How Implicit Attitudes toward Vaccination Affect Vaccine Hesitancy and Behaviour: Developing and Validating the V-IRAP

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.

Predictors of Vaccination Intentions and Behaviour during the COVID-19 Pandemic in Italy

The present research aimed at understanding individuals' vaccination intentions and protective behaviours against COVID-19 through two different studies. In Study 1 (N = 213, 73% women; mean age = 24.03) the Protection Motivation Theory model was tested considering the fear of COVID-19 as a possible mediator between threat appraisal (in terms of both health and social life) and intentions to get vaccinated when the vaccination was not yet available. Study 2 (N = 1111, 68.9% women; mean age = 38.33) was conducted when the vaccine became available for the entire population. Through this study, by adopting the 5C model of vaccine hesitancy as a theoretical framework, we aimed to understand how people who got vaccinated and the ones who did not differed, considering fear of vaccination, personality and vaccination hesitancy. In Study 1, social limitations, perceived severity and COVID-19 perceived vulnerability were significantly and positively related to fear of COVID-19. Contrary to what we expected, fear of COVID-19 was not a significant predictor of vaccination intention, which was predicted by both response efficacy and self-efficacy. In Study 2, in line with previous studies, vaccine hesitancy was negatively related to vaccination. More specifically, the social-oriented dimension of collective responsibility was the strongest predictor of effective behaviour. Our findings provide insights into the complexity of vaccine acceptance and emphasise the need for targeted interventions to promote vaccination and mitigate the spread of infectious diseases.

The Moderating Effect of Vaccine Hesitancy on the Relationship between the COVID-19 Vaccine Coverage Index and Vaccine Coverage

To examine COVID-19 vaccination barriers in the US, this study drew on publicly available county-level data (n = 3130) to investigate the impact of vaccine hesitancy on the relationship between county-level social/structural barriers and vaccine coverage. A hierarchical regression was performed to establish the relationship between the COVID-19 Vaccine Coverage Index (CVAC) and vaccine coverage, assess the moderating effect of vaccine hesitancy on this relationship, and explore the influence of ethno-racial composition on vaccine coverage. A significant, negative relationship (r² = 0.11, f² = 0.12) between CVAC and vaccine coverage by county was established (step 1). When vaccine hesitancy was introduced as a moderator (step 2), the model significantly explained additional variance in vaccine coverage (r² = 0.21, f² = 0.27). Simple slopes analysis indicated a significant interaction effect, whereby the CVAC-vaccine coverage relationship was stronger in low hesitancy counties as compared with high hesitancy counties. Counties with low social/structural barriers (CVAC) but high hesitancy were projected to have 14% lower vaccine coverage. When county-level ethno-racial composition was introduced (step 3), higher proportions of white residents in a county predicted decreased vaccination rates (p < 0.05). Findings indicate that CVAC should be paired with vaccine hesitancy measures to better predict vaccine uptake. Moreover, counties with higher proportions of white residents led to decreases in vaccine uptake, suggesting that future intervention strategies should also target whites to reach herd immunity. We conclude that public health leaders and practitioners should address both social/structural and psychological barriers to vaccination to maximize vaccine coverage, with a particular focus on vaccine hesitancy in communities with minimal social/structural barriers.

Community-Centered Assessment to Inform Pandemic Response in Georgia (US)

The Georgia Community Engagement Alliance (CEAL) Against COVID-19 Disparities Project conducts community-engaged research and outreach to address misinformation and mistrust, to promote inclusion of diverse racial and ethnic populations in clinical trials and increase testing and vaccination uptake. Guided by its Community Coalition Board, The GEORGIA CEAL Survey was administered among Black and Latinx Georgia 18 years and older to learn about community knowledge, perceptions, understandings, and behaviors regarding COVID-19 testing and vaccines. Survey dissemination occurred using survey links generated through Qualtrics and disseminated among board members and other statewide networks. Characteristics of focus counties were (a) highest proportion of 18 years and older Black and Latinx residents; (b) lowest COVID-19 testing rates; and (c) highest SVI values. The final sample included 2082 surveyed respondents. The majority of participants were men (57.1%) and Latinx (62.8%). Approximately half of the sample was aged 18-30 (49.2%); the mean age of the sample was 33.2 years (SD = 9.0), ranging from 18 to 82 years of age. Trusted sources of COVID-19 information that significantly predicted the likelihood of vaccination included their doctor/health care provider (p-value: 0.0054), a clinic (p-value: 0.006), and university hospitals (p-value: 0.0024). Latinx/non-Latinx, Blacks vs. Latinx, Whites were significantly less likely to get tested and/or vaccinated. Non-Latinx, Blacks had higher mean knowledge scores than Latinx, Whites (12.1 vs. 10.9, p < 0.001) and Latinx, Blacks (12.1 vs. 9.6, respectively, p < 0.001). The mean knowledge score was significantly lower in men compared to women (10.3 vs. 11.0, p = 0.001), in those who had been previously tested for COVID-19 compared to those who had never been tested (10.5 vs. 11.5, respectively, p = 0.005), and in those who did not receive any dose of vaccination compared to those who were fully vaccinated (10.0 vs. 11.0, respectively, p < 0.001). These data provide a benchmark for future comparisons of the trajectory of public attitudes and practices related to the COVID-19 pandemic. They also point to the importance of tailoring communication strategies to specific cultural, racial, and ethnic groups to ensure that community-specific barriers to and determinants of health-seeking behaviors are appropriately addressed.

The Long-COVID Experience Changed People's Vaccine Hesitancy but Not Their Vaccination Fear

Starting in early 2020, the COVID-19 pandemic has been responsible, worldwide, for millions of deaths and patients with long-COVID syndrome. In an attempt to stop the spread of the virus, the blanket administration of COVID-19 vaccines proved to be the most effective measure, yet the existence and availability of functional vaccines did not and, still, do not ensure the willingness and intent of people to be vaccinated. This study assessed the similarities and differences in vaccine fears and vaccine hesitancy through between clusters of subjects: people that were not infected with COVID-19, people that had COVID but did not develop long-lasting symptoms, and people that were infected with COVID and developed long-COVID syndrome. From the sample of 1111 Italian people, it was found that individuals who experienced mild symptoms showed higher vaccine hesitancy (confidence, complacency, and collective responsibility) than those who did not contract COVID-19. People affected by long-COVID showed a lower overall hesitancy than individuals who had COVID-19 without incurring long-lasting symptoms and, thus, essentially resembled people who had no experience of COVID-19 infection in terms of the vaccine hesitancy scores. Vaccine fear remained unchanged across all three of the examined clusters.

So Far, So Close: Identification with Proximal and Distal Groups as a Resource in Dealing with the COVID-19 Pandemic

A robust body of research has highlighted the fundamental role of social identifications in dealing with emergencies and in predicting commitment behaviors. We report the results of two studies carried out in Italy to assess whether the subjective sense of belonging to meaningful proximal and distal social groups affected people's ability to cope with the pandemic crisis. Study 1 (N = 846) shows that different identifications with proximal (i.e., family and friends) and distal social groups (i.e., nation, European, and humankind) may act as buffers for individuals by reducing negative emotions and negative expectations about the future after COVID-19 and by increasing people's intentions to adhere to containment measures and to be involved in prosocial actions. Study 2 (N = 350) highlights the role of European identification in predicting propensities for using the tracing app and getting vaccinated. These results confirm the benefits of various types of identification (proximal vs. distant) in helping individuals deal with the COVID-19 pandemic.

Public Awareness and Sentiment toward COVID-19 Vaccination in South Korea: Findings from Big Data Analytics

Despite a worldwide campaign to promote vaccination, South Korea is facing difficulties in increasing its vaccination rate due to negative perceptions of the vaccines and vaccination policies. This study investigated South Koreans' awareness of and sentiments toward vaccination. Particularly, this study explored how public opinions have developed over time, and compared them to those of other nations. We used Pfizer, Moderna, Janssen, and AstraZeneca as keywords on Naver, Daum, Google, and Twitter to collect data on public awareness and sentiments toward the vaccines and the government's vaccination policies. The results showed that South Koreans' sentiments on vaccination changed from neutral to negative to positive over the past two years. In particular, public sentiments turned positive due to South Koreans' hopeful expectations and a high vaccination rate. Overall, the attitudes and sentiments toward vaccination in South Korea were similar to those of other nations. The conspiracy theories surrounding the vaccines had a significant effect on the negative opinions in other nations, but had little impact on South Korea.