Understanding the Prevalence and Associated Factors of Behavioral Intention of COVID-19 Vaccination Under Specific Scenarios Combining Effectiveness, Safety, and Cost in the Hong Kong Chinese General Population

Document Type : Original Article

Authors

1 Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

2 School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

3 Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

Abstract

Background
The prevalence of coronavirus disease 2019 (COVID-19) vaccination is very critical in controlling COVID-19. This study mainly aimed to (1) investigate behavioral intentions of COVID-19 vaccination under various specific scenarios, and (2) associated factors of the afore-mentioned vaccination intentions.
 
Methods
A random anonymous telephone survey interviewed 450 Chinese adults from September 16-30, 2020 in Hong Kong, China. Nine scenarios of behavioral intentions of COVID-19 vaccinations were measured combining effectiveness (80% versus 50%), safety (rare versus common mild side effect), and cost (free versus HK$ 500).
 
Results
The prevalence of behavioral intentions of COVID-19 vaccination under the 9 specific scenarios was very low and varied greatly (4.2% to 38.0%). The prospective countries of manufacture also influenced vaccination intention (eg, Japan: 55.8% vs China: 31.1%). Only 13.1% intended to take up COVID-19 vaccination at the soonest upon its availability. The attributes of effectiveness and side effect influenced vaccination intention most. Positively associated factors of behavioral intentions of COVID-19 vaccination included trust/satisfaction toward the government, exposure to positive social media information about COVID-19 vaccines, descriptive norms, perceived impact on the pandemic, perceived duration of protectiveness, and life satisfaction.
 
Conclusion
Intention of COVID-19 vaccination was low in the Hong Kong general population, especially among younger people, females, and single people. Health promotion is warranted to enhance the intention. The significant factors identified in this study may be considered when designing such health promotion. Future research is required to confirm the findings in other countries. Such studies should pay attention to the specific context of cost, safety, and effectiveness, which would lead to different responses in the level of behavioral intention of COVID-19 vaccination (BICV).

Keywords

Main Subjects


  1. World Health Organization (WHO). Coronavirus Disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update. WHO; 2020.
  2. Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020;383(6):510-512. doi:10.1056/NEJMp2008017
  3. Venkatesh A, Edirappuli S. Social distancing in COVID-19: what are the mental health implications? BMJ. 2020;369:m1379. doi:10.1136/bmj.m1379
  4. Wares J, Krehbiel S. Herd Immunity Won't Solve America's COVID-19 Problem. The Coversation. June 16, 2020. Available at: https://theconversation.com/herd-immunity-wont-solve-americas-covid-19-problem-139724.  Accessed October 6, 2020.
  5. World Health Organization (WHO). Draft Landscape of COVID-19 Candidate Vaccines. WHO; 2020.
  6. South China Morning Post. Coronavirus Vaccine Pre-Orders Top 5 Billion in Worldwide Scramble for Supplies. https://www.scmp.com/news/world/united-states-canada/article/3096986/coronavirus-vaccine-pre-orders-top-5-billion.  Accessed October 6, 2020. 2020.
  7. Subbaraman N. Who gets a COVID vaccine first? access plans are taking shape. Nature. 2020;585(7826):492-493. doi:10.1038/d41586-020-02684-9
  8. Kaur SP, Gupta V. COVID-19 vaccine: a comprehensive status report. Virus Res. 2020;288:198114. doi:10.1016/j.virusres.2020.198114
  9. Petrelli F, Contratti CM, Tanzi E, Grappasonni I. Vaccine hesitancy, a public health problem. Ann Ig. 2018;30(2):86-103. doi:10.7416/ai.2018.2200
  10. World Health Organization (WHO). Ten Threats to Global Health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.  Accessed December 15, 2020. 2019.
  11. U.S. Food & Drug Administration (USFDA). Development and Licensure of Vaccines to Prevent COVID-19. USFDA; 2020.
  12. Aubrey A. A COVID-19 Vaccine May Be Only 50% Effective. Is That Good Enough? National Public Radio. September 12, 2020. https://www.npr.org/sections/health-shots/2020/09/12/911987987/a-covid-19-vaccine-may-be-only-50-effective-is-that-good-enough.  Accessed October 6, 2020.
  13. Bartsch SM, O'Shea KJ, Ferguson MC, et al. Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention. Am J Prev Med. 2020;59(4):493-503. doi:10.1016/j.amepre.2020.06.011
  14. Wong LP, Alias H, Wong PF, Lee HY, AbuBakar S. The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Hum Vaccin Immunother. 2020;16(9):2204-2214. doi:10.1080/21645515.2020.1790279
  15. Wang J, Jing R, Lai X, et al. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines (Basel). 2020;8(3):482. doi:10.3390/vaccines8030482
  16. Frank K, Arim R. Canadians’ Willingness to Get a COVID-19 Vaccine when One Becomes Available: What Role Does Trust Play? Ottawa: Statistics Canada; 2020.
  17. Jose R, Narendran M, Bindu A, Beevi N, L M, Benny PV. Public perception and preparedness for the pandemic COVID 19: a health belief model approach. Clin Epidemiol Glob Health. 2021;9:41-46. doi:10.1016/j.cegh.2020.06.009
  18. Palamenghi L, Barello S, Boccia S, Graffigna G. Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy. Eur J Epidemiol. 2020;35(8):785-788. doi:10.1007/s10654-020-00675-8
  19. Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes toward a potential SARS-CoV-2 vaccine: a survey of US adults. Ann Intern Med. 2020;173(12):964-973. doi:10.7326/m20-3569
  20. Harapan H, Wagner AL, Yufika A, et al. Acceptance of a COVID-19 vaccine in southeast Asia: a cross-sectional study in Indonesia. Front Public Health. 2020;8:381. doi:10.3389/fpubh.2020.00381
  21. Neumann-Böhme S, Varghese NE, Sabat I, et al. Once we have it, will we use it? a European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ. 2020;21(7):977-982. doi:10.1007/s10198-020-01208-6
  22. Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: how many people would get vaccinated? Vaccine. 2020;38(42):6500-6507. doi:10.1016/j.vaccine.2020.08.043
  23. Dror AA, Eisenbach N, Taiber S, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775-779. doi:10.1007/s10654-020-00671-y
  24. Kraut A, Graff L, McLean D. Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel. Vaccine. 2011;29(46):8357-8363. doi:10.1016/j.vaccine.2011.08.084
  25. Lin CA, Lagoe C. Effects of news media and interpersonal interactions on H1N1 risk perception and vaccination intent. Commun Res Rep. 2013;30(2):127-136. doi:10.1080/08824096.2012.762907
  26. Bock JO, Hajek A, König HH. Psychological determinants of influenza vaccination. BMC Geriatr. 2017;17(1):194. doi:10.1186/s12877-017-0597-y
  27. Head KJ, Kasting ML, Sturm LA, Hartsock JA, Zimet GD. A national survey assessing SARS-CoV-2 vaccination intentions: implications for future public health communication efforts. Sci Commun. 2020;42(5):698-723. doi:10.1177/1075547020960463
  28. Hartley K, Jarvis DSL. Policymaking in a low-trust state: legitimacy, state capacity, and responses to COVID-19 in Hong Kong. Policy Soc. 2020;39(3):403-423. doi:10.1080/14494035.2020.1783791
  29. Fridman I, Lucas N, Henke D, Zigler CK. Association between public knowledge about COVID-19, trust in information sources, and adherence to social distancing: cross-sectional survey. JMIR Public Health Surveill. 2020;6(3):e22060. doi:10.2196/22060
  30. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211. doi:10.1016/0749-5978(91)90020-t
  31. Wang K, Wong ELY, Ho KF, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: a cross-sectional survey. Vaccine. 2020;38(45):7049-7056. doi:10.1016/j.vaccine.2020.09.021
  32. Parletta N, Aljeesh Y, Baune BT. Health behaviors, knowledge, life satisfaction, and wellbeing in people with mental illness across four countries and comparisons with normative sample. Front Psychiatry. 2016;7:145. doi:10.3389/fpsyt.2016.00145
  33. Kwok KO, Li KK, Chan HHH, et al. Community responses during early phase of COVID-19 epidemic, Hong Kong. Emerg Infect Dis. 2020;26(7):1575-1579. doi:10.3201/eid2607.200500
  34. Centre for Health Protection. Statistics on Vaccination Programmes in the Past 3 Years. https://www.chp.gov.hk/en/features/102226.html.  Accessed December 14, 2020. Published 2020.
  35. Smith KL, Matheson FI, Moineddin R, et al. Gender differences in mental health service utilization among respondents reporting depression in a national health survey. Health (N Y). 2013;10(5):1561-1571. doi:10.4236/health.2013.510212
  36. Keene J, Li X. Age and gender differences in health service utilization. J Public Health (Oxf). 2005;27(1):74-79. doi:10.1093/pubmed/fdh208
  37. Masters NB, Shih SF, Bukoff A, et al. Social distancing in response to the novel coronavirus (COVID-19) in the United States. PLoS One. 2020;15(9):e0239025. doi:10.1371/journal.pone.0239025
  38. Glass DC, Kelsall HL, Slegers C, et al. A telephone survey of factors affecting willingness to participate in health research surveys. BMC Public Health. 2015;15:1017. doi:10.1186/s12889-015-2350-9
  39. Wilking H, Spitznagel H, Werber D, Lange C, Jansen A, Stark K. Acute gastrointestinal illness in adults in Germany: a population-based telephone survey. Epidemiol Infect. 2013;141(11):2365-2375. doi:10.1017/s0950268813000046
  40. Yu Y, Lau JTF, Lau MMC. Competing or interactive effect between perceived response efficacy of governmental social distancing behaviors and personal freedom on social distancing behaviors in the chinese adult general population in Hong Kong. Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.195
  41. Yang X, She R, Lau MM, Lau JT. Anticipated socio-political developments and related personal responses as structural determinants of mental health problems: a population-based study. Int J Soc Psychiatry. 2020;66(1):58-66. doi:10.1177/0020764019879948
  42. Clark A, Jit M, Warren-Gash C, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health. 2020;8(8):e1003-e1017. doi:10.1016/s2214-109x(20)30264-3
  43. Ni MY, Yao XI, Leung KSM, et al. Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study. Lancet. 2020;395(10220):273-284. doi:10.1016/s0140-6736(19)33160-5
  44. Wikipedia. Protests Over Responses to the COVID-19 Pandemic. https://en.wikipedia.org/wiki/Protests_over_responses_to_the_COVID-19_pandemic.  Accessed on June 4, 2020. 2020.
  45. Carnegie Endowment for International Peace (CEIP). Global Protest Tracker. https://carnegieendowment.org/publications/interactive/protest-tracker.  Accessed September 15, 2020.
  46. Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11(1):1-47. doi:10.1177/109019818401100101
  47. Folkman S, Lazarus RS. Stress, Appraisal, and Coping. New York: Springer Publishing Company; 1984.
  48. Ylöstalo PV, Ek E, Laitinen J, Knuuttila ML. Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors. J Dent Res. 2003;82(3):194-199. doi:10.1177/154405910308200309
  49. Grant N, Wardle J, Steptoe A. The relationship between life satisfaction and health behavior: a cross-cultural analysis of young adults. Int J Behav Med. 2009;16(3):259-268. doi:10.1007/s12529-009-9032-x
  50. Sikkema KJ, Watt MH, Drabkin AS, Meade CS, Hansen NB, Pence BW. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14(2):252-262. doi:10.1007/s10461-009-9650-y
Volume 11, Issue 7
July 2022
Pages 1090-1101
  • Receive Date: 20 October 2020
  • Revise Date: 16 December 2020
  • Accept Date: 04 January 2021
  • First Publish Date: 18 January 2021