A Theory-Based Analysis of COVID-19 Vaccine Hesitancy among African Americans in the United States: A Recent Evidence

Abstract

African Americans have been disproportionately vaccinated at lower rates, which warrants the development of theory-based interventions to reduce vaccine hesitancy in this group. The fourth-generation theories, e.g., multi-theory model (MTM) of health behavior change, are vital in developing behavioral interventions. Therefore, the current study aims to determine recent trends in COVID-19 vaccination rates and to test the MTM model in predicting the initiation of COVID-19 vaccines among vaccine-hesitant Blacks. A sample of 428 unvaccinated African Americans were recruited through a web-based survey using a 28-item psychometric valid questionnaire. Chi-square, independent-samples-t-test or Welch’s t test, and Pearson’s correlation tests were utilized for the analyses. Hierarchical regression modelling was performed to determine the increment in variation accounted for through addition of predictors over a set of models. Nearly 48% of unvaccinated Blacks reported being vaccine-hesitant. The vaccine-hesitant group was relatively younger (40.5 years ± 15.8 vs. 46.2 years ± 17.4, p < 0.001), were Republicans (22.1% vs. 10.0%, p < 0.001), lived in the North-East region (26.0% vs. 11.4%, p < 0.001) and had religious affiliations other than Christianity (21.2% vs. 13.6%, p = 0.04). The mean scores of perceived advantages ((9.01 ± 3.10 vs. 7.07 ± 3.60, p < 0.001) and behavioral confidence (8.84 ± 3.76 vs. 5.67 ± 4.09, p < 0.001) were higher among vaccine non-hesitant group as opposed to the hesitant ones. In a final regression model, all MTM constructs) predicted nearly 65% of variance in initiating COVID-19 vaccination behavior among the vaccine-hesitant group (adjusted R2 = 0.649, F = 32.944, p < 0.001). With each unit increment in MTM constructs (e.g., participatory dialogue and behavior confidence), the initiation of COVID-19 vaccination among vaccine-hesitant Blacks increased by 0.106 and 0.166 units, respectively. Based on the findings of this study a m-health educational intervention to promote COVID-19 vaccine uptake behavior among Blacks is proposed.

Attitudes and Behavior toward COVID-19 Vaccination in Japanese University Students: A Cross-Sectional Study

“…In a study of university students' vaccine-accepting behaviors [27], only 50% reported that health care providers recommended COVID-19 vaccination. Young adults who hesitated to receive the vaccine were reported to have low beliefs about the benefits of the vaccine, indicating the need for a health promotion program [28].…”

Assessing Acceptability of COVID-19 Vaccine Booster Dose among Adult Americans: A Cross-Sectional Study

“…This demonstrates that vaccine hesitancy is not only a function of trust but also attributed to one's perception of low risk for the disease or carefree attitudes. This lends support to developing educational and m-health interventions based on fourth-generation behavioral theories [57]. These interventions may include simple yet interactive messaging, success stories, and testimonials from the community leaders [57].…”

“…This lends support to developing educational and m-health interventions based on fourth-generation behavioral theories [57]. These interventions may include simple yet interactive messaging, success stories, and testimonials from the community leaders [57]. To summarize, a successful vaccination campaign aiming to address and improve individuals' ability to appraise information and interventions to promote vaccine acceptance behavior will be critical.…”

COVID-19 Booster Vaccination Hesitancy in the United States: A Multi-Theory-Model (MTM)-Based National Assessment

“…The possible score range for MTM constructs was 0–12 units. The MTM tool is based on the fourth-generation behavioral theory and has a long-standing history to measure a variety of behaviors amidst the COVID-19 pandemic [ 27 , 28 , 29 ].…”