The mediating role of vaccine hesitancy in the relations of COVID-19 conspiracy beliefs and vaccination outcomes: Which dimensions matter?

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.

Vaccine hesitancy as indecision: Creation and evaluation of the Unidimensional Vaccine Hesitancy Scale

BACKGROUND

Several authors have argued that vaccine hesitancy should be conceptualized as indecision in the vaccination decision-making process, but no established measure with support for its psychometric properties and validity has been created from this operational definition.

AIMS

To resolve this tension, this article undergoes a four-study scale development process to create the 4-item Unidimensional Vaccine Hesitancy Scale (UVHS).

MATERIALS AND METHODS

We conduct four survey studies utilizing a total sample size of 884.

RESULTS

In Studies 1 (n = 297) and 2 (n = 298), we provide psychometric support for the measure via exploratory and confirmatory factor analysis. In Studies 3 (n = 193) and 4 (n = 106), we support the concurrent and discriminant validity of the measure by assessing its relations with relevant constructs, such as vaccination readiness and acceptance, and we also provide initial indicators of the scale's possible predictive qualities by testing its time-separated effects with vaccination willingness, receipt and word-of-mouth.

DISCUSSION

We leverage these results to provide a number of theoretical insights and suggestions for future practice. Of note, we highlight that different conceptualizations and operationalizations for the same construct can produce notably differing empirical findings, and vaccine hesitancy is no different.

CONCLUSION

Our cumulative efforts indicate that the UVHS is an appropriate measure to assess vaccine hesitancy as indecision.

Why fall for misinformation? Role of information processing strategies, health consciousness, and overconfidence in health literacy

Health misinformation, defined as false or misleading claims lacking scientific evidence, poses a significant threat to public health. This paper investigates factors associated with the failure to discern misinformation, including health consciousness, information processing strategies, and inaccurate self-assessments of health literacy. Through an online experiment involving 707 English-speaking U.S. participants (mean age = 43 years, 56.2% female), we found that misinformation beliefs about nutrition, vaccination, vaping, and cancer were significantly correlated, implying susceptibility across health topics. Greater susceptibility was associated with higher health consciousness, lower objective health literacy, more elaboration, and more selective scanning. Results provided evidence for the Dunning-Kruger effect and metacognitive monitoring errors, whereby confident individuals were unaware of inadequate health literacy and showed poor misinformation identification. Findings suggest that promoting both health literacy education and cognitive reflection skills among the general adult population could empower them to more critically evaluate online health information.

Investigating the Relation of Political Orientation and Vaccination Outcomes: Identifying the Roles of Political Ideology, Party Affiliation, and Vaccine Hesitancy

Popular press and academic articles alike suggest that political orientation is a primary determinant of vaccination willingness, vaccination, and vaccine word-of-mouth (i.e., sharing of information regarding vaccines). In the current article, we test the validity of these suggestions, and we also assess the differential roles of political ideology (e.g., liberal-conservative) and party affiliation (e.g., Democrat-Republican) as well as the mediating effect of vaccine hesitancy's dimensions. To do so, we perform a four-wave survey study with 223 participants that completed all waves. Our results support that political orientation indeed relates to our outcomes of interest. Our results also show that political ideology has a more pronounced effect than party affiliation, and the vaccine hesitancy dimensions of Health Risks and Healthy mediate many of these relations. From these results, we suggest many directions for future research and practice, including the integration of political discourse theories in studies on political orientations and vaccination.

Gender and vaccination: understanding the multifaceted role of a multidimensional conceptualization of vaccine hesitancy

Popular press and academic articles alike speculate that gender influences vaccine receipt, but they often disagree whether men or women are less likely to become vaccinated. In the current article, we further test the relation of gender and vaccination in four datasets, and we assess the mediating role of vaccine hesitancy dimensions. Our results demonstrate that: (1) gender has significant relations with several vaccine hesitancy dimensions, which are mixed between both women and men having negative perceptions regarding vaccination; (2) gender does not significantly relate to flu and COVID-19 vaccination willingness or receipt, but women were more likely to receive other vaccines; and (3) a significant indirect effect did emerge in the two datasets collected after widespread access to the COVID-19 vaccine, such that the perception that vaccines cause health risks mediates the relation of gender with flu vaccination willingness as well as COVID-19 vaccination willingness and receipt. Our discussion integrates these findings with models of preventative behaviors and identifies directions for future research.

Influences on COVID-19 booster uptake among adults intending to receive a booster: a qualitative study

Bivalent COVID-19 vaccine boosters have been recommended for all Americans 12 years of age and older. However, uptake remains suboptimal with only 17% of the United States (US) population boosted as of May 2023. This is a critical public health challenge for mitigating the ongoing effects of COVID-19 infection. COVID-19 booster uptake is not currently well understood, and few studies in the US have explored the vaccination process for booster uptake in a 'post-pandemic' context. This study fills gaps in the literature through qualitative analysis of interviews with a racially/ethnically diverse sample of Arkansans who received the COVID-19 vaccine main series and expressed intent to receive a booster (n = 14), but had not yet received the COVID-19 booster at the time we recruited them. All but one did not receive the booster by the time of the interview. Participants described influences on their vaccination behavior and uptake of boosters including reduced feelings of urgency; continued concerns about the side effects; social contagion as a driver of urgency; increasing practical barriers to access and missing provider recommendations. Our findings highlight the importance of considering vaccination as an ongoing, dynamic process drawing on past/current attitudes, prior experience, perceptions of risk and urgency and practical barriers. Based on these findings, healthcare providers should continue to provide strong, consistent recommendations for COVID-19 boosters to patients, even among those with histories of vaccine uptake.

Should Communication Campaigns Promoting Vaccination Address Misinformation Beliefs? Implications from a Nationally Representative Longitudinal Survey Study among U.S. Adults

Public health communication campaign planners must carefully consider whether misinformation beliefs are important to target and, ideally, correct. Guided by the reasoned action approach, we hypothesized that behavior-specific beliefs regarding COVID-19 vaccination would account for any observed relationship between general coronavirus misinformation beliefs (misinformation beliefs that are not specific to the anticipated consequences of COVID-19 vaccination) and subsequent vaccine uptake. To test our hypothesis, we used panel data from a two-wave nationally representative sample of U.S. adults pre- and post-vaccine availability (T1: July 2020, T2: April/June 2021, analytic sample: n = 665). Contrary to our hypothesis, we find a residual observed relationship between general coronavirus misinformation beliefs and subsequent vaccine uptake (AOR = 0.40, SE = 0.10). Intriguingly, our post-hoc analyses do show that after also adjusting for T2 behavioral beliefs, this association was no longer significant. With this and other justifications, we recommend that messages promoting vaccination prioritize targeting relevant behavioral beliefs.

Understanding and mitigating negative affect in preventive health behaviors: Evidence from the COVID-19 vaccination process

The study investigated the willingness for vaccine uptake during the COVID-19 pandemic (April-June 2021), and explored the effect of both mindfulness and health education in managing negative affect post-vaccination. In study 1, a sample of 468 Chinese college students completed a one-time survey, assessing loneliness, stress, medical fear, and vaccination likelihood. Results showed that medical fear mediated the relationship between loneliness, stress and vaccination likelihood. In study 2, 70 college students were randomly assigned to one of three intervention conditions (mindfulness, health education, and control) during vaccination. Participants in mindfulness group showed lower negative affect scores than the control group post-intervention (p = 0.019). However, no significant difference was reported between health education with the other two conditions. As such, medical fear would be an important factor to target for improving the likelihood of vaccine uptake. Furthermore, a short mindfulness intervention was effective to improve experience of vaccination through mitigating negative affect.

How perceived coercion polarizes unvaccinated people: The mediating role of conspiracy beliefs

During the COVID-19 pandemic, different policies were implemented to increase vaccination uptake. Meanwhile, conspiracy theories spread widely, and vaccinated versus unvaccinated people increasingly polarized against each other. This study examined the associations between perceived vaccination coercion, conspiracy beliefs and polarization. We tested the relationship of vaccination status with perceived vaccination coercion, conspiracy beliefs, and polarization, with a total sample size of N = 1202 (n = 400 in China, n = 401 in the US, and n = 401 in the UK), among them n = 603 were vaccinated and n = 599 were unvaccinated. As pre-registered, unvaccinated people perceived more vaccination coercion and endorsed more conspiracy theories. Conspiracy mentality was positively related to perceived coercion. Contrary to our hypotheses, vaccinated people were more polarized toward unvaccinated people than vice versa. Finally, conspiracy beliefs mediated the link between perceived coercion and polarization among unvaccinated people.

Relations of behavioral inhibition and activation system sensitivities with vaccination outcomes: Investigating the mediating role of vaccine hesitancy in older adults

The study of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities has produced a multitude of models and frameworks to better understand decision-making and behavior. We extend this research to the study of a vaccination by exploring the relation of BIS and BAS sensitivities with vaccination willingness, receipt, and word-of-mouth. We also assess whether dimensions of vaccine hesitancy mediate these relations, testing whether they are viable explanatory mechanisms. By conducting a multi-wave survey study, our results support that BIS sensitivity does not meaningfully relate to vaccine hesitancy or vaccination outcomes. On the other hand, BAS sensitivity related to detrimental vaccination outcomes, and these effects were mediated by vaccine hesitancy dimensions associated with perceptions that vaccines cause health risks and are not needed for healthy individuals. Based on extant BIS and BAS theory, these results suggest that certain people may see refraining from vaccination as a nonpunishment.

Relation of Personal Characteristics with Human Papillomavirus Vaccination Outcomes: Assessing the Mediating Role of Vaccine Hesitancy Dimensions

Recent findings suggest that the rate of certain cancers can be reduced by increasing human papillomavirus (HPV) vaccination coverage, resulting in considerable research interest on the antecedents of HPV vaccine receipt to identify avenues to promote vaccination. The current article continues this stream of research by (1) studying the three HPV vaccination outcomes of willingness, receipt, and word-of-mouth, (2) investigating the antecedent effects of sociodemographic characteristics, health insurance status, provider conversation, and political orientation, and (3) testing the mediating role of vaccine hesitancy dimensions using a recently developed conceptualization. We achieve these goals by conducting a cross-sectional study with 404 participants (Agemean = 37.64; AgeSD = 14.91; 57% female; 72% white; 100% located in U.S.). Our results show that provider conversations and political orientation had the most consistent and strong effects of the personal characteristics, whereas perceptions that vaccines pose health risks and perceptions that vaccines are not needed for healthy individuals produced the most consistent and strong effects of the vaccine hesitancy dimensions. Other personal characteristics and vaccine hesitancy dimensions also produced intermittent significant effects, including age, education, and race. Together, these results support that personal characteristics and vaccine hesitancy dimensions relate to a broader range of outcomes associated with HPV vaccination than previously known, and these results also support that the recently developed conceptualization of vaccine hesitancy is apt for understanding HPV vaccine perceptions. Our discussion concludes with highlighting avenues for future research and practice that can leverage our discovered relations to improve HPV vaccination outcomes.

The Multidimensional Vaccine Hesitancy Scale: A Validation Study

Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach’s coefficients α > 0.70; McDonald’s ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study’s conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions.

Black-and-white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID-19

Understanding predictors of parents' willingness to vaccinate their children appears fundamental to promote vaccine acceptability, especially in a pandemic scenario. The present study aimed to investigate the role of conspiracy beliefs and absolutist thinking in parental attitude toward COVID-19 vaccine, and the predictive role of parents' individual differences on decisions against children's vaccination. An online survey was administered to 415 parents of children aged 5-11, at the very beginning of the vaccination targeting this population in Italy. Results showed that absolutism predicted the tendency to believe in conspiracies, associated with a negative attitude toward the COVID-19 vaccine administration to children. Moreover, mothers were less willing to vaccinate children and parents of children aged 5-7 were more hesitant, or even against vaccination, than parents of older children. Finally, the worry about consequences of COVID-19 infection on children's health facilitated vaccine adherence. These findings contribute to deepening mechanisms regarding the vaccine acceptability.