The relation between conspiracism, government trust, and COVID-19 vaccination intentions: The key role of motivation

Efficacy-focused and autonomy-supportive messaging in social media vaccine campaigns: insights from a Facebook split test

BACKGROUND

In the context of social media vaccine campaigns, understanding the impact of message framing on audience engagement is crucial. This study examines the efficacy of messages centered on efficacy versus autonomy, informed by theoretical frameworks: the Extended Parallel Process Model (EPPM) and Self Determination Theory (SDT).

METHODS

Utilizing the Facebook A/B Split Test (FBST) feature, an online experiment was conducted to compare the response to two different messages: one emphasizing vaccine efficacy (EPPM-informed) and the other focusing on individual autonomy in making vaccine decisions (SDT-informed). The primary measure of interest was the number of clicks on a link directing to a pro-vaccine website.

RESULTS

The findings indicated that the autonomy-centered (SDT-informed) message resulted in a significantly higher click-through rate to the pro-vaccine website, particularly among users aged 65 and above. Furthermore, analysis of comments from Facebook users identified factors potentially contributing to vaccine hesitancy, with mistrust being the most dominant.

CONCLUSIONS

The study underscores the importance of tailoring social media vaccine campaigns to address the autonomy needs of the target audience while considering trust-related issues to mitigate vaccine hesitancy. Emphasizing individual autonomy in vaccine decision-making processes can enhance engagement with pro-vaccine content, especially in older demographics.

Effects of Government Mistrust and Group-Based Medical Mistrust on COVID-19 Vaccine Hesitancy Among a Sample of African Americans

BACKGROUND

Despite the demonstrated efficacy of coronavirus disease (COVID-19) vaccines, higher rates of vaccine hesitancy among African Americans remain concerning. As determinants of vaccine hesitancy, the simultaneous roles of government mistrust and group-based medical mistrust have not been examined via from a cognitive information perspective among African Americans.

PURPOSE

We examined the direct and indirect effects of government mistrust and group-based medical mistrust on COVID-19 vaccine hesitancy in a sample of African Americans.

METHODS

We obtained data from 382 African Americans in South-East Michigan via an online survey. We assessed demographic variables, government mistrust, group-based medical mistrust, COVID risk and COVID worry, and positive and negative beliefs regarding the COVID-19 vaccine (i.e., vaccine pros and cons), and vaccine hesitancy. We examined our hypotheses with path analyses.

RESULTS

Results indicated significant direct effects of government mistrust on vaccine hesitancy; however, despite a significant correlation, there was no direct effect of group-based medical mistrust on vaccine hesitancy. The effect of group-based medical mistrust was fully mediated by both vaccine pros and cons, whereas the effect of government mistrust was partially mediated by vaccine pros. COVID risk and COVID worry did not mediate the effects of mistrust to vaccine hesitancy.

CONCLUSION

Negative effects of group-based medical mistrust on COVID-19 vaccine hesitancy among African Americans may be amenable to interventions that focus on beliefs about the vaccine rather than beliefs about vulnerability to the virus. However, given its direct effect, it may be necessary to focus directly on government mistrust to diminish its effects on COVID-19 vaccine hesitancy.

Impacts of travel duration on urban-rural resident free vaccination behavior: Chinese COVID-19 vaccine booster dose evidence

This study aimed to evaluate how the duration of travel affects the behavior of urban and rural residents regarding free COVID-19 vaccination, and provide scientific evidence for promoting free vaccination and building an immune barrier to cope with future epidemics. From August 3, 2022 to February,18,2023, A follow-up survey was conducted in urban and rural adults in four cities in China to collect information on socio-demographic factors, vaccination status and travel time for vaccination. Propensity score matching (PSM) analysis was deployed to measure the net difference of the enhanced vaccination rate between urban and rural residents in different traffic time distribution. A total of 5780 samples were included in the study. The vaccination rate of the booster dose of COVID-19 vaccine among rural residents was higher than that of urban residents with a significant P-value (69.36% VS 64.49%,p < .001). The traffic time had a significant negative impact on the COVID-19 booster vaccination behavior of urban and rural residents. There was a significant interaction between the travel time to the vaccination point and the level of trust in doctors. Travel time had a negative impact on the free vaccination behavior of both urban and rural residents. The government should optimize and expand the number of vaccination sites and enhance residents' trust in the medical system. This is crucial for promoting free vaccination and effective epidemic management in the future.

Opinion Leadership and Sharing Positive and Negative Information About Vaccines on Social Media: A Mixed-Methods Approach

In our research, we examined how three dimensions of opinion leadership-connectivity, maven, and persuasiveness-are associated with sharing positive and negative information about vaccines among parents in Hong Kong through a mixed-methods approach. In two studies, we assessed opinion leadership following a sociometric approach that involved using data from social media (Study 1) and a self-assessment using survey data (Study 2), which yielded largely consistent results. In particular, whereas connectivity and maven were significantly associated with sharing positive information about vaccines, all three dimensions were significantly associated with sharing negative information about vaccines. Those findings suggest that different dimensions of opinion leadership play different roles in information sharing depending on the information's valence. Moreover, the similar pattern of findings from both studies suggested that the sociometric approach and self-assessment may capture the multidimensional nature of opinion leadership equally well. In sum, the findings advance theoretical discussions on the role of opinion leadership in information sharing and offer practical insights into promoting vaccination for children among parents.

Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan

In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn't trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals' national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.

Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions

Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.

Promoters and Barriers of Vaccine Hesitancy

This systematic review explores the psychological antecedents of Vaccine Hesitancy, a significant determinant of vaccination behavior. Following PRISMA guidelines, an extensive search was conducted starting from 1673 papers and resulting in 48 publications from various databases. The review identifies psychological factors, specifically cognitive, personality, experiential, and social factors contributing to hesitancy. Cognitive factors include health literacy, conspiracy beliefs, trust, and perceived risk. Personality traits such as extraversion, openness, and psychological capital impact hesitancy, while psychopathy increases it. Personal experiences, like perceived stress and racial discrimination, indirectly affect hesitancy. Social factors, including social relationships and norms, play a significant role in reducing hesitancy. Tailored interventions addressing these factors can enhance vaccine acceptance.

Trust in government, social media and willingness to vaccinate

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust.

The protective power of dissent? A longitudinal study on cognitive and socio-emotional determinants of COVID-19 vaccine hesitancy among young people in Canada

COVID-19 has elicited polarized reactions to public health measures, fueling anti-vaccination movements worldwide which indicate that vaccine hesitancy represents a common expression of dissent. We investigate changes in cognitive (i.e., trust in government, conspiracy beliefs, vaccine attitudes, and other COVID-19-related factors) and socio-emotional factors (i.e., psychological distress and social support) over time, and examine if these factors are associated with COVID-19 vaccine hesitancy. A sample of Canadian young adults (N = 2,695; 18 to 40 years old) responded to an online survey in May/June 2021 (after the first vaccination campaign) and then in November 2021 (after vaccine mandates were introduced). Based on survey answers, participants were categorized as "not hesitant", "hesitant", and "do not intend to get vaccinated" at each time point. Results from generalized estimating equation models indicate that vaccination hesitancy decreased over time. The importance attributed to specific COVID-19-related factors (e.g., research and science about COVID-19 vaccines, opinions of friends and family) decreased whereas psychological distress increased over time. Cognitive and socio-emotional factors were associated with vaccine hesitancy, with participants who did not intend to get vaccinated reporting the lowest psychological distress scores. We argue that dissent may be an empowering way for young people to restore a sense of personal agency via the opposition to a system perceived as illegitimate and/or unfair. These results raise important questions about potential collateral effects of top-down government and public health interventions in times of crisis.

Motivation for COVID-19 Vaccination: Applying a Self-Determination Theory Perspective to a Global Health Crisis

Examining the spectrum of vaccine attitudes within the general public, spanning from hesitancy to confidence, is pivotal in addressing the challenges posed by the COVID-19 pandemic. Despite widespread campaigns advocating for vaccine uptake, a proportion of the population harbour reservations about the safety and efficacy of vaccines. This study seeks to explore the determinants of vaccine attitudes in Canada, leveraging key concepts from the well-established Self-Determination Theory (SDT), including basic psychological needs and the quality of an individual's motivation. During a crucial juncture in the COVID-19 pandemic (December 2021), 292 participants were recruited and completed an online survey assessing levels of satisfaction/frustration of basic psychological needs (sense of autonomy, relatedness, and competence), vaccine attitudes (confidence and hesitancy), and motivation towards vaccination (controlled and autonomous). Two mediation models were employed to examine whether autonomous-controlled motivation mediated the relationship between need satisfaction-frustration and vaccine attitudes. Model 1 revealed a full mediating effect, indicating that need satisfaction influenced vaccine confidence only through autonomous motivation (ab1 = 0.09, SE = 0.04, z = 2.19, 95 % CI [0.01, 0.18]). Meanwhile, Model 2 demonstrated that need frustration was associated with vaccine hesitancy partially through controlled motivation (ab2 = 0.05, SE = 0.02, z = 2.54, 95 % CI [0.02, 0.10]). These findings underscore the applicability of SDT in investigating the motivational mechanisms that shape vaccine attitudes. Recognizing psychosocial factors, including the balance of basic needs and quality of motivations, may be integral to informing effective public health strategies.

Social cognition, personality and social-political correlates of health behaviors: Application of an integrated theoretical model

OBJECTIVE

Dispositional, intra-personal constructs such as personality traits and generalized beliefs are consistently related to health behaviors, but relatively few studies have tested the theory-based mechanisms by which these constructs relate to health behaviors and compared them across behavior type. In the current study we tested an integrated theoretical model in which belief-based social cognition constructs (attitudes, subjective norms, perceived behavioral control) were proposed to mediate effects of personality traits (conscientiousness, extroversion) and socio-political beliefs (political beliefs, locus of control, free will beliefs) on participation in three health-related behaviors: physical activity, COVID-19 vaccination, and sugar-sweetened beverage restriction.

METHODS

Proposed integrated model effects were tested in a five-week prospective correlational study. Finnish residents completed measures of personality, socio-political, and social cognition constructs with respect to physical activity participation (N = 557), COVID-19 vaccination uptake (N = 1,115), and sugar-sweetened beverage restriction (N = 558) and self-reported their behavior at follow-up.

RESULTS

Structural equation models revealed direct effects of intention on behavior, and of social-cognition constructs on intention, across all behaviors. We also found indirect effects of political beliefs on behavior mediated by social cognition constructs and intentions for COVID-19 vaccination and sugar-sweetened beverage restriction behaviors, indirect effects of conscientiousness on behavior mediated by social cognition constructs and intentions for physical activity and sugar-sweetened beverage restriction behaviors, and indirect effects of health locus of control on behavior mediated by social cognition constructs and intentions for physical activity behavior. Finally, we found a negative total effect of populist beliefs on behavior for COVID-19 vaccination behavior.

CONCLUSION

Findings contribute to an evidence base for the effects of dispositional and social cognition constructs of health behaviors, point to a possible mechanism by which these generalized constructs relate to health behavior, and outline how the pattern of effects varies across the different behaviors.

Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants

BACKGROUND

People's perceived risk of being infected and having severe illness was conceived as a motivational source of adherence to behavioral measures during the COVID-19 crisis.

METHODS

We used online self-reported data, spanning 20 months of the COVID-19 crisis in Belgium (n = 221,791; 34.4% vaccinated; July 2020 - March 2022) to study the association between risk perception and motivation.

RESULTS

Both perceived infection probability and severity fluctuated across time as a function of the characteristics of emerging variants, with unvaccinated persons perceiving decreasingly less risk compared to vaccinated ones. Perceived severity (and not perceived probability) was the most critical predictor of autonomous motivation for adherence to health-protective measures, a pattern observed at both the between-day and between-person level among both vaccinated and unvaccinated individuals. An integrated process model further indicated that on days with higher hospitalization load, participants reported being more adherent because risk severity and autonomous motivation for adherence were more elevated on these days.

CONCLUSIONS

These findings suggest that risk severity served as a critical and dynamic resource for adherence to behavioral measures because it fostered greater autonomous regulation.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Vaccine conspiracy association with higher COVID-19 vaccination side effects and negative attitude towards booster COVID-19, influenza and monkeypox vaccines: A pilot study in Saudi Universities

Conspiracies regarding vaccines are widely prevalent, with negative consequences on health-seeking behaviors. The current study aimed to investigate the possible association between the embrace of vaccine conspiracies and the attitude to booster COVID-19, seasonal influenza, and monkeypox (mpox) vaccinations as well as the perceived side effects following COVID-19 vaccination. The target population involved academic staff and university students in health colleges in the Kingdom of Saudi Arabia. A self-administered questionnaire was distributed in January 2023 to collect data on participants' demographics, self-reported side effects following each dose, willingness to get booster COVID-19, seasonal influenza, and mpox vaccinations, as well as an evaluation of vaccine conspiracies and attitude to mandatory vaccination. Among the 273 participants, the willingness to receive yearly booster COVID-19 vaccination was observed among 26.0% of the participants, while it was 46.9% and 34.1% for seasonal influenza and mpox vaccinations, respectively. Multinomial logistic regression analyses demonstrated a significant correlation between endorsing vaccine conspiracies and higher frequency of self-reported side effects following uptake of the second and third doses of COVID-19 vaccines. Vaccine conspiracies were also correlated with attitude toward booster COVID-19, influenza, mpox, and mandatory vaccination. The findings of this pilot study highlighted the potential adverse impact of the preexisting notions and negative attitudes toward vaccines, which could have contributed to heightened perceived side effects following COVID-19 vaccination. The study also highlighted the ongoing divisions concerning mandatory vaccination policies, emphasizing the need for cautious implementation of this strategy as a last resort for public health benefit.

Believing in conspiracy theories in Spain during the COVID-19 pandemic: Drivers and public health implications

Conspiracy theories jeopardize public health by disseminating misinformation and undermining authoritative health guidelines. This study explores social factors associated with the belief in conspiracy theories in Spain during the COVID-19 pandemic. Drawing upon the theoretical framework of Max Weber, it posits that beliefs in conspiracy theories are linked to both instrumental rationality considerations, such as trust in health authorities, science, and pharmaceutical companies, as well as value-rationality based factors, such as ideological orientation. The study analyzes recent, nationally representative survey data and is the first to examine the social predictors of belief in conspiracy theories in Spain during the pandemic. The findings highlight that conspiracy theory beliefs are (a) associated with considerably worse vaccination behaviors, (b) not or only very weakly associated with standard demographics such as age, sex, or education, (c) related to instrumental rationality considerations, and (d) only weakly related to value-rationality indicators such as ideological and religious affiliations. In conclusion, the study underscores the significance of public health policies that specifically address conspiracy theory convictions, and to that end, advocates for the application of a Weberian sociological perspective to better understand the diverse rationalities underlying these beliefs, particularly in the absence of discernible demographic predictors.

Lessons learned from COVID-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy

BACKGROUND

Enhancing the public's vaccine literacy is critical for curbing vaccine hesitancy and enhancing society's pandemic preparedness, particularly in an era of infodemic. Evidence on vaccine literacy as an influencing factor of hesitancy is scarce. Lessons could be learned from COVID-19 vaccination implementation. Taking the COVID-19 vaccines as an example, the current study aimed to examine the relationship between vaccine literacy and hesitancy and the mediating role of psychological antecedents of vaccination on the relationship.

METHODS

A baseline online questionnaire survey among the general public in China based on quota sampling was conducted in April 2021 to measure participants' vaccine literacy, psychological antecedents of vaccination, COVID-19 vaccination status, and vaccine hesitancy. A follow-up online survey tracked the updated COVID-19 vaccination status among those who hadn't taken COVID-19 vaccines at the baseline survey. Structural equation modeling has been applied to examine the direct and indirect effect of vaccine literacy on vaccine hesitancy. Time-to-event analysis was used to explore the effect of vaccine hesitancy on vaccination behavior.

RESULTS

Lower vaccine hesitancy was associated with higher vaccine literacy. The "3Cs" psychological antecedents were important mediators between vaccine literacy and vaccine hesitancy. The pathway between critical/interactive vaccine literacy and vaccine hesitancy through the "3Cs" psychological antecedents played a more important role. Time-to-event analysis showed participants with a higher vaccine hesitancy were prone to have a longer delay in vaccination.

CONCLUSIONS

Improving the public's ability to obtain and evaluate vaccination information can fix the public's psychological determinants of vaccination, reducing vaccine hesitancy and promoting vaccination. Governments need to put more effort into guiding and regulating the media to disseminate evidence-based information, rectifying misinformation, and improving the public's vaccine literacy through education, especially the public's capability to critically discern mixed information.

Who is motivated to accept a booster and annual dose? A dimensional and person-centered approach

The transmissibility of new COVID-19 variants and decreasing efficacy of vaccines led authorities to recommend a booster and even an annual dose. However, people's willingness to accept new doses varied considerably. Using two independent longitudinal samples of 4596 (Mean age = 53.6) and 514 (Mean age = 55.9) vaccinated participants, we examined how people's (lack of) vaccination motivation for their first dose was associated with their intention to get a booster (Sample 1) and an annual dose (Sample 2) several months later (Aim 1). We also aimed to capture the impact of the motivational heterogeneity on these intentions by capitalizing on participants' different motivational profiles collected at baseline (Aim 2). Across both samples, autonomous motivation, controlled motivation, and distrust-based amotivation were uniquely related to, respectively, higher, lower, and even lower booster and annual dose intentions. Further, a two-step clustering procedure revealed five profiles, with the profiles characterized by higher autonomous motivation (i.e. Good Quality and High Quantity profiles) reporting the highest vaccination intentions and the profile characterized by the highest number of obstacles (i.e. Global Amotivated profile) yielding the lowest vaccination intentions. These results stress the critical need to support citizens' volitional endorsement of vaccination to harvest long-term benefits with respect to COVID-19.

How the Stringency of the COVID-19 Restrictions Influences Motivation for Adherence and Well-Being: The Critical Role of Proportionality

BACKGROUND

The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens'behavior, motivation and mental health.

METHODS

Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest.

RESULTS

Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures.

CONCLUSION

Stringent measures are not per se demotivating or compromising of people's well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.

Social media trust predicts lower COVID-19 vaccination rates and higher excess mortality over 2 years

Trust plays a crucial role in implementing public health interventions against the COVID-19 pandemic. We examined the prospective associations of interpersonal, institutional, and media trust with vaccination rates and excess mortality over time in two multinational studies. In study 1, we investigated the country-level relationships between interpersonal trust, vaccination rates, and excess mortality across 54 countries. Interpersonal trust at the country level was calculated by aggregating data of 80,317 participants from the World Values Survey in 2017-20. Data on vaccination rates and excess mortality were obtained from the World Health Organization. Our findings indicated that higher levels of interpersonal trust were linked to higher vaccination rates and lower excess mortality rates in both 2020 and 2021. In study 2, we collected data from 18,171 adults in 35 countries/societies, stratified by age, gender, and region of residence. At the country/society level, interpersonal trust and trust in local healthcare facilities, local healthcare services, and healthcare professionals were associated with higher vaccination rates and lower excess mortality, whereas social media trust was associated with lower vaccination rates and higher excess mortality across three time points over 2 years. Our findings are robust when controlling for country-level covariates of the government stringency index, population density, and medical resources (i.e. critical care beds) in both studies.

A qualitative study exploring the social contagion of attitudes and uptake of COVID-19 vaccinations

Vaccination attitudes and uptake can spread within social networks. This study aims to understand the perceived social contagion mechanisms of vaccination uptake in the context of COVID-19 pandemic. Eleven semi-structured interviews were conducted following a purposive sampling of three hesitant, three anti- COVID-19 vaccine and five pro- COVID-19 vaccine (27% females). Thematic Analysis suggested two general themes reflecting the type of contagion: 1) information contagion and 2) behavior contagion. Transcending these themes was the notion of ownership of choice/decision. Almost all participants used the media and experts as the main source of information regarding vaccination. They influenced - and they were being influenced by - friends and family members with whom they share similar traits and attitudes and have a close relationship of trust and intimacy. Also, being exposed to positive attitudes and beliefs toward vaccination and COVID-19 vaccines, enhanced vaccination behaviors. However, the vaccination decision-making process was not perceived as a passive process - there was ownership over the decisions made. This study highlights the perceived mechanisms of social contagion. It also suggests that the meaning individuals pose on their social world is crucial on their decision-making. Policymakers are advised to consider including social networks of individuals and trusted sources (i.e. healthcare providers) when delivering interventions or educational campaigns on vaccinations.

COVID-19 Vaccination Hesitancy in Autoimmune Disease Patients: Policy Action and Ethical Considerations

As COVID-19 vaccination guidelines were issued by Advisory Committee on Immunization Practices (ACIP) and the Centers for Diseases Control and Prevention (CDC) across the US, each state and clinical provider instituted vaccine implementation and education policies and protocols for high-risk populations. However, current research has shown that while people with autoimmune diseases were listed by ACIP and CDC as a COVID-19 high-risk population, the rate of adherence to implementation and education protocols, as well as the prioritization of this sub-population as a high-risk group, varied among the clinicians and vaccinators thus impacting the hesitancy towards the COVID-19 vaccine and a correlation to low vaccination rates. The purpose of this review was to explore factors of COVID-19 vaccination hesitancy in people living with autoimmune diseases in relation to current implementation and education policies and protocols, as well as ethical and contextual factors, while providing possible implications. COVID-19 vaccine hesitancy in people living with autoimmune disease was greater than in the general population, as demonstrated by increased levels of overall mistrust and fear of potential risk and harmful side effects. Evidence has shown that COVID-19 vaccination is safe and effective for patients with autoimmune diseases. Additionally, the benefits of COVID-19 vaccination outweigh its potential risks and adverse effects in this population. However, the non-adherence to policy and protocols, especially community education protocols, by those providing the vaccination have a negative impact on the overall perception of the vaccine and needs to be addressed at local and state levels in order to protect this population. Future research should provide strategies to guide collaborative efforts between government and local agencies in providing tailored vaccination campaigns to this population. In parallel with policy, COVID-19 vaccination intervention implementation and educational protocols should be developed with evidence-based guidelines for public health and clinical professionals that are targeted at this vulnerable high-risk population.

Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework

COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.

Psychometric development of the COVID-19 vaccine misinformation scale and effects on vaccine hesitancy

To help inform post-COVID-19 pandemic practical health policies, the researchers created the COVID-19 vaccine misinformation scale (CVMS). During the COVID-19 pandemic, falsehoods spread online which casted doubt and concerns about the vaccine. Example misconceptions included vaccination leads to greater vulnerability to other illness and would alter someone's DNA. The researchers performed two large surveys with U.S. participants. The researchers reviewed debunked COVID-19 vaccine falsehoods online. Construction of the CVMS followed standard psychometric scale development steps. Statistical analysis provided support for the 10-item CVMS with satisfactory reliability, discriminant validity, and convergent validity. Predictive validity regression analysis demonstrated the CVMS associated with higher vaccine hesitancy. The prevalence of vaccine misbeliefs broadened pandemic healthcare challenges. On top of existing duties, healthcare workers had to explain vaccine efficacy and safety to dispel fallacies. The researchers discuss implications for the CVMS within the context of motivated reasoning theory.

Empathy moderates the relationship between cognitive load and prosocial behaviour

Cognitive load reduces both empathy and prosocial behaviour. However, studies demonstrating these effects have induced cognitive load in a temporally limited, artificial manner that fails to capture real-world cognitive load. Drawing from cognitive load theory, we investigated whether naturally occurring cognitive load from the ongoing COVID-19 pandemic moderated the relationship between empathy and prosocial behaviour (operationalised as support for public health measures). This large study in an Australian sample (N = 600) identified negative relationships between pandemic fatigue, empathy for people vulnerable to COVID-19, and prosocial behaviour, and a positive relationship between empathy and prosocial behaviour. Additionally, we found that the negative effect of the pandemic on prosocial behaviour depended on empathy for vulnerable others, with pandemic fatigue's effects lowest for those with the highest empathy. These findings highlight the interrelationships of cognitive load and empathy, and the potential value of eliciting empathy to ease the impact of real-world cognitive load on prosocial behaviour.

An exploration on COVID-19 vaccination motivation patterns from the perspective of the Chaxu culture in metropolis of China: A multi-center study

Objectives

Chaxugeju is a very special Chinese culture following a self-centered and outward expanding social network, which might be a significant culture factor for vaccination behavior. This study aimed to identify the motivation pattern in China, and paid special focus on socio-economic status (SES), region, and migration.

Methods

We used a latent class analysis, with a sample of 12,432 participants collected in China from April to June, to identify the COVID-19 vaccination motivation patterns. Multinomial logistic regression models were utilized to separately explore associations between SES, migration, region, and COVID-19 vaccination motivation patterns.

Results

Three COVID-19 vaccination motivation patterns were identified: Self-protection (41.9%), Trust and Self-protection (38.5%), and Trust and Differential Protection (19.6%). Participants with higher income were more likely to be Trust and Self-protection, and when income is more than 50,000 CNY per month, they are more likely to be self-protection. Professional/white collar were more likely to be Self-protection. Participants from Shenzhen were more likely to be Trust and Differential protection. The moderating effects of gender were found for income and region. Gender does not moderate the associations of occupation or migration and COVID-19 vaccination motivation patterns.

Conclusion

Three motivational patterns were identified in which the Trust & Differential Pattern followed the traditional self-family-community Chaxu circle. However, the Chaxu motivation pattern was not the dominant one which might be weakened by SES. Migration and Shenzhen preserved the traditional social network, keeping in the trust and differential pattern. All of these factors in various cultural contexts should be considered when promoting vaccines.

Trust and vaccination intentions: Evidence from Lithuania during the COVID-19 pandemic

In this paper, we study the relationship between trust and COVID-19 vaccination intentions. Vaccinating a large share of the population is essential for containing the COVID-19 pandemic. However, many individuals refuse to get vaccinated, which might be related to a lack of trust. Using unique survey data from Lithuania during the COVID-19 pandemic, we show that trust in government authorities, science, and pharmaceutical companies are important predictors of individual vaccination intentions. We do not find evidence that trust in strangers, the healthcare system, or the media predict intentions to get vaccinated against COVID-19.

The impact of trust in government on pandemic management on the compliance with voluntary COVID-19 vaccination policy among adolescents after social unrest in Hong Kong

BACKGROUND

The launch of COVID-19 vaccines among students provides an opportunity to re-open schools safely. Nonetheless, under the voluntary vaccination policy, the lack of trust in government since the unprecedented massive social unrest in Hong Kong may hinder the vaccination progress. This study aims to assess the impact of trust in government regarding pandemic management on the willingness, uptake, and intention of COVID-19 vaccination among students in Hong Kong.

METHODS

Based on maximum variation sampling of 12 secondary schools of diverse socioeconomic background, 1,020 students aged 14-16 years completed an online survey between September and October 2021.

RESULTS

59.2% of the sample received at least one dose of the COVID-19 vaccine, 25.2% showed willingness of vaccination, 44.7% of the unvaccinated intended to receive the vaccine, whereas 13.4% were trustful to the government regarding pandemic management. Results from multivariable logistic regressions showed independent associations of trust with greater vaccination uptake [aOR = 1.63 (95% CI = 1.06-2.52), compared to distrust], willingness [aOR = 12.40 (7.72-19.93)], and intention [aOR = 4.49 (2.06-9.75)]. However, the impact of trust on vaccine uptake reversed [aOR = 0.53 (0.32-0.87)] after additional adjustment for the willingness of vaccination.

CONCLUSION

Students with higher trust in government regarding pandemic management tended to have greater vaccination willingness and hence uptake; nonetheless, given the same level of willingness, distrust might have facilitated a faster adoption of vaccination as a self-initiated protective behavior. As the level of trust is generally low among secondary school students in Hong Kong, rebuilding trust during adolescence is of importance for better preparedness of the next pandemic.

A cross-national and longitudinal analysis of handwashing and its predictors during the COVID-19 pandemic in France and Belgium

BACKGROUND

Using a longitudinal design, we investigate how the adherence to handwashing and its underlying socio-psychological predictors evolved over time during the COVID-19 pandemic and under distinct circumstances (e.g. when the crisis was more acute or chronic).

METHOD

We collected data (N = 753) in Belgium and France at the onset of the COVID-19 pandemic when the crisis was at its peak (April 2020), and almost a year later (February 2021), when the outbreak was more manageable.

RESULTS

Regression models suggest that the compliance with handwashing and its pattern of underlying predictors remained remarkably stable over time despite the variations in contextual factors such as the severity of the health crisis and the stringency of health measures. As such, the findings also highlight the robustness of the models that predict it, namely the Theory of Planned Behavior. The intentions to perform the behavior, the perceived control over it, and being part of the (para)medical field were among the strongest predictors.

CONCLUSIONS

In practice, the stability of the underlying factors suggests a set of action levers that can be used in communication campaigns aimed at fostering its adherence throughout the pandemic.

Measuring the Intention in Favour and Against Getting Vaccinated from COVID-19 Using the Health Belief Model: Cross-Sectional Study of Pakistan

Vaccination is without a doubt one of the most efficient ways to stop the COVID-19 pandemic from spreading. The goal of this study was to look into the acceptance and resistance to COVID-19 vaccination and its associated components using the Health Belief Model, which is a framework for changing health behaviours (HBM). The current study is quantitative; hence data was collected from attendants of patients admitted to hospitals in Pakistan's top-tier cities using a survey-based self-administered questionnaire. Nonprobability convenient sampling was utilised to approach the respondents. The model was tested in two stages using partial least squares (variance-based structural equation modelling). The measurement model's reliability and validity imply that the data is reliable and valid. Except for the impact of benefits on accepting behaviour, all of the study postulated relationships are supported by the results. The study agenda adds to our understanding of health care, immunisation, consumer behaviour, and behavioural research. It adds to the body of knowledge in the fields of immunisation and behavioural research by examining people's behaviours and changes during the worldwide mass vaccination period.

I dream of socializing, sports, and serenity: Imagining a positive future-vaccinated self is associated with better attitudes toward COVID-19 vaccination

In the context of the COVID-19 pandemic, governments are attempting to vaccinate a large proportion of their adult population against the virus. While many people hurried to receive the vaccine, vaccination rates then started stagnating and governments are searching for solutions to motivate remaining citizens to receive the vaccine. Previous studies show that imagining oneself in the future can motivate health prevention behaviors, but our study is the first to use a future selves paradigm to study vaccination motivators. In two mixed methods studies we examine the effects of imagining of a future-vaccinated self (FVS) on vaccine attitudes, where participants were asked to think about what their life would be like once they had received the COVID-19 vaccine. In Study 1 (n = 114), we coded the most important categories of FVS. Several FVS were identified and related to increased social and leisure activities, reduced negative emotion and societal constraints, possible side effects of the vaccine, and societal changes. In Study 2 (n = 113), we used a 2 × 2 design in which participants' reflections on their FVS were guided or open and visualized from a first- or third-person perspective. The guided condition produced greater acceptance of the vaccine, and the first-person perspective produced greater behavioral intentions to be vaccinated. We discuss the effectiveness of future selves interventions for promoting vaccination in different societal contexts.

Influenza and Other Prophylactic Vaccination Coverage in Polish Adult Patients Undergoing Allergen Immunotherapy-A Survey Study among Patients and Physicians

Vaccines against infectious diseases may raise safety concerns in patients undergoing allergen immunotherapy (AIT). The objective of our study was to investigate influenza vaccine and other selected prophylactic vaccines coverage in patients treated with AIT and the attitude of physicians towards vaccinations in this group of patients. We conducted a questionnaire-based study among patients undergoing AIT and physicians. The patients’ survey evaluated influenza and other prophylactic vaccines coverage. The physicians’ survey assessed their experience and opinions on prophylactic vaccinations during AIT. In total, 176 patients (aged 18−79 years) and 120 doctors filled the questionnaires. Patients were assigned to two groups—inhaled allergens group (n = 101) and insect venoms group (n = 68). The number of patients who received any dose (36% and 45%, p = 0.26), as well as two or more doses (17% and 22%, p = 0.43) of influenza vaccine was comparable between two groups. However, in both groups there was a significant (p < 0.0001) decrease in influenza vaccine uptake after the beginning of AIT. Patients from the inhaled allergens group declared a higher tetanus vaccine rate (41% vs. 19%, p = 0.004). The groups did not differ in the pneumococcal and tick-borne encephalitis vaccination coverage. A majority of doctors believe that prophylactic vaccinations in patients undergoing AIT are safe and effective (96% and 94%, respectively); however, as many as 87% of them identify with the need to create clear recommendations regarding vaccinating patients undergoing AIT. Prophylactic vaccine coverage is not satisfactory among Polish adult patients undergoing AIT. Polish doctors are convinced of the validity of prophylactic vaccinations during AIT.