Vaccination Against COVID-19: A Longitudinal Trans-Theoretical Study to Determine Factors that Predict Intentions and Behavior

Abstract

Background Despite the clear benefits of vaccination, their uptake against common infectious diseases is suboptimal. In December 2020, vaccines against COVID-19 became available. Purpose To determine factors that predict who will take the COVID-19 vaccine based on a conceptual model. Methods An online survey was administered twice: prior to public vaccination, and after vaccinations were available. Participants were 309 Israelis with initial data and 240 at follow-up. Baseline questionnaires measured intentions to be vaccinated and hypothesized predictors clustered in four categories: background, COVID-19, vaccination, and social factors. Self-reported vaccination uptake was measured at follow-up. Results Sixty-two percent of the sample reported having been vaccinated. Intentions were strongly associated with vaccination uptake and mediated the effects of other predictors on behavior. Eighty-six percent of the variance in vaccination intentions was explained by attitudes toward COVID-19 vaccination, regret for having declined vaccination, trust in vaccination, vaccination barriers, past flu vaccination, perceived social norms, and COVID-19 representations. Conclusions Beliefs related directly to the COVID-19 vaccine explained most of the variance in intentions to vaccinate, which in turn predicted vaccination uptake.

Psychosocial factors affecting COVID-19 vaccine uptake in the UK: a prospective cohort study (CoVAccS – wave 3)

“…Protection Motivation Theory 27 ), and previous research conducted in other countries. 9-11 Other psychological factors were also associated with vaccine uptake, namely greater perceived social norms relating to vaccination, greater perceived necessity for vaccination, and greater perceived safety of the vaccine. These factors have also been associated with COVID-19 vaccination intention in other UK studies.…”

“…In Israel, vaccination intention (measured in the week before a COVID-19 vaccine was made available to the general public) was strongly associated with later behaviour (measured after vaccinations were available for all individuals). 11 COVID-19 illness and vaccine attitudes and beliefs, perceived social norms, past influenza vaccination explained 86% of the variance in vaccination intention, which itself mediated associations with behaviour.…”

Social cognition theories and behavior change in COVID-19: A conceptual review

“…While subjective norms reflect perceived social pressure from significant others to perform a COVID-19 preventive behavior, moral norms reflect beliefs that performing the behavior is the socially responsible course of action. Results indicate an important role for this construct as an additional predictor of physical distancing intentions and behavior (e.g., Hagger, Smith, et al, 2020 ; Hagger, Smith, Keech, Moyers, & Hamilton, 2021 ) and general COVID-19 preventive behaviors ( Kojan, Burbach, Ziefle, & Calero Valdez, 2021 ), intention to avoid COVID-19 ( Raza, Ali, & Hussain, 2021 ), and COVID-19 vaccination intentions ( Matute et al, 2021 ) and behavior ( Shiloh et al, 2021 ). These studies have progressed knowledge on the social cognition correlates of COVID-19 preventive behaviors, and we look to future research that further elicits specific beliefs concerning COVID-19 prevention and examines their effects on preventive behaviors.…”

“…The theories have also been applied to predict COVID-19 vaccine intentions (e.g., Chu & Liu, 2021 ; Matute, Palau-Saumell, Meyer, Derqui, & Jiménez-Asenjo, 2021 ; Sherman et al, 2021 ; Shiloh, Peleg, & Nudelman, 2021 ). Similar patterns of effects for key social cognition constructs on vaccine intentions have been observed as those found for other COVID-19 preventive behaviors.…”

“…Many studies applying social cognition theories in the context of COVID-19 preventive behaviors have focused on the prediction of intention, with relatively few providing follow-up measures of behavior (e.g., Clark et al, 2020 ; Das et al, 2021 ; Derksen et al, 2020 ). This is particularly the case for vaccine behavior, likely due to the challenges of collecting behavioral data and the relatively short time vaccines have been made available (for an exception, see Shiloh et al, 2021 ). A sole focus on intention is problematic because although intentions are an important theoretical antecedent of behavior, and are often closely associated with behavior in research on social cognition theories (e.g., Carpenter, 2010 ; McEachan et al, 2011 ; Milne et al, 2000 ), the relationship is far from perfect with modest effect sizes observed across studies ( Sheeran & Webb, 2016 ).…”