The determinants of COVID-19 vaccination intention: a meta-review

Communication Strategies to Promote COVID-19 Vaccination Intention: How Effective are Source, Appeal, Framing, and Evidence Type Approaches?

This systematic review analyzed the effectiveness of key persuasive strategies - source, appeal, framing, and evidence (SAFE) - on COVID-19 vaccination intention. Quantitative studies were searched in Web of Science, Scopus, and PubMed following the PRISMA guidelines. From the 61 studies that met inclusion criteria, source and framing are the most commonly applied SAFE strategies. However, source characteristics are a more consistent influence on vaccine intentions than message framing strategies, with expert sources and general practitioners emerging as the key sources contributing to greater vaccine intentions. In addition, a range of mediators and moderators influence the process through which SAFE message strategies impact vaccine intentions. Framing effects, in particular, are moderated by political identity, source characteristics, and vaccine perceptions. Tests of mediating processes highlight how health behavior judgments (e.g. perceived vaccine benefits, risks, trust in vaccination, perceived severity) and message response/perceptions (e.g. counterarguing, perceived similarity/empathy) operate as key intervening factors between SAFE message strategies and vaccine intentions. Overall, when practitioners apply various structural approaches (narrative elements, fear appeals, framing cues) to vaccine promotion campaigns, they should be cognizant of who is providing that appeal. Targeted populations may benefit most from different structural elements if they are integrated with sources that resonate with the audience.

Predictors of Persistent COVID-19 Vaccine Refusal Among Previously Infected Patients in Nebraska

Objectives. To identify factors associated with persistent COVID-19 vaccine refusal among Nebraska residents 6 months after an initial COVID-19 diagnosis. Methods. Using case investigation surveillance data and vaccination records from the Nebraska Department of Health and Human Services, a cohort of 16 344 unvaccinated, COVID-19‒confirmed individuals (May 2021‒February 2023) were asked for their reason for nonvaccination (RNV), then followed for 6 months to assess subsequent vaccination status. We used a modified Poisson regression to estimate risk of unvaccinated status at follow-up against predictors, including RNV, demographic characteristics, adherence to mitigation measures, hospitalization, and rurality. Results. Compared with those whose RNV was missed opportunity/lack of convenience, individuals who cited religious exemption (adjusted incidence risk ratio [AIRR = 1.36; 95% confidence interval [CI] = 1.31, 1.41), philosophical objection (AIRR = 1.28; 95% CI = 1.24, 1.34), or institutional confidence/complacency concerns (AIRR = 1.26; 95% CI = 1.19, 1.33) showed greatest risk of nonvaccination. Older age, nonadherence to mitigation measures, and higher rurality are positively associated with nonvaccination. Minority status and hospitalization were correlated with vaccination. Conclusions. Ideology-centered objections held significant weight among previously infected individuals who displayed sustained reluctance toward COVID-19 vaccination. Distinguishing sources of misinformation among ideologically similar communities could instigate reconsideration for vaccination. (Am J Public Health. 2025;115(3):414-424. https://doi.org/10.2105/AJPH.2024.307921).

Role of Individual, Social and Health Factors as Determinants of COVID-19 Vaccine Hesitancy: Results from the Second Phase of the Italian EPICOVID19 Web-Based Survey

BACKGROUND

Despite scientific breakthroughs in vaccine development, some people remain reluctant to accept the anti-SARS-CoV-2 vaccine. This study evaluates attitudes and behaviours towards the vaccine and factors associated with refusal/hesitancy at the start of Italy's vaccination campaign.

METHODS

EPICOVID19 is a two-phase observational web-based study where adult volunteers completed questionnaires in April-June 2020 and January-February 2021. Refusal/hesitancy towards the vaccine was assessed among those not yet vaccinated. We analysed factors associated with refusal/hesitancy by applying multivariate multinomial logistic regression models.

RESULTS

Among 36,820 survey participants (mean age of 51 years, 59.7% women, 63.6% highly educated), 2449 (6.7%) were against or hesitant, 4468 (12.1%) were inclined but unsure, and 29,903 (81.2%) were willing to be vaccinated. Factors positively associated with refusal/hesitancy included female sex, middle age, at-risk occupations, medium and low education, deprived status, being underweight, previous SARS-CoV-2 positivity, poor perceived health, no fear of contracting SARS-CoV-2, the fear of contaminated food and natural disasters, and low trust in science, media, government, or institutions. Low hesitancy was associated with student and retired status, overweight and obesity, moderate and high alcohol consumption, no concern about economic and working conditions, and sensitivity to climate change/environmental pollution and epidemics.

CONCLUSIONS

This survey showed that, during the first month of Italy's vaccination campaign, some individuals were reluctant to receive the anti-SARS-CoV-2 vaccine. This study highlights potential target groups for tailored communication and prevention campaigns.

Characteristics of the First Italian Older Adults Vaccinated with an Adjuvanted Respiratory Syncytial Virus (RSV) Vaccine

Background and Objectives: Three respiratory syncytial virus (RSV) vaccines have been recently made available for older adults. Understanding the principal characteristics of the first vaccine-takers can pave the way for a successful vaccination campaign. The objective of this study was to explore the sociodemographic and clinical characteristics of the first Italian users of an adjuvanted RSV vaccine and their attitudes towards RSV and vaccination. Materials and Methods: This cross-sectional study was conducted in 2024 in Liguria (Italy). Individuals aged ≥60 years with no contraindications to the adjuvanted vaccine RSVPreF3 OA were eligible. Following vaccination, subjects filled in a questionnaire, which comprised items on sociodemographic and clinical characteristics, attitudes towards RSV and RSV vaccination and a vaccination trust indicator (VTI). Results: A total of 453 vaccinees completed the survey. Their mean age was 74.9 ± 8.0 years, and 50.6% were males. Nine of ten (89.2%) individuals had ≥1 co-morbidity, of which cardiovascular conditions (70.4%), respiratory diseases (27.6%) and diabetes (18.5%) were the most common. Uptake of the routine vaccines was high: 91.2% and 98.7% received the 2023/2024 season influenza and ≥2 COVID-19 vaccines, respectively. The most common reasons for the current RSV vaccination were general practitioner advice (43.9%), followed by the willingness to be protected against (20.8%) and feelings of being at risk (16.6%) of RSV. The average VTI score was 91.5%, suggesting high trust in vaccines. More positive attitudes towards RSV vaccination were observed (p < 0.01) among subjects who received more COVID-19 vaccine doses, whose reasons for the current RSV vaccination were the willingness to be protected or to be in good health and the feeling of being at risk for RSV. Conclusions: The first Italian users of the novel RSVPreF3 OA vaccine were represented by high-risk individuals with a comparatively high prevalence of co-morbidities, high uptake of the seasonal respiratory vaccines and high trust in immunization.

Factors influencing COVID-19 vaccination intentions and mediating effects among older adults in Southwest China

This study examines the factors influencing COVID-19 vaccination intentions among Chinese residents over the age of 60, with a focus on the mediating roles of Health Beliefs and Cues to Vaccination Action in the relationship between vaccine knowledge and vaccination intentions. We conducted a cross-sectional online survey involving 1,305 participants from Southwest China. Multiple logistic regression analysis identified potential determinants of vaccination intention, including socioeconomic characteristics, knowledge, health beliefs, and cues to vaccination action. Furthermore, mediation analysis using the causal mediation analysis method explored the mediating effects within the knowledge-to-intention pathway. Vaccination intention and its related factors: among the 1212 elderly people included in the study, 92.9% expressed willingness to receive the COVID-19 vaccine. Main factors influencing their vaccination willingness included Residency (urban vs. rural, OR = 0.47, p < 0.01), Age (75 + vs. others, OR = 0.41, p < 0.05), Marital status (OR = 0.36, p < 0.01), Occupation ( business/service vs. others, OR = 0.33, p < 0.05), Awareness of vaccine effectiveness (OR = 1.23, p < 0.01), Cues to vaccination action (OR = 1.31, p < 0.01) and COVID-19 related knowledge (OR = 1.06, p < 0.01). The analysis revealed two significant mediators-Health Beliefs and Cues to Vaccination Action. These mediators (p<0.05 for both natural indirect effect and natural direct effect) acted along two key pathways: (1) From Knowledge of COVID-19 to Health Beliefs to Vaccination Intention: Natural Direct Effects (NDE) ranged from 0.012 to 0.016, with Natural Indirect Effects (NIE) from 0.001 to 0.003, indicating that mediators accounted for 4% to 18% of the total effect. (2) From Knowledge of COVID-19 to Cues of Vaccination Action to Vaccination Intention: NDE ranged from 0.012 to 0.016 and NIE from 0.002 to 0.003, with mediators accounting for 9% to 20% of the effect. The intention to vaccinate against COVID-19 among older adults varies significantly based on socioeconomic and health belief factors. The study identifies health beliefs and cues to action not only as direct contributors but also as crucial mediators in the pathway from knowledge to vaccination intention among older individuals. These findings can extend our understanding of the impact of sociodemographic factors and health beliefs on the COVID-19 vaccination willingness among older adults.

The potential role of perceived neighborhood social cohesion on COVID-19 vaccination uptake among individuals aged 50 and older: Results from the Korean Community Health Survey

The COVID-19 pandemic highlighted the critical importance of vaccination in controlling infectious diseases. While previous research has identified social cohesion as a potential facilitator of health behaviors, empirical studies exploring its direct impact on COVID-19 vaccination rates, especially across different age groups, remain limited. This cross-sectional study utilized data from the 2021 Korean Community Health Survey, a nationally representative survey conducted in South Korea. The analysis focused on adults aged 50 and older, categorizing them into two age groups (50-64 and ≥65). We investigated the association between perceived neighborhood social cohesion and COVID-19 vaccination status, controlling for socio-economic status, health behaviors, and concerns related to COVID-19. Statistical analysis was conducted using complex sample multiple logistic regression to adjust for potential confounders. The study included 135,352 participants, with an analysis showing that in the age group ≥65, higher levels of perceived neighborhood social cohesion were significantly associated with increased vaccination uptake (aOR for trust between neighbors: 1.200, 95% CI: 1.058-1.362; aOR for mutual assistance among neighbors: 1.491, 95% CI: 1.312-1.695). Interestingly, these associations were not significant in the 50-64 age group. Additionally, satisfaction with healthcare services was associated with higher vaccination uptake in both age groups (aOR: 1.106, 95% CI: 1.004-1.219 for 50-64; aOR: 1.306, 95% CI: 1.160-1.471 for ≥65). Our findings suggest that perceived neighborhood social cohesion plays a crucial role in influencing COVID-19 vaccination uptake among older adults, particularly those aged 65 and above. These results indicate that health policies aimed at enhancing social cohesion may effectively improve vaccination rates, especially among the elderly. Future research should explore the impact of social cohesion on other age groups and assess the causal relationships in longitudinal studies.

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.

Behavioral, cognitive and emotional determinants of getting vaccinated for COVID-19 and the mediating role of institutional trust among young adults in Cyprus

BACKGROUND

Vaccination uptake is a complex behavior, influenced by numerous factors. Behavioral science theories are commonly used to explain the psychosocial determinants of an individual's health behavior. This study examined the behavioural, cognitive, and emotional determinants of COVID-19 vaccination intention based on well-established theoretical models: Acceptance and Commitment Therapy (ACT), Capability, Opportunity, Motivation, and Behaviour (COM-B) and the Health Belief Model (HBM). Additionally, it examined the mediating role of institutional trust in the relationship between determinants of these models and vaccination intentions.

METHODS

A cross-sectional study was conducted from January to May 2022, where university students in Cyprus completed an online survey.

RESULTS

A total of 484 university students completed the online survey, with 23.8% reporting being vaccinated with fewer than three vaccination doses and/or no intention to vaccinate further. Hierarchical logistic regression analysis showed that higher scores in institutional trust, perceived severity, motivation, physical and psychological capability were significantly associated with higher odds of intending to vaccinate. Higher psychological flexibility and not being infected with COVID-19 were also associated with higher odds of vaccination intention, but not in the final model when all determinants were included. Additionally, significant indirect effects of psychological and physical capability, motivation and perceived severity on vaccination intention were found to be mediated by institutional trust.

CONCLUSIONS

When tackling COVID-19 vaccination hesitancy, behavioural, cognitive, and emotional aspects should be considered. Stakeholders and policymakers are advised to implement targeted vaccination programs in young people while at the same time building trust and improving their capabilities and motivation towards getting vaccinated.

Vaccine literacy, vaccination intention, and their correlation among adults in Mainland China: a cross-sectional study

BACKGROUND

Vaccination is one of the most economic and effective strategies for preventing infectious diseases. However, public intention to be vaccinated is, to a certain degree, influenced by issues related to vaccine hesitancy, anti-vaccine movement, and public concerns about safety and adverse effects. Vaccine literacy is considered as a positive factor in improving vaccination intention, however, the correlation between vaccine literacy and vaccination intention has not been thoroughly investigated in mainland China. This study aims to (1) explore the correlation between vaccine literacy and vaccination intention among adults in mainland China; (2) investigate whether participants could seek out vaccine information on their own initiative and whether they knew basic information of common vaccines.

METHODS

An online cross-sectional survey was conducted on 614 adult participants from 27 May to 8 June 2023 by a convenience sampling. Data were collected by using the questionnaire of demographic characteristics, vaccine literacy, vaccination intention, initiative of seeking out vaccine information, and basic vaccine quiz about common vaccines. Data were analyzed by using IBM SPSS version 24.0 at a significance level of 0.05.

RESULTS

The mean scores of functional, and interactive-critical vaccine literacy were 2.97 ± 0.70 and 2.73 ± 0.66; the vaccination intentions of influenza, hepatitis B, COVID-19 and HPV were 58.5%, 80.0%, 71.3% and 62.9% respectively; interactive-critical vaccine literacy was significantly and positively associated with vaccination intention. The results also showed: 71.4% of the participants could seek out vaccine information on their own initiative, however, a certain proportion of the participants merely knew vaccine names and did not know basic information of common vaccines, especially influenza vaccine and hepatitis B vaccine.

CONCLUSIONS

There is still room for improvement in vaccine literacy, vaccination intention of influenza and HPV vaccines, and basic vaccine information. Based on the significantly positive correlation between interactive-critical vaccine literacy and vaccination intention, it is advisable to harness vaccine literacy to boost vaccination intention by communicating and learning basic information of common vaccines.

COVID-19 Booster Vaccination Status and Long COVID in the United States: A Nationally Representative Cross-Sectional Study

Early studies have found that the initial COVID-19 vaccination series was protective against severe symptoms and long COVID. However, few studies have explored the association of booster doses on severe disease outcomes and long COVID. This cross-sectional analysis used data from the 2022 US National Health Interview Survey data to investigate how vaccination status correlates with COVID-19 infection severity and long COVID among previously infected individuals. Participants were categorized into three groups: those who had received at least one booster, those with only the initial complete vaccination series, and those with either an incomplete series or no vaccinations. Out of 9521 survey respondents who reported a past positive COVID-19 test, 51.2% experienced moderate/severe infections, and 17.6% experienced long COVID. Multivariable regression models revealed that receiving at least one booster shot was associated with lower odds of experiencing moderate/severe symptoms (aOR = 0.78, p < 0.001) compared to those unvaccinated or with an incomplete series. Additionally, having at least one booster reduced long COVID odds by 24% (aOR = 0.76, p = 0.003). Completing only the primary vaccine series did not significantly decrease the likelihood of severe illness or long COVID. These findings support the continued promotion of booster vaccinations to mitigate long COVID risks in vulnerable populations.

Determinants of COVID-19 vaccination intention in Central and Eastern Europe: A cross-sectional study in Poland, Romania, and Slovenia

BACKGROUND

Identifying predictors of vaccination intention is critical to developing appropriate programs and campaigns targeting groups reluctant to be vaccinated. This study aimed to identify the determinants of vaccination intention at the beginning of the COVID-19 pandemic in three Central and Eastern European (CEE) countries: Poland, Romania, and Slovenia.

METHODS

In this cross-sectional study, a sample of unvaccinated 1723 Poles, Romanians, and Slovenians completed an online survey (April 2021). Questions included measures of vaccination intention, attitudes towards vaccines, conspiracy mindset, preference for a type of vaccine, and trust in information sources.

RESULTS

The results showed that mistrust of vaccine benefits and concerns about commercial profiteering negatively predicted vaccination intention. Conversely, trust in information from medical professionals and scientists, official sources, and traditional media was positively related to vaccination intention, while trust in digital media was negatively related to vaccination intention. In addition, preference for mRNA vaccine type was a positive significant predictor of vaccination intention. The differences between countries are discussed.

CONCLUSIONS

The study results deliver suggestions for developing appropriate vaccine uptake programs and campaigns that should consider presenting the positive outcomes of vaccines via official sources and traditional media based on scientific evidence and medical professionals' knowledge.

"It's not that I don't trust vaccines, I just don't think I need them": Perspectives on COVID-19 vaccination

In Quebec (Canada), the roll-out of the vaccination started slowly in December 2020 due to limited vaccine supply. While the first and second doses were well-accepted among adults and vaccine uptake was above 90%, in late 2021 and 2022, vaccine acceptance decreased for children vaccination and receipt of a 3rd or a 4th dose. In the autumn of 2022, four focus groups were conducted with vaccine-hesitant parents of children aged 0-4 and adults who expressed little intention to receive a booster dose. The objective of this study was to gather participants' perspectives on vaccination in general, on the COVID-19 vaccination campaign and the information available, and to gain insights into the underlying reasons for their low intention of either having their child(ren) vaccinated, or receiving an additional dose of vaccine. A total of 35 participants took part in the focus groups. While participants expressed a certain level of trust and confidence in public health and government authorities regarding pandemic management and the vaccination campaign, they were also concerned that transparent information was lacking to support an informed decision on booster doses and children's vaccination. Many participants felt adequately protected against the infection during the focus groups, citing a lack of perceived benefits as the primary reason for refusing a booster dose. Parents who refused to administer the COVID-19 vaccine to their young children felt that the vaccine was not useful for children and were concerned about potential side effects. The majority reported that their opinions regarding other recommended vaccines had not changed since the beginning of the pandemic. While these results are reassuring, our findings highlight the importance of transparency in public health communications about vaccines to increase confidence and to develop strategies to address vaccine fatigue and complacency toward COVID-19 vaccines.