Abstract
African Americans have been disproportionately vaccinated at lower rates, which warrants the development of theory-based interventions to reduce vaccine hesitancy in this group. The fourth-generation theories, e.g., multi-theory model (MTM) of health behavior change, are vital in developing behavioral interventions. Therefore, the current study aims to determine recent trends in COVID-19 vaccination rates and to test the MTM model in predicting the initiation of COVID-19 vaccines among vaccine-hesitant Blacks. A sample of 428 unvaccinated African Americans were recruited through a web-based survey using a 28-item psychometric valid questionnaire. Chi-square, independent-samples-t-test or Welch’s t test, and Pearson’s correlation tests were utilized for the analyses. Hierarchical regression modelling was performed to determine the increment in variation accounted for through addition of predictors over a set of models. Nearly 48% of unvaccinated Blacks reported being vaccine-hesitant. The vaccine-hesitant group was relatively younger (40.5 years ± 15.8 vs. 46.2 years ± 17.4, p < 0.001), were Republicans (22.1% vs. 10.0%, p < 0.001), lived in the North-East region (26.0% vs. 11.4%, p < 0.001) and had religious affiliations other than Christianity (21.2% vs. 13.6%, p = 0.04). The mean scores of perceived advantages ((9.01 ± 3.10 vs. 7.07 ± 3.60, p < 0.001) and behavioral confidence (8.84 ± 3.76 vs. 5.67 ± 4.09, p < 0.001) were higher among vaccine non-hesitant group as opposed to the hesitant ones. In a final regression model, all MTM constructs) predicted nearly 65% of variance in initiating COVID-19 vaccination behavior among the vaccine-hesitant group (adjusted R2 = 0.649, F = 32.944, p < 0.001). With each unit increment in MTM constructs (e.g., participatory dialogue and behavior confidence), the initiation of COVID-19 vaccination among vaccine-hesitant Blacks increased by 0.106 and 0.166 units, respectively. Based on the findings of this study a m-health educational intervention to promote COVID-19 vaccine uptake behavior among Blacks is proposed.
Highlights
Our study found a greater proportion of African Americans with vaccine hesitancy living in the Northeast and this could be an attribute related to that distribution
Our study found that a substantial proportion of African Americans who have not yet been vaccinated have a high degree of vaccine hesitancy (48.6%)
Our study found that age, residence in North-East region of the United States, having a Republican political affiliation, and belonging to a religion other than Christianity or atheist resulted in statistically significant greater proportion of vaccine-hesitant African Americans
Summary
The COVID-19 pandemic is an ongoing public health threat, which accelerated the development of the COVID-19 vaccine to prevent severe illness, hospitalizations, and mortality [1]. In May 2020, a partnership between the Departments of Health and Human. Services and Defense established the Operation Warp Speed (OWS) with a projected goal of producing 300 million doses by early 2021 [2]. In the United States, on 11 December 2020, Pfizer’s BioNTech (BNT161b2) vaccine was approved by the Food and Drug Administration (FDA) as the first vaccine for emergency use for people 16 years and older [3]. A week later, Moderna’s (mRNA-1273) vaccine was approved by the FDA followed by the approval of single-shot Johnson and Johnson’s vaccine
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