Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Abstract

Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.

COVID-19 vaccine hesitancy in Africa: a scoping review

“…The reasons for vaccine hesitancy varied across studies (Table 2 ). Concern for safety was the most-mentioned factor [ 17 – 19 , 25 , 34 , 36 , 36 , 37 , 37 , 38 , 40 , 41 , 41 – 43 , 43 – 53 ]. Some of these concerns appeared to stem from mistrust towards the pharmaceutical industry, results from clinical trials, poor vaccine promotion with conflicting information, misinformation from social media, and the fear of getting ill or side effects from the vaccine [ 26 , 36 , 40 , 44 ].…”

Behavioral determinants for COVID-19 vaccine acceptance among students, faculty, and staff at a rural public university

“…Beliefs around both injunctive and descriptive social norms are some of the strongest predictors of vaccine confidence (Davis et. al., 2022 ) In this study, Non-acceptors were 79.7 times more likely to say they are not likely to get a COVID-19 vaccine if a doctor or nurse recommends it to them than Acceptors (ERR = 0.01). Surprisingly, Non-acceptors were 19.2 times more likely to say that they have a medical professional in their life who they believe would generally disapprove of them getting a COVID-19 vaccine than Acceptors (ERR = 0.05).…”

“…The BA methodology has been used in 59 low-to-middle-income countries through 38 organizations (including UNICEF) to determine behavioral determinants associated with desired childcare practices (e.g. exclusive breastfeeding, child vaccination) (Davis, et al, 2022 ). This approach was recently used in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo, and Tanzania to examine 12 potential behavioral determinants of vaccine COVID-19 acceptance and found statistically significant differences in behavioral determinants of COVID-19 vaccine confidence among the different countries (Kebede et al, 2021 ).…”

“…Another recently published study used BA to identify determinants of vaccine hesitancy in Dhaka (Davis et. al., 2022 ). The current study team adapted the BA COVID-19 vaccine questionnaire used in lower-middle-income countries (LMICs) to fit the present context, as high-income countries can learn from the experience of LMICs in fighting endemic and pandemic infectious diseases.…”

Acceptance of COVID-19 Vaccines among Adults in Lilongwe, Malawi: A Cross-Sectional Study Based on the Health Belief Model

“…At the same time, Malawi has its own unique cultural and religious background, so it is essential to work with trusted community leaders. Religious leaders can also act as vaccine advocates, using existing trust relationships to advocate for vaccination [ 31 , 32 ].…”