Cognitive Factors Influencing COVID-19 Vaccination Intentions: An Application of the Protection Motivation Theory Using a Probability Community Sample

Campaign Governance and Partnerships: Unraveling COVID-19 Vaccine Promotion Efforts in China's Neighborhoods

Background

COVID-19 vaccine promotion helps counter vaccine hesitancy and raise vaccine acceptance. Therefore, the Chinese state created collaborative infrastructures of COVID-19 vaccine promotion programs to promote stakeholder engagement and unload the burden of policy practitioners. However, partnerships in COVID-19 vaccine promotion programs have been underrepresented.

Methods

To address this lacuna, we qualitatively explored how partnerships in the COVID-19 vaccine promotion campaign (CVPC) were organized in China's neighborhoods. Specifically, we recruited participants via personal networks, referrals from acquaintances, and snowballing approaches, and conducted the qualitative thematic analysis following interviews with 62 Chinese stakeholders.

Results

This study indicates that to promote partnerships in CVPCs, neighborhood managers formed leadership in CVPCs, expanded the collaborative network, trained Health Promotion Practitioners (HPPs), and coordinated with HPPs to shape partnership agreements, produced COVID-19 vaccine promotional materials and advertised COVID-19 vaccines via diverse media tools. Although coproduction of CVPCs to a certain extent promoted state-society interaction in neighborhoods and state responsiveness to public demands, partners' disagreements on strategies applied by states for promoting COVID-19 vaccines eroded partnerships in CVPCs.

Conclusion

To construct a robust partnership in CVPCs, depoliticizing CVPCs and creating shared values among stakeholders in CVPCs are expected. Our study will not only deepen global audiences' understanding of CVCPs in China but also offer potential neighborhood-level solutions for implementing local and global health promotion efforts.

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.

COVID-19 Vaccination Coverage and Factors Influencing Vaccine Hesitancy among Patients with Inborn Errors of Immunity in Latvia: A Mixed-Methods Study

BACKGROUND

The European Society for Immunodeficiencies recommends that all patients with inborn errors of immunity (IEI) without contraindications should receive SARS-CoV-2 vaccination. The aim of this study was to investigate the reasons that discourage IEI patients from receiving the recommended vaccination and to assess vaccination coverage among IEI patients in Latvia.

METHODS

In this multicenter mixed-methods study, the vaccination status of all patients with IEI within two tertiary centers in Latvia was reviewed using electronic health records. Semi-structured interviews were conducted with 16 IEI patients who did not undergo vaccination, and a thematic analysis was performed.

RESULTS

A total of 341 patients (49.3% female; median age 19.7 years (IQR:17)) were included in the quantitative part. The proportion of fully vaccinated individuals aged ≥ 12 years was 66.8%-70.9% with patients with selective IgA deficiency and 58.8% with other IEI (χ² = 14.12, p < 0.001). The proportion of fully vaccinated individuals aged 5-11 years was 11.1%. Age was associated with vaccination status: younger patients were found to have a significantly lower likelihood of receiving vaccination (U = 8585, p < 0.001). The five main themes identified were as follows: (1) fear and uncertainty; (2) risk and benefit assessment: COVID-19 vaccine-is it worth it? (3) external influences: the dark horse of the decision-making-people around us; (4) individuals against the system; and (5) beliefs about vaccination and COVID-19. Under-representation of certain IEI groups and recall bias are possible limitations of this study.

CONCLUSIONS

While most reasons for hesitancy were similar to those previously described in the general population, disease-specific concerns were also identified.

Applying two behavioral theories to predict the willingness to receive COVID-19 vaccine booster in the elderly: A cross-sectional study

BACKGROUND

The COVID-19 vaccination booster can effectively protect the elderly from infection while also lowering the risk of serious illness and death. However, barriers remain in willingness of the elderly to boost vaccination.

OBJECTIVE

Using the protection motivation theory (PMT) and the theory of planned behavior (TPB), to study the factors that influence willingness of the elderly to get the COVID-19 vaccine booster.

METHODS

The elderly who visited three randomly selected medical institutions in Nanjing's core urban region between March and April 2022 were chosen as study participants. A face-to-face survey was conducted using purposeful sampling and a self-designed questionnaire. The questionnaire contained sociodemographic characteristics, the elderly's willingness to obtain a COVID-19 vaccine booster, and psychosocial cognitive components based on the PMT and TPB. SmartPLS 3.0 was used to conduct structural equation modeling.

RESULTS

214 participants were included in the analysis. The combined model of the two behavioral theories explained the willingness to accept COVID-19 vaccine booster well with R2 of 0.490. Self-efficacy (β = 0.315) was the strongest predictor of vaccine booster willingness. Subjective norms (β = 0.160), perceived severity (β = 0.157), and perceived vulnerability (β = 0.159) also showed positive effects on vaccine booster willingness, while response cost (β = -0.143) had a negative effect on the willingness. No significant association between attitudes, response efficacy and the willingness was discovered.

CONCLUSION

The willingness of the elderly to receive the COVID-19 vaccine booster was affected by psychosocial cognitive factors. This study supports the applicability of the PMT and TPB models to interpret the willingness of the elderly in such areas.

Predicting COVID-19 vaccination intentions: the roles of threat appraisal, coping appraisal, subjective norms, and negative affect

BACKGROUND

As a new disease, communities possess little natural immunity to COVID-19 and vaccines are considered critical to preventing and reducing the incidence of severe illness. This study, inspired by Protection Motivation Theory (PMT), examines the relationship between citizens' threat appraisal, coping appraisal, subjective norms, negative affect, and their COVID-19 vaccination intentions.

METHODS

A sample of 340 citizens from two main cities in Mainland China, Xi'an and Wuxi, was used for data analysis. Structural Equation Modeling (SEM) was employed with latent and observed variables to test hypotheses. Data were analyzed using AMOS 24.0.

RESULTS

Several findings extend current understanding. Firstly, our proposed model explains 73% of the variance in vaccination intentions. Secondly, perceived severity only indirectly shapes COVID-19 vaccination intentions through negative affect. Thirdly, negative affect and response costs are negatively related to COVID-19 vaccination intentions. Finally, Perceived probability, subjective norms, response efficacy and self-efficacy are positively related to COVID-19 vaccination intentions; among them, self-efficacy contributes the most, followed by response efficacy and subjective norms, and lastly perceived probability.

CONCLUSION

Theoretically, this study increases current understanding about subjective norms and affective responses. We provoke a certain amount of thought about the role of affect response in relation to threat appraisal and vaccination intentions. Specifically, governments must be vigilant that citizens' negative affect, such as fear, may cause vaccine hesitation.

The impact of infectious disease prevention behavior on quality of life: A moderated mediation model

Objective

To explore the mechanism of infectious disease prevention behavior on quality of life, and to investigate the mediating role of self-efficacy and the moderating role of family structure.

Methods

A total of 3015 subjects were selected by multistage stratified cluster sampling.

Results

Infectious disease prevention behavior had a significant positive predictive effect on the quality of life (β = 0.08, p < 0.001), The self-efficacy of family members had a partial mediating effect on the relationship between infectious disease prevention behavior and quality of life (β = 0.01, p < 0.001). Compared to nuclear family, conjugal family (β = 0.05, p < 0.001) and single-parent family (β = 0.04, p < 0.01) could regulate the relationship between infectious disease prevention behavior and the quality of life, stem family (β = -1.53, p < 0.05), conjugal family (β = 1.63, p < 0.05), and collective family (β = -1.37, p < 0.05) could regulate the relationship between infectious disease prevention behavior and self-efficacy, conjugal family (β = 0.00, p < 0.001) could regulate the relationship between self-efficacy and quality of life.

Conclusion

Infectious disease prevention behavior can affect the quality of life through self-efficacy. Different family structures play a regulatory role in different paths, and a regulatory mediation model is established.

Cross-sectional assessment of predictors for COVID-19 vaccine uptake: an online survey in Greece

Objective

To estimate the percentage of the general population vaccinated against the COVID-19 and to investigate the factors associated with COVID-19 vaccine uptake.

Material and methods

We conducted an online cross-sectional study in Greece during August 2021. We included individuals over 18 years of age. Independent variables included socio-demographic data of the participants and attitudes towards COVID-19 vaccination and pandemic. Our outcome variable was COVID-19 vaccination status, measured through "yes/no" answers.

Results

Most participants had been vaccinated against the COVID-19 (87.8%). Multivariate analysis identified that increased age and a higher level of education were associated with an increased likelihood of COVID-19 vaccination. Also, participants working in health services, participants without a previous COVID-19 diagnóstico, and those with previous seasonal influenza vaccination history had a greater probability to take a COVID-19 vaccine. Additionally, increased self-perceived severity of COVID-19, knowledge regarding COVID-19, and trust in COVID-19 vaccines and scientists were associated with COVID-19 vaccine uptake. On the other hand, the likelihood of vaccination was lower for participants who were more concerned about the side effects of COVID-19 vaccination.

Conclusions

Understanding the factors affecting individuals' decision to take a COVID-19 vaccine is essential to improve the COVID-19 vaccination coverage rate. Policymakers and scientists should scale up their efforts to increase the COVID-19 vaccination rate among specific population groups such as young people, people with a low level of education, etc.

Social cognition theories and behavior change in COVID-19: A conceptual review

The COVID-19 pandemic has had unprecedented health, economic, and social consequences worldwide. Although contact reductions and wearing face coverings have reduced infection rates, and vaccines have reduced illness severity, emergence of new variants of the coronavirus that causes COVID-19, and the shift from pandemic to endemic patterns of infection, highlights the importance of ongoing preventive behavior adherence to manage future outbreaks. Research applying social cognition theories may assist in explaining variance in these behaviors and inform the development of efficacious behavior change interventions to promote adherence. In the present article, we summarize research applying these theories to identify modifiable determinants of COVID-19 preventive behaviors and the mechanisms involved, and their utility in informing interventions. We identify limitations of these applications (e.g., overreliance on correlational data, lack of long-term behavioral follow-up), and suggest how they can be addressed. We demonstrate the virtue of augmenting theories with additional constructs (e.g., moral norms, anticipated regret) and processes (e.g., multiple action phases, automatic processes) to provide comprehensive, parsimonious behavioral explanations. We also outline how the theories contribute to testing mechanisms of action of behavioral interventions. Finally, we recommend future studies applying these theories to inform and test interventions to promote COVID-19 preventive behavior adherence.

Effective factors in people's preventive behaviors during covid-19 pandemic: a systematic review and meta-synthesis

Background

The overwhelming outbreak of covid-19 has forced governments all over the world to consider different measures to face this challenging situation. A vitally important element to the declining transmission of viruses is changing behaviors based on reliable information. This study was designed and implemented to identify factors affecting the preventive behaviors during the covid-19 pandemic.

Methods

This thematic synthesis was carried out in order to create a set of central themes that summarize all of the issues raised in the articles reviewed in this study. We used PRISMA 2020 guidelines to direct this systematic review and meta synthesis. The process of analyzing data includes three different stages: 1) creating codes; 2) production of descriptive themes; 3) and finally, the creation of analytical themes. The Standards for Reporting Qualitative Research checklist was used to evaluate the articles' quality.

Results

Five central themes emerged from 8 included articles, (1) Social factors (subthemes: environmental context, political leadership, multimedia), (2) Cultural factors (subthemes: national culture, religious culture, the family beliefs, work culture, foreign culture), (3) Economic factors (subthemes: economic situation of the individual, the government supports, infrastructures), (4) Personal factors (subthemes: people experiences, cognitive ability, physical factors, different motivational level, sense of responsibility, risk management, and self-management skills), and (5) Knowledge and Education factors (subthemes: access to information, skill training). Furthermore, SRQR items that were weakly reported were “researcher characteristics and reflexivity”, “Sampling strategy”, “Data collection methods”, “Data analysis”, and “techniques to enhance trustworthiness.

Conclusion

Health policymakers and other public health officials in various countries can use the factors listed to develop appropriate, evidence-based policies. They should investigate behavioral characteristics in their community based on their abilities, and then design and implement appropriate executive actions.

Factors associated with COVID-19 vaccination behaviour in Latvian population: cross-sectional study

Vaccination is the most effective way of limiting the spread of COVID-19. However, despite the proven effectiveness and safety of vaccines, there is resistance in society and the course of vaccination is slow. The aim of this study was to identify the factors associated with COVID-19 vaccination behaviour. Methods: The data originate from a representative sample of Latvian residents (N  = 1017) taken in September 2021. The data were analysed using Chi-squared test, Mann-Whitney test, Spearman's rank correlation coefficient, Kruskal Wallis test, and Binary Logistic regression analysis. Results: The results of the study reveal several factors that are associated with COVID-19 vaccination behaviour. These factors are a higher level of education, motivation for protecting oneself against illness, for promoting collective immunity, protecting relatives and other people from infection, as well as motivation for vaccination in order to keep a job or continue studies, and institutional trust. On the other hand, perceived social support from relatives is negatively associated with vaccination behaviour. Conclusion: A higher level of education and confidence in evidence-based information on COVID-19, provided by official sources of information, is the key factor in deciding whether to protect oneself from serious illness or to make a choice to promote collective immunity and protect other people. The need for vaccination in order to continue working and/or learning is also an essential motive for vaccination. On the other hand, the belief that, if necessary, it is possible to receive support from relatives may be a delaying factor in the behaviour of vaccination.

Acceptance of COVID-19 Booster Vaccination Based on the Protection Motivation Theory (PMT): A Cross-Sectional Study in China

The promotion of the booster shots against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is an open issue to be discussed. Little is known about the public intention and the influencing factors regarding the booster vaccine. A cross‐sectional survey in Chinese adults was conducted using an online questionnaire, which designed on the basis of protection motivation theory (PMT) scale and vaccine hesitancy scale (VHS). Hierarchical multiple regression was used to compare the fitness of the PMT scale and VHS for predicting booster vaccination intention. Multivariable logistic regression was used to analyze the factors associated with the acceptance. Six thousand three hundred twenty‐one (76.8%) of participants were willing to take the booster shot. However, the rest of the participants (23.2%) were still hesitant to take the booster vaccine. The PMT scale was more powerful than the VHS in explaining the vaccination intention. Participants with high perceived severity (adjusted odds ratio [aOR] = 0.69) and response cost (aOR = 0.47) were less willing to take the booster shots, but participants with high perceived susceptibility (aOR = 1.19), response efficacy (aOR = 2.13), and self‐efficacy (aOR = 3.33) were more willing to take the booster shots. In summary, interventions based on PMT can provide guidance to ensure the acceptance of the booster vaccine.

Applying an extended protection motivation theory to predict Covid-19 vaccination intentions and uptake in 50-64 year olds in the UK

Objectives

To examine the correlates of Covid-19 vaccination intentions and subsequent uptake as outlined in an extended version of protection motivation theory (PMT).

Design

A two-wave online survey conducted at the start of the vaccination rollout to 50–64 year olds in the UK and three months later.

Measures

Unvaccinated UK adults (N = 438) aged 50–64 completed baseline measures from PMT (perceived vulnerability, perceived severity, maladaptive response rewards, response efficacy, self-efficacy, response costs, intention) as well as measures of injunctive and descriptive norms, demographics, Covid-19 experiences, and past influenza vaccine uptake. Self-reported uptake of a Covid-19 vaccination was assessed three months later (n = 420).

Results

The extended PMT explained 59% of the variance in Covid-19 vaccination intentions, after controlling for demographics, Covid-19 experiences, and past influenza vaccine uptake. All extended PMT variables, with the exception of perceived severity and descriptive norms, were significant independent predictors of intention. In line with national figures, 94% of the sample reported having received a Covid-19 vaccination at follow-up with intention found to be the key predictor of uptake.

Conclusions

Interventions to increase Covid-19 vaccination uptake need to increase intentions to be vaccinated by emphasizing the benefits of vaccination (e.g., in terms of reducing risk) and likely approval from others while also addressing the concerns (e.g., safety issues) and common misperceptions (e.g., natural immunity versus vaccines) that people might have about Covid-19 vaccines. Future research is needed in countries, and on groups, with lower uptake rates.

Predicting COVID-19 booster vaccine intentions

Achieving broad immunity through vaccination is a cornerstone strategy for long‐term management of COVID‐19 infections, particularly the prevention of serious cases and hospitalizations. Evidence that vaccine‐induced immunity wanes over time points to the need for COVID‐19 booster vaccines, and maximum compliance is required to maintain population‐level immunity. Little is known of the correlates of intentions to receive booster vaccines among previously vaccinated individuals. The present study applied an integrated model to examine effects of beliefs from multiple social cognition theories alongside sets of generalized, stable beliefs on individuals' booster vaccine intentions. US residents (N = 479) recruited from an online survey panel completed measures of social cognition constructs (attitude, subjective norms, perceived behavioral control, and risk perceptions), generalized beliefs (vaccine hesitancy, political orientation, and free will beliefs), and COVID‐19 vaccine intentions. Social cognition constructs were related to booster vaccine intentions, with attitude and subjective norms exhibiting the largest effects. Effects of vaccine hesitancy, political orientation, and free will beliefs on intentions were mediated by the social cognition constructs, and only vaccine hesitancy had a small residual effect on intentions. Findings provide preliminary evidence that contributes to an evidence base of potential targets for intervention messages aimed at promoting booster vaccine intentions.