Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey

Abstract

Background COVID-19 vaccines will become available in China soon. Understanding communities’ responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). Conclusions Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination.

Fear of COVID-19 and Perceived COVID-19 Infectability Supplement Theory of Planned Behavior to Explain Iranians’ Intention to Get COVID-19 Vaccinated

“…That is, the present study found that attitude, subjective norms, and perceived behavioral control in the TPB were all significant factors explaining intention of COVID-19 vaccination uptake. This finding corresponds well with what prior TPB studies on vaccination uptake have found [ 18 , 28 , 29 , 30 , 31 ]. For example, Guidry et al found that American adults who were more positive toward COVID-19 vaccination and had higher levels of subjective norms held greater intention to get COVID-19 vaccinated [ 31 ].…”

“…More specifically, the TPB (or part of the TPB) has not been applied to studies with a sample size larger than 10,000 participants. For example, the sample size was 2653 in Zhang et al’s study [ 28 ]; 398 in Shmueli’s study [ 18 ]; 374 in Sturman et al’s study [ 29 ]; 2529 in Cordina et al’s study [ 30 ]; and 788 in Guidry et al’s study [ 31 ]. In this regard, the present authors proposed to use a large-scale study incorporating more than 10,000 individuals to fully examine the effectiveness of the extended TPB.…”

Preventive Behaviors During the COVID-19 Pandemic: Associations With Perceived Behavioral Control, Attitudes, and Subjective Norm

“…We examined the associations with eight different preventive health behaviors, but there are many other preventive behaviors we did not examine that could have different associations. For example, we did not assess "getting a COVID-19 vaccination" since no vaccine was available at the time of data collection, but for this specific behavior, we would expect similar associations based on other studies (19,20). Additionally, although this study found associations with perceived behavioral control, attitudes, and subjective norm, further research would be needed to identify the specific reasons and barriers associated with avoiding each of these preventive behaviors.…”

“…Interest in and evidence for the association between the TPB and preventive health behaviors in the current COVID-19 pandemic has also been growing. For example, TPB predicted whether factory workers (19) and parents with children under the age of 18 years (20) in China intend to get a COVID-19 vaccination for themselves or their children, respectively. Furthermore, a study conducted in China found that attitude toward epidemic prevention affected individuals' intention to adopt epidemic prevention, while norms did not have a significant impact, and perceived feasibility to adopt epidemic prevention was found to be a barrier (21).…”

Intention to receive vaccine against COVID-19 and associated factors among health professionals working at public hospitals in resource limited settings

“…The study revealed that perception was another predictor, with one standard deviation additional change in perception, an intention to receive vaccine against COVID-19 increases by 0.43 standard deviations keeping other variables constant. Similar studies including French [25] and China [24,32]. These studies identified that, fear about COVID-19 and selfperceived risk of infection were associated with COVID-19 vaccine acceptance in health professionals.…”