Using the precaution adoption process model to understand decision-making about the Covid-19 booster vaccine in England
Carly J Meyer, Louis Goffe, Vivi Antonopoulou, Fiona Graham, Mei Yee Tang, Jan Lecouturier, Aikaterini Grimani, Paul Chadwick, Falko F Sniehotta
- The views of those individuals who are hesitant to having a Covid-19 booster vaccine will not be homogenous. Our study used a stage model, the Precaution Adoption Process Model, to understand factors that differentiated people at different stages of decision-making about the booster vaccine.
- Being ‘unengaged’ or ‘undecided’ about having a Covid-19 booster vaccine were both associated with less perceived knowledge about the safety and effectiveness of the booster vaccine and less perceived susceptibility, indicating that public education remains an important priority.
- Being ‘unengaged’ about having a Covid-19 booster vaccine was uniquely associated with a combination of socio-demographic and socio-economic factors, as well as weaker subjective norms, suggesting that public health officials need to understand and address the additional barriers faced by people who have less financial security, and use strong role models to promote booster vaccine uptake among these people.
- Attitude towards the booster vaccine was uniquely associated with being undecided about having the vaccine once available to them, as was having had the Oxford/AstraZeneca vaccine previously and not being of white British ethnicity. It is recommended that public health messaging persuade people of the benefits of booster vaccination and alleviate any concerns the public might have about combining the booster vaccine with the Oxford/AstraZeneca vaccine. Public health efforts aimed at supporting vaccine uptake in minority ethnic groups should also continue.
Background: Covid-19 continues to pose a threat to public health. Booster vaccine programmes are critical to achieve population-level immunisation. The application of a stage theory model can help our understanding of vaccine decision-making in the context of perceived threats of Covid-19.
Purpose: To use the Precaution Adoption Process Model (PAPM) to profile the general public’s decision-making about having a Covid-19 booster vaccine (CBV).
Methods: An online, cross-sectional survey informed by the PAPM, the Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making.
Results: Of the total 2,004 respondents: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against Covid-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive Covid-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive Covid-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs. London).
Conclusions: Public health interventions promoting CBV may improve uptake through tailoring of messaging according to which decision stage they are in regarding having a Covid-19 booster.
See full paper, ‘Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England’ in PsyArXiv Preprints here