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

Considering the impact of vaccine communication in the COVID-19 pandemic among adults in Canada: A qualitative study of lessons learned for future vaccine campaigns

We aimed to understand how experiences with vaccine-related information and communication challenges during the COVID-19 pandemic impacted motivations and behaviors among Canadian adults regarding future vaccines. Semi-structured interviews were conducted with participants purposively selected to ensure diversity in age, sex at birth, self-identified gender, and region. Data were analyzed using thematic analysis; findings were mapped to the Information-Motivation-Behavioral Skills Model focusing on factors affecting vaccine hesitancy and uptake. Of 62 interviews completed, most were with woman (n = 32, 51.6%) and residents of Ontario (n = 36, 58.1%); the median age was 43.5 yr (interquartile range 23.3 yr). Themes included: 1) accessibility of information, 2) ability to assess information accuracy and validity, 3) trust in communications from practitioners and decision-makers, and 4) information seeking behaviors. Participants expressed various concerns about vaccines, including fears about potential side effects, particularly regarding the long-term effects of novel vaccinations. These concerns may reflect broader societal anxieties, which have been intensified by widespread misinformation and an overload of vaccine information. Moreover, participants highlighted a lack of trust in the information provided by government agencies and pharmaceutical companies, primarily driven by concerns regarding their underlying motives. Concerns about COVID-19 vaccine safety and effectiveness negatively impacted future vaccine attitudes and behaviors. Vaccine hesitancy studies should consider how individuals receive, perceive, and seek information within social contexts and risk profiles.

In Whom We Trust: The Effect of Trust, Subjective Norms, and Socioeconomic Status on Attitudes and COVID-19 Vaccination Intentions

As COVID-19 vaccination hesitancy remains a major public health issue, understanding the factors influencing attitudes and COVID-19 vaccination intentions is a public health priority. Applying the theory of planned behavior (TPB), this study examined the role of two forms of social trust - namely, particularized trust toward relationally close others and generalized trust toward people in general - in moderating the relationship between social norms (injunctive and descriptive) and COVID-19 vaccination attitudes and intent. In two studies (n = 235 for Study 1, n = 273 for Study 2, total N = 508), we found some support for the TPB in the context of COVID-19 vaccination, with attitudes and injunctive norms significantly predicting vaccination intention. However, perceived behavioral control was not a significant predictor of COVID-19 vaccination intention. Extending the TPB, we found that trust in others had an amplifying effect on the relationship between descriptive norms and COVID-19 vaccination attitudes. However, trust attenuated the link between injunctive norms and attitudes toward COVID-19 vaccination. The implications of these findings are discussed.

Explicating college students' COVID-19 prevention behaviors: Integrating information seeking and response efficacy into the reasoned action approach

Objective: This study investigated correlations between college students' intentions to adopt COVID-19 prevention behaviors (i.e., handwashing, mask wearing, and social distancing) and their attitudes, perceived norms, perceived efficacy, and information seeking. Participants: Students (N = 326) from a large Midwestern university recruited via simple random sampling. Methods: Using a cross-sectional survey from mid-March to April 2021, structural equation modeling assessed intentions across behaviors. Results: Attitudes and perceived self-efficacy were variably associated with intentions. Perceived injunctive norms were linked to intention across all behaviors. Response efficacy was associated only with social distancing intentions. Information seeking was tied to attitudes, perceived injunctive norms, and perceived response efficacy, across all behaviors. Conclusions: Information seeking affected how college students evaluate prevention behaviors, emphasizing the importance of disseminating accessible and accurate health information in this context. The findings also highlight the need for future interventions to tailor to the unique barriers and motivators for different prevention behaviors.

Conspiracy beliefs explain why intolerance of uncertainty, personal control, and political uncontrollability predict willingness to get vaccinated against COVID-19

Conspiracy theories tend to be disseminated in times when anxiety and uncertainty prevail. Thus, the outbreak of the COVID-19 pandemic was fertile ground for the dissemination of conspiracy theories. The current study examined the role of conspiracy belief in the association between individual differences in perceptions of lack of control and certainty, and willingness to get vaccinated against COVID-19. Participants (N = 323) completed measures of willingness to get vaccinated, belief in COVID-19 vaccines conspiracy, intolerance of uncertainty (IOU), perceived personal control, and political uncontrollability. Results show that conspiracy beliefs mediated the positive association between perceived personal control and willingness to get vaccinated, and the negative association between political uncontrollability and willingness to get vaccinated. Additionally, conspiracy belief had a suppression effect on the association between IOU and willingness to get vaccinated. These findings indicate that uncertainty and sense of lack of control heighten the need for an explanation that offers some degree of clarity, which in turn is related to adoption of conspiracy theories and may consequently have negative effects on health behavior.

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

The impact of risk perception and institutional trust on COVID-19 vaccine hesitancy in China

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan

In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn't trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals' national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.

Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions

Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.

Evolving Trends in College Students' Health Education: A Bibliometric Analysis

This study offers new insights into college students' health education (CSHE) regarding its research status, hot spots, and trends by conducting a comprehensive bibliometric analysis of this field in the past decade (2014 to 2024). Specifically, we analyzed publication trends and used the bibliometric method with CiteSpace software to explore collaborative networks, detailed co-citation status, and co-occurrence dynamics based on 1358 Web of Science Core Collection articles. Our results indicate increased relevant publications and the collaboration networks show complex institutional and regional partnerships. At the same time, co-citation and co-occurrence analyses highlight interdisciplinary research themes that encompass public health. The study particularly underscores the emerging importance of mental health, global health, and innovative educational approaches. These findings reveal trends in CSHE research and provide crucial insights for future studies, stressing the need for interdisciplinary collaboration and creative strategies to tackle student health challenges. Moreover, in practice, this study contributes to promoting and practicing targeted health intervention policies and countermeasures aimed at enhancing student well-being, such as establishing dedicated health education courses, providing specialized training for teachers, conducting regular health assessments, and providing funding for CSHE.

Trust in government, social media and willingness to vaccinate

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust.

Readiness for influenza and COVID-19 vaccination in Germany: a comparative analysis

Introduction

Vaccination readiness refers to psychological motives and beliefs that decisively determine individual and collective vaccination prevention behavior. Readiness to be vaccinated depends on expected individual and social benefits and harms. Differences exist in the perception of the threat of potential influenza vs. COVID-19 infection and its significance for the social environment. The study aimed to compare the 7C components of vaccination readiness for influenza and COVID-19 vaccination in adulthood.

Methods

A total of 317 adults answered the 7C vaccination readiness scale in two vaccination-specific versions (influenza vs. COVID-19) in an online survey from September 2022 to March 2023. Data were analyzed using repeated measures, including analysis of covariance, correlations, and multiple regression.

Results

For COVID-19, there is a higher readiness to be vaccinated compared to influenza regarding complacencyR (ηp  = 0.683), constraintsR (ηp  = 0.684), collective responsibility (ηp  = 0.782), and compliance (ηp  = 0.365). However, confidence (ηp  = 0.161) and conspiracyR (ηp  = 0.256) indicate an enhanced readiness for influenza vaccination (interaction scales × vaccination type: ηp  = 0.602). Individual influenza vaccination recommendations and age do not or only marginally moderate these effects (interaction vaccination type × recommendation: ηp  = 155).

Discussion

The 7C subscales reveal a differentiated pattern of readiness for the two vaccination types. This emphasizes the relevance of the multidimensional structure of the construct of vaccination readiness as well as the relevance of moderating effects of the respective vaccination type on the underlying motives and beliefs. Vaccination attitudes are influenced by cultural and social conditions as well as medical standards of care. Comparing attitudes to different vaccinations in different countries thus represents an important research desideratum in order to understand the concept of vaccination readiness more comprehensively.

Promotion of Knowledge and Trust Surrounding Scarce Resource Allocation Policies: A Randomized Clinical Trial

Importance

The COVID-19 pandemic prompted rapid development of scarce resource allocation policies (SRAPs) in case demand for critical health services eclipsed capacity.

Objective

To test whether a brief educational video could improve knowledge of how the University of California Health's SRAP would be implemented and trust in health systems to implement such policies in accordance with ethical principles during the pandemic.

Design, Setting, and Participants

This randomized clinical trial used an educational video intervention embedded in a longitudinal web-based survey and was conducted between May and December 2020 and analyzed during March 2024. A total of 1971 adult participants were enrolled, of whom 939 completed follow-up; participants with matched baseline and follow-up responses were analyzed. California residents were randomized to view the intervention (n = 345) or not (n = 353) and stratified by age, sex, education, racial identity, and self-reported health care worker status. Non-California residents were allocated to the control group (n = 241).

Interventions

A brief (6-minute) "explainer" video that provided an overview of mechanics and ethical principles underpinning the University of California Health SRAP, subtitled in 6 languages.

Main Outcomes and Measures

Self-reported survey assessment of knowledge of components of SRAP, graded as correct vs incorrect, and trust graded on a 10-point Likert scale. Anxiety about such policies was graded on a 10-point Likert scale with an a priori noninferiority margin of half of a standard deviation. Participants answered items at baseline and follow-up (approximately 10 weeks after baseline), with randomization occurring between administrations.

Results

Of 770 randomized participants with responses at both points, 566 (73.5%) were female, and the median (IQR) age was 43.5 (36-57) years. Intervention participants demonstrated improvement of 5.6 (95% CI, 4.8-6.4; P < .001) more correct knowledge items of 20 vs controls, as well as significant improvements in reported trust in fairness/consistency and honesty/transparency about SRAP implementation. There was no significant change in reported anxiety surrounding SRAP in either treatment or control groups.

Conclusions and Relevance

The trial found that a brief educational video is sufficient to explain complex ethical tenets and mechanics of SRAP and improved knowledge of such policies and trust in health systems to implement them equitably while not exacerbating anxiety about potential policy implications. This informs practice by providing a framework for educating people about the use of these policies during future situations necessitating crisis standards of care.

Trial Registration

ClinicalTrials.gov Identifier: NCT04373135.

Assessing vaccinated persons' intention to take the COVID-19 boosters using a combined theoretical framework: an online survey in Egypt

Vaccines, like the Corona Virus Disease-2019 (COVID-19) vaccines, can control diseases, but vaccine hesitancy reduces their use. It is important to assess the intention to use COVID-19 vaccines boosters and the determinants of this intention to help in developing programs to promote the uptake of boosters. An online survey collected data from adults in Egypt between March and June 2022 using a questionnaire that assessed demographic characteristics, and constructs of the Theory of Planned Behaviour (TPB) and the Health Belief Model (HBM). The survey was uploaded to SurveyMonkey and the links were posted on social media platforms. Binary regression analysis was used and the dependent variable was intention to use boosters of COVID-19 vaccines. The independent variables were indicators of the HBM including perceived susceptibility to COVID-19 infection (medical history) and possibility of disease prevention (awareness of the availability of types of COVID-19 vaccines); and indicators of the TPB including attitude toward COVID-19 vaccines (that they are harmful, that they may lead to death and confidence in locally and foreign manufactured vaccines), perceived norms (the percentage of vaccinated persons in one's circle) and perceived control over booster uptake (presence of government mandates for COVID-19 vaccination). The confounders were sociodemographic factors (age, sex, education, and place of residence). Complete responses were available from 1113 out of 1401 participants (79.4%), with mean (SD) age = 25 (9.5) years, of whom, 66.7% (n = 742) were females and 68.6% (n = 764) were university students. About 39.4% and 31.2% indicated that they would get or would definitely get the booster dose of the COVID-19 vaccines. In multiple regression, intention to use a booster dose was significantly related to not agreeing (AOR = 4.87, P < 0.001) or not agreeing at all (AOR = 8.46, P = 0.001) that vaccines are harmful and to having no confidence (AOR = 0.21, P < 0.001) or no confidence at all (AOR = 0.14, P < 0.001) in foreign-manufactured vaccines. Most university-educated Egyptians in the study intended to take the COVID-19 vaccine booster dose and this intention was associated with attitude toward the harm of the vaccine and confidence in foreign-manufactured vaccines. Awareness campaigns are needed to counteract misinformation and promote booster dose uptake.

The role of Contact-Tracing Mobile Apps in pandemic prevention: A multidisciplinary perspective on health beliefs, social, and technological factors

During the recent COVID-19 pandemic, governments implemented mobile applications for contact tracing as a rapid and effective solution to mitigate the spread of the virus. However, these seemingly straightforward solutions did not achieve their intended objectives. In line with previous research, this paper aims to investigate the factors that influence the acceptance and usage of contact-tracing mobile apps (CTMAs) in the context of disease control. The research model in this paper integrates the Unified Theory of Acceptance and Use of Technology and the Health Belief Model (HBM). The present study involved a diverse sample of 770 French participants of all genders, ages, occupations, and regions. Critical elements from the Health Belief Model, technological factors related to the app, and social factors, including the centrality of religiosity, were assessed using well-established measurement scales. The research's findings demonstrate that several factors, such as perceived benefits and perceived severity, social influence, health motivation, and centrality of religiosity, significantly impact the intention to use a CTMA. These findings suggest that CTMAs hold promise as valuable tools for managing future epidemics. However, addressing challenges, revising implementation strategies, and potentially collaborating with specialized industry partners under regulatory frameworks are crucial. This practical insight can guide policymakers and public health officials in their decision-making.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Germany under the Tinfoil Hat? The associations of the big five personality traits and coronavirus conspiracy beliefs with the intention to get vaccinated

BACKGROUND

The governments of democracies worldwide are relying on the active cooperation of their populations to combat COVID-19. Simultaneously, beliefs in conspiracy theories surrounding the pandemic have flourished. The present article examines the effects of the big five personality traits and conspiracy beliefs on the intention to get vaccinated against COVID-19 in Germany.

METHODS

This correlational, cross-sectional mediation analysis was conducted using data from a nationwide German household panel (N = 1390).

RESULTS

Openness to experience (β = -.082, p = .004) and neuroticism (β = .112, p < .001) showed direct effects on conspiracy beliefs, while conspiracy beliefs had the strongest effect on vaccination intention (β = -.424, p < .001). Indirect positive effects of openness (β = .035, p = .005) and negative effects of neuroticism (β = -.047, p < .001) on the intention to get vaccinated via conspiracy beliefs were identified, with a mediation in the strict sense only for openness. No direct or total effect of the big five on vaccination intention could be found.

CONCLUSIONS

The big five personality traits are associated, although indirectly, with the intention to be vaccinated. Compared with similar studies on the effects of the big five on COVID-19-related outcomes, we found slightly higher proportions of explained variance in conspiracy beliefs and significantly higher explained variance in vaccination intention. In order to increase the willingness to be vaccinated, targeted and nationwide uniform information measures should be provided addressing feelings of security, of not being excluded, and the activation of critical reasoning.

The importance of 'dread risk' for vaccine communication

BACKGROUND

Perceptions of 'dread risk,' information source beliefs, and trust in these sources are important variables towards understanding vaccine attitudes. The main objective of this research was to learn the associations among these phenomena and, particularly, how these variables may impact our understanding of vaccine attitudes.

METHODS

In the summer of 2020, a total of 336 (Mage = 53.55; SDage = 18.58) participants answered an online Qualtrics survey about their 'dread risk' perceptions of vaccines, their information source beliefs (e.g. credible, easy-to-access, etc.), trust in information sources, and vaccine attitudes.

RESULTS

Results suggest participants had generally low levels of negative vaccine attitudes (M = 3.27; SD = 1.40). Regression analyses to predict negative vaccine attitudes found 'dread risk' perceptions to be the most significant predictor (beta = .61, p < .001), over and above information source beliefs and trust in information sources (F (9, 320) = 75.07, p < .001; adjusted R2 = .67). Age was also significantly and negatively correlated with 'dread risk' (r = -.22, p < .001).

CONCLUSIONS

Results suggest that vaccine communication efforts should continue to identify individuals' 'dread risk' perceptions about vaccines and emphasize this content in messaging. Future research should aim to understand more about the relationships between negative vaccine attitudes, 'dread risk' perceptions, information source beliefs, and trust in information sources to better predict vaccine-related decisions, (in)actions, and to support effective vaccine communication.

Mixed methods examination of risk perception on vaccination intentions: The perspective of doctor-patient communication

AIM

From the perspective of doctor-patient communication, this research used multiple methods combined natural language processing (NLP), a cross-sectional survey and an online experiment to investigated how risk perception influenced people's vaccination intention.

METHODS

In Study 1, we used Python to crawl 335,045 comments about COVID-19 vaccine published in a social media platform Sina Weibo (equivalent of Twitter in China) from 31 December 2020 to 31 December 2021. Text analysis and sentiment analysis was used to examine how vaccination intention, as measured by linguistic features from the LIWC dictionary, changed with individuals' perceptions of pandemic risk. In Study 2, we adopted a cross-sectional questionnaire survey to further test the relation of risk perception, vaccination intention, trust in physicians, and perceived medical recommendations in a Chinese sample (n = 386). In Study 3, we conducted an online experiment where we recruited 127 participants with high trust in physicians and 127 participants with low trust, and subsequently randomly allocated them into one of three conditions: control, rational recommendation, or perceptual recommendation.

RESULTS

Text and sentiment analysis revealed that the use of negative words towards COVID-19 vaccine had a significant decrease at high (vs. low) risk perception level time (Study 1). Trust in physicians mediated the effect of risk perception on vaccination intention and this effect was reinforced for participants with low (vs. high) level of perceived medical recommendation (Study 2), especially for the rational (vs. perceptual) recommendation condition (Study 3).

CONCLUSION

Risk perception increased vaccination intention through the mediating effect of trust in physicians and the moderating effect of perceived medical recommendations. Rational (vs. perceptual) recommendation is more effective in increasing intention to get vaccinated in people with low trust in physicians.

Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study

BACKGROUND

Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future.

OBJECTIVE

This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China.

METHODS

This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM).

RESULTS

A total of 5780 participants were included, with 53.04% (3066/5780) being female. The vaccination rate was 12.18% (704/5780; 95% CI 11.34-13.02) in the total sample, 13.76% (341/2478; 95% CI 12.40-15.12) among the rural participants, and 10.99% (363/3302; 95% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all P＜.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all P＜.05). PSM analysis uncovered a 3.42% difference in vaccination rates between urban and rural participants.

CONCLUSIONS

The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated.

The negative impact of misinformation and vaccine conspiracy on COVID-19 vaccine uptake and attitudes among the general public in Iraq

Background

Vaccine hesitancy is a major barrier to infectious disease control. Previous studies showed high rates of COVID-19 vaccine hesitancy in the Middle East. The current study aimed to investigate the attitudes towards COVID-19 vaccination and COVID-19 vaccine uptake among adult population in Iraq.

Methods

This self-administered survey-based study was conducted in August-September 2022. The survey instrument assessed participants' demographics, attitudes to COVID-19 vaccination, beliefs in COVID-19 misinformation, vaccine conspiracy beliefs, and sources of information regarding the vaccine.

Results

The study sample comprised a total of 2544 individuals, with the majority reporting the uptake of at least one dose of COVID-19 vaccination (n = 2226, 87.5 %). Positive attitudes towards COVID-19 vaccination were expressed by the majority of participants (n = 1966, 77.3 %), while neutral and negative attitudes were expressed by 345 (13.6 %) and 233 (9.2 %) participants, respectively. Factors associated with positive attitudes towards COVID-19 vaccination in multivariate analysis included disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies. Higher COVID-19 vaccine uptake was significantly associated with previous history of COVID-19 infection, higher income, residence outside the Capital, disbelief in COVID-19 misinformation, disagreement with vaccine conspiracies, and reliance on reputable information sources.

Conclusion

COVID-19 vaccine coverage was high among the participants, with a majority having positive attitudes towards COVID-19 vaccination. Disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies were correlated with positive vaccine attitudes and higher vaccine uptake. These insights can inform targeted interventions to enhance vaccination campaigns.

Predicting vaccination hesitancy: The role of basic needs satisfaction and institutional trust

Autonomous motivation is considered a powerful driver of health behaviour, but less is known about the specific roles played by basic needs. Drawing on the context of the COVID-19 pandemic, this research examined basic needs as a motivational determinant of vaccination. We hypothesized that satisfaction of basic needs (autonomy, competence, relatedness) has both a direct and an indirect effect (through trust in science and government) on vaccine hesitancy. Two studies (Study 1: N = 968 French and British; Study 2, pre-registered: N = 716 Americans) tested our hypotheses and compared vaccinated and non-vaccinated individuals using multigroup structural equation models. We found positive direct (in both studies) and indirect (in Study 1) effects of autonomy satisfaction on vaccine acceptance. In contrast, competence satisfaction was directly and indirectly, via science mistrust, related to vaccine hesitancy, particularly among non-vaccinated people. Competence satisfaction also indirectly reduced the intention to vaccinate in both studies. We found no impact of relatedness. Complementing previous work on self-determination theory, our research demonstrates the importance of considering the distinct roles of basic needs. Moreover, we highlight that increasing autonomy and science trust may be an efficient strategy to improve vaccine acceptance and vaccination, even among reluctant individuals.

Hesitancy Towards COVID-19 Vaccine Among Students of Medical and Allied Health Sciences in Khyber Pakhtunkhwa

Objective

To measure COVID-19 vaccine hesitancy and its associated factors among medical and allied health sciences students of Khyber Pakhtunkhwa.

Methodology

This cross-sectional survey was conducted online using Google survey platform in March 2021. Study population comprised of medical and allied health sciences students studying in medical/allied health sciences academic institutes in Khyber Pakhtunkhwa. The web-based online link was provided to around 800 students to fill in the questionnaire via email, WhatsApp and/or social media network. Response rate was around 50%. The main outcome variable was vaccine hesitancy. Factors associated with vaccine hesitancy were explored by bivariate and multivariate regression analysis.

Results

Out of 398 medical and allied health sciences students, there were 193 (48.5%) males and 205 (51.5%) females with mean age was 22.6± 2.8 years. The vaccine hesitancy rate was found to be 52.8%. A significant relationship between vaccine hesitancy and gender was observed. Other factors including lack of adequate knowledge about vaccines (p < 0.001), Chinese origin of vaccines (p < 0.001), lack of knowledge that vaccination can reduce the chances of acquiring infection (p < 0.001), fear of potential side effects (p < 0.001) and hidden agenda behind free forceful vaccination (p = 0.045), were found to be main barriers or reasons responsible for COVID-19 vaccine hesitancy among medical and allied health sciences students.

Conclusion

Important associated barriers with COVID-19 vaccine hesitancy included gender, lack of information, fear of side effects, lack of trust in imported and Chinese vaccines, and perception of hidden agenda behind COVID-19 vaccination.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

One-size fits all? Evaluating group differences in an integrated social cognition model to understand COVID-19 vaccine intention and uptake

Vaccine programs significantly reduce disease burden within a population. The COVID-19 vaccine facilitated a return to "normal"; however, vaccine coverage remains below target levels. Identifying predictors of vaccine uptake is vital for individual and community health. The present study used the Reasoned Action Approach and integrated hazard-specific risk perception, to predict COVID-19 vaccine intention and uptake behavior. Informed by the diffusion of innovations theory, differences in associations and model effects were tested by early adopter status of the seasonal influenza vaccine. We recruited participants online within the United States for a longitudinal survey study. The integrated social cognition model provided an acceptable to ideal fit for both groups but performed better among the not early adopter group with better fit statistics, mostly stronger effect sizes, and greater variance accounted for in intention to vaccinate against COVID-19. Instrumental attitudes toward the COVID-19 vaccine predicted intention for both groups, and uptake among the non-early adopters. Capacity predicted intention among early adopters, and behavior among non-early adopters. Among non-early adopters, subjective norms had a direct effect on intention and an indirect effect on vaccine uptake behavior. Intervention research to support COVID-19 vaccine uptake focusing on the utility of vaccines, fostering self-efficacy, and providing normative information is warranted.

Investigating Beliefs in Anti-Vax Conspiracy Theories among Medical Students

While the doctors' role in immunization is essential, their lack of knowledge or vaccine hesitancy may affect their ability to communicate effectively and educate patients about vaccination, vaccine hesitancy, and vaccine conspiracy theories. This, in turn, may hinder health policy aimed at fighting infectious diseases. Vaccine hesitancy is prevalent not only among the general population but also among healthcare workers; thus, this study is aimed at assessing future doctors' attitudes towards anti-vax conspiracy theories. A total of 441 medical students at Poznan University of Medical Sciences completed a web-based survey designed to explore their attitudes toward the six most prevalent anti-vaccine conspiracy theories. The survey showed that although over 97% of future doctors support vaccinations as an effective form of fighting infectious diseases, and 80% did not believe in any anti-vax conspiracy theory, a significant fraction of 20% of medical students either believed in at least one such theory or were unsure. It has also shown that male and younger students who had not received a flu vaccination and defined themselves as politically right-wing or conservative and religious were more likely to believe in anti-vax conspiracy theories. Our data suggest that, in order to overcome medical students' ambivalent attitudes towards anti-vax conspiracy theories, they should receive more education about the importance of vaccination in preventing disease and about effective ways to combat vaccine hesitancy and anti-vax conspiracy theories.

The Vaccination Fear Scale (VFS-6): Adaptation, Cross-Cultural Validation, and Invariance among Genders and Six Different Cultures, Applying Classical Test Theory (CTT) and Item Response Theory (IRT)

The coronavirus disease 2019 (COVID-19) pandemic had a meaningful impact on several areas of human activity. With respect to psychological assessment, the requirements to study the fear of vaccination as a means to diminish negative behaviour towards vaccination had been reported. This study aimed to evaluate the factorial invariance of the six-item Vaccination Fear Scale (VFS-6) across individuals and cultures. To achieve this goal, a sample of university students was recruited (n = 2535; mean age = 20.59, SD = 2.04; males: 26.75%, females: 73.25%) from Spain (n = 388; 15.3%), Italy (n = 376; 14.83%), Lebanon (n = 487; 19.21%), Nigeria (n = 561; 22.13%), Turkey (n = 410; 16.17%), and Ukraine (n = 313; 12.34%). The results showed that the most appropriate factorial structure, exhibiting excellent fit indices, was a model with two correlated factors (cognitive symptoms: items 1, 2, and 4; somatic symptoms: items 3, 5, and 6) for both the total sample and individual samples from each country and language (Spanish, Italian, Arabic, English, Turkish, and Ukrainian). Notably, the VFS-6 demonstrated configural, metric, scalar, and strict invariance across sex. Regarding countries and languages, configural invariance was observed between them. Also, metric invariance was observed between Spain, Italy, and Ukraine and between Lebanon, Nigeria, and Turkey, which indicates the presence of two well-differentiated groups of countries and the possibility of inferential analysis between them. Item Response Theory analysis suggested an appropriate level of discrimination and difficulty of the test. These significant findings lay the groundwork for future investigations into vaccination fear across diverse cultural backgrounds, providing valuable insights for addressing vaccination-related concerns worldwide.

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

Background

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

Methods

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

Results

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

Conclusion

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

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.

A Survey of Fear for Others, Fear for Self, and Pandemic Anxiety Predicting Intention to Take the First Booster Vaccine to Combat COVID-19

This study examined the impact of fear and anxiety on the intent to take the first COVID-19 booster vaccine. The objective of this study is to provide guidance for messaging campaigns of public health practitioners. A survey approach provided insights about individuals' emotions of fear and anxiety related to adopting the first booster vaccine for the Coronavirus disease 2019 (COVID-19).

METHODS

Three independent variables were considered in their ability to predict the intent to take the first COVID-19 booster vaccine (BINT): Fear for Others (FOTH), Fear for SELF (FSELF), and COVID-19 Anxiety (CANX).

RESULTS

The confirmatory factor analysis supported an underlying three-factor solution for three central emotions in this study. A path analysis indicated significant direct effects for FOTH and FSELF in the prediction of BINT. The interdependent nature of these variables on the intent to get the first booster vaccine also was indicated by significant indirect effects.

DISCUSSION

Fear should be more precisely refined to include the fear for others (FOTH) beyond consideration of the fear for self (FSELF) from the impact of COVID-19.

CONCLUSIONS

FOTH and FSELF were demonstrated to be direct predictors of BINT. CANX was only found to be significant as part of indirect effects impacting BINT. Future investigation should be given to the mediating role of anxiety with FOTH and FSELF as the context changes.

From intentions to practices: what drove people to get the COVID-19 vaccine? Findings from the French longitudinal socioepidemiological cohort survey

OBJECTIVE

In many countries, before COVID-19 vaccines became available, reluctance to get vaccinated was particularly prevalent among women, the most disadvantaged social groups and ethnoracial minorities, known to be at higher risk for the virus. Using a longitudinal perspective, we analyse the social determinants that are associated with the transition from attitudes towards vaccination to actual vaccination practices.

DESIGN

Representative population-based prospective cohort.

SETTINGS

From November 2020 to July 2021.

PARTICIPANTS

Adults included in the Epidemiology and Living Conditions (EpiCoV) cohort (n=86 701).

MAIN OUTCOME MEASURES

Attitudes towards vaccination in November 2020 before COVID-19 vaccines were available in France (in January 2021) and vaccination practices in July 2021.

RESULTS

Among those who were initially reluctant in November 2020, the youngest, the poorest 10% (OR=0.68, 0.59-0.77), non-European immigrants (OR=0.72, 0.59-0.88) and descendants of non-European immigrants (OR=0.72, 0.61-0.86) were less likely to be vaccinated in July 2021, irrespective of trust in government and scientists. The same social factors were associated with non-vaccination among those who initially were undecided or who favoured vaccination.

CONCLUSION

Despite the fact that COVID-19 vaccines were relatively available and free of charge in France in July 2021, social inequalities in vaccination against the virus remained the same than those observed in vaccination reluctance in November 2020, before vaccines were available. While adjusting for trust, migration background, younger age and lower income were associated with lower vaccination uptake irrespective of initial intention. By neglecting to genuinely target specific groups that were initially reluctant to be vaccinated, vaccination policies contributed to strengthening pre-existing social inequalities around COVID-19 burden.

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.

Psychological Factors of Vaccination Intent among Healthcare Providers, Parents, and Laypeople

The interrelatedness of social-structural aspects and psychological features with vaccination intention provides the context to explore personal psychological features related to vaccination. Specifically, we focused on general decision making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. Our study aimed to map the function (promotive, protective, risk, vulnerability) of a set of personal psychological aspects in the intention to vaccinate among people holding different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and laypeople, within the post-pandemic context. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from -0.128 to -0.983, all ps < 0.01). The main results indicate that, regardless of the sample/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate: for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system, play such roles; for HPs, the experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. Our findings provide insights into the function of psychological factors of vaccination intention across different social roles, particularly healthcare providers, parents, and laypeople, and emphasize the need for tailored immunization interventions in the post-pandemic landscape.

Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID-19

BACKGROUND

Vaccination against COVID-19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5-17 years against COVID-19 by applying the Theory of Planned Behavior.

METHODS

Participants in this cross-sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID-19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling.

RESULTS

Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non-Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID-19 vaccine. Over one-third (37.5%) of caregivers reported disagreement or indecision about future COVID-19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID-19 information-seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID-19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms.

CONCLUSIONS

Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy.

Vaccine Conspiracy Beliefs Scale: Validation and Measurement Invariance in a Youth Sample

The Vaccine Conspiracy Beliefs Scale (VCBS) is a widely used measure of conspiracy beliefs about vaccines, but evidence of its validity and measurement invariance, especially in youth samples, is still largely missing. The present study examined VCBS scores' factor structure, measurement invariance, convergent and discriminant validity, and incremental predictive validity. A sample of 803 Serbian youths (age range 15-24; 59.2% females) was recruited for the study. A modified single-factor model of the VCBS was supported, and showed evidence of full scalar invariance across gender, age, vaccination status, and personal history of COVID-19. Evidence of the VCBS scores' convergent and discriminant validity was obtained by examining associations with general conspiracy beliefs, vaccination attitudes, vaccination knowledge, intentions to get vaccinated against COVID-19, paranoia worries, fear of injections and blood draws, importance of God, self-rated health, and self-rated family's financial situation. The VCBS scores predicted a unique variance in the intention to get vaccinated against COVID-19, over and above vaccination attitudes and vaccination knowledge. The results suggest that the VCBS is a valid measure of vaccine conspiracy beliefs in youth.

Relationship Between Fear of Monkeypox and Intention to be Vaccinated Against Monkeypox in a Peruvian Sample. The Mediating Role of Conspiracy Beliefs About Monkeypox

The present study evaluated the predictive capacity of fear of Monkeypox (MPX) on the intention to be vaccinated against MPX and the influence of conspiracy beliefs as a mediating variable in this relationship in 516 Peruvian sample with an average age of 27.10 years participated. Monkeypox Fear Scale, MPX Conspiracy Beliefs Scale and a single item of intention to be vaccinated against MPX were used. Statistical analyses have included estimation of descriptive statistics for all variables in the model tested and Structural Equation Modeling to predict intention to be vaccinated against monkeypox. It has been found that fear has a positive impact on conspiracy beliefs about MPX and intention to be vaccinated against MPX. Finally, conspiracy beliefs are negatively related to intention to be vaccinated. As for indirect effects, both are statistically significant. The model explains 11.4% of the variance in beliefs and 19.1% in intention to be vaccinated. It is concluded that fear of MPX played an important role, both directly and indirectly, in the intention to be vaccinated against MPX, having conspiratorial beliefs about MPX as a mediating variable. The results have important implications for public health practices aimed at combating doubts about MPX vaccination.

Comparison of SARS-CoV-2 Vaccination Skepticism, Reasons, and Concerns Between Mass Vaccination Centers and General Practices in Germany 2021

Introduction

The reluctance to be vaccinated against COVID-19 has significantly curbed vaccine uptake. Unlike mass vaccination centers, general practitioners (GPs) might be able to address some of the patients' concerns through their long-term doctor-patient relationship. This study compared vaccination reasons, concerns and skepticism about vaccination, and perceived importance of the vaccine and its hypothetical value between vaccination centers and GP practices.

Methods

A survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474).

Results

Participants in vaccine centers stated more prosocial and benefit-oriented reasons for vaccination, whereas participants in GP practices more often stated the GP's recommendation as the reason. Perceived importance of the vaccine in combating the pandemic was rated higher among individuals at vaccine centers and with higher health awareness and self-efficacy. Participants at both types of sites who preferred a GP for vaccination expressed more vaccination skepticism, which was also related to older age, more health risk concerns related to COVID-19 vaccines, and lower perceived importance of the vaccine.

Conclusion

Our results indicate opportunities for framing future vaccination campaigns that include vaccination centers. Additionally, a rapid GP involvement in future mass vaccinations might be crucial for overcoming attitudinal barriers and achieving higher vaccine uptake.

Sense of safety and opinions about COVID-19 vaccinations in Polish school teachers: the role of conspiracy theories belief and fear of COVID-19

The co-occurrence of COVID-19 conspiracy theories (CCT) and fear of the coronavirus (FCV) can be linked to how safe people feel and how much they endorse vaccinations. School teachers were one of the vaccination priority groups in Poland. We conducted three cross-sectional studies (N1 = 1006; N2 = 1689; N3 = 627) to find out the potential interaction effects of CCT belief and FCV in predicting sense of safety (SoS; Studies 1-3), opinions about vaccinations efficacy (Studies 2-3) and endorsement of vaccinations of children (Study 3) among school teachers. In all three studies, the belief in CCT was related to lower SoS only when FCV was low. For low CCT belief, although the belief in vaccination efficacy was higher than for CCT endorsers, it was unrelated to FCV. However, for high and average CCT belief, FCV was linked to belief in vaccination efficacy. FCV was positively related to acceptance of vaccinating children on all levels of CCT endorsement. The results are discussed in light of the available literature and their potential use in public health.

Believing in conspiracy theories in Spain during the COVID-19 pandemic: Drivers and public health implications

Conspiracy theories jeopardize public health by disseminating misinformation and undermining authoritative health guidelines. This study explores social factors associated with the belief in conspiracy theories in Spain during the COVID-19 pandemic. Drawing upon the theoretical framework of Max Weber, it posits that beliefs in conspiracy theories are linked to both instrumental rationality considerations, such as trust in health authorities, science, and pharmaceutical companies, as well as value-rationality based factors, such as ideological orientation. The study analyzes recent, nationally representative survey data and is the first to examine the social predictors of belief in conspiracy theories in Spain during the pandemic. The findings highlight that conspiracy theory beliefs are (a) associated with considerably worse vaccination behaviors, (b) not or only very weakly associated with standard demographics such as age, sex, or education, (c) related to instrumental rationality considerations, and (d) only weakly related to value-rationality indicators such as ideological and religious affiliations. In conclusion, the study underscores the significance of public health policies that specifically address conspiracy theory convictions, and to that end, advocates for the application of a Weberian sociological perspective to better understand the diverse rationalities underlying these beliefs, particularly in the absence of discernible demographic predictors.

Vaccination Attitudes Examination (VAX) Scale: a Bifactor-ESEM approach in a youth sample (15-24 years)

BACKGROUND

The Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX's structural, convergent, and discriminant validity is still limited, especially in youth samples.

METHODS

The present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (Mage = 18.23, SDage = 2.66, age range = 15-24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria.

RESULTS

The results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors' contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry.

CONCLUSIONS

The present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes.

Vaccine attitudes and acceptance among older adults in North Dakota: Understanding demographic characteristic variability

OBJECTIVES

Older adults face increased risks from infectious diseases which are often preventable with vaccines. The current study examines demographic variation in vaccine hesitancy among older adults in North Dakota.

METHODS

A mailed survey assessing age, gender, years of education, self-rated health, rurality, and political leaning as well as vaccine attitudes and vaccine acceptance was conducted with 739 older adults (65+), oversampled from rural counties.

RESULTS

Vaccine hesitant attitudes were significantly higher among rural and politically-conservative older adults; whereas, vaccine acceptance was significantly higher among older, healthier, and politically-liberal older adults. Vaccine attitudes were significantly associated with vaccine acceptance and mediated the association between political leaning and vaccine acceptance.

DISCUSSION

These findings highlight the demographic characteristics predictive of older adults' vaccine attitudes and acceptance. By better understanding the nuanced factors leading to hesitation to be vaccinated, practitioners can develop strategies to increase vaccination rates among this at-risk population.

Understanding and managing the Self-Wise during a healthcare crisis

The COVID-19 pandemic has brought an interesting yet worrisome phenomenon to the fore. A segment of the population, which we call the Self-Wise, seems to exhibit an inflated sense of self-expertise relative to domain experts, which - combined with a lack of trust in the latter - leads them to ignore or reject expert advice. We argue and demonstrate that this phenomenon is distinct from other "illusory superiority" phenomena, most notably Dunning-Kruger and Lake Wobegon. Three studies with US participants provide compelling evidence for the existence of the Self-Wise phenomenon. In the context of COVID-19, its behavioral consequences are non-compliance with expert-based COVID-19 guidelines and measures (e.g., wearing a mask and getting vaccinated). The studies also provide insight into additional characteristics of the Self-Wise, which can be used for identification and targeting purposes. We tested the effectiveness of two tailored interventions that aimed at reducing this segment's "illusory superiority" and (re-)establishing their trust in medical experts. The interventions proved effective in terms of reducing the "illusory superiority" of the Self-Wise, and generally enhanced the participants' intention to comply with COVID-19 guidelines. However, to substantially change the non-conforming COVID-19 behavior of the Self-Wise likely requires stronger and sustained mitigation strategies or interventions.

Misinformation, Trust, and Use of Ivermectin and Hydroxychloroquine for COVID-19

Importance

The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment.

Objective

To quantify the prevalence of non-evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists.

Design, Setting, and Participants

This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection.

Main Outcome and Measure

Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources.

Results

A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non-evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non-evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non-evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non-evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13).

Conclusions and Relevance

In this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non-evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.

Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study

People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.

A comparative study of eight COVID-19 protective measures and their impact on Swiss tourists' travel intentions

A comparative vignette-based experimental survey design incorporating various socio-psychological factors, linked to the Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and the Domain-Specific Risk-Taking scale (DOSPERT) was carried out to test variations in eight travel-related COVID-19 protective measures on Swiss tourists' travel intentions. Among the tested measures, vaccination passports, surgical masks and quarantining are those that stand out the most, with surgical masks having the greatest acceptance and willingness to adopt while traveling. Quarantining, on the other hand, appears to have a deterrent influence on travel intentions, and vaccination passports have the lowest perceived barriers during travel, but the highest perceived benefits in mitigating the spread of the infection. The discussion of individual differences has specific implications for tourism management against the background of our empirical findings.

Anti-Vaccination Attitude and Vaccination Intentions Against Covid-19: A Retrospective Cross-Sectional Study Investigating the Role of Media Consumption

Objective

The present study explores, retrospectively, the link between anti-vaccination attitude and vaccination intentions and extends this relationship to the effect of media consumption style on attitude.

Method

Generalized linear mixed-models were used to estimate vaccination intentions (related to each of the four available vaccines at the time of the survey) relying on anti-vaccination attitude measured using the Italian translation of the Vaccination Attitude Examination (VAX) scale. Multiple linear regression was used to estimate which media type and which consumption frequency were responsible for variation in the anti-vaccination attitude.

Results

Greater anti-vaccination attitude led to lower vaccination intention (b=-8.33, p<.0001) confirming the attitude-intention link. Crucially, consuming vaccination related information via printed press weekly (b=-0.74, p=.0001) or daily (b=-0.96, p<.0001) were the only protective factors against developing anti-vaccination attitudes. On the other hand, discussing vaccination with the family physician weekly (b=0.66, p=.002) or even daily (b=0.52, p=.026), and actively looking for vaccination related information on specialized websites and blogs every day (b=0.64, t=2.78, p=.006) were risk factors related to increased anti-vaccination attitude. No effects of social media on anti-vaccination attitude were found.

Conclusions

The results confirm that vaccination intentions can be linked to the underlying anti-vaccination attitude. Moreover, our results suggest that the web and the blog sphere, but not social media, are the most anti-vaccination fuelling media and that health practitioners engage with the most vaccination-hesitant individuals. Further interventions could leverage these insights to tackle the vaccination hesitancy issue.

[COVID-19 vaccination status, sources of used information and socio-demographic characteristics-results of the CoSiD study]

BACKGROUND

Despite the benefits of a COVID-19 vaccination, too few people in Germany were still considered vaccinated in the summer of 2022. This was explained, among other factors, by socio-demographic differences. The article also analyses this correlation by including the sources of information used on corona vaccination based on the data from the third survey of the "Accompanying research on the communication of corona vaccination in Germany" (CoSiD study, Nov./Dec. 2021; n = 4366 16-year-olds and older).

METHODS

Bi- and multivariate correlations were analysed between the uptake of vaccination or the intention to vaccinate of the unvaccinated and socio-demographic characteristics as well as sources of information on COVID-19 vaccination.

RESULTS

Of the respondents, 87.7% have been vaccinated at least once. The vaccination rate tends to increase with age, education level and household income and is higher among people in the old federal states and without a migration background. The sources of information on COVID-19 vaccination were mostly discussions among family, friends and colleagues (81.8%) and German TV and radio stations (77.1%). In the multivariate model, higher proportions of people without vaccination intentions were found among respondents who obtained information from TV and radio stations from abroad as well as from social media.

DISCUSSION

Information offerings for specific target groups must take social inequalities even more into account. One challenge here is that the use of different information sources is related to different vaccination intentions. In particular, people with vaccination intentions and the undecided can be reached with easily understandable, trustworthy information offerings.

Predictors of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses: A cross-sectional study

AIMS AND OBJECTIVES

To assess the levels of second COVID-19 booster dose/new COVID-19 vaccine hesitancy among nurses and explore the potential predictors of vaccine hesitancy.

BACKGROUND

COVID-19 full vaccination seems to be highly effective against highly contagious variants of SARS-CoV-2. Healthcare workers are at high-risk group since they have experienced high levels of COVID-19-associated morbidity and mortality.

DESIGN

An on-line cross-sectional study was carried out in Greece in May 2022, using a self-administered questionnaire.

METHODS

The study population included nurses in healthcare services who were fully vaccinated against COVID-19 at the time of study. We considered socio-demographic characteristics, COVID-19-related variables, and attitudes toward COVID-19 vaccination and pandemic as potential predictors of vaccine hesitancy. We applied the STROBE checklist in our study.

RESULTS

Among 795 nurses, 30.9% were hesitant toward a second booster dose or a new COVID-19 vaccine. Independent predictors of hesitancy included lower educational level, absence of a chronic condition, good/very good self-perceived physical health, lack of flu vaccination during 2021, front-line nurses that provided healthcare to COVID-19 patients, nurses that had not been diagnosed with COVID-19 and nurses that had at least one relative/friend that has died from COVID-19. Moreover, increased compliance with hygiene measures, increased fear of a second booster dose/new COVID-19 vaccine and decreased trust in COVID-19 vaccination were associated with increased hesitancy.

CONCLUSIONS

Our study shows that a significant percentage of nurses are hesitant toward a second booster dose/new COVID-19 vaccine. This initial hesitancy could be a barrier to efforts to control the COVID-19 pandemic.

RELEVANCE TO CLINICAL PRACTICE

Nurses' role during the COVID-19 pandemic is essential since they are the front-line healthcare workers empowering the public with their passion and empathy. There is a need to communicate COVID-19 vaccine science in a way that is accessible to nurses in order to decrease COVID-19 vaccine hesitancy.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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.

Analysis of Differences in User Groups and Post Sentiment of COVID-19 Vaccine Hesitators in Chinese Social-Media Platforms

(1) Background: The COVID-19 epidemic is still global and no specific drug has been developed for COVID-19. Vaccination can both prevent infection and limit the spread of the epidemic. Eliminating hesitation to the COVID-19 vaccine and achieving early herd immunity is a common goal for all countries. However, efforts in this area have not been significant and there is still a long way to go to eliminate vaccine hesitancy. (2) Objective: This study aimed to uncover differences in the characteristics and sentiments of COVID-19 vaccine hesitators on Chinese social-media platforms and to achieve a classification of vaccine-hesitant groups. (3) Methods: COVID-19-vaccine-hesitation posts and user characteristics were collected on the Sina Microblog platform for posting times spanning one year, and posts were identified for hesitation types. Logistic regression was used to conduct user-group analysis. The differences in user characteristics between the various types of COVID-19 vaccine posts were analysed according to four user characteristics: gender, address type, degree of personal-information disclosure, and whether they followed health topics. Sentiment analysis was conducted using sentiment analysis tools to calculate the sentiment scores and sentiment polarity of various COVID-19 vaccine posts, and the K-W test was used to uncover the sentiment differences between various types of COVID-19-vaccine-hesitation posts. (4) Results: There are differences in the types of COVID-19-vaccine-hesitation posts posted by users with different characteristics, and different types of COVID-19-vaccine-hesitation posts differ in terms of sentiment. Differences in user attributes and user behaviors are found across the different COVID-19-vaccine-hesitation types. Ultimately, two COVID-19-vaccine-hesitant user groups were identified: Body-related and Non-bodily-related. Users who posted body-related vaccine-hesitation posts are more often female, disclose more personal information and follow health topics on social-media platforms. Users who posted non-bodily-related posts are more often male, disclose less personal information, and do not follow health topics. The average sentiment score for all COVID-19-vaccine-hesitant-type posts is less than 0.45, with negative-sentiment posts outweighing positive- and neutral-sentiment posts in each type, among which the "Individual rights" type is the most negative. (5) Conclusions: This paper complements the application of user groups in the field of vaccine hesitation, and the results of the analysis of group characteristics and post sentiment can help to provide an in-depth and comprehensive analysis of the concerns and needs of COVID-19 vaccine hesitators. This will help public-health agencies to implement more targeted strategies to eliminate vaccine hesitancy and improve their work related to the COVID-19 vaccine, with far-reaching implications for COVID-19-vaccine promotion and vaccination.

Defensive information processing and nonadherence to health-protective behaviors

PLAIN LANGUAGE SUMMARY

In this issue of Cancer, Clarke et al. measure defensive information processing (DIP) to avoid fecal immunochemical testing for colorectal cancer. DIP is a way of reducing the negative psychological effects of threats such as cancer and may influence health-protective behaviors such as the completion of recommended cancer screening. This editorial complements Clarke et al.'s study with a discussion of interventions for decreasing DIP around cancer screening and other health-protective recommendations.