Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting
2.2. Study Population and Sampling Methods
2.3. Sample Size
2.4. Tools of Data Collection
2.5. Plan of Data Collection
2.6. Ethical Considerations and Approval
2.7. Statistical Analysis
3. Results
3.1. Respondents’ Sociodemographic Characteristics
3.2. COVID-19 Booster Dose Acceptance in Low-, Middle, and High-Income Countries
3.3. Characteristics of Vaccinated and Non-Vaccinated Participants
3.4. Leading Causes behind Booster Dose Rejection
3.5. Source of Information about COVID-19
3.6. Determinants of Booster Dose Acceptance
Determinants of Booster Dose Acceptance Using Multivariable Regression Analysis
4. Discussion
4.1. Booster Dose Acceptance
4.2. Acceptance Rate in Low-Middle, and High-Income Countries
4.3. Determinants of Booster Dose Acceptance
4.4. Health Belief Model
4.5. Causes of COVID-19 Vaccine Rejection
4.6. Source of Information about Vaccination
4.7. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | n (%) | |
---|---|---|
Sex | Males | 548 (37.3) |
Females | 920 (62.7) | |
Age | Mean ± SD (min-max) | 36.53 ± 13.45 (18.0–88.0) |
Marital status | Single | 596 (40.6) |
Married | 811 (55.2) | |
Divorced | 42 (2.9) | |
Widow | 19 (1.3) | |
Education | Diploma | 87 (5.9) |
Secondary education | 171 (11.6) | |
University students | 705 (48.0) | |
Postgraduate | 505 (34.4) | |
Working | I do not work | 186 (12.7) |
Retired | 50 (3.4) | |
Students | 293 (20.0) | |
Working in the medical field | 526 (35.8) | |
Working outside the medical field | 413 (28.1) | |
Chronic Disease | Yes | 237 (16.1) |
No | 1231 (83.9) | |
Previous COVID-19 infection | Yes | 750 (51.1) |
No | 718 (48.9) | |
A relative had a COVID-19 infection | Yes | 1268 (86.4) |
No | 200 (13.6) | |
Immunocompromised relative | Yes | 210 (14.3) |
No | 1258 (85.7) |
Dependent (Vaccination) | Total | Accept Vaccination (n = 1093) | Reject Vaccination (n = 375) | p | |||
---|---|---|---|---|---|---|---|
n | % | n | % | ||||
Sex | Female | 920 | 658 | 71.5 | 262 | 28.5 | 0.001 |
Male | 548 | 435 | 79.4 | 113 | 20.6 | ||
Age | Mean ± SD | 37.5 ± 13.8 | 33.9 ± 12.0 | <0.001 | |||
Body mass index | Mean ± SD | 26.2 ± 5.5 | 25.6 ± 5.8 | 0.075 | |||
Marital status | Married | 811 | 630 | 77.7 | 181 | 22.3 | 0.002 |
Single # | 657 | 463 | 69.6 | 194 | 30.4 | ||
Education | Secondary education | 171 | 143 | 83.6 | 28 | 16.4 | 0.002 |
Diploma/Art | 87 | 73 | 83.9 | 14 | 16.1 | ||
University | 705 | 517 | 73.3 | 188 | 26.7 | ||
Higher Education | 505 | 360 | 71.3 | 145 | 28.7 | ||
Previous COVID-19 infection | No | 718 | 560 | 78.0 | 158 | 22.0 | 0.003 |
Yes | 750 | 533 | 71.1 | 217 | 28.9 | ||
Immunocompromised relative | No | 1258 | 950 | 75.5 | 308 | 24.5 | 0.028 |
Yes | 210 | 143 | 68.1 | 67 | 31.9 |
Dependent: Vaccination | Total (n = 1468) | Accept Vaccination | Reject Vaccination | p | |||
---|---|---|---|---|---|---|---|
n | % | n | % | ||||
Social media | No | 646 (44.0) | 469 | 72.6 | 177 | 27.4 | 0.166 |
Yes | 822 (56.0) | 624 | 75.9 | 198 | 24.1 | ||
Relative and friends | No | 1122 (76.4) | 835 | 74.4 | 287 | 25.6 | 1 |
Yes | 346 (23.6) | 258 | 74.6 | 88 | 25.4 | ||
Literature | No | 816 (55.6) | 613 | 75.1 | 203 | 24.9 | 0.551 |
Yes | 652 (45.4) | 480 | 73.6 | 172 | 26.4 | ||
Ministry of Health website | No | 863 (58.7) | 375 | 66.6 | 188 | 33.4 | <0.001 |
Yes | 905 (41.3) | 718 | 79.3 | 187 | 20.7 | ||
CDC website | No | 681 (46.4) | 854 | 74.0 | 300 | 26.0 | 0.492 |
Yes | 787 (53.6) | 239 | 76.1 | 75 | 23.9 | ||
WHO website | No | 1154 (78.6) | 492 | 72.3 | 189 | 27.8 | 0.081 |
Yes | 314 (21.4) | 601 | 76.34 | 186 | 23.6 | ||
Other | No | 1452 (98.9) | 1082 | 74.6 | 369 | 25.4 | 0.517 |
Yes | 17 (1.1) | 11 | 64.7 | 6 | 35.3 |
Dependent: Vaccination | Question/Category | Total | Accept Vaccination | Reject Vaccination | p | Cronbach Alpha | |||
---|---|---|---|---|---|---|---|---|---|
n | n | % | n | % | 0.68 | ||||
Perceived susceptibility | Q1: I think there is a risk of COVID-19 infection | High | 601 | 74 | 12.3 | 527 | 87.7 | <0.001 | 0.65 |
Low | 387 | 137 | 35.4 | 250 | 64.6 | ||||
Neutral | 480 | 164 | 34.2 | 316 | 65.8 | ||||
Q2: I think COVID-19 variants have a higher risk of infection than the existing strains | High | 600 | 93 | 15.5 | 507 | 84.5 | 0.65 | ||
Low | 447 | 157 | 35.1 | 290 | 64.9 | ||||
Neutral | 421 | 125 | 29.7 | 296 | 70.3 | ||||
Perceived severity | Q3: I think COVID-19 infection is a severe disease | High | 709 | 113 | 15.9 | 596 | 84.1 | <0.001 | 0.65 |
Low | 304 | 127 | 41.8 | 177 | 58.2 | ||||
Neutral | 455 | 135 | 29.7 | 320 | 70.3 | ||||
Q4: I agree that COVID-19 variants can cause more severe illness than the existing strains | High | 553 | 112 | 20.3 | 441 | 79.7 | <0.001 | 0.66 | |
Low | 391 | 138 | 35.3 | 253 | 64.7 | ||||
Neutral | 524 | 125 | 23.9 | 399 | 76.1 | ||||
Perceived benefit | Q5: I believe the COVID-19 boosters are effective against early circulating COVID-19 strains | High | 654 | 43 | 6.6 | 611 | 93.4 | <0.001 | 0.63 |
Low | 399 | 219 | 54.9 | 180 | 45.1 | ||||
Neutral | 415 | 113 | 27.2 | 302 | 72.8 | ||||
Q6: I believe the COVID-19 boosters are effective to extend protection against COVID-19 infection. | High | 699 | 54 | 7.7 | 645 | 92.3 | <0.001 | 0.63 | |
Low | 369 | 221 | 59.9 | 148 | 40.1 | ||||
Neutral | 400 | 100 | 25.0 | 300 | 75.0 | ||||
Q7: I believe the COVID-19 boosters are effective against COVID-19 variants | High | 612 | 39 | 6.4 | 573 | 93.6 | <0.001 | 0.63 | |
Low | 421 | 229 | 54.4 | 192 | 45.6 | ||||
Neutral | 435 | 107 | 24.6 | 328 | 75.4 | ||||
Perceived barriers | Q8: I think COVID-19 vaccine boosters are safe | High | 594 | 39 | 6.6 | 555 | 93.4 | <0.001 | 0.65 |
Low | 426 | 228 | 53.5 | 198 | 46.5 | ||||
Neutral | 448 | 108 | 24.1 | 340 | 75.9 | ||||
Q9: I am worried about the serious adverse reaction after vaccination | High | 411 | 197 | 47.9 | 214 | 52.1 | <0.001 | 0.67 | |
Low | 711 | 98 | 13.8 | 613 | 86.2 | ||||
Neutral | 346 | 80 | 23.1 | 266 | 76.9 | ||||
Q10: I know persons had severe side effects after being vaccinated | High | 362 | 158 | 43.6 | 204 | 56.4 | <0.001 | 0.68 | |
Low | 788 | 126 | 16.0 | 662 | 84.0 | ||||
Neutral | 318 | 91 | 28.6 | 227 | 71.4 | ||||
Perceived Efficacy | Q11: It is easy for me to get the COVID-19 vaccine if I wanted to | High | 1056 | 251 | 23.8 | 805 | 76.2 | 0.042 | 0.67 |
Low | 120 | 35 | 29.2 | 85 | 70.8 | ||||
Neutral | 292 | 89 | 30.5 | 203 | 69.5 | ||||
Cues to action | Q12: Did you use to have confirmed or suspected cases in your daily close contacts? | No | 772 | 595 | 77.1 | 177 | 22.9 | 0.018 | 0.70 |
Yes | 696 | 498 | 71.6 | 198 | 28.4 | ||||
Q13: Do you know about the following COVID-19 variants? | All Types | 321 | 249 | 77.6 | 72 | 22.4 | 0.257 | 0.73 | |
Four Types | 115 | 82 | 71.3 | 33 | 28.7 | ||||
I Don’t Know | 160 | 123 | 76.9 | 37 | 23.1 | ||||
One Type | 354 | 270 | 76.3 | 84 | 23.7 | ||||
Three Types | 198 | 144 | 72.7 | 54 | 27.3 | ||||
Two Types | 320 | 225 | 70.3 | 95 | 29.7 |
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Ghazy, R.M.; Abdou, M.S.; Awaidy, S.; Sallam, M.; Elbarazi, I.; Youssef, N.; Fiidow, O.A.; Mehdad, S.; Hussein, M.F.; Adam, M.F.; et al. Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region. Int. J. Environ. Res. Public Health 2022, 19, 12136. https://doi.org/10.3390/ijerph191912136
Ghazy RM, Abdou MS, Awaidy S, Sallam M, Elbarazi I, Youssef N, Fiidow OA, Mehdad S, Hussein MF, Adam MF, et al. Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region. International Journal of Environmental Research and Public Health. 2022; 19(19):12136. https://doi.org/10.3390/ijerph191912136
Chicago/Turabian StyleGhazy, Ramy Mohamed, Marwa Shawky Abdou, Salah Awaidy, Malik Sallam, Iffat Elbarazi, Naglaa Youssef, Osman Abubakar Fiidow, Slimane Mehdad, Mohamed Fakhry Hussein, Mohammed Fathelrahman Adam, and et al. 2022. "Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region" International Journal of Environmental Research and Public Health 19, no. 19: 12136. https://doi.org/10.3390/ijerph191912136