Levels and factors derived from the Health Action Process Approach of behavioral intentions to take up COVID-19 vaccination: A random population-based study

Abstract

Objectives COVID-19 vaccination needs a high population coverage to achieve herd immunity. We investigated prevalence of three scenarios of intention of free COVID-19 vaccination involving: 1) 80% effectiveness and rare and mild side effects (Scenario 1), 2) 50% effectiveness and rare and mild side effect RMSE (Scenario 2), and 3) immediate vaccination (Scenario 3), and their associated factors derived from the pre-intentional motivational phase of the Health Action Process Approach (HAPA). Methods A random population-based telephone survey interviewed 450 Chinese adults in the general population (September 16–30, 2020). The four HAPA constructs included a) risk perception scale, b) overall scale/four subscales of positive outcome expectancy of COVID-19 vaccination, c) overall scale/three subscales of negative outcome expectancy of COVID-19 vaccination, and d) the overall scale/two subscales of self-efficacy of COVID-19 vaccination. Results The prevalence of intention of COVID-19 vaccination under Scenarios 1 to 3 was 38.0%, 11.1%, and 13.1%, respectively. Logistic regression analyses adjusted for background factors showed that 1) the associations between risk perception and the three scenarios of intention were non-significant; 2) the overall scale/four subscales of positive outcome expectancy were in general positively associated with two scenarios of intention (80% effectiveness and immediate vaccination); 3) the overall scale/three subscales of negative outcome expectancy were in general negatively associated with all three scenarios of intention; 4) the overall scale/two subscales of self-efficacy were only positively associated with the intention that involved 80% effectiveness. When all the four overall scales were entered into an adjusted model, positive and negative outcome expectancy, but not risk perception and self-efficacy, were independently associated with the three scenarios. Conclusions In this study population, the prevalence of intention of COVID-19 vaccination was very low and might not result in population protection. Health promotion should modify outcome expectancies to increase intention of COVID-19 vaccination.

Association of Social-Cognitive Factors with Individual Preventive Behaviors of COVID-19 among a Mixed-Sample of Older Adults from China and Germany

“…In contrast, self-efficacy needs to be addressed in a country-specific manner: while in China, more motivational self-efficacy is imperative for more preventive physical distancing, in Germany more volitional self-efficacy seems to be required. This might be interpreted by the cultural difference (e.g., collectivism vs. individualism) [ 54 , 55 ]. For collectivism-oriented countries (e.g., China), the networks and physical connection are commonly highlighted.…”

Factors Influencing Intention on Condom Use During Sexual Intercourse With Regular Female Partners Among Men Who Have Sex With Men in Western China: A Structural Equation Modeling Analysis

“…The HAPA model proposes that behavioral change consists of 2 phases (preintentional and postintentional). In the preintentional phase, it is assumed that behavioral intention is determined by (1) risk perception (i.e., the individual's perceived susceptibility to a health threat), (2) positive outcome expectancy regarding the particular behavior, (3) negative outcome expectancy regarding the particular behavior, and (4) self-efficacy (i.e., confidence in performing the behavior) 18 . Behavioral intention is one of the most powerful predictors of various actual behaviors 19 .…”

“…Behavioral intention is one of the most powerful predictors of various actual behaviors 19 . Many studies on HAPA have focused on the preintentional phase, including condom use among senior high school students, condom use with various types of female sex partners among male individuals who inject drugs in China, and the behavioral intention of COVID-19 vaccination 18,20,21 . However, there are few studies on the behavioral intention of condom use during sexual intercourse with regular female partners among MSM.…”

“…In the preintentional phase, it is assumed that behavioral intention is determined by (1) risk perception (i.e., the individual's perceived susceptibility to a health threat), (2) positive outcome expectancy regarding the particular behavior, (3) negative outcome expectancy regarding the particular behavior, and (4) self-efficacy (i.e., confidence in performing the behavior). 18 Behavioral intention is one of the most powerful predictors of various actual behaviors. 19 Many studies on HAPA have focused on the preintentional phase, including condom use among senior high school students, condom use with various types of female sex partners among male individuals who inject drugs in China, and the behavioral intention of COVID-19 vaccination.…”