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Despite the public health value of immunizations, vaccine hesitancy is a widespread phenomenon and received special attention during the global COVID-19 pandemic. The Vaccination Attitudes Examination (VAX) Scale aims to identify anti-vaccination attitudes for understanding vaccine hesitancy. The present study is the validation of the German version of the VAX scale in pre-/mid-pandemic samples. All individuals completed an online-survey assessing prior and expected future vaccination behaviors, further constructs associated with vaccine hesitancy, as well as anti-vaccination attitudes using the translated VAX scale among others. In a first study, 297 individuals were surveyed before the COVID-19 pandemic. A second study included 260 individuals recruited during the COVID-19 pandemic. For validation, two confirmatory factor analyses have been conducted. Reliability measures (internal consistency, test–retest-correlation) were determined. The four subscales were confirmed by Confirmation Factor Analysis with a very good to excellent fit. The subscales showed good to excellent reliability and convergent validity determinants. Average VAX values significantly distinguished between individuals who had previously received or refused immunization and predicted expected vaccination behavior. The German translation of the VAX scale is effective in identifying anti-vaccination attitudes and can be used for further research on anti-vaccination attitudes and vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Objectives: During the COVID-19 pandemic, online health information search has been shown to influence the public's health beliefs, risk attitudes, and vaccination behavior. This study constructs a conditional process model to explore how online health information search impacts public vaccination behavior, considering critical factors like healthcare system satisfaction, vaccine risk perception, and the perceived usefulness of information. Methods: Data from the 2021 Chinese General Social Survey (N = 2,547) were analysed. The study utilized logistic regression, path analysis, and the Bootstrap method to test the conditional process model. Results: Increased online health information search promotes vaccination behavior, while increased vaccine risk perception hinders vaccination behavior. Higher satisfaction with the healthcare system encourages vaccination behavior, but online health information search reduces healthcare system satisfaction. Satisfaction with the healthcare system and vaccine risk perception play a chain mediating role between online health information search and vaccination behavior. Additionally, the perceived usefulness of information has a negative moderating effect on online health information search and healthcare system satisfaction. Conclusion: The research findings provide new insights for health information dissemination and vaccination interventions. [ABSTRACT FROM AUTHOR]

BackgroundPublic health campaigns are essential for promoting vaccination behavior, but factors such as socioeconomic status, geographical location, campaign quality, and service accessibility influence vaccine uptake. In the Wuxi region of China, disparities in vaccination behavior are seen between urban and rural populations and among different socioeconomic groups. This study aims to explore the factors related to public health campaigns that affect vaccination behavior in Wuxi, contributing to better public health strategies.MethodsA cross-sectional survey was conducted among 750 participants in Wuxi, focusing on their perceptions of socioeconomic status, geographical location, health campaign quality, and vaccination convenience. The questionnaire was developed based on a literature review and expert input using the Delphi method. Data were analyzed using descriptive statistics, reliability and validity tests, correlation analysis, and regression analysis, employing both SPSS and R software.ResultsSocioeconomic status, geographic location, campaign quality, and accessibility all significantly influence vaccination behavior. Higher socioeconomic backgrounds, urban residency, better campaign quality, and greater accessibility to vaccination services are positively correlated with higher vaccination uptake. Regression analysis revealed that public health campaigns and accessibility are particularly influential in promoting vaccination behavior.ConclusionTo improve vaccination rates, targeted strategies focusing on low socioeconomic groups, rural areas, and improving campaign quality and service accessibility are necessary. Public health campaigns should be clear, culturally relevant, and utilize multiple communication channels. Future research should address misinformation, explore behavioral economics, and integrate emerging technologies like AI to optimize vaccination efforts.

ABSTRACTThis review quantified the association of vaccine literacy (VL) and vaccination intention and status. PubMed, Scopus, and Web of Science were searched. Any study, published until December 2022, that investigated the associations of interest were eligible. For each outcome, articles were grouped according to the vaccine administrated and results were narratively synthesized. Inverse-variance random-effect models were used to compare standardized mean values in VL domain(s) between the two groups: individuals willing vs. unwilling to get vaccinated, and individuals vaccinated vs. unvaccinated. This review of 18 studies shows that VL strongly predicts the vaccination intention while its association with vaccination status is attenuated and barely significant, suggesting that other factors influence the actual vaccination uptake. However, given the scarce evidence available, the heterogeneity in the methods applied and some limitations of the studies included, further research should be conducted to confirm the role of VL in the vaccination decision-making process.

The contribution of vaccination to global health, especially in low-middle-income countries is one of the achievements in global governance of modern medicine, averting 2–3 million child deaths annually. However, in Nigeria, vaccine-preventable-diseases still account for one-in-eight child deaths before their fifth-year birthday. Nigeria is one of the ten countries where 4.3 million children under five are without complete immunization. Therefore, the goal of this contribution is to shed light on the reasons to set a foundation for future interventions. To conduct focus groups, a simplified quota sampling approach was used to select mothers of children 0–12 months old in four geographical clusters of Nigeria. An interview guide developed from the 5C psychological antecedence model was used (assessing confidence, complacency, calculation, constraints, collective responsibility); two concepts were added that had proved meaningful in previous work (religion and masculinity). The data were analyzed using a meta-aggregation approach. The sample was relatively positive toward vaccination. Still, mothers reported low trust in vaccine safety and the healthcare system (confidence). Yet, they had great interest in seeking additional information (calculation), difficulties in prioritizing vaccination over other equally competing priorities (constraints) and were aware that vaccination translates into overall community wellbeing (collective responsibility). They had a bias toward God as ultimate giver of good health (religion) and their husbands played a dominant role in vaccination decision-making (masculinity). Mothers perceived their children vulnerable to disease outbreaks, hence, motivated vaccination (complacency). The study provided a useful qualitative tool for understanding mothers’ vaccination decision-making in low resources settings.

ObjectivesDuring the COVID-19 pandemic, online health information search has been shown to influence the public’s health beliefs, risk attitudes, and vaccination behavior. This study constructs a conditional process model to explore how online health information search impacts public vaccination behavior, considering critical factors like healthcare system satisfaction, vaccine risk perception, and the perceived usefulness of information.MethodsData from the 2021 Chinese General Social Survey (N = 2,547) were analysed. The study utilized logistic regression, path analysis, and the Bootstrap method to test the conditional process model.ResultsIncreased online health information search promotes vaccination behavior, while increased vaccine risk perception hinders vaccination behavior. Higher satisfaction with the healthcare system encourages vaccination behavior, but online health information search reduces healthcare system satisfaction. Satisfaction with the healthcare system and vaccine risk perception play a chain mediating role between online health information search and vaccination behavior. Additionally, the perceived usefulness of information has a negative moderating effect on online health information search and healthcare system satisfaction.ConclusionThe research findings provide new insights for health information dissemination and vaccination interventions.

Abstract Background The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behavior change was likewise heterogeneous. Factors influencing precautionary behavior adoption during COVID-19 have been associated with multidimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behavior change during COVID-19 has been less studied. Methods To consider how the direct disease experience (“near misses”) and behavior change during the 2014–2016 Ebola virus disease (EVD) outbreak may have impacted behavior change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with quasi-likelihood information criterion (QIC)-based model selection was conducted to evaluate the influence of the interaction between and individual effects of the outbreak (EVD and COVID-19) and the “near-miss” experience on adoption of individual precautionary behaviors. Thematic analysis of interview transcripts explored reasons for differential behavior adoption between the two outbreaks. Results At the population level, being a “near miss” was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Participants who report near miss experiences during Ebola were significantly more likely to report having a household member test positive for COVID-19 (p

Previous studies on the co-evolving between vaccination strategies and epidemics mainly assumed that the vaccination strategies were made in the period between two spreading seasons. However, individual cognition during the spreading seasons might also alter the vaccination strategy and inversely influence the epidemic spreading. We propose a coupled disease-behavior model to describe the dynamic evolution of vaccination behavior during the spread of infectious diseases. The model integrates a susceptible-infected-vaccinated (SIV) model with the diffusion of vaccination behavior. We focus on the trade-off between perceptions of infection risk and the vaccination behaviors of neighbors, characterizing individual vaccination opinions. We introduce an opinion-critical value to map vaccination opinions into vaccination behavior. The vaccination coverage of the disease-behavior model is studied in network models and real-world networks. In addition, when societal costs are measured based on the degree of initial vaccinees, the cost of randomly selecting initial vaccinees is lowerthan selecting individuals with high or low degrees as vaccinees. Evaluating an individual's ability to transmit vaccination behavior based on the neighbor's number is inappropriate. We find that the impact of effective spreading rates on group vaccination is not one-sided and that reducing fear and highlighting the dangers of infectious diseases are crucial to increasing vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behavior change was likewise heterogeneous. Factors influencing precautionary behavior adoption during COVID-19 have been associated with multidimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behavior change during COVID-19 has been less studied. Methods: To consider how the direct disease experience ("near misses") and behavior change during the 2014–2016 Ebola virus disease (EVD) outbreak may have impacted behavior change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with quasi-likelihood information criterion (QIC)-based model selection was conducted to evaluate the influence of the interaction between and individual effects of the outbreak (EVD and COVID-19) and the "near-miss" experience on adoption of individual precautionary behaviors. Thematic analysis of interview transcripts explored reasons for differential behavior adoption between the two outbreaks. Results: At the population level, being a "near miss" was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Participants who report near miss experiences during Ebola were significantly more likely to report having a household member test positive for COVID-19 (p<0.001). Qualitatively, participants often reflected on themes around more proximal and personal experiences with Ebola than with COVID-19; they also commented on how EVD led to better preparedness at the systems level and within communities for how to behave during an outbreak, despite such awareness not necessarily translating into action during COVID-19. Conclusions: The results suggest that perceived proximity and intensity to disease threats in space and time affect behavioral decisions. For successive disease threats, comparisons of the present outbreak to past outbreaks compound those effects, regardless of whether individuals were directly impacted via a "near-miss" experience. Measures, such as risk communication and community engagement efforts, that gauge and reflect comparisons with previous outbreaks should be considered in response strategies to enhance the adoption of precautionary behavior. [ABSTRACT FROM AUTHOR]

Abstract Background The Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX’s structural, convergent, and discriminant validity is still limited, especially in youth samples. Methods The present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (M age = 18.23, SD age = 2.66, age range = 15–24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria. Results The results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors’ contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry. Conclusions The present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes.

Previous studies on the co-evolving between vaccination strategies and epidemics mainly assumed that the vaccination strategies were made in the period between two spreading seasons. However, individual cognition during the spreading seasons might also alter the vaccination strategy and inversely influence the epidemic spreading. We propose a coupled disease–behavior model to describe the dynamic evolution of vaccination behavior during the spread of infectious diseases. The model integrates a susceptible–infected–vaccinated (SIV) model with the diffusion of vaccination behavior. We focus on the trade-off between perceptions of infection risk and the vaccination behaviors of neighbors, characterizing individual vaccination opinions. We introduce an opinion-critical value to map vaccination opinions into vaccination behavior. The vaccination coverage of the disease–behavior model is studied in network models and real-world networks. In addition, when societal costs are measured based on the degree of initial vaccinees, the cost of randomly selecting initial vaccinees is lower than selecting individuals with high or low degrees as vaccinees. Evaluating an individual’s ability to transmit vaccination behavior based on the neighbor’s number is inappropriate. We find that the impact of effective spreading rates on group vaccination is not one-sided and that reducing fear and highlighting the dangers of infectious diseases are crucial to increasing vaccination coverage.

A self-designed questionnaire was used anonymously to investigate the knowledge and awareness level of human papilloma viruses（HPV）and vaccination behavior among interns from four hospitals in Jiangsu Province. This study aims to explore the influencing factors of vaccination behavior. A total of 1 250 questionnaires were distributed，and 1 230 valid copies were recalled. The results showed that the awareness rate of cervical cancer was 53.6%，while that of HPV was 33.3% and 54.7% of the students were aware of HPV vaccination. The knowledge of vaccine was obtained through school education（42.0%），official propaganda （36.1%），media communication（35.2%），and interpersonal communication（30.2%）. More than 60% of the respondents believed vaccine’s safety，efficacy，and immunity duration would affect its promotion，and 54.3% of them could accept vaccines at a cost less than 500 yuan. The vaccination rate of sampled female students was 15.7%. Multi -factor logistic regression analysis showed that the higher acceptable cost of the vaccine，getting the knowledge of the vaccine through interpersonal communication，the belief that HPV can be reinfected after recovery，and education level were important factors in promoting the vaccination behavior. Learning about the vaccine through media，such as television networks，negatively impacts vaccination behavior. Therefore，it is necessary to adopt comprehensive measures to improve the vaccination rate and emphasize interpersonal communication as a means of information dissemination. [ABSTRACT FROM AUTHOR]

The interrelatedness of social-structural aspects and psychological features with vaccination intention provides the context to explore personal psychological features related to vaccination. Specifically, we focused on general decision making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. Our study aimed to map the function (promotive, protective, risk, vulnerability) of a set of personal psychological aspects in the intention to vaccinate among people holding different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and laypeople, within the post-pandemic context. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from −0.128 to −0.983, all ps < 0.01). The main results indicate that, regardless of the sample/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate: for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system, play such roles; for HPs, the experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. Our findings provide insights into the function of psychological factors of vaccination intention across different social roles, particularly healthcare providers, parents, and laypeople, and emphasize the need for tailored immunization interventions in the post-pandemic landscape. [ABSTRACT FROM AUTHOR]

Abstract Background China’s current immunization program was revised in 2007. Some common childhood vaccines such as those for influenza, pediatric pneumonia, Haemophilus influenzae, varicella, and rotavirus have not been included in the National Immunization Program (NIP) and need to be purchased by children’s guardians at their own expense. Rural areas, constrained by economic development and vaccine awareness, have a low non-NIP vaccination rate and more family medical expenses and social burden. This study aims to examine the awareness and attitude of rural parents about non-NIP vaccines and relevant factors influencing their vaccination intention to provide strategic suggestions for expanding and improving the Chinese government’s NIP policy. Methods A qualitative method of in-depth interviews were conducted for this study. We interviewed 30 rural parents in a central Chinese village to investigate their awareness of non-NIP vaccines and their vaccination intention and behavior. All the interview data were analyzed through the Colaizzi seven-step data analysis method. Results This study summarized the individual and social level factors influencing the non-NIP vaccination intention of rural parents. The individual level factors include four themes: perceived severity with physical harm, treatment consumption (cost of the treatment of the subject diseases), psychological burden, and social consequences being subthemes; perceived vulnerability with age vulnerability, medical history, immune quality (children’s underlying immune status), and environmental vulnerability (sanitary condition of the rural environment) as subthemes; perceived efficacy with effect perception, psychological comfort, protective strength, and functional compensation (functions of non-NIP vaccines unreplaceable by NIP vaccines) being subthemes; and perceived cost consisting of two subthemes cost burden and adverse reaction. The social level influencing factors include the vaccination opinions in rural social networks, the accessibility of health services and vaccine products, and the guidance and promotion of vaccination policies. These factors act outside of individuals’ subjective awareness and influence decisions regarding non-NIP vaccination in rural areas. Conclusion Based on these influencing factors, this study constructs a structural model for non-NIP vaccination decision-making process in rural areas of China. The results play a guiding role in directing attention to children’s health, promoting non-NIP vaccination, facilitating the dissemination of vaccine knowledge in rural areas, and improving NIP policies and practices in China.

Background The elderly are a priority population for COVID-19 vaccination. COVID-19 vaccination can effectively reduce the risk of developing severe and critically ill patients or even death in COVID-19 patients. However, the current vaccination rate of the elderly in China is relatively low, and the COVID-19 vaccination behavior among the elderly has been rarely reported in current studies. Objective To investigate COVID-19 vaccination behavior and its influencing factors among the elderly in China, and to provide a reference for improving the COVID-19 vaccination rate of the elderly. Methods A total of 1 323 older adults aged 60 years and above in Wujin District of Changzhou City, Zhongmu County of Zhengzhou City, Chengzhong District of Xining City and Linkou County of Mudanjiang City were selected as research subjects from August 3 to August 14 in 2022 by using a stratified random sampling method and investigated by self-designed questionnaires. Binary Logistic regression analysis was used to explore the influencing factors of the first dose of COVID-19 vaccination, full course of COVID-19 vaccination, and booster dose of COVID-19 vaccination. Results 96.60% (1 278/1 323) of the elderly received the first dose of COVID-19 vaccine, 91.76% (1 214/1 323) completed the full course of COVID-19 vaccination, and 79.67% (1 054/1 323) received the booster dose of COVID-19 vaccine. The results of binary Logistic regression analysis showed that compared with the older adults aged 60-64 years, the older adults aged 75 years and above were less likely to receive the first dose of the COVID-19 vaccine〔OR (95%CI) =0.27 (0.11, 0.62), P

• HCPs play an important role in informing pregnant women about maternal vaccinations. • Strategies to increase MPV uptake should not only focus on providing information. • Decrease experienced barriers in pregnant women that are intended to accept the MPV. In December 2019, the maternal pertussis vaccination (MPV) became part of the Dutch National Immunization Program. This study aims to study MPV behavior and associated psychosocial, attitudinal and organizational factors of pertussis vaccination behavior during pregnancy in the Netherlands. We conducted a cross-sectional survey among pregnant women and recent mothers, up to six months post-partum. The primary outcome measure of this study was MPV behavior. Associations between psychosocial, attitudinal and organizational factors and MPV behavior were assessed using univariate and multivariate binary logistic regression analysis. In total 1348 participants filled out the questionnaire, including 1282 (95.1%) MPV acceptors and 66 (4.9%) MPV refusers. The most important factors associated with MPV behavior were: attitude (aOR: 10.19; 95%CI: 4.30–24.16), outcome expectations (aOR: 8.94; 95%CI: 3.60–22.21), omission bias (aOR: 0.11; 95%CI: 0.02–0.59) and physical accessibility (aOR: 7.44; 95%CI: 3.37–16.46). Pregnant women make their decision about the MPV primarily based on attitudinal and psychosocial factors, such as outcome expectations and attitude. A combination and variation of different messages, about the advantages (effectiveness) and disadvantages (side effects) of maternal vaccination, can be used in reaching pregnant women with a positive and negative attitude about the MPV. In addition, strategies to increase MPV uptake should not only focus on providing information, but also decrease experienced practical barriers, such as poor physical accessibility, in people that are intended to receive the MPV but are not getting vaccinated. [ABSTRACT FROM AUTHOR]

Background: The Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX's structural, convergent, and discriminant validity is still limited, especially in youth samples. Methods: The present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (Mage = 18.23, SDage = 2.66, age range = 15–24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria. Results: The results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors' contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry. Conclusions: The present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes. [ABSTRACT FROM AUTHOR]

A plethora of research has highlighted that trust in science, political trust, and conspiracy theories are all important contributors to vaccine uptake behavior. In the current investigation, relying on data from 17 countries (N = 30,096) from the European Social Survey we examined how those who received (and wanted to receive the COVID‐19 vaccine) compared to those who did not differ in their trust in: science, politicians and political parties, international organizations and towards people in general. We also examined whether they differed in how much they believed in conspiracy theories. Those who received (or wanted to receive) the COVID vaccine scored significantly higher in all forms of trust, and lower in conspiracy theory beliefs. A logistic regression suggested that trust in science, politicians, international organizations, as well as belief in conspiracy theories were significant predictors, even after accounting for key demographic characteristics. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the willingness to pay (WTP) for human papillomavirus (HPV) vaccine and its influencing factors among Chinese female health care workers for improving HPV vaccination strategies in China. MethodsAn online survey was conducted among 18 – 45 years old female health care workers from 310 hospitals in 31 provincial level administrative divisions across China during November – December 2021. A self-designed questionnaire was used to collect information on demographics, HPV vaccination status, HPV-related knowledge, protective motivation theory (PMT)-based HPV vaccination-related cognition and attitude, and the amount of WTP for HPV vaccination. Structural equation model was adopted to analyze influencing factors of WTP. ResultsOf the 15 969 valid respondents aged 30.6 ± 6.2 years, 43.4%, 33.2%, and 23.4% reported the highest amount (CNY) of WTP for HPV vaccine ranging 0 – 1 600, 1 601 – 3 200, and 3 201 – 5 000, respectively; higher amount of WTP was reported by the respondents aged 18 – 26 years, being Han ethnic, unmarried/divorced/widowed, having the education of master degree or above, without professional title, with a monthly income more than 8 000 CNY, working in a tertiary hospital, and already receiving HPV vaccination or having an appointment for the vaccination. The scores for multidimensional PMT-based cognition and attitude about HPV vaccination were significantly correlated with HPV vaccine acceptance and the WTP for HPV vaccine (P < 0.001 for all). The structural equation model analysis showed that perceived susceptibility (β = 0.046), perceived severity (β = 0.012), response efficacy (β = 0.027), self-efficacy (β = 0.155), HPV-related knowledge (β = 0.151) and vaccination behavior (β = 0.154) were positively associated with the WTP for HPV vaccination; whereas response cost was negatively associated with the WTP for HPV vaccination (β = – 0.183). ConclusionChinese female health care workers have a relatively higher WTP for HPV vaccination. Price of HPV vaccine, convenience of vaccination/ appointment services, and safety of vaccines remain the main influencing factors of the WTP.

Background: China's current immunization program was revised in 2007. Some common childhood vaccines such as those for influenza, pediatric pneumonia, Haemophilus influenzae, varicella, and rotavirus have not been included in the National Immunization Program (NIP) and need to be purchased by children's guardians at their own expense. Rural areas, constrained by economic development and vaccine awareness, have a low non-NIP vaccination rate and more family medical expenses and social burden. This study aims to examine the awareness and attitude of rural parents about non-NIP vaccines and relevant factors influencing their vaccination intention to provide strategic suggestions for expanding and improving the Chinese government's NIP policy. Methods: A qualitative method of in-depth interviews were conducted for this study. We interviewed 30 rural parents in a central Chinese village to investigate their awareness of non-NIP vaccines and their vaccination intention and behavior. All the interview data were analyzed through the Colaizzi seven-step data analysis method. Results: This study summarized the individual and social level factors influencing the non-NIP vaccination intention of rural parents. The individual level factors include four themes: perceived severity with physical harm, treatment consumption (cost of the treatment of the subject diseases), psychological burden, and social consequences being subthemes; perceived vulnerability with age vulnerability, medical history, immune quality (children's underlying immune status), and environmental vulnerability (sanitary condition of the rural environment) as subthemes; perceived efficacy with effect perception, psychological comfort, protective strength, and functional compensation (functions of non-NIP vaccines unreplaceable by NIP vaccines) being subthemes; and perceived cost consisting of two subthemes cost burden and adverse reaction. The social level influencing factors include the vaccination opinions in rural social networks, the accessibility of health services and vaccine products, and the guidance and promotion of vaccination policies. These factors act outside of individuals' subjective awareness and influence decisions regarding non-NIP vaccination in rural areas. Conclusion: Based on these influencing factors, this study constructs a structural model for non-NIP vaccination decision-making process in rural areas of China. The results play a guiding role in directing attention to children's health, promoting non-NIP vaccination, facilitating the dissemination of vaccine knowledge in rural areas, and improving NIP policies and practices in China. [ABSTRACT FROM AUTHOR]

It is puzzling that a sizeable percentage of people refuse to get vaccinated against COVID‐19. This study aimed to examine social psychological factors influencing their vaccine hesitancy. This longitudinal study traced a cohort of 2663 individuals in 25 countries from the time before COVID‐19 vaccines became available (March 2020) to July 2021, when vaccination was widely available. Multilevel logistic regressions were used to examine determinants of actual COVID‐19 vaccination behavior by July 2021, with country‐level intercept as random effect. Of the 2663 participants, 2186 (82.1%) had been vaccinated by July 2021. Participants' attitude toward COVID‐19 vaccines was the strongest predictor of both vaccination intention and subsequent vaccination behavior (p <.001). Perceived risk of getting infected and perceived personal disturbance of infection were also associated with higher likelihood of getting vaccinated (p <.001). However, religiosity, right‐wing political orientation, conspiracy beliefs, and low trust in government regarding COVID‐19 were negative predictors of vaccination intention and behavior (p <.05). Our findings highlight the importance of attitude toward COVID‐19 vaccines and also suggest that certain life‐long held convictions that predate the pandemic make people distrustful of their government and likely to accept conspiracy beliefs and therefore less likely to adopt the vaccination behavior. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) vaccination has been proven to be the most effective method to prevent cervical cancer. This study aimed to determine the HPV vaccination behavior and preference in Chinese female health care workers. A nationwide cross-sectional study was performed to recruit 15,967 respondents aged 18–45 years from 31 provinces in China's mainland in 2021. Of them, 30.0% have been vaccinated or have made an appointment. Regardless of actual vaccination status, respondents mostly preferred the 9-valent HPV vaccine (58.6%), followed by 4-valent (15.6%) and 2-valent vaccines (3.1%); additionally, 17.9% did not have a preference. Moreover, health beliefs on HPV and HPV vaccination were measured using a health belief model (HBM) analysis. Six HBM constructs differed significantly by HPV vaccination status. Higher levels of perceived susceptibility (beta = 0.074), perceived benefit (beta = 0.072), self-efficacy (beta = 0.304), and cues to action (beta = 0.039) scales were significantly associated with increasing HPV vaccine uptake. In contrast, perceived severity (beta = −0.019) and perceived barriers (beta = −0.089) were negative factors. In conclusion, HPV vaccine uptake is high in Chinese female health care workers. HBM constructs may be effective in facilitating the improvement and delivery of targeted intervention programs to increase HPV vaccine uptake. [ABSTRACT FROM AUTHOR]

• Preference by groups for COVID-19 vaccine by public is yet to be researched in Bangladesh. • Primary data were collected via an online survey (n = 2291) during countrywide lockdown (December 2020–January 2021). • Strong public preference of early vaccination was towards the frontline workers, severely sick and the elderly. • Preference rankings varied across sociodemographic factors including differences between urban and rural residents. • Effective communication on vaccine delivery are needed for any future health crisis for effective national immunization. One of the most challenging aspects of the COVID-19 pandemic is the inability to ensure equitable distribution of vaccines to fight the pandemic. Many governments around the globe had to prioritize and perform a triage in distributing the vaccines due to the limited supply as well as a lack of financial strength to acquire a sufficient number of vaccines in time. The present study assessed the public opinion in Bangladesh regarding vaccination prioritization strategy and its associated aspects. Due to the infectious nature of the viral transmission, the study used an online survey and collected a sample of 2291 respondents, distributed proportionally across sex, and income groups. Descriptive statistics and multinomial logistic regression modelling were utilized to conduct the analyses. The results emphasized unanimous preference of prioritized vaccination leaning towards the frontline workers, the severely sick and the elderly. However, the segregation across ethnicity was noted with no major preference among sexes or religion. The results reinforce the Bangladesh government's undertaken strategy of prioritization. However, the preference rankings varied across sociodemographic factors including self-assessed COVID-19 knowledge and income tiers, among others. The findings underline the necessity of improved risk communication strategies to ensure public confidence and conformity to vaccination efforts and their effective deployment across the country. [ABSTRACT FROM AUTHOR]

Background: In 2019, the World Health Organization identified vaccine hesitancy as a top ten global health threat, which has been exacerbated by the COVID-19 pandemic. Despite local and nationwide public health efforts, adolescent COVID-19 vaccination uptake in the US remains low. This study explored parents' perceptions of the COVID-19 vaccine and factors influencing hesitancy to inform future outreach and education campaigns. Methods: We conducted two rounds of individual interviews via Zoom in May–September 2021 and January–February 2022, with parents of adolescents from the Greater Newark Area of New Jersey, a densely populated area with historically marginalized groups that had low COVID-19 vaccination uptake. Data collection and analysis was guided by the Increasing Vaccination Model and WHO Vaccine Hesitancy Matrix. Interview transcripts were double-coded and thematically analyzed in NVivo. Results: We interviewed 22 parents (17 in English, 5 in Spanish). Nearly half (45%) were Black and 41% were Hispanic. Over half (54%) were born outside of the US. Most of the parents described that their adolescents had received at least one dose of a COVID-19 vaccine. All but one parent had received the COVID-19 vaccine. Despite strong vaccination acceptance for themselves, parents remained hesitant about vaccinating their adolescents. They were mostly concerned about the safety and potential side effects due to the novelty of the vaccine. Parents sought information about the vaccines online, through healthcare providers and authorities, and at community spaces. Interpersonal communication exposed parents to misinformation, though some personal connections to severe COVID-19 illness motivated vaccination. Historical mistreatment by the healthcare system and politicization of the vaccine contributed to parents' mixed feelings about the trustworthiness of those involved with developing, promoting, and distributing COVID-19 vaccines. Conclusions: We identified multilevel influences on COVID-19 vaccine-specific hesitancy among a racially/ethnically diverse sample of parents with adolescents that can inform future vaccination interventions. To increase vaccine confidence, future COVID booster campaigns and other vaccination efforts should disseminate information through trusted healthcare providers in clinical and also utilize community settings by addressing specific safety concerns and promoting vaccine effectiveness. [ABSTRACT FROM AUTHOR]

Background. Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population. Methods. We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the ‘baseline’ behavior, while the following sibling’s uptake was suggested as the ‘current’ behavior. The risk factors of VR were determined with logistic regression analysis. Results. The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of ‘baseline VR’ was 12.7 % whereas the ‘current VR’ was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR. Conclusions. The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population. [ABSTRACT FROM AUTHOR]

Abstract Background From 2015 to 2018, the Netherlands faced an outbreak of invasive meningococcal disease (IMD) caused by serogroup W. To counter the rise in infections, the government introduced a catch-up menACWY vaccination campaign for teenagers in 2018 and 2019. The outbreak situation induced substantial media attention and a run on menACWY vaccines outside the vaccination campaign. This study aimed to gain insights into the dynamics of public perceptions of and responses to the outbreak and the menACWY vaccination, and into the media coverage about the outbreak. Methods Three repeated surveys (N = 1110) between 2017 and 2019 were sent to parents of teenagers invited for a menACWY catch-up vaccination, other parents, and individuals with no under-age children. These surveys assessed IMD risk perceptions, attitudes towards the menACWY vaccination, trust in involved institutions, and willingness to vaccinate with the menACWY vaccine. Changes in the public perceptions and responses were studied with linear multilevel regression analyses. In addition, 103 national newspaper articles from the period 2017–2019 were thematically coded with themes about IMD and the menACWY vaccination. Results The survey results showed clear increases in perceived IMD severity, positive attitude towards the menACWY vaccination, and willingness to vaccinate over time. Perceived IMD vulnerability remained low across all three waves, and trust in involved institutions increased slightly. Differences between the survey groups were limited. The newspaper articles discussed the rise in infections extensively, the disease symptoms, and the possible fatal outcome of IMD. In addition, while many articles discussed the menACWY vaccine shortage, few discussed the safety or effectiveness of the vaccine. Conclusion The real-time insights into the interrelated dynamics of public perceptions, responses, and media coverage provide an integrated portrait of the social developments during this outbreak. The focus on IMD severity and the absence of doubt in the public discussion about vaccine safety may have played an important role in the societal response to this outbreak and the recommended vaccine.

Abstract Background The World Health Organization (WHO) proposed COVID-19 vaccination as an emergent and important method to end the COVID-19 pandemic. Since China started vaccination programs in December 2020, vaccination has spread to provinces and municipalities nationwide. Previous research has focused on people's vaccination willingness and its influencing factors but has not examined vaccination behavior. We examine the effectiveness of psychosocial factors in predicting vaccination behavior. Methods A cross-sectional online survey was performed among Chinese adults on 8 May and 4 June 2021. The statistical analysis of the data included univariate analysis, receiver operator characteristics (ROC) analysis and ordinal multiclassification logistic regression model analysis. Results Of the 1300 respondents, 761 (58.5%) were vaccinated. Univariate analysis showed that a high education level and good subjective health status were protective factors for vaccination behavior, while suffering from chronic diseases was a risk factor. ROC analysis showed that subjective health status (AUC = 0.625, 95% CI: 0.594–0.656, P

IntroductionThis study explores associations among adult vaccination, ethnicity, gender, and socioeconomic variables such as educational attainment and income, as well as neighborhood factors.MethodsA telephone quota sample of New Jersey adults (N = 1,984) was used to text associations among proposed predictors of vaccination behaviors.ResultsOur multivariate logistic regression analyses found that certain races/ethnicity, respondents' household income, and perceived safety of one's community were the strongest predictors of COVID-19 vaccination. The odds of COVID-19 vaccination were 52% lower for Black/African American respondents compared to white/Caucasian respondents (p = 0.001) and 44% lower for Hispanic/Latino respondents compared to white/Caucasian respondents (p = 0.001).DiscussionThe results add new insights to public health communication research and suggest careful interventions across racial groups, considering existing racial disparities in vaccination.

BackgroundDespite being recognized as one of the most successful public health measures, vaccination is still considered to be unnecessary and unreliable in the context of the COVID-19 pandemic. The current study utilized a two-pronged approach in analyzing vaccine hesitancy and health behaviors after vaccination by employing a mixed-method design. Phase 1 was aimed at identifying predictors of COVID-19 vaccine hesitancy and acceptance among the Pakistani population using protection motivation theory (PMT), whereas Phase 2 was aimed at exploring the factors related to the vaccination of COVID-19.MethodA convenient sample of 1,736 individuals from the vaccine-eligible population (12 years and above) was selected to collect data on vaccine hesitancy and acceptance (Phase 1). Phase 2 of the study explored post-vaccination health behaviors, especially adherence to safety measures for COVID-19, through 23 in-depth interviews with the vaccinated population.ResultsMultiple regression analyses showed that response cost is a major predictor of vaccine hesitancy (in Phase 1). In terms of the role of demographic variables, the results showed that being male (for severity: B = −0.481; threat appraisal: B = −0.737), old age (B = −0.044), not vaccinated, and not infected with COVID-19 (themselves and family members) are strongly associated with vaccination hesitancy. Results of thematic analysis in Phase 2 revealed that perceived individual experience and insensitivity toward the severity of the disease are strongly associated with a lack of adherence to safety measures of COVID-19. Faith and religious beliefs and reliance on traditional remedies are also key predictors of people's general non-compliance to health behaviors. One interesting aspect that was revealed in the analysis was the general financially and socially destabilized situation in the context of developing countries that contributed to general apathy in the pandemic situation.ConclusionThe findings of the current study may help in devising a health model for the public from the developing world to deal with future pandemic situations.

Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of COVID-19 related complications compared to the general population in Germany. However, little is known about the other determinants of COVID-19 vaccination behavior for the population of German university students. This study aimed to investigate determinants of vaccination behavior in this population. The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities from October 27th to November 14th, 2021, via an online survey (n=7,267). Multiple logistic regressions were calculated to examine associations of psychological antecedents of vaccination (5Cs: confidence, complacency, constraints, calculation, collective responsibility), Critical Health Literacy in a Pandemic (CHL-P), and additional determinants (previous infection, trust in the health care system, feeling informed about the COVID-19 vaccine) and vaccination status (not vaccinated vs. fully vaccinated). All 5Cs were associated with reporting to be vaccinated, except for complacency. Regarding the CHL-P, students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had higher odds for reporting being vaccinated (OR=3.02; 95% CI: 2.26-4.04). Students who felt well informed about the COVID-19 vaccines were also more likely to report being fully vaccinated (OR=2.20; 95% CI: 1.51-3.21). Due to our finding that the 5Cs are associated with vaccination status among university students, we recommend that the different components of the 5Cs should be considered in future vaccination campaigns implemented in the university context.

Coronavirus disease 2019 (COVID-19) has brought great uncertainty to our society and it may have disrupted people's ontological security. Consequently, this hospital-based study concerns the impact of ontological insecurity on vaccination behavior against COVID-19. This cross-sectional study was conducted among hospital inpatients. A questionnaire survey addressing inpatient ontological insecurity and vaccination behavior against COVID-19 was administered in Taizhou, China. A total of 1223 questionnaires were collected; specifically, 1185 of them were credible, for a validity rate of 96.9%. The score of ontological insecurity was 13.27 ± 7.84, which was higher in participants who did not recommend vaccination for others than those who did (12.95 ± 8.25 vs 14.00 ± 6.78, P = 0.022). There was no difference between the vaccinated and unvaccinated groups (13.22 ± 7.96 vs 13.35 ± 7.67, P = 0.779). Lower ontological insecurity (odds ratio [OR] = 1.40, 95% confidence interval [CI]: 1.08–1.81) and being inoculated with COVID-19 vaccines (OR = 2.17, 95% CI: 1.67–2.82) were significantly associated with recommendation of COVID-19 vaccines to others after adjusting for sex, age, education, and occupation. Associations between low ontological insecurity and recommendations for COVID-19 vaccines were observed in men, adults aged 18–59 years, non-farmers, and vaccine recipients. This study suggests that the ontological insecurity of participants affects their behavior of recommending the COVID-19 vaccination to others rather than getting vaccinated themselves. This promotion of vaccination can be considered from the perspective of improving ontological security in China. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) vaccination has been proven to be the most effective method to prevent cervical cancer. This study aimed to determine the HPV vaccination behavior and preference in Chinese female health care workers. A nationwide cross-sectional study was performed to recruit 15,967 respondents aged 18–45 years from 31 provinces in China’s mainland in 2021. Of them, 30.0% have been vaccinated or have made an appointment. Regardless of actual vaccination status, respondents mostly preferred the 9-valent HPV vaccine (58.6%), followed by 4-valent (15.6%) and 2-valent vaccines (3.1%); additionally, 17.9% did not have a preference. Moreover, health beliefs on HPV and HPV vaccination were measured using a health belief model (HBM) analysis. Six HBM constructs differed significantly by HPV vaccination status. Higher levels of perceived susceptibility (beta = 0.074), perceived benefit (beta = 0.072), self-efficacy (beta = 0.304), and cues to action (beta = 0.039) scales were significantly associated with increasing HPV vaccine uptake. In contrast, perceived severity (beta = −0.019) and perceived barriers (beta = −0.089) were negative factors. In conclusion, HPV vaccine uptake is high in Chinese female health care workers. HBM constructs may be effective in facilitating the improvement and delivery of targeted intervention programs to increase HPV vaccine uptake.

Background: In 2019, the World Health Organization identified vaccine hesitancy as a top ten global health threat, which has been exacerbated by the COVID-19 pandemic. Despite local and nationwide public health efforts, adolescent COVID-19 vaccination uptake in the US remains low. This study explored parents’ perceptions of the COVID-19 vaccine and factors influencing hesitancy to inform future outreach and education campaigns. Methods: We conducted two rounds of individual interviews via Zoom in May–September 2021 and January–February 2022, with parents of adolescents from the Greater Newark Area of New Jersey, a densely populated area with historically marginalized groups that had low COVID-19 vaccination uptake. Data collection and analysis was guided by the Increasing Vaccination Model and WHO Vaccine Hesitancy Matrix. Interview transcripts were double-coded and thematically analyzed in NVivo. Results: We interviewed 22 parents (17 in English, 5 in Spanish). Nearly half (45%) were Black and 41% were Hispanic. Over half (54%) were born outside of the US. Most of the parents described that their adolescents had received at least one dose of a COVID-19 vaccine. All but one parent had received the COVID-19 vaccine. Despite strong vaccination acceptance for themselves, parents remained hesitant about vaccinating their adolescents. They were mostly concerned about the safety and potential side effects due to the novelty of the vaccine. Parents sought information about the vaccines online, through healthcare providers and authorities, and at community spaces. Interpersonal communication exposed parents to misinformation, though some personal connections to severe COVID-19 illness motivated vaccination. Historical mistreatment by the healthcare system and politicization of the vaccine contributed to parents’ mixed feelings about the trustworthiness of those involved with developing, promoting, and distributing COVID-19 vaccines. Conclusions: We identified multilevel influences on COVID-19 vaccine-specific hesitancy among a racially/ethnically diverse sample of parents with adolescents that can inform future vaccination interventions. To increase vaccine confidence, future COVID booster campaigns and other vaccination efforts should disseminate information through trusted healthcare providers in clinical and also utilize community settings by addressing specific safety concerns and promoting vaccine effectiveness.

Despite the availability of a safe and effective vaccine being well‐recognized as a critical tool to end the COVID‐19 pandemic, many individuals remain vaccine hesitant for various reasons. In the literature, one well‐established finding is that skeptical attitudes towards vaccination are higher amongst individuals low in conscientiousness. However, no research is available to corroborate whether the relationship between conscientiousness and intention to vaccinate has force in real life. The present research investigated whether, in addition to self‐reported conscientiousness, objectively observable index of conscientiousness behaviors is related to individual perception of vaccination. Based on self‐reported data, Study 1 fully replicated prior findings that higher levels of conscientiousness are associated with more positive attitudes towards vaccination in a Chinese student sample. Using the time of arrival for an appointment as a proxy measure for conscientiousness behaviors, Study 2 revealed that non‐student adults who arrived early to appointments showed stronger COVID‐vaccine uptake intentions than those who arrived late to appointments. Moving beyond vaccination intention to actual behavior, Study 3 found that the arrival punctuality rates of vaccinated participants were higher than those of unvaccinated participants. Overall, our research highlights the important role of conscientiousness‐related traits in individuals' COVID‐19 vaccination attitudes and behavior. [ABSTRACT FROM AUTHOR]

(1) Background: Although the evidence is consistent that vaccines for COVID-19 effectively prevent severe illness or death, the rapid development of vaccines has led to increased beliefs about possible negative consequences and conspiracy theories about the vaccine. Several factors influence whether or not people decide to be vaccinated. Some studies suggest that our perception of what significant others do and think influences our behavior. (2) Methods: This study evaluates the predictive role of beliefs about negative consequences of the COVID-19 vaccine, conspiracy beliefs about this vaccine, and social influence on the intention to vaccinate against COVID-19 in three Latin American and Caribbean countries: Chile, Mexico, and Colombia. Using convenience sampling, 2075 adults from Chile (48.3%), Mexico (27.6%), and Colombia (24.6%) participated by answering an online questionnaire with variables of interest. (3) Results: Despite the differences between countries, the results showed that the proposed model is invariant and explains between 56–66% of the COVID-19 vaccination intent. Specifically, controlling for age, socioeconomic status, political orientation, and educational level, we found that beliefs about the negative consequences of the COVID-19 vaccine were the main predictor followed by social influence. Beliefs in conspiracy theories did not predict vaccination intention (4) Conclusions: Considering these variables in campaigns to boost vaccination intention is discussed. [ABSTRACT FROM AUTHOR]

Introduction With the COVID-19 pandemic recognized as a major threat to human health, promoting vaccination is of paramount importance to public health. Objectives To examine the association between factors of the Health Belief Model (HBM) and intentions to be vaccinated against COVID-19, when a vaccine becomes available. Methods A literature review has been made through PubMed database. Results The HBM dimensions “perceived barriers”, “perceived benefits” and “perceived severity” were considered to be significant predictors of acceptance of vaccinations. The HBM constructs of cues to action (trust in third-party information sources), perceived severity of and susceptibility to COVID-19, and beliefs about the protection benefits of a COVID-19 vaccine, subsequently may elicit willingness to vaccinate. Individual predictors of vaccination were believing the vaccine is effective at preventing COVID-19, recalling their doctor recommending the vaccine. Common perceived barriers against vaccination included believing the vaccine could give people the virus, believing the vaccine can make individuals ill afterwards and preferring to develop immunity “naturally”. Patients who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Conclusions HBM is an effective tool for identifying facilitators and barriers to health behaviors. Health promotion should make use of the HBM, as the model provides a theoretically understanding of the dynamics that may enable the success of important health-related policy in the wake of COVID-19 and future pandemics and identifies the communication mechanisms that must be leveraged by governments and authorities in enforcing policy. Disclosure No significant relationships.

Multiple sclerosis (MS) is a chronic immune-mediated disease with a neurodegenerative component of the central nervous system. Immunomodulatory therapy can increase the risk of infection, which is a particular risk for MS patients. Therefore, a complete vaccination status is of utmost importance as protection against vaccine-preventable infectious diseases. Our aim was to investigate the vaccination status, vaccination card knowledge and the vaccination behavior of MS patients with regard to vaccinations against tetanus, diphtheria, pertussis and poliomyelitis. Three hundred twenty-seven patients with MS were evaluated by anamnesis, clinical examination, structured interview and vaccination card control in this two-center study. Based on the recommendations of the Robert Koch Institute, we assessed the completeness of the vaccination status of the examined vaccinations. Furthermore, a comparative analysis of patients with complete/incomplete or correctly/wrongly self-reported vaccination status was performed. In the cohort analyzed, the vaccination coverage was 79.5% for tetanus, 79.2% for diphtheria, 74.8% for pertussis and 84.8% for poliomyelitis. The assumed vaccination status was higher for tetanus (86.5%) and lower for diphtheria (69.4%), pertussis (61.2%) and poliomyelitis (75.9%). Patients who were unvaccinated or only partially vaccinated against tetanus had received vaccination advice from a physician less often in the past year (13.4 vs. 36.9%, p < 0.001) and had no one to check the vaccination card more often (35.8 vs. 12.3%, p < 0.001). High sensitivity (93.7%) and low specificity (30.3%) were determined regarding the validity of self-reported tetanus vaccination status. Patients with a correctly reported tetanus vaccination status were more likely to have their vaccination card checked by a physician than those who overestimated or underestimated their vaccination status (76.7 vs. 63.0/43.8%, p = 0.002). Similar findings were seen with regard to diphtheria, pertussis and poliomyelitis vaccination. Patients without a regular vaccination card control (17.1%) were more likely to be male (44.6 vs. 29.4%, p = 0.037), had fewer siblings on average (1.1 vs. 1.6, p = 0.016), dealt less frequently with the issue of vaccination in the past year (32.1 vs. 69.3%, p < 0.001) and more frequently had the wish to receive vaccination advice (48.2 vs. 34.4%, p = 0.030) than patients in whom the vaccination card was checked regularly by a physician. To minimize the risk of infection in MS patients, treating physicians should provide regular vaccination counseling and perform vaccination card controls, as these factors are associated with a higher vaccination coverage and a higher validity of self-reported vaccination statuses. [ABSTRACT FROM AUTHOR]

The population with diabetes is more susceptible to severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-2, and have a significantly higher coronavirus disease-2019 (COVID-19) mortality rate. Previous studies have shown low willingness for the COVID-19 vaccination, and there are limited reports on the behavior and relevance of the COVID-19 vaccination. This study aimed to determine the uptake behavior and associated factors of the COVID-19 vaccine. In our cross-sectional questionnaire-based clinical study, 645 diabetes patients affiliated with two affiliated hospitals of Changzhi Medical College completed the questionnaire between June to October 2021. The health belief model (HBM) was used in examining factors influencing vaccination behavior. After adjusting for covariates with significant differences in social background characteristics, a multivariable logistic regression was used to determine predictors related to uptake in COVID-19 vaccination. A total of 162 vaccinated and 483 unvaccinated eligible diabetic patients were recruited. Patients who believed that the COVID-19 syndrome is severe (aOR3.67, 95%CI 1.88–7.17; p < 0.001), believe that vaccination can significantly reduce the risk of SARS-Cov-2 infection (aOR3.48, 95%CI 1.80–6.73; p < 0.001), believe that vaccination is beneficial to themselves and others (aOR 4.53, 95%CI 1.71–11.99; p = 0.002), think that relatives' vaccination status has a positive impact on their vaccination behavior (aOR 5.68, 95%CI 2.83–11.39; p < 0.001), and were more likely to be vaccinated; worrying about the adverse health effects of COVID-19 vaccination (aOR 0.18, 95%CI 0.09–0.35; p < 0.001) was negatively correlated with COVID-19 vaccination behavior. Health care workers should provide targeted informative interventions based on the safety and protective effects theory of HBM to improve vaccination behavior in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: From 2015 to 2018, the Netherlands faced an outbreak of invasive meningococcal disease (IMD) caused by serogroup W. To counter the rise in infections, the government introduced a catch-up menACWY vaccination campaign for teenagers in 2018 and 2019. The outbreak situation induced substantial media attention and a run on menACWY vaccines outside the vaccination campaign. This study aimed to gain insights into the dynamics of public perceptions of and responses to the outbreak and the menACWY vaccination, and into the media coverage about the outbreak.Methods: Three repeated surveys (N = 1110) between 2017 and 2019 were sent to parents of teenagers invited for a menACWY catch-up vaccination, other parents, and individuals with no under-age children. These surveys assessed IMD risk perceptions, attitudes towards the menACWY vaccination, trust in involved institutions, and willingness to vaccinate with the menACWY vaccine. Changes in the public perceptions and responses were studied with linear multilevel regression analyses. In addition, 103 national newspaper articles from the period 2017-2019 were thematically coded with themes about IMD and the menACWY vaccination.Results: The survey results showed clear increases in perceived IMD severity, positive attitude towards the menACWY vaccination, and willingness to vaccinate over time. Perceived IMD vulnerability remained low across all three waves, and trust in involved institutions increased slightly. Differences between the survey groups were limited. The newspaper articles discussed the rise in infections extensively, the disease symptoms, and the possible fatal outcome of IMD. In addition, while many articles discussed the menACWY vaccine shortage, few discussed the safety or effectiveness of the vaccine.Conclusion: The real-time insights into the interrelated dynamics of public perceptions, responses, and media coverage provide an integrated portrait of the social developments during this outbreak. The focus on IMD severity and the absence of doubt in the public discussion about vaccine safety may have played an important role in the societal response to this outbreak and the recommended vaccine. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) proposed COVID-19 vaccination as an emergent and important method to end the COVID-19 pandemic. Since China started vaccination programs in December 2020, vaccination has spread to provinces and municipalities nationwide. Previous research has focused on people's vaccination willingness and its influencing factors but has not examined vaccination behavior. We examine the effectiveness of psychosocial factors in predicting vaccination behavior. Methods: A cross-sectional online survey was performed among Chinese adults on 8 May and 4 June 2021. The statistical analysis of the data included univariate analysis, receiver operator characteristics (ROC) analysis and ordinal multiclassification logistic regression model analysis. Results: Of the 1300 respondents, 761 (58.5%) were vaccinated. Univariate analysis showed that a high education level and good subjective health status were protective factors for vaccination behavior, while suffering from chronic diseases was a risk factor. ROC analysis showed that subjective health status (AUC = 0.625, 95% CI: 0.594–0.656, P < 0.001) was the best predictor of vaccination behavior. Logistic regression analysis with subjective health status as a dependent variable indicated that older age, female sex, depression, neurasthenia, obsession, hypochondriasis and chronic disease were significant risk factors, while positive coping tendencies were a significant protective factor. Conclusion: Our study found a simple and effective marker, subjective health status, that can predict vaccination behavior. This finding can guide future epidemic prevention work. [ABSTRACT FROM AUTHOR]

BackgroundDuring the COVID-19 pandemic, vaccine hesitancy (VH) on COVID-19 vaccination still exists in different populations, which has a negative impact on epidemic prevention and control. The objectives were to explore college students' willingness to vaccinate, determine the factors influencing the vaccination behavior of students with COVID-19 vaccine hesitancy, and provide a basis for improving the compliance of college students with COVID-19 vaccination.MethodsThe universities in Wuhan are categorized into three levels according to their comprehensive strength and randomly sampled at each level, of which ten universities were selected. A self-designed anonymous electronic questionnaire was distributed online from May 12 to 31, 2021 to investigate the hesitancy, vaccination status, and influencing factors of COVID-19 vaccination among college students in Wuhan.ResultsOf the 1,617 participants (1,825 students received the electronic questionnaire) surveyed, 19.0% reported COVID-19 vaccine hesitancy. Among the vaccine-hesitant students, 40.1% were vaccinated against COVID-19. The binary logistic regression analysis shows that families' attitudes “Uncertain” (odds ratio (OR) = 0.258 [0.132–0.503]), vaccination risk psychology (OR = 0.242 [0.079–0.747]) and wait-and-see mentality (OR = 0.171 [0.068–0.468]) are negative factors for the vaccination behavior of hesitant students, while herd mentality (OR = 7.512 [2.718–20.767]) and uncertainty of free policy's impact on vaccine trust (OR = 3.412 [1.547–7.527]) are positive factors.ConclusionThe vaccine hesitancy among college students in Wuhan was relatively high. Family support, herd mentality and free vaccination strategies can help improve vaccination among hesitant students, while vaccination risk psychology and “wait-and-see” psychology reduce the possibility of vaccination. The vaccination strategy of college students should be strengthened from the perspective of social psychological construction.

This study draws upon the stimulus-organism-response (S–O-R) framework in examining the influence of stimulus factors (i.e., passive exposure to and active information seeking for COVID-19 vaccine information on social media) on users' internal psychological mechanisms (i.e., perceived information overload and psychological reactance) and vaccination behavior. We collected two-wave online panel data (W 1 N = 411, W 2 N = 264) in Hong Kong and tested our hypothesized model using structural equation modeling. The results showed that passive information exposure and active information seeking on social media were positively associated with both vaccination initiation (i.e., receiving the first dose) and full vaccination (i.e., completing the recommended 3-dose schedule at W2). We identified different mediation pathways from passive information exposure and active information seeking to vaccine skepticism through perceived information overload and psychological reactance. Specifically, a double-edged sword effect was found for active information seeking. Active information seeking was associated with lower vaccine skepticism both directly and indirectly through lower psychological reactance. On the other hand, active information seeking was associated with higher perceived information overload, which in turn was associated with higher psychological reactance and subsequently higher vaccine skepticism. Passive information exposure indirectly affected psychological state and vaccine skepticism through higher active information seeking. These findings contribute to the literature on the impact of social media use on vaccination behavior in the context of public health emergencies and offer practical implications for governments and social media platforms in risk communication and vaccination promotion. • Passive information exposure and active information seeking on social media were positively associated with COVID-19 vaccination behaviors. • Active information seeking was associated with lower psychological reactance but higher perceived information overload. • Active information seeking had a dual effect on vaccine skepticism mediated via perceived information overload and psychological reactance. • The effect of passive information exposure on psychological states and vaccine skepticism was fully mediated by active information seeking. • Lower vaccine skepticism led to the initiation and completion of COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Abstract Background Seasonal influenza vaccination coverage remains suboptimal in most developed countries, despite longstanding recommendations of public health organizations. The individual’s decision regarding vaccination is located at the core of non-adherence. We analyzed large-scale data to identify personal and social behavioral patterns for influenza vaccination uptake, and develop a model to predict vaccination decision of individuals in an upcoming influenza season. Methods We analyzed primary data from the electronic medical records of a retrospective cohort of 250,000 individuals between the years 2007 and 2017, collected from 137 clinics. Individuals were randomly sampled from the database of Maccabi Healthcare Services. Maccabi’s clients are representative of the Israeli population, reflect all demographic, ethnic, and socioeconomic groups and levels. We used several machine-learning models to predict whether a patient would get vaccinated in the future. Models’ performance was evaluated based on the area under the ROC curve. Results The vaccination decision of an individual can be explained in two dimensions, Personal and social. The personal dimension is strongly shaped by a “default” behavior, such as vaccination timing in previous seasons and general health consumption, but can also be affected by temporal factors such as respiratory illness in the prior year. In the social dimension, a patient is more likely to become vaccinated in a given season if at least one member of his family also became vaccinated in the same season. Vaccination uptake was highly assertive with age, socioeconomic score, and geographic location. An XGBoost-based predictive model achieved an ROC-AUC score of 0.91 with accuracy and recall rates of 90% on the test set. Prediction relied mainly on the patient’s individual and household vaccination status in the past, age, number of encounters with the healthcare system, number of prescribed medications, and indicators of chronic illnesses. Conclusions Our ability to make an excellent prediction of the patient’s decision sets a major step toward personalized influenza vaccination campaigns, and will help shape the next generation of targeted vaccination efforts.