Analysis of the Impact of Media Trust on the Public's Motivation to Receive Future Vaccinations for COVID-19 Based on Protection Motivation Theory

Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations

RATIONALE

Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes.

OBJECTIVE

The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations.

METHOD

We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles.

RESULTS

The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions.

CONCLUSIONS

While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.

How do self-exempt beliefs affect intentions to quit smoking? An exploration of the mediating role of threat appraisal and coping appraisal

Introduction

Numerous smokers are cognizant of the detrimental effects associated with this habit yet exhibit a persistent reluctance to cease their tobacco consumption. Self-exempt beliefs serve as an obstacle to the cessation of this addictive behavior. This research explored the impact of self-exempt beliefs on the readiness to quit smoking based on the Protection Motivation Theory (PMT) model and the mediating roles of threat appraisal and coping appraisal.

Methods

Self-exempt beliefs, PMT constructs, and the intention to quit smoking constituted the theoretical model. The questionnaires were collected from 488 Chinese adult male smokers based on snowball sampling. Exploratory Factor Analysis (EFA) was used to examine the underlying factor structure of the pre-designed self-exempt beliefs scale. The reliability, validity, path coefficients, and explanatory power of the model were calculated using Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results and discussion

The results showed that : (1) three common factors (skeptic beliefs, bulletproof beliefs, and "worth it" beliefs) with a total of 11 items were retained after EFA; (2) skeptic beliefs and "worth it" beliefs had a significantly negative effect on both threat appraisal and coping appraisal, while bulletproof beliefs did not; (3) bulletproof beliefs had a significantly positive direct impact on intention to quit, "worth it" beliefs had a significantly negative direct impact on intention, while skeptic beliefs had no significantly direct impact on intention; (4) threat appraisal and coping appraisal positively and significantly predicted cessation intention; and (5) threat appraisal and coping appraisal, as two main cognitive processes, acted as full mediations between skeptic beliefs and the intention to quit, as complementary partial mediations between "worth it" beliefs and the intention, and as non-mediation between bulletproof beliefs and the intention. Our findings suggest that efforts to undermine or "prevent" these self-exempt beliefs, particularly "worth it" and skeptic beliefs, may be an effective tactic for health communication interventions for quitting smoking.

COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario: A qualitative study

BACKGROUND

The burden of the current COVID-19 pandemic is not shared equally in Canadian society, with Indigenous Peoples being disproportionately affected. Moreover, there is a lack of research pertaining to vaccination behaviour in Métis communities. This Métis-specific and Métis-led qualitative study endeavours to understand COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario (MNO).

METHODS

Data was collected via one-on-one interviews. Participants were recruited via the MNO's existing social media channels. Participants filled out a screening survey indicating their intention to vaccinate against COVID-19 as yes, no, or unsure. Sixteen participants (9 yes, 3 unsure, 4 no) were interviewed. Interviews averaged 30 min, and the questions and probes were developed in collaboration with the MNO. The interviewer received Métis-specific cultural safety training. Interviews were transcribed verbatim and uploaded to NVivo 12.

RESULTS

A deductive analysis using the Social Ecological Model framework (SEM) for vaccine behaviour and two blinded coders was used to understand the data. An additional factor, COVID-19 public health measures, was added to the framework to better capture the experiences of participants during the COVID-19 pandemic. Overall, the factors with the greatest number of coded references included Vaccine roll-out and availability, Organization of the public into priority groups, Public discourse, Interpersonal influences, Interface with health professionals, Knowledge state, Trust, and Vaccine risk perception. Bandwagoning (following others' behaviour) and Freeloading (perceiving enough people have been vaccinated), both factors of the SEM, were not discussed. Yes, no, and unsure participant groups were compared to understand the influences of each factor based on COVID-19 vaccination intention.

CONCLUSIONS

MNO citizens COVID-19 vaccine behaviour was negatively and positively influenced by a number of factors. This information will allow the MNO and public health units to better tailor their messaging for COVID-19 vaccine uptake campaigns and future pandemic emergencies.

Meta-analysis on application of Protection Motivation Theory in preventive behaviors against COVID-19

The present study aims to conduct a systematic review and meta-analysis on quantitative conclusion and appraisal of findings from Protection Motivation Theory to predict protective behaviors against COVID-19. This meta-analysis covered the period between 2019 and 2022. Web of Science, Science Direct, Scopus, Emerald, PubMed, Springer, Sage, Online Wiley Library, Taylor & Francis and ProQuest were searched to find related articles to the study topic. Using Effect Size of Random model, the quality of each study, homogeneous of studies and Publication bias of data were analyzed and assessed by CMA2 software. The results indicate that perceived severity (β=0.197), perceived vulnerability (β=0.160), response efficacy (β=0.251) and self-efficacy (β=0.270) are positively associated with COVID-19 disease. In addition, the results show that Response cost (β=-0.074) is a negative and weak predictor of motivation to protect against COVID-19. The results of this study regarding Protection Motivation Theory (PMT)- as a very strong and flexible theory during outbreak of COVID-19- may suggest that despite positive protection, the mean of Effect Size of total PMT elements is less than average size. Meta-analysis of studies shows that coping appraisal variables provide the strongest predictors of behavior and intention. Furthermore, self-efficacy was identified as the most important determinant in protective behaviors against COVID-19.

'We were having a rather long conversation about the uproar': memorable messages about COVID-19 vaccinations in a mostly young, white sample

BACKGROUND

Interpersonal communication motivates many decisions related to COVID-19 prevention practices. Previous research shows that the frequency of interpersonal communication is significant. Less is known, however, about who messages interpersonal communication about COVID-19 and what information those messages convey. We sought to understand better these interpersonal communication messages for individuals who are asked to become vaccinated against COVID-19.

METHODS

Using a memorable messages approach, we interviewed 149 adults, mostly young, white, college students, about their vaccination choices as they were influenced by messages about vaccination they had received from respected members of their interpersonal networks. Date was analyzed using thematic analysis.

RESULTS

Three themes emerged from these interviews of primarily young, white, college students: a dialectic of feeling forced to become vaccinated vs. choice to become vaccinated; a tension between protecting oneself vs. protecting others through vaccination; and, finally, perceptions that family members who were also medical experts were particularly influential.

CONCLUSIONS

The dialectic between feelings of choice versus force may require further study into the longer-term impacts of messages that may prompt feelings of reactance and produce undesired outcomes. The dialectic between messages being remembered for their altruism as compared to their selfishness opens opportunities to consider the relative influence of these two impulses. These findings also provide insight into broader topics about countering vaccine hesitancy for other diseases. These findings may not be generalizable to older, more diverse populations.

The pattern from the first three rounds of vaccination: declining vaccination rates

Introduction

Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations.

Methods

On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses.

Results

A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05).

Conclusion

As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.

How Motivation to Reduce Uncertainty Predicts COVID-19 Behavioral Responses: Strategic Health Communication Insights for Managing an Ongoing Pandemic

During highly uncertain times such as the coronavirus disease 2019 (COVID-19) pandemic, it is vital to understand and predict individuals’ responses to governments’ crisis and risk communication. This study draws on the Orientation-Stimulus-Orientation-Response (O-S-O-R) model to examine (1) whether uncertainty reduction motivation (a pre-orientation factor) drove Americans to turn to traditional news media and/or social media (stimuli) to obtain COVID-19 information; (2) if these media preferences shaped their COVID-19 knowledge, cognitive information vetting, and trust in government communication (post-orientation factors); and finally (3) whether these factors contributed to their intended and actual behaviors (responses), such as getting vaccinated. Thus, this study explores how multiple communicative and cognitive mechanisms contribute to public compliance with government health recommendations during a pandemic. Mediation analyses showed positive indirect effects between uncertainty reduction motivation and behavioral outcomes via use of social media (in relation to traditional news media) and COVID-19 knowledge and cognitive information vetting. This study discusses theoretical and practical health communication implications of these findings.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

COVID-19 Vaccine Uptake and Hesitancy among Pregnant and Lactating Women in Saudi Arabia

INTRODUCTION

Pregnant and breastfeeding women comprise a high-risk group for the development of severe COVID-19. Therefore, vaccination is highly recommended for perinatal women; however, vaccination levels for this group remain inadequate. This study explores the percentage of COVID-19 vaccination among Saudi pregnant and lactating women, as well as their attitudes toward it.

METHODS

We conducted a cross-sectional questionnaire-based survey on a sample of Saudi pregnant and breastfeeding women. The study included pregnant and lactating women.

RESULTS

The percentage of COVID-19 vaccine uptake was 78.2%. A total of 45 (21.8%) out of 206 women did not receive the vaccine. The overall vaccine hesitancy was 21.8%. Breastfeeding women were 2.86 more likely not to receive the vaccine as compared to pregnant women. Being a mother of over five children increased the vaccine uptake among our participating women (n = 20, 90%; p < 0.01). The majority of the subjects had taken the Pfizer vaccine (81.98%, 132/161). The availability of the COVID-19 vaccine was the most common factor for choosing a particular vaccine. Protection from infection (60.2%, 97/161) was reported as the main driver for vaccine uptake. The most common reason perceived for delaying COVID-19 vaccination was being worried about the side effects (176, 85.44%) on one's own body and the effects on the unborn child (130, 63.1%).

CONCLUSION

We uncovered high levels of hesitancy, primarily induced by concerns about adverse effects and social media-related misinformation. These high levels of vaccine uptake are likely due to the large-scale obligatory vaccination program provided in Saudi Arabia, which was well-structured and far reaching. Our results provide further support for the so-called "protection motivation theory" in boosting vaccine acceptance. Counseling and educating pregnant and breastfeeding women about COVID-19 vaccination is the need of the hour.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology

OBJECTIVE

Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally.

SETTING AND PARTICIPANTS

Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021.

RESULTS

Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries.

CONCLUSION

Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.

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

Vaccination is the most effective way of limiting the spread of COVID-19. However, despite the proven effectiveness and safety of vaccines, there is resistance in society and the course of vaccination is slow. The aim of this study was to identify the factors associated with COVID-19 vaccination behaviour.

Methods: The data originate from a representative sample of Latvian residents (N  = 1017) taken in September 2021. The data were analysed using Chi-squared test, Mann–Whitney test, Spearman's rank correlation coefficient, Kruskal Wallis test, and Binary Logistic regression analysis.

Results: The results of the study reveal several factors that are associated with COVID-19 vaccination behaviour. These factors are a higher level of education, motivation for protecting oneself against illness, for promoting collective immunity, protecting relatives and other people from infection, as well as motivation for vaccination in order to keep a job or continue studies, and institutional trust. On the other hand, perceived social support from relatives is negatively associated with vaccination behaviour.

Conclusion: A higher level of education and confidence in evidence-based information on COVID-19, provided by official sources of information, is the key factor in deciding whether to protect oneself from serious illness or to make a choice to promote collective immunity and protect other people. The need for vaccination in order to continue working and/or learning is also an essential motive for vaccination. On the other hand, the belief that, if necessary, it is possible to receive support from relatives may be a delaying factor in the behaviour of vaccination.

Media Exposure and Media Credibility Influencing Public Intentions for Influenza Vaccination

Due to the low rate of influenza vaccination in China, this study explores the factors influencing the Chinese public’s influenza vaccination intentions. Based on the technology acceptance model (TAM), this study builds a theoretical model to examine the factors influencing Chinese public intentions toward influenza vaccination. We define media exposure and media credibility as external variables and the perceived characteristics of influenza vaccines as intermediate variables in the proposed model. A total of 597 valid questionnaires were collected online in this study. Combined with structural equation modeling (SEM), SPSS 22.0 and AMOS 17.0 were used to conduct empirical research, supporting the proposed research hypotheses. The results show that media exposure and media credibility have no direct effects on the audience’s intention to take the influenza vaccine. However, media exposure positively influences media credibility, influencing vaccination intentions through perceived usefulness (PU) and perceived ease of use (PEOU). Furthermore, PU and PEOU significantly positively influence behavioral intentions, and PEOU significantly affects PU. This paper has proven that media with better credibility gained more trust from the audience, indicating a new perspective for the promotion of influenza vaccination. This study suggests releasing influenza-related information via media with great credibility, further improving public acceptance of becoming vaccinated.