines is a two-birds-one-stone strategy in preventing the spread of COVID-19 and limiting the occurrence of foodborne illness. The aim of this study was to determine the drivers that motivate workers to adhere to hygiene practices based on social cognitive theory.

Methods

The cross-sectional survey targeting food workers using face-to-face interviews was conducted from July to September 2022. Stratified random sampling and convenience sampling were employed to locate survey sites and respondents, respectively. The survey uses a credible questionnaire evaluated by multiple reliability and validity measures. Binary logistic regression was employed to identify significant determinants of adherence to WHO-initiated hygiene practices.

Results

A total of 900 workers were interviewed and 609 valid questionnaires were received. The study showed that the average correct rate of knowledge about hygiene practices was only 51.09%, that perceived non-adherence to hygiene practices was most likely to result in lower customer satisfaction and the spread of COVID-19, and that only about 11.7% of the workers always adhered to hygiene practices. Three of the cognitive dimensions in the personal factors, self-efficacy, risk perception, and knowledge, had significant positive effects on adherence practices. Among the demographic variables, there were significant differences in adherence practices differing by income level and place of residence.

Conclusion

It was found that workers' knowledge of the WHO-initiated hygiene practices is insufficient and that the frequency of adherence to hygiene practices is poor and require improvement. The significant drivers and effects of demographic variables provide evidence-based guidance to identify priority intervention information and populations to improve worker hygiene practices.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy

Introduction

Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy.

Methods

This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures.

Results

In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures.

Discussion

Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.

Unvaccinated Adolescents' COVID-19 Vaccine Intentions: Implications for Public Health Messaging

PURPOSE

COVID-19 vaccine uptake remains low for US adolescents and contributes to excess morbidity and mortality. Most research has assessed parental intention to vaccinate their children. We explored differences between vaccine-acceptant and vaccine-hesitant unvaccinated US adolescents using national survey data.

METHODS

A nonprobability, quota-based sample of adolescents, aged 13-17 years, was recruited through an online survey panel in April 2021. One thousand nine hundred twenty seven adolescents were screened for participation and the final sample included 985 responses. We assessed responses from unvaccinated adolescents (n = 831). Our primary measure was COVID-19 vaccination intent ("vaccine-acceptant" defined as "definitely will" get a COVID-19 vaccine and any other response classified as "vaccine-hesitant") and secondary measures included reasons for intending or not intending to get vaccinated and trusted sources of COVID-19 vaccine information. We calculated descriptive statistics and chi-square tests to explore differences between vaccine-acceptant and vaccine-hesitant adolescents.

RESULTS

Most (n = 831; 70.9%) adolescents were hesitant, with more hesitancy observed among adolescents with low levels of concern about COVID-19 and high levels of concern about side effects of COVID-19 vaccination. Among vaccine-hesitant adolescents, reasons for not intending to get vaccinated included waiting for safety data and having parents who would make the vaccination decision. Vaccine-hesitant adolescents had a lower number of trusted information sources than vaccine-acceptant adolescents.

DISCUSSION

Differences identified between vaccine-acceptant and vaccine-hesitant adolescents can inform message content and dissemination. Messages should include accurate, age-appropriate information about side effects and risks of COVID-19 infection. Prioritizing dissemination of these messages through family members, state and local government officials, and healthcare providers may be most effective.

Racial and Ethnic Differences in Maternal and Child COVID-19 Vaccination Intent Among Pregnant and Postpartum Women in the USA (April-June 2020): an Application of Health Belief Model

This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49 years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.

Older adults' acceptance of the COVID-19 vaccine: Application of the health belief model

AIMS

To determine the prevalence of COVID-19 vaccination acceptance among older adults and the factors that independently predict vaccine acceptance using the Health Belief Model (HBM).

DESIGN

This was a cross-sectional, descriptive study.

METHODS

Consenting older adults aged 60 years and older (n = 384) from Primary Health Care Centers in rural and urban areas of Mansoura District, Egypt, who could interact adequately with researchers participated in the study. The data were collected through an electronic questionnaire that included socio-demographic data, health-related characteristics, and health beliefs based on the HBM framework.

RESULTS

Overall, 46.9% were willing to receive the COVID-19 vaccine, 19.5% declined, and 33.6% were undecided. Higher perceptions of COVID-19 severity, vaccine benefits, and action cues were associated with vaccine acceptance (p = 0.05).

PUBLIC CONTRIBUTION

Vaccination campaigns that highlight the benefits of immunization should be prioritized by policymakers. In addition, vaccinated peoples should use social media to spread awareness about the advantages and challenges of vaccination. Nurse leaders should apply the HBM to forecast health-related behaviors, especially vaccination attitudes.

The impact of the COVID-19 pandemic on parental vaccine hesitancy: A cross-sectional survey

BACKGROUND

It is unclear how hesitancy towards pediatric vaccines has changed quantitatively since the onset of the COVID-19 pandemic, and if changes are more readily apparent in clusters of low COVID-19 vaccination. In this study, we assess how clusters of low COVID-19 vaccination correlate with changing parental beliefs about childhood vaccines.

METHODS

A cross-sectional, opt-in, internet-based survey of parents resident in the U.S. was conducted during August-September 2022. Our survey measured changes in beliefs about childhood vaccine safety, importance, and effectiveness since the start of COVID-19. We also measured parents' perceived vaccination rates in the community, assessing its relationship with changing vaccination perceptions using Rao-Scott chi-square tests, and multinomial logistic regression models.

RESULTS

Among 310 parents of children 0-17 years old, 11 % (95 % CI: 7 %, 15 %) believed that childhood vaccines are less safe, 12 % (95 % CI: 8 %, 17 %) less important, and 13 % (95 % CI: 9 %, 18 %) less effective since the start of the COVID-19 pandemic. About 9 % (95 % CI: 5 %, 12 %) stated COVID-19 vaccination coverage was low in their community. Among those who stated COVID-19 vaccination coverage was low, 38 % reported believing childhood vaccines were less effective (vs 12 % of those who stated vaccination coverage was high). This corresponds to 4.34 times greater odds of believing childhood vaccines were less effective since the start of the pandemic (95 % CI: 1.38, 13.73) in those who believe COVID-19 vaccination coverage to be low in their community vs high.

CONCLUSION

Our study demonstrates that parental perceptions about childhood vaccines have been affected by the COVID-19 pandemic through geographic and social clustering of non-vaccination. Beliefs about the COVID-19 vaccine have spillover with beliefs about childhood vaccines, and more negative beliefs may be clustering in areas with low vaccination coverage, which could predispose the area to outbreaks of vaccine-preventable disease.

COVID-19 Vaccination Hesitancies: A Spanish-Language Focus Group Analysis in Texas

COVID-19 related health disparities are prevalent among higher risk populations like the Hispanic community. Vaccination is one readily available public health tool, yet vaccine uptake is lower among minority populations and hesitations and concerns are high. In the present study, interpersonal and media sources of information about COVID-19 were discussed in a series of six focus groups with Spanish-language dominant and bilingual English-Spanish respondents in a large metropolitan area in Texas. Participants reported using legacy media as a main source of information about COVID-19 vaccines and encountered conspiracy theories and misinformation on social media. Using the Health Belief Model as the theoretical lens, we found individuals' and family members' perceived susceptibility to COVID-19 played a part in participants wanting to find and get the vaccine. Provider recommendations may have served as cues to action. Ease of receiving the vaccines at church and pharmacies may have served to boost participants self-efficacy. Perceived barriers include vaccine specific reasons such as the fast pace of initial authorization, side effects, and long-term effects along with conspiracy theories. Prevailing information gaps regarding the COVID-19 vaccines and the resulting uncertainty are discussed. Understanding information sources and the trust Hispanic communities place in these sources is important in designing effective health messages.

Beyond intention: Predicting children's COVID-19 vaccine uptake using the theory of planned behavior

This prospective study tested if parental factors from the theory of planned behavior (TPB) predicted children's uptake of the COVID-19 vaccine and examined whether parents' intention to vaccinate children against COVID-19 would mediate such associations. Participants were 852 Hong Kong parents of 1076 children aged 5-12. At Time 1, parents reported on items measuring the TPB predictors (i.e. attitudes, subjective norms, and perceived behavioral control) and intention. At Time 2 (approximately 4 months after Time 1), parents reported whether their children had received the COVID-19 vaccine. Attitudes, perceived behavioral control, and intention predicted children's actual uptake of the COVID-19 vaccine. Intention mediated the relations between two TPB predictors, namely attitudes and subjective norms, and children's COVID-19 vaccination uptake. The TPB is considered a useful framework in the development of future COVID-19 vaccine programs for children to promote parents' intention and the subsequent uptake of the COVID-19 vaccine among children.

Examining health sciences students' intention to uptake COVID-19 vaccination using the theory of planned behavior

To examine the association between the theory of planned behavior (TPB) constructs and Health Sciences students' intentions to receive COVID-19 vaccination. A cross-sectional study was conducted in Saudi Arabia by recruiting Health Sciences students as participants. Using Structural Equation Modeling (SEM), the proposed TPB model was evaluated. The sample of 505 individuals consisted of more males (n = 275; 54.5%) than females and was relatively young (88% were between the ages of 18 and 30). The suggested TPB model explained 78.2% of the variation in intention to get COVID-19 immunization. We found that greater levels of perceived behavioral control (β = 1.58, p < .001) and attitude (β = .44, p < .001) strongly predicted increased vaccination intentions. The subjective norm construct was not a significant predictor of vaccination intentions (β = 0.06, p = .34). The findings of this study indicate that the TPB can be utilized effectively to obtain insight into the factors associated with COVID-19 adherence and help in the development of effective COVID-19 intervention strategies.

Modelling the Factors That Predict the Intention to Take COVID-19 Vaccine in Nigeria

This study developed a model that predicted factors that prompt the intention to take the COVID-19 vaccine among Nigerians. Data were collected from 385 respondents across Nigeria using snowball sampling technique with online questionnaire as instrument. Results indicated that cues to action, health motivation, subjective norms, and perceived behavioural control positively predicted the intention to take COVID-19 vaccine in Nigeria. However, perceived susceptibility, severity, and COVID-19 vaccine benefits did not predict the intention to take the COVID-19 vaccine. Further findings showed that COVID-19 vaccine barrier and attitude was negatively associated with the intention to take the COVID-19 vaccine.

Understanding factors influencing healthcare workers' intention towards the COVID-19 vaccine

Globally, healthcare workers (HCWs) are at high risk of acquiring Coronavirus infection. In addition, they are role models for the general public concerning attitudes towards the COVID-19 vaccine. In addition, they play a critical role in successfully promoting practices aiming to reduce the transmission of COVID-19 infection. Therefore, this study broadly based on the theory of planned behavior (TPB) explores the factors influencing HCWs' intention to be vaccinated. An online survey was administered using Google Form to collect data from HCWs working in the public health sector of Pakistan. The sample included 813 participants, two-thirds were female, and one-third were male. In addition, 41.5% of them were aged between 26-35 years, 32.6% had master's level education, 25% were nurses, and 57.7% of them were living in urban areas. Data analysis was run using Partial Least Squares Structural Equation Modeling (PLS-SEM). The research findings reveal the positive and significant effect of the TPB factors (attitude, subjective norms, and perceived behavioral control) and the extended factor of vaccine confidence on HCWs' intention to be vaccinated. This study's model explains 66.4% of variations in HCWs' intention to be vaccinated.

Does personal experience with COVID-19 impact investment decisions? Evidence from a survey of US retail investors

This paper explores the link between personal experience with COVID-19 and US retail investors' financial decision-making during the first COVID-19 wave. Do retail investors that have personally experienced COVID-19 change their investments after the pandemic outbreak, and if so, why? We use a cross-sectional dataset from an online survey of US retail investors collected in July and August 2020 to assess if and how respondents change their investment decisions after the COVID-19 outbreak. On average retail investors increase their investments during the first wave of COVID-19 by 4.7%, while many of them decrease their investments suggesting a high heterogeneity of investor behaviours. We provide the first evidence that personal experience with the virus can have unexpected positive effects on retail investments. Investors who have personal experience with COVID-19, who are in a vulnerable health category, who tested positive, and who know someone in their close circle of friends or family who died because of COVID-19, increase their investments by 12%. We explain our findings through terror management theory, salience theory and optimism bias, suggesting that reminders of mortality, focussing on selective salient investment information, and over-optimism despite personal vulnerable health contribute to the increase in retail investments. Increased levels of savings, saving goals and risk capacity are also positively associated with increased investments. Our findings are relevant to investors, regulators, and financial advisors, and highlight the importance of providing retail investors with access to investment opportunities in periods of unprecedented shocks such as COVID-19.

Parents' COVID-19, HPV, and Monkeypox vaccination intention: A multilevel structural equation model of risk, benefit, barrier, and efficacy perceptions and individual characteristics

OBJECTIVE

This study seeks to comparatively examine parents' intention to vaccinate their children for three infectious diseases, including COVID-19, HPV, and monkeypox.

METHODS

Utilizing a mixed-design survey and multilevel structural equation models, we investigated if perception of the diseases and vaccines explained the variance in parents' vaccine-specific decision-making and population difference in vaccination intention.

RESULTS

Compared with the COVID-19 vaccine, parents were more willing to get an HPV vaccine for their children due to greater perceived benefit and lower perceived barrier. Concerns about vaccine safety and lower disease risk perception were associated with lower intention to get a monkeypox vaccine. Parents of color, less educated, and lower-income parents were less willing to get vaccines for their children due to low benefit perception and high perceived barriers.

CONCLUSION

Parents were motivated by different social and psychological factors when deciding whether to get a COVID-19, HPV, and monkeypox vaccine for their children.

PRACTICE IMPLICATIONS

Vaccine promotion should be tailored to the characteristics of the target population and the vaccines. Underprivileged communities may be better approached with information about vaccine benefit and barriers, and vaccines for unfamiliar diseases may be better communicated with disease risk information.

Utilizing the theory of planned behavior to predict COVID-19 vaccination intention: A structural equational modeling approach

It is essential to achieve herd immunity in order to control the COVID-19 pandemic, and this requires a high level of vaccination rate. Despite the importance of vaccination, hesitancy and unwillingness in receiving the COVID-19 vaccine still exists. It is therefore crucial to comprehend the intentions of adults regarding COVID-19 vaccination, which is beneficial for establishing community immunity and an efficient future pandemic response. An online survey was administered to 2722 adults in Vietnam. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were used to test the reliability and validity of the developed scales. Then, structural equational modeling (SEM) was employed to test correlations. This study found that favorable attitudes toward COVID-19 vaccines played the most important role in shaping adults' intention to receive these vaccines, followed by perceived behavioral control, perceived benefits of COVID-19 vaccines, and subjective norms. Concurrently, all three core dimensions of the theory of planned behavior mediated the link between the perceived benefits of COVID-19 vaccines and the intention to receive them. Also, there were significant differences between males and females in the way they formed this intention. The findings of this study offer valuable guidance for practitioners on how to encourage adults to receive COVID-19 vaccinations, as well as how to limit the transmission of the COVID-19 virus.

Psychological Distance, Construal Level, and Parental Vaccine Hesitancy for COVID-19, HPV, and Monkey Pox Vaccines

Building on the construal-level theory and the multi-dimensional model of behavioral barriers, this study examined whether psychological distance and construal level explain the association between behavioral intention and behavioral barriers that may lead to parental vaccine hesitancy. Results of multilevel structural equation models show that low vaccination intention, far distance perception, and abstract construal of vaccines led to more global concerns, such as vaccine safety and relevance. Such effects emerged when people considered specific vaccines, such as coronavirus disease 2019 (COVID-19), human papillomavirus (HPV), and monkeypox vaccines, and when they considered multiple vaccines in general.

Determination of factors influencing young adults' intention to have COVID-19 vaccine in the Philippines: An integration of Health Belief Model and the Theory of Planned Behavior

Objectives

The COVID-19 pandemic continues to increase around the world and businesses and markets across the world significantly decreased. The purpose of this study was to determine the factors that affect the intention to be vaccinated for the COVID-19 vaccine among young Filipino adults by integrating the Health Belief Model and Extended Theory of Planned Behavior.

Study design

A cross-sectional study design was utilized.

Methods

Factors such as understanding of the COVID-19 vaccine, self-efficacy, cues to action, perceived barriers, perceived benefits, perceived side effects, perceived behavioral control, attitude, subjective norm, and intention to be vaccinated were analyzed by utilizing Structural Equation Modeling (SEM).

Results

With 865 young Filipino adults who answered a self-administered survey, it was seen that Understanding of the COVID-19 vaccine has the highest direct significant effect on cues to action, followed by perceived barriers, and perceived benefits. Interestingly, the primary factor was Understanding COVID-19 vaccines which had an indirect significant effect on the intention to get vaccinated. This is because knowing what the vaccine is for, its effects, and the application would lead to the acceptance of the COVID-19 vaccine. Moreover, the impact of being known to have the COVID-19 vaccine would lead to the intention to get vaccinated.

Conclusions

The findings of this study can be utilized especially by the government in developing strategies for encouraging people to take the COVID-19 vaccine. Finally, the model construct of the study can be applied to explore more factors that can affect the intention to be vaccinated with the COVID-19 vaccine and other vaccines people worldwide.

Fear of COVID-19 disease and vaccination as predictors of vaccination status

Vaccination rates are still insufficient to prevent the spread of COVID-19, so immunity must be increased among the population in order to reduce the virus' spread and the associated medical and psychosocial effects. Although previous work has identified various factors associated with a low willingness to get vaccinated, the role of emotions such as fear of vaccination (FVAC) or fear of COVID-19 (FCOV), vaccination as a subjective norm (SN), psychological factors like general control beliefs (CB) or psychological resilience, and their interaction have been investigated less intensively. We used data from three cross-sectional waves of the German Panel COSMO (November 2021, N = 1010; February 2022, N = 1026; March 2022, N = 1031) and multiple logistic regression analyses to test whether vaccination rates are moderated by those factors. After controlling for covariates (age, sex, confidence in own intuition, optimism, well-being), we found that CB was no significant predictor of vaccination status. Higher FCOV and higher ratings in SN, however, were associated with an increased likelihood of being vaccinated. In contrast, higher FVAC was associated with a decreased likelihood of being vaccinated. Psychological resilience did not consistently moderate the associations between fear and vaccination status.

Risk-efficacy framework - a new perspective on threat and efficacy appraisal and the role of disparity

The current study aims to provide a more nuanced understanding of threat and efficacy appraisal and account for the influence of disparity in the accessibility to risk prevention resources in predicting attitudes and behaviors. We propose a Risk-Efficacy Framework by integrating theories, including the extended parallel process model, health belief model, social cognitive theory, and construal level theory of psychological distance to achieve such a goal. An online survey targeting the U.S. population was conducted to empirically test the model (N = 729). The survey measured people's threat and efficacy appraisals related to COVID-19 and its vaccines and their attitudes and behavioral intention. The results of the survey supported the model's propositions. Specifically, perceived susceptibility moderated perceived severity's effects on attitudes and behaviors, such that perceived severity's influence attenuated as perceived susceptibility increased. Perceived accessibility to risk prevention resources moderated the influence of self and response efficacy. The former's effects on attitudes and behaviors increased, and the latter's effects decreased when perceived accessibility was high. The proposed framework provides a new perspective to examine the psychological determinants of prevention adoption and contributes to designing and implementing campaigns distributing prevention to underserved populations. The framework offers insights for risk managers such as public health authorities by articulating the dynamic nature of risks. When communicating early-stage lesser-known risks to the public, campaigns should highlight their severity and the response efficacy of risk solutions. Differently, more resources should be devoted to cultivating self-efficacy for widespread risks with more mitigation resources.