Exploring the behavioral determinants of COVID-19 vaccine acceptance among an urban population in Bangladesh: Implications for behavior change interventions
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Abstract
While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh.
Methods
We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines.
Results
The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p<0.001) predictors of vaccine acceptance in this population are beliefs around both injunctive and descriptive social norms. Specifically, Acceptors were 3.2 times more likely to say they would be very likely to get a COVID-19 vaccine if a doctor or nurse recommended it, twice as likely to say that most people they know will get a vaccine, and 1.3 times more likely to say that most close family and friends will get a vaccine. The perceived safety of vaccines was found to be important since Non-acceptors were 1.8 times more likely to say that COVID-19 vaccines are “not safe at all”. Beliefs about one’s risk of getting COVID-19 disease and the severity of it were predictive of being a vaccine acceptor: Acceptors were 1.4 times more likely to say that it was very likely that someone in their household would get COVID-19, 1.3 times more likely to say that they were very concerned about getting COVID-19, and 1.3 times more likely to say that it would be very serious if someone in their household contracted COVID-19. Other responses of Acceptors on what makes immunization easier may be helpful in programming to boost acceptance, such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols.
Conclusion
An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.
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SciScore for 10.1101/2021.04.23.21255974: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study protocol was approved by the institutional Ethics Committee of the Chattogram Veterinary and Animal Sciences University, Bangladesh (permit ref. no. CVASU/Dir (R and E) EC/2020/169).
Consent: We informed respondents about the study objectives, and obtained their written consent before conducted interview.Sex as a biological variable There are BA studies in the peer-reviewed literature on exclusive breastfeeding (46) HWWS among internally displaced women in the Kurdistan region of Iraq (40) timely oral polio vaccination agricultural extension behaviors in India (47), dietary salt reduction in Nepal (48) transition from the lactational amenorrhea method to other modern family … SciScore for 10.1101/2021.04.23.21255974: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study protocol was approved by the institutional Ethics Committee of the Chattogram Veterinary and Animal Sciences University, Bangladesh (permit ref. no. CVASU/Dir (R and E) EC/2020/169).
Consent: We informed respondents about the study objectives, and obtained their written consent before conducted interview.Sex as a biological variable There are BA studies in the peer-reviewed literature on exclusive breastfeeding (46) HWWS among internally displaced women in the Kurdistan region of Iraq (40) timely oral polio vaccination agricultural extension behaviors in India (47), dietary salt reduction in Nepal (48) transition from the lactational amenorrhea method to other modern family planning methods in Bangladesh (36) and cervical cancer screening in Senegal (49). Randomization Sampling: We interviewed adult men and women for this BA study and selected them randomly through a convenience sampling strategy from five different areas of Dhaka – the capital city of Bangladesh. Blinding not detected. Power Analysis The Barrier Analysis approach recommends a minimum sample size of 45 Doers (Acceptors) and 45 Non-doers (Non-acceptors) in order to detect statistically-significant Odds Ratios of 3.0 or higher, an alpha error of 5%, and a power of 80% (37). Table 2: Resources
No key resources detected.
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).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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