Development and Validation of the Multidimensional COVID-19 Vaccine Hesitancy Scale

The Motivation for COVID-19 Vaccination and Preventive Behavior

COVID-19, a viral infection that emerged in late 2019, induces a severe acute respiratory syndrome marked by significant clinical symptoms, and the potential for progressive respiratory failure and death. People facing the threat of COVID-19 not only feared being infected, but were also worried about the side-effects of vaccination. This conflict affected their epidemic prevention behavior. To understand this issue, the present study explored whether infection anxiety affected the psychological avoidance or approach to getting vaccinated and the intention to take epidemic prevention measures. The study implemented a cross-sectional, web-based survey. We created questionnaires using Surveycake, an online e-form questionnaire platform. We used the snowball sampling method via a social media app to recruit participants. If individuals were willing to participate in the research, we emailed the e-form questionnaire link to them to collect data. After questionnaire collection, 288 questionnaires were returned, and 277 valid questionnaires were obtained for structural equation modeling analysis. According to the statistical results, it was found that infection anxiety was positively related to avoidance-avoidance conflict, and the power of infection anxiety on avoidance conflict was 23.0%. Infection anxiety was negatively related to approach-approach conflict regarding vaccination, and the power of infection anxiety on approach-approach conflict was 22.0%. Approach-approach conflict regarding vaccination was negatively related to prevention behavior, while avoidance-avoidance conflict regarding vaccination was positively related to prevention behavior. The two conflicts explained 12.5% of the total variance in prevention behavior. The study results highlight the long-term importance of achieving vaccine goals in order to prepare for future health emergencies similar to the recent COVID-19 pandemic.

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.

Understanding COVID-19 vaccine hesitancy in Meghalaya, India: Multiple correspondence and agglomerative hierarchical cluster analyses

Meghalaya, a state in the northeastern region of India, had a markedly low vaccine uptake compared to the other states in the country when COVID-19 vaccines were being rolled out in 2021. This study aimed to characterize the distinct vaccine-hesitant subpopulations in healthcare and community settings in Meghalaya state in the early days of the vaccination program. We used data from a cross-sectional survey that was administered to 200 healthcare workers (HCWs) and 200 community members, who were a priori identified as 'vaccine-eligible' and 'vaccine-hesitant,' in Shillong city, Meghalaya, in May 2021. The questionnaire collected information on participants' sociodemographic characteristics, COVID-19 history, and presence of medical comorbidities. Participants were also asked to provide a dichotomous answer to a set of 19 questions, probing the reasons for their hesitancy towards COVID-19 vaccines. A multiple correspondence analysis, followed by an agglomerative hierarchical cluster analysis, was performed to identify the distinct clusters of vaccine-hesitant participants. We identified seven clusters: indecisive HCWs (n = 71), HCWs skeptical of COVID-19 and COVID-19 vaccines (n = 128), highly educated male tribal/clan leaders concerned about infertility and future pregnancies (n = 14), less educated adults influenced by leaders and family (n = 47), older adults worried about vaccine safety (n = 76), middle-aged adults without young children (n = 56), and highly educated ethnic/religious minorities with misinformation (n = 8). Across all the clusters, perceived logistical challenges associated with receiving the vaccine was identified as a common factor contributing to vaccine hesitancy. Our study findings provide valuable insights for local and state health authorities to effectively target distinct subgroups of vaccine-hesitant populations with tailored health messaging, and also call for a comprehensive approach to address the common drivers of vaccine hesitancy in communities with low vaccination rates.

"I See a lot of Crazy Things and I Don't Know What to Believe": Lessons Learned about Health Literacy and Strategies for Communicating with Vaccine-Hesitant College Students

Throughout the COVID-19 pandemic, the American College Health Association (ACHA) has partnered with CommunicateHealth (CH) to develop COVID-19 mitigation resources for colleges and universities. In 2021, the CH team conducted a series of applied research activities to gain a nuanced understanding of factors that shape perceptions of risk and drive vaccine hesitancy among campus audiences-especially college students who are emerging adults (approximately ages 18 to 22). Based on our findings, CH and ACHA identified key traits of vaccine-hesitant college students and implications for future vaccine communication campaigns. First, vaccine-hesitant students are more likely to ask "why" and "how" questions such as "Why do I need to get vaccinated?" and "How was the vaccine developed and tested?". Secondly, these students want to have open, authentic dialogue rather than simply accepting health recommendations from a trusted source. Finally, the CH team noted that vaccine-hesitant students were not highly motivated by their own personal risk of getting sick from COVID-19; concern about spreading COVID-19 to others was a much stronger motivating factor. Leveraging these insights, CH and ACHA developed strategies to apply health literacy principles to reach vaccine-hesitant college students with the right information at the right time-and to leverage relevant motivators and overcome barriers to vaccination. By implementing these strategies, CH and ACHA developed clear and empowering educational materials about COVID-19 vaccination tailored to the unique information needs of vaccine-hesitant students.

A Parent Version of the Motors of COVID-19 Vaccination Acceptance Scale for Assessing Parents' Motivation to Have Their Children Vaccinated

Parents' motivation to vaccinate their children against coronavirus disease 2019 (COVID-19) plays a crucial role in the uptake of COVID-19 vaccines among children. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) is a valuable tool for assessing individuals' vaccination-related attitudes and the factors influencing their decision to be vaccinated against COVID-19. This study adapted the MoVac-COVID19S to create a parent version (P-MoVac-COVID19S) and examined the psychometric soundness of two P-MoVac-COVID19S versions (a 9-item version (P-MoVac-COVID19S-9) and a 12-item version (P-MoVac-COVID19S-12)) for assessing parents' motivation to vaccinate their children. A total of 550 parents completed the P-MoVac-COVID19S and a questionnaire assessing the factors that impact parents' intention to allow their children to receive the COVID-19 vaccine using a vaccine acceptance scale. We enquired about the level of parental worry regarding the adverse effects of COVID-19 vaccines on children's health and the number of COVID-19 vaccine doses received by parents. The factor structures of the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 were examined using confirmatory factor analysis. The internal consistency, test-retest reliability, and concurrent validity of the P-MoVac-COVID19S were also examined. The results revealed that the P-MoVac-COVID19S-12 has a four-factor structure, which aligns well with the theoretical framework of the cognitive model of empowerment; the P-MoVac-COVID19S-9 has a one-factor structure. Both the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 had good internal consistency and test-retest reliability and acceptable concurrent validity. The results of this study demonstrated that the P-MoVac-COVID19S is a reliable and valid instrument for assessing parent's motivation to vaccinate their children against COVID-19.

Measuring the importance of influencing factor for COVID-19 vaccination intention in China

Background

Vaccination is considered an effective approach to deter the spread of coronavirus disease (COVID-19). However, vaccine hesitancy is a common issue that makes immunization programs more challenging. To promote vaccination in a targeted and efficient way, this study aims to develop and validate a measurement tool for evaluating the importance of influencing factors related to COVID-19 vaccination intention in China, and to examine the demographic differences.

Methods

In study 1, we developed a Factor Importance Evaluation Questionnaire (FIEQ) based on semi-structured interview results and used exploratory factor analysis (EFA) to explore its factor structure. In study 2, we verified the four-factor structure of FIEQ by confirmatory factor analysis (CFA). We then administered FIEQ to Chinese participants and conducted a student t-test and analysis of variance to examine the differences in the importance evaluation of factors based on gender and educational level.

Results

In study 1, we developed a four-factor construct and retained 20 items after EFA (N = 577), with acceptable reliability (alpha = 0.87) and validity. In study 2, we found that the model fit was good (χ2 = 748.03 (162), p < 0.001, GFI = 0.949, RMSEA = 0.049, SRMR = 0.048, AGFI = 0.934), and reliability was acceptable (alpha = 0.730) (N = 1,496). No gender difference was found in factor importance. However, individuals with different educational levels reported significantly different importance evaluations of three factors, including perceived benefits and social norms (F = 3.786, p = 0.005), perceived influences from reference groups (F = 17.449, p < 0.001), and perceived risks (F = 2.508, p = 0.04).

Conclusion

This study developed and validated FIEQ for measuring the importance of influencing factors related to the COVID-19 vaccination intention in Chinese participants. Moreover, our findings suggest that the educational level may play a role in how individuals evaluate the importance of factors. This study provides insights into the concerns that individuals have regarding vaccination and offers potentially effective and targeted strategies for promoting COVID-19 vaccination.

Factors associated with COVID-19 vaccination during June-October 2021: A multi-site prospective study

INTRODUCTION

Vaccine hesitancy presents a challenge to COVID-19 control efforts. To identify beliefs associated with delayed vaccine uptake, we developed and implemented a vaccine hesitancy survey for the COVID-19 Community Research Partnership.

METHODS

In June 2021, we assessed attitudes and beliefs associated with COVID-19 vaccination using an online survey. Self-reported vaccination data were requested daily through October 2021. We compared responses between vaccinated and unvaccinated respondents using absolute standardized mean differences (ASMD). We assessed validity and reliability using exploratory factor analysis and identified latent factors associated with a subset of survey items. Cox proportional hazards models and mediation analyses assessed predictors of subsequent vaccination among those initially unvaccinated.

RESULTS

In June 2021, 29,522 vaccinated and 1,272 unvaccinated participants completed surveys. Among those unvaccinated in June 2021, 559 (43.9 %) became vaccinated by October 31, 2021. In June, unvaccinated participants were less likely to feel "very concerned" about getting COVID-19 than vaccinated participants (10.6 % vs. 43.3 %, ASMD 0.792). Among those initially unvaccinated, greater intent to become vaccinated was associated with getting vaccinated and shorter time to vaccination. However, even among participants who reported no intention to become vaccinated, 28.5 % reported vaccination before study end. Two latent factors predicted subsequent vaccination-being 'more receptive' was derived from motivation to protect one's own or others' health and resume usual activities; being 'less receptive' was derived from concerns about COVID-19 vaccines. In a Cox model, both factors were partially mediated by vaccination intention.

CONCLUSION

This study characterizes vaccine hesitant individuals and identifies predictors of eventual COVID-19 vaccination through October 31, 2021. Even individuals with no intention to be vaccinated can shift to vaccine uptake. Our data suggest factors of perceived severity of COVID-19 disease, vaccine safety, and trust in the vaccine development process are predictive of vaccination and may be important opportunities for ongoing interventions.

COVID-19 Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional Study

The current healthcare system’s efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Factors influencing attitudes toward vaccine safety and vaccine effectiveness amongst UK healthcare professionals prior to and at the time of COVID-19 vaccine rollout: Insights from the CoPE-HCP cohort study

Given the potential for nosocomial outbreaks, we must understand factors associated with negative vaccine attitudes amongst healthcare professionals (HCPs) before the rollout of a newly developed vaccine in a pandemic setting. The aim of this prospective cohort study was to study the impact of preexisting and prevailing mental health on United Kingdom HCPs' attitudes towards a newly developed COVID-19 vaccine. Two online surveys were distributed: first during vaccine development (July-September, 2020) and second during nationwide vaccine rollout (December 2020-March 2021). Mental health (PHQ-9 for depression; GAD-7 for anxiety) was assessed in both surveys. Negative attitude regarding vaccine safety and vaccine effectiveness was assessed at vaccine rollout. A series of logistic regression models were developed relating mental health (preexisting during vaccine development, ongoing and new-onset during rollout, and changes in symptom severity) to negative vaccine attitudes. In 634 HCPs, the presence of depression and/or anxiety during vaccine development was associated with elevated negative attitude towards vaccine safety (adj. OR 1.74 [95% CI 1.10-2.75], p = .02), but not vaccine effectiveness (1.13 [0.77-1.66], p = .53) at rollout. This was independent of other characteristics: age, ethnicity, professional role, and history of contracting COVID-19. Ongoing depression and/or anxiety (1.72 [1.10-2.69], p = .02) was associated with elevated negative attitude regarding vaccine effectiveness, but not vaccine safety. Worsened combined symptom scores over time were associated with elevated negative vaccine effectiveness attitudes (1.03 [1.00-1.05], p < .05), but not vaccine safety. Overall, adverse mental health can impact on HCPs' attitudes towards a newly developed vaccine. Further work is required to understand how this translates to vaccine uptake.

Dysmenorrhea, intermenstrual bleeding, menstrual flow volume changes, and irregularities following COVID-19 vaccination and the association with vaccine skepticism: A retrospective observational study

BACKGROUND

COVID-19 vaccines have provided fertile ground for research, especially with the unprecedented spread of misinformation about this disease and its vaccines. Among women, one of the most frequently reported side effects of the vaccine has been menstrual disturbance.

OBJECTIVE

To investigate the perceived impact of COVID-19 vaccines on the menstrual cycle. In addition, the research seeks to identify factors that could predispose certain individuals to experience these effects, thereby contributing to a deeper understanding of the interplay between vaccines and menstrual health.

DESIGN

We conducted a retrospective observational cross-sectional study.

METHODS

Any woman of menstruating age who received at least one dose of the COVID-19 vaccine and currently resides in Saudi Arabia was invited to complete an online questionnaire. The questionnaire compared menstruation characteristics-regularity, volume, intermenstrual bleeding, and dysmenorrhea-before and after receiving the COVID-19 vaccine, taking into consideration possible predisposing factors such as polycystic ovarian syndrome, contraceptives, or period-blocking pills.

RESULTS

Women without polycystic ovarian syndrome experienced less change in dysmenorrhea post-vaccine compared to those with polycystic ovarian syndrome (23.88% versus 37.78%, p = 0.045). Women using hormonal contraceptives were about two times more likely to experience changes in volume compared to those not using contraceptives (odds ratio = 2.09, 95% confidence interval = 1.23-3.57, p = 0.006). COVID-19 vaccine skeptics were about three times more likely to perceive changes in regularity post-vaccine compared to non-skeptics (odds ratio = 2.96, 95% confidence interval = 1.79-4.90, p < 0.001). They were also three times more likely to perceive changes in volume post-vaccine (odds ratio = 3.04, 95% confidence interval = 1.95-4.74, p < 0.001).

CONCLUSION

Our data suggest significant associations between COVID-19 skepticism, the use of hormonal contraceptives, and the reported post-vaccine menstrual disturbances. This underscores the importance of public education efforts aimed at dispelling misinformation and addressing controversies related to these vaccines.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Factors influencing parents' willingness to vaccinate their preschool children against COVID-19: Results from the mixed-method study in China

During the COVID-19 pandemic, little is known about parental hesitancy to receive the COVID-19 vaccine for preschool children who are the potential vaccinated population in the future. The purpose of this mixed-method study was to explore the factors influencing Chinese parents' decision to vaccinate their children aged 3-6 years old against COVID-19. In July 2021, we conducted semi-structured interviews (n = 19) and a cross-sectional survey (n = 2605) with parents of kindergarten children in an urban-rural combination pilot area in China. According to the qualitative study, most parents were hesitant to vaccinate their children with the COVID-19 vaccine. In the quantitative study, we found that three-fifths of 2605 participants were unwilling to vaccinate their children against COVID-19. Furthermore, the main predictors of parents' intention to vaccinate their children were fathers, lower level of education, and positive attitudes toward vaccination. Based on our findings, targeted health education techniques may be able to boost childhood COVID-19 immunization rates.

The psychometric properties and the factorial structure of COVID-19 Vaccines Acceptance scale (VAC-COVID-19) within the Arabic language in a Palestinian contex

Background

The COVID-19 Vaccines Acceptance scale (VAC-COVID-19) is an international measure designed to evaluate vaccination acceptance against the COVID-19 virus. The current scale was translated from English to Arabic and validated within the Palestinian context.

Aims

Our study aimed to test the factorial structure and the psychotic properties of the VAC-COVID-19 within the Palestinian context using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) through 484 participants selected using online method techniques.

Findings

The VAC-COVID-19 was a reliable and valid method in assessing COVID-19 vaccine acceptance among Palestinians. Results of CFA indicated a stable construct of a two-factor solution in assessing COVID-19 vaccination acceptance in a Palestinian context. (1) Reasons for not receiving the vaccination, and (2) for receiving the vaccination.

Conclusion

The VAC-COVID-19 was a valid method to assess vaccination acceptance in the Arabic language within the Palestinian context. Therefore, it is recommended to conduct similar studies with diverse samples in Palestinian society; it would be prudent to target at-risk populations needed to develop the scale and its factorial structure. The VAC-COVID-19 can be a useful measure to assess vaccination acceptance among Palestinians, enabling health providers to implement interventions to modify negative attitudes toward not receiving vaccinations.

Adaptation and Preliminary Validation of the Fear of Coronavirus Vaccination Scale in the Prospective Study among a Representative Sample of Polish, Israeli, Slovenian, and German Adults during the COVID-19 Pandemic

Although concerns about harm and side effects are among the most important factors determining vaccine hesitancy, research on the fear of vaccination is sparse. The purpose of this study is a validation the Fear of Coronavirus Vaccination Scale (FoCVVS), adapted from the Fear of COVID-19 Scale. A representative sample of 1723 young adults aged 20-40 from Poland, Israel, Slovenia, and Germany participated during two time-points of the third COVID-19 pandemic wave. The online survey included demographic variables and several well-being dimensions, including gender, vaccination status, fear of coronavirus (FoCV-19S), physical health (GSRH), life satisfaction (SWLS), and perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). Exploratory factor analysis (EFA) was performed at T1, and confirmatory analysis (CFA) at T2. The second-order two-factor structure demonstrated the best fit and very good discriminant and convergent validation. The general factor of the FoCVVS included two subscales assessing the emotional and physiological symptoms of fear of vaccination. Unvaccinated people showed higher levels of fear of vaccination than those vaccinated. A vaccination status, fear of vaccination T1, and fear of COVID-19 T1 were significant predictors of fear of vaccination T2. Vaccination-promoting programs should be focused on decreasing fear and enhancing the beneficial effects of vaccination.

The Role of Positive and Negative Information Processing in COVID-19 Vaccine Uptake in Women of Generation X, Y, and Z: The Power of Good is Stronger Than Bad in Youngsters?

Background

Positive and negative focus in information processing associated with age has a diverse role in COVID-19 vaccine uptake. The aim of the study was the exploration of the generational diversity among psychological predictors of COVID-19 vaccine uptake.

Methods

A cross-sectional research was conducted. The sample included 978 Hungarian women. Based on former literature findings, the COVID-19 vaccine uptake predictors were chosen from the health beliefs model, COVID-19 vaccine hesitancy, and psychological flexibility. Multivariate logistic regression analysis was conducted to investigate the predictors of COVID-19 vaccine uptake in women of Gen X, Gen Y, and Gen Z.

Results

In Gen X women, the influence of significant predictors are more prone to the positivity in COVID-19 vaccine uptake behavior, perceived benefits being the most relevant, increasing the likelihood of vaccine uptake more than four times. In Gen Y women, perceived barriers, lack of confidence/skepticism and avoidance significantly reduce the probability of vaccine uptake, showing an accentuated negative focus in information processing related to COVID-19 vaccination. The vaccine uptake in Gen Z is predicted only by the perceived benefits, and the likelihood of COVID-19 vaccine uptake is heightened in chance more than 19 times.

Conclusion

Women belonging to Gen X or Gen Y, the perceived benefits hold the key to vaccine uptake, while in women of Gen Z, low risks, lack of threats, and accessibility could motivate the decision of vaccine uptake. The findings are useful in generation-adapted vaccination campaigns and can also serve as inspiration for evolutionary psychology studies on health behavior and the broad area of study in cognitive biases in health information processing.

Using the integrative model of behavioural prediction to understand COVID-19 vaccine hesitancy behaviour

The officials realized that the vaccination drive alone would not be  sufficient, but the individual's response towards getting vaccinated needs to be assessed and addressed, especially in India, where the diverse culture could widely affect the population's vaccination behaviour. The study aimed to identify the predictors of vaccine hesitancy behaviour using the health belief model and theory of planned behaviour and understand mediating and moderating influence of knowledge and social support on the relationship between the predictors and vaccine hesitancy behaviours among the Indian population. Data was collected from 1006 samples. Regression analysis was performed to assess the variances exerted on vaccine hesitancy behaviours. Also, SEM AMOS was employed to examine the mediation and moderation effects of knowledge about vaccines and social support. The findings indicated that around 11% of the respondents were hesitant to get vaccinated. The combined models of HBM and TPB provide high predictive power. The analysis also revealed that knowledge about vaccine significantly mediates partially between a few constructs of HBM and TPB concerning hesitancy. This study provides the theoretical framework and suggests that the health belief model and the theory of planned behaviour model could explain the psychological influences of vaccine hesitancy in India.

Contrasting Association Between COVID-19 Vaccine Hesitancy and Mental Health Status in India and Saudi Arabia-A Preliminary Evidence Collected During the Second Wave of COVID-19 Pandemic

Background

Vaccine hesitancy is a global public health threat. Understanding the role of psychological factors in vaccine hesitancy is often neglected and relatively less explored.

Aim and Objectives

To analyze the relationship between mental health and COVID-19 vaccine hesitancy before and after the advent of COVID-19 vaccines (AC19V) in the general population of India and Saudi Arabia (KSA) which vary in severity of the pandemic and vaccine mandates.

Materials and Methods

A total of 677 adult participants from India and KSA participated in this cross-sectional online web-based survey. Sociodemographic details and current COVID-19 status pertaining to infection and vaccination were collected. Depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and perceptive need for mental health support (MHS) were assessed before and after AC19V. A newly constructed and validated COVID19 vaccine hesitancy scale-12 (COVID19-VHS12) scale was used to evaluate the COVID-19 vaccine hesitancy.

Results

Prevalence and levels of depression and anxiety symptoms decreased significantly in Saudis but not in Indians after AC19V. PTSD symptoms showed a significant reduction in both India and KSA. Anxiety symptoms were higher in KSA than India before AC19V while PTSD was higher in India before and after AC19V. Except for the place of residence and employment status, the subgroups of sociodemographic variables which were at higher risk of negative mental health before AC19V showed improvement in their mental health after AC19V. The prevalence of COVID-19 vaccine hesitancy in India and KSA was 50.8% (95% CI 45.73–55.89%) and 55.7% (95% CI 50.16–61.31%), respectively. A bidirectional association between vaccine hesitancy and mental health was observed in KSA but not in India. Higher vaccine hesitancy favored higher levels of depression, anxiety, and perceptive need for MHS and vice versa in KSA. None of the mental health parameters predicted vaccine hesitancy in India, while higher vaccine hesitancy increased the risk of anxiety.

Conclusion

Vaccine hesitancy has a negative impact on mental health and vice versa over and above the impact of sociodemographic factors and COVID-19 vaccination and infection status which shows variations between India and KSA.