Vaccine hesitancy for COVID-19 explored in a phenomic study of 259 socio-cognitive-behavioural measures in the UK-REACH study of 12,431 UK healthcare workers

  1. I Chris McManus
  2. Katherine Woolf
  3. Christopher A Martin
  4. Laura B Nellums
  5. Anna L Guyatt
  6. Carl Melbourne
  7. Luke Bryant
  8. Amit Gupta
  9. Catherine John
  10. Martin D Tobin
  11. Sue Carr
  12. Sandra Simpson
  13. Bindu Gregary
  14. Avinash Aujayeb
  15. Stephen Zingwe
  16. Rubina Reza
  17. Laura J Gray
  18. Kamlesh Khunti
  19. Manish Pareek

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Abstract

Background

Vaccination is key to successful prevention of COVID-19 particularly nosocomial acquired infection in health care workers (HCWs). ‘Vaccine hesitancy’ is common in the population and in HCWs, and like COVID-19 itself, hesitancy is more frequent in ethnic minority groups. UK-REACH (United Kingdom Research study into Ethnicity and COVID-19 outcomes) is a large-scale study of COVID-19 in UK HCWs from diverse ethnic backgrounds, which includes measures of vaccine hesitancy. The present study explores predictors of vaccine hesitancy using a ‘phenomic approach’, considering several hundred questionnaire-based measures.

Methods

UK-REACH includes a questionnaire study encompassing 12,431 HCWs who were recruited from December 2020 to March 2021 and completed a lengthy online questionnaire (785 raw items; 392 derived measures; 260 final measures). Ethnicity was classified using the Office for National Statistics’ five (ONS5) and eighteen (ONS18) categories. Missing data were handled by multiple imputation. Variable selection used the islasso package in R , which provides standard errors so that results from imputations could be combined using Rubin’s rules. The data were modelled using path analysis, so that predictors, and predictors of predictors could be assessed. Significance testing used the Bayesian approach of Kass and Raftery, a ‘very strong’ Bayes Factor of 150, N=12,431, and a Bonferroni correction giving a criterion of p<4.02 × 10 −8 for the main regression, and p<3.11 × 10 −10 for variables in the path analysis.

Results

At the first step of the phenomic analysis, six variables were direct predictors of greater vaccine hesitancy: Lower pro-vaccination attitudes; no flu vaccination in 2019-20; pregnancy; higher COVID-19 conspiracy beliefs; younger age; and lower optimism the roll-out of population vaccination. Overall 44 lower variables in total were direct or indirect predictors of hesitancy, with the remaining 215 variables in the phenomic analysis not independently predicting vaccine hesitancy. Key variables for predicting hesitancy were belief in conspiracy theories of COVID-19 infection, and a low belief in vaccines in general. Conspiracy beliefs had two main sets of influences:

  • Higher Fatalism, which was influenced a) by high external and chance locus of control and higher need for closure, which in turn were associated with neuroticism, conscientiousness, extraversion and agreeableness; and b) by religion being important in everyday life, and being Muslim.

  • receiving information via social media, not having higher education, and perceiving greater risks to self, the latter being influenced by higher concerns about spreading COVID, greater exposure to COVID-19, and financial concerns.

    • There were indirect effects of ethnicity, mediated by religion. Religion was more important for Pakistani and African HCWs, and less important for White and Chinese groups. Lower age had a direct effect on hesitancy, and age and female sex also had several indirect effects on hesitancy.

    Conclusions

    The phenomic approach, coupled with a path analysis revealed a complex network of social, cognitive, and behavioural influences on SARS-Cov-2 vaccine hesitancy from 44 measures, 6 direct and 38 indirect, with the remaining 215 measures not having direct or indirect effects on hesitancy. It is likely that issues of trust underpin many associations with hesitancy. Understanding such a network of influences may help in tailoring interventions to address vaccine concerns and facilitate uptake in more hesistant groups.

    Funding

    UKMRI-MRC and NIHR

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      SciScore for 10.1101/2021.12.08.21267421: (What is this?)

      Please note, not all rigor criteria are appropriate for all manuscripts.

      Table 1: Rigor

      EthicsConsent: After registering, participants accessed an online consent form and the online questionnaire administered via REDCap 34.
      IRB: Ethical approval: The study was approved by the Health Research Authority (Brighton and Sussex Research Ethics Committee; ethics reference: 20/HRA/4718).
      Sex as a biological variablenot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power AnalysisToo inclusive ethnic groupings can mask important ethnic and cultural differences, but too fine a categorisation can lose statistical power.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      After registering, participants accessed an online consent form and the online questionnaire administered via REDCap 34.
      REDCap
      suggested: (REDCap, RRID:SCR_003445)
      Statistical analysis: Statistical analyses were performed in SPSS and R 43.
      SPSS
      suggested: (SPSS, RRID:SCR_002865)

      Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

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      IdentifierStatusTitle
      ISRCTN11811602NANA

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      • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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      • No protocol registration statement was detected.

      Results from scite Reference Check: We found no unreliable references.

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    2. Version published to 10.1101/2021.12.08.21267421v1 on medRxiv