Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: results from representative surveys in 2016 and 2018

BACKGROUND

The 5C psychological antecedents of vaccination (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) facilitate understanding vaccination decisions in specific target groups as well as the general public's informational needs. This study aims to explain pre-pandemic vaccination behaviour (a) in general, (b) for specific vaccines such as influenza, and (c) for certain target groups (e.g. people over the age of 59 years, parents, healthcare workers), using the 5C model and sociodemographic variables. The intention to get an influenza vaccination was also analysed for target groups.

METHODS

The 5C, self-reported vaccination behaviour and the intention to vaccinate were collected in two representative telephone surveys in Germany - one in 2016 (n1 = 5,012) and another in 2018 (n2 = 5,054). Parents, people over the age of 59 years, chronically ill people, people with a migratory background, pregnant women and healthcare workers were target groups.

RESULTS

Overall, the 5C model had higher explanatory power than sociodemographic variables. The pattern of vaccine hesitancy slightly differed between vaccinations and target groups. Confidence in safety and effectiveness was always a significant predictor. Complacency (the underestimation of disease risks) and Constraints were significant predictors as well. Calculation (of risks and benefits) was important for influenza vaccination intentions.

CONCLUSIONS

This work builds an important benchmark for understanding potential changes in vaccine acceptance due to the pandemic. The benchmark can be used in research on potential effects of the pandemic on vaccination behaviours. Intervention designers can also use the results to understand specific audiences and their vaccination decisions.

Vicarious experiences of long COVID: A protection motivation theory analysis for vaccination intentions

Context

Long COVID can appear as a severe late consequence (sequela) of a COVID-19 infection, leading to the inability to work or participate in social life for an unknown amount of time. To see friends or family struggling with long COVID might influence people's risk perceptions, vaccine efficacy expectations, and self-efficacy perceptions to prevent COVID-19 and its consequences.

Methods

In an online survey in August 2022, n = 989 German-speaking participants indicated whether they knew someone who suffered from long COVID illness. Four dimensions of protection motivation theory (PMT) were assessed afterwards, as well as vaccination intentions.

Results

Multiple mediation analysis with participants who knew vs. didn't know someone with long COVID (n = 767) showed that knowing someone with long COVID was associated with higher perceived affective and cognitive risk of long COVID-19 as well as higher perceived vaccine efficacy. Self-efficacy, i.e., the ease to protect oneself against long COVID, was lower in participants who knew long-COVID patients. Indirect positive effects for response efficacy and affective risk suggest that vicarious experience with long COVID is associated with increased intentions to get a COVID-19 vaccine.

Conclusion

The protection from long COVID through vaccination are relevant aspects for individual decisions and health communication.

Factors associated with COVID-19 vaccination in Belize

Background

We analyzed the factors associated with vaccine uptake, vaccination intention, and reasons for vaccine hesitancy in Belize.

Methods

We collected a nationally representative household survey of the population in Belize aged 15 years and older (September-October 2021). We compared potential correlates between vaccinated and unvaccinated people using Chi-square tests. Then, we performed logistic regression analysis to identify factors associated with vaccination uptake among all respondents and vaccination intention among the unvaccinated.

Results

Our analysis included data from 1261 interviews. Nearly four out of every five people reported being vaccinated, having received at least one dose. Adolescents and young adults were more likely to be unvaccinated. Significant differences were observed for most behavioral variables. Among the 41.7% of the unvaccinated respondents who said they would probably not or definitely not get vaccinated, the primary reason for their hesitation was fear of side effects. Additionally, almost one third of the unvaccinated individuals expressed a lack of trust in vaccines. Factors associated with increased likelihood of vaccination were efficacy beliefs, self-efficacy and vaccine attitudes. People who believed it was easy to get a vaccine were over 23 times (OR 23.63 [95% CI: 14.21-39.27]) more likely to be vaccinated, while those who believed in vaccine safety were 2.57 times [OR 95% CI: 1.52-4.35] more likely to be vaccinated. Among the unvaccinated, factors associated with intention to get vaccinated were self-identifying as Garifuna and having clear efficacy beliefs.

Conclusions

To our knowledge, this is the first study describing factors associated with COVID-19 vaccine uptake and vaccine hesitancy in Belize. Our findings revealed that accessibility has been the primary limitation in increasing vaccine coverage, and <7% of the eligible population have been strong vaccine deniers. To enhance vaccine uptake, targeted outreach efforts are necessary to address access barriers. Our results call for increased efforts improving self-efficacy, efficacy beliefs, and perceived norms.

Which measures of perceived vulnerability predict protective intentions-and when?

Assessing perceived vulnerability to a health threat is essential to understanding how people conceptualize their risk, and to predicting how likely they are to engage in protective behaviors. However, there is limited consensus about which of many measures of perceived vulnerability predict behavior best. We tested whether the ability of different measures to predict protective intentions varies as a function of the type of information people learn about their risk. Online participants (N = 909) read information about a novel respiratory disease before answering measures of perceived vulnerability and vaccination intentions. Type-of-risk information was varied across three between-participant groups. Participants learned either: (1) only information about their comparative standing on the primary risk factors (comparative-only), (2) their comparative standing as well as the base-rate of the disease in the population (+ base-rate), or (3) their comparative standing as well as more specific estimates of their absolute risk (+ absolute-chart). Experiential and affective measures of perceived vulnerability predicted protective intentions well regardless of how participants learned about their risk, while the predictive ability of deliberative numeric and comparative measures varied based on the type of risk information provided. These results broaden the generalizability of key prior findings (i.e., some prior findings about which measures predict best may apply no matter how people learn about their risk), but the results also reveal boundary conditions and critical points of distinction for determining how to best assess perceived vulnerability.

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

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18-74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated.

Cognitive underpinnings of COVID-19 vaccine hesitancy

RATIONALE

Vaccines save lives. Despite the undisputed value of vaccination, vaccine hesitancy continues to be a major global challenge, particularly throughout the COVID-19 global pandemic. Since vaccination decisions are counter-intuitive and cognitively demanding, we propose that vaccine hesitancy is associated with executive function-a group of high-level cognitive skills including attentional control, working memory, inhibition, self-regulation, cognitive flexibility, and strategic planning.

OBJECTIVE

We set out to test (i) whether vaccine hesitancy is driven by individual differences in executive function beyond established socio-demographic factors (e.g., education, political orientation, gender, ethnicity, age, religiosity) and depressed mood, and (ii) whether this relationship is exacerbated by situational stress.

METHODS

Two studies were conducted with U.S. residents. Using a cross-sectional design, Study 1 examined the associations between executive function, socio-demographic factors, COVID-19 conspiracy beliefs, trust in health authorities, and COVID-19 vaccine hesitancy. Using an experimental design, Study 2 focused solely on unvaccinated individuals and tested the interactive effect of executive function and stress on willingness to receive a COVID-19 vaccine. We used ordinal logistic regressions to analyze the data.

RESULTS

Individual differences in executive function predicted participants' COVID-19 conspiracy beliefs, trust in health authorities, and their willingness to vaccinate against COVID-19. Importantly, the unique contribution of executive function to vaccine hesitancy could not be explained by socio-demographic factors or depressed mood. Furthermore, Study 2 revealed that weaker executive function had detrimental effects on COVID-19 vaccine acceptance and trust in health authorities mainly under heightened stress.

CONCLUSIONS

Individual differences in executive function and situational stress jointly impact COVID-19 vaccination decisions and need to be considered together when designing health communications aimed at reducing COVID-19 vaccine hesitancy. Interventions that lower stress and promote trust have the potential to increase vaccine acceptance, especially for individuals with weaker executive function.

Barriers and facilitators of willingness to vaccinate against COVID-19: Role of prosociality, authoritarianism and conspiracy mentality. A four-wave longitudinal study

Aim

We investigated longitudinal relations between individual willingness to undergo vaccination against COVID-19 and three social factors: conspiracy mentality, prosociality, and authoritarianism.

Method

This longitudinal study comprised four measurement points. The first wave sample included 1130 responses and was representative of the Polish population in terms of gender, age, and place of residence. Analyses were performed using random intercept cross-lagged panel models.

Results

We observed bidirectional positive cross-lagged relationships between prosociality and willingness to undergo vaccination in the first three waves of measurement. Authoritarianism and conspiracy mentality translated into a lower willingness to vaccinate between the third and fourth points of measurement when the vaccination became a near-term possibility.

Conclusions

Eliciting prosocial motivation to vaccinate can be paramount in overcoming vaccine hesitancy. Because conspiracy thinking may be a crucial barrier to willingness to be vaccinated, it is critical to focus on planning interventions and campaigns undermining conspiracy theories about COVID-19.

The seductive allure of technical language and its effect on covid-19 vaccine beliefs and intentions

Previous research has demonstrated a ‘seductive allure’ of technical or reductive language such that bad (e.g., circular) explanations are judged better when irrelevant technical terms are included. We aimed to explore if such an effect was observable in relation to a covid-19 vaccinations and if this subsequently affected behavioural intentions to take up a covid-19 vaccine. Using a between subjects design we presented participants (N = 996) with one of four possible types of vignette that explained how covid-19 vaccination and herd immunity works. The explanations varied along two factors: (1) Quality, explanations were either good or bad (i.e., tautological); (2) Language, explanations either contained unnecessary technical language or did not. We measured participants’ evaluation of the explanations and intentions to vaccinate. We demonstrate a ‘seductive allure’ effect of technical language on bad vaccine explanations. However, an opposite ‘repellent disdain’ effect occurred for good explanations which were rated worse when they contained technical language. Moreover, we show that evaluations of explanations influence intentions to vaccinate. We suggest that misinformation that includes technical language could be more detrimental to vaccination rates. Importantly, however, clear explanatory public health information that omits technical language will be more effective in increasing intentions to vaccinate.

"Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions

OBJECTIVE

The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children.

METHOD

This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children.

RESULTS

64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information.

CONCLUSION

Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.

Links between conspiracy beliefs, vaccine knowledge, and trust: Anti-vaccine behavior of Serbian adults

RATIONALE

Immunization is a critical tool in the fight against infectious disease epidemics. Understanding hesitancy towards immunization is even more important nowadays, with the continuous threat of COVID-19 pandemic. Medical conspiracy beliefs, scientific skepticism, as well as low trust in governmental institutions, and evidence-based knowledge all have troubling effects on immunization.

OBJECTIVE

To examine how these factors cross-react to influence vaccine behavior against any vaccine preventable disease (VPD), we hypothesized a model consisting of the belief in conspiracy theories as the predictor, and as the mediators subjective and objective vaccine knowledge, and trust in the health care system and science. The model was tested by examining the vaccine intentions for the children and self for any VPD.

METHODS

Two separate studies were conducted on the representative samples of Serbian population; the first study investigated the intentions for child vaccination and the second study examined the vaccine intentions against any VPD, including adult vaccination. We used path analysis followed by logistic regression to analyze the data.

RESULTS

The results revealed high vaccine hesitancy motivated by the belief in the vaccine conspiracy theories, through its effect on reduced trust in medical science and institutions, and low objective vaccine knowledge.

CONCLUSIONS

The results of this study may be used to implement appropriate policy changes and implementation of the public health campaigns to promote immunization with a wide range of vaccines against common diseases, such as measles, human papillomaviruses, or pertussis, and novel diseases, such as COVID.

Fearing the disease or the vaccine: The case of COVID-19

As studies indicate that people perceive COVID-19 as a threatening disease, the demand for a vaccine against the disease could be expected to be high. Vaccine safety concerns might nevertheless outweigh the perceived disease risks when an individual decides whether or not to accept the vaccine. We investigated the role of perceived risk of COVID-19 (i.e., perceived likelihood of infection, perceived disease severity, and disease-related worry) and perceived safety of a prospective vaccine against COVID-19 in predicting intentions to accept a COVID-19 vaccine. Three Finnish samples were surveyed: 825 parents of small children, 205 individuals living in an area with suboptimal vaccination coverage, and 1325 Facebook users nationwide. As points of reference, we compared the perceptions of COVID-19 to those of influenza and measles. COVID-19 was perceived as a threatening disease—more so than influenza and measles. The strongest predictor of COVID-19 vaccination intentions was trusting the safety of the potential vaccine. Those perceiving COVID-19 as a severe disease were also slightly more intent on taking a COVID-19 vaccine. Informing the public about the safety of a forthcoming COVID-19 vaccine should be the focus for health authorities aiming to achieve a high vaccine uptake.