Vaccination Intentions Research Articles

Interventions involving nudge theory for COVID-19 vaccination: A systematic review and meta-analysis.

New approaches to mitigate vaccine hesitancy and improve vaccine uptake are urgently needed. Nudging has shown effective results in several health areas. However, the effectiveness of interventions involving nudge theory in increasing COVID-19 vaccination remains unclear. We searched PubMed, Web of Science, and Scopus for randomized controlled trials published before December 31, 2022, to determine whether interventions involving nudge theory improved COVID-19 vaccination behavior and intent. Risk ratio (RR) and a 95% confidence interval (CI) were used as pooled measures to assess vaccination behavior. Intention to vaccinate was reported in a narrative synthesis. Sixteen randomized controlled trials involving 176,125 participants were included. Interventions involving nudge theory weakly boosted the COVID-19 vaccine uptake rate (RR = 1.21, 95% CI [1.07, 1.36], p < .01). Subgroup analysis showed a weak positive effect of social norms (RR = 2.04, 95% CI [1.61, 2.57]), defaults (RR = 1.32, 95% CI [1.03, 1.69]), and salient reminders (RR = 1.19, 95% CI [1.04, 1.36]). Nudge interventions integrating multiple components were more efficacious in increasing vaccination rates compared to nudge alone. The effect of nudging interventions weakened over time (p < .001). Most studies (10 of 11) involving vaccination intention outcomes showed positive or partially positive results. Interventions involving nudge theory can promote COVID-19 vaccination behavior and intentions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of Digital Education on Human Papillomavirus Knowledge, Vaccination Intent and Completion Rates in Adolescents and Young Adults: A Meta-Analysis.

To examine the effects of digital educational intervention on HPV knowledge, vaccination intent and completion rates among adolescents and young adults. A systematic review and meta-analysis. The study followed PRISMA guidelines. Studies included randomised controlled trials assessing digital HPV educational interventions on individuals aged 9-26 years. Odds ratios (ORs), confidence intervals (CIs) and standardised mean differences (SMDs) were calculated and analysed with fixed- and random-effects models, depending on the degree of heterogeneity. Seven databases (Medline, PubMed, CINAHL, Cochrane Library, Web of Science, EMBASE and ASC) were searched from inception through April 9, 2024. Twelve studies enrolled 4925 participants were included. Six studies demonstrated that the intervention group significantly had higher HPV knowledge compared to the control group. Five studies reported a significant improvement on vaccination intent and vaccine completion rate. Subgroup analysis of the completion rates indicated that male participants demonstrated significantly greater vaccine competed rates. A tailored educational intervention was likely to effectively enhance HPV vaccine completion rates. Our findings confirmed that digital education was beneficial in enhancing adolescents and young adults' HPV knowledge, vaccination intention and vaccine completion rates. The tailored education might be considered prioritised in the design of interventions, while also considering the impact of gender on digital education. Digital interventions for HPV vaccinations require at least 7 months of follow-up, highlighting the vital role of tailored education for high-risk groups in designing effective interventions. The efficacy of digital interventions for HPV vaccination may differ across genders. There was no direct patient or public contribution, as this is a review of previous research. CRD-42023406919.

Factors associated with the intention to vaccinate children: a Finnish population survey on influenza

Abstract Background Influenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences. Our aim was to assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children in Finland. Methods We conducted a survey among parents (n = 17,844) of eligible children (aged 6 months-6 years), selected randomly from five Finnish municipalities. Children and their parents were selected from high and low coverage areas, and the study was conducted in February-March 2022. Logistic regressions were used to determine associations between vaccination intention and e.g., sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study. Results Participation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent’s education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64% and realised vaccination 51%. Conclusions Despite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating. Key messages • Parental vaccine decision-making in settings where the vaccination is given free of charge is complex, and not always driven by intention to vaccinate. • Most parents had the intention to vaccinate, but some children still ended up not receiving their influenza vaccine.

COVID-19 impact on childhood vaccination attitudes in pregnant antenatal class attendants in Rome

Abstract Background The COVID-19 pandemic caused a decrease in vaccination rates, impacting vulnerable populations such as pregnant women (PW), who concern about future children’s immunisations. The aim of this study was to assess whether the pandemic led to changes in childhood vaccination attitudes among PW attending antenatal classes at the Fondazione Policlinico Universitario A. Gemelli in Rome. Specifically, it assessed the impact of the pandemic on the perceived usefulness of information sources, their trust in healthcare workers (HCWs) and the National Health Service (NHS), their perception of the risk of infection and severity of vaccine-preventable diseases (VPDs), and their vaccination intentions. Methods A repeated cross-sectional study was conducted across three flu seasons by administering an anonymous questionnaire: one before and two during the pandemic. Intention to vaccinate children was expressed as the percentage of PW who selected each vaccination from the questionnaire. Trust in HCWs and the NHS, and perception of the risk of infection and severity of VPDs were expressed as the percentage of PW who answered “quite” or “very”. For the usefulness of information sources, mean scores were calculated. To assess differences of the three periods a chi-square test was performed (p = 0.05). Results Course attendance surged from 105 to 340. Significant shifts in vaccination intentions were noted: 7.5% and 10% decreases for measles (p = 0.02) and pertussis (p = 0.004), respectively, from 2019-20 to 2020-21. Perceived contagion risk decreased, but perceived disease severity increased. A significant reduction in the proportion of PW suspecting economic interest behind NHS workers promoting vaccination, and an increase in the perceived usefulness of non-institutional websites and of the advice from non-NHS physicians were noted. Conclusions PW’s attitudes towards vaccinations might have been modified by COVID-19 pandemic, regarding risk perception and trust in NHS HCWs. Key messages • Our findings suggests that PW’s attitudes towards childhood vaccinations might be modified by the COVID-19 pandemic, in particular risk perception and trust in NHS healthcare workers. • These findings could help Public Health to develop evidence-based interventions and communication strategies, to maintain vaccine confidence and mitigate potential adverse effects.

Determinants of willingness to vaccinate against HPV among adults: an Italian cross-sectional study

Abstract Background In Italy, heterosexual males over the age of 18 do not participate in the free-of-charge HPV vaccine offer, nor do women over the age of 26, with regional differences; however, they can vaccinate for a fee. This survey aims to assess the vaccination readiness of the 18-40 year old population group, their perceived need with respect to the vaccine, and the determinants of the vaccination choice. Methods A questionnaire-based cross-sectional study targeting the general population in the 18-40 age group has been ongoing since March 2024. Recruitment occurs through social media and flyers. Demographic characteristics, social determinants, deprivation index by area via HAZ (health action zone) method (SR: -15;25), risk factors, main barriers to vaccination are assessed. Our main outcome is HPV vaccination willingness. People already vaccinated were excluded from the analysis. Descriptive and logistic regression analyses were performed with Jamovi. Results Our preliminary results included 159 individuals of whom 57.2% would like to receive HPV vaccine. The main characteristics of the sample were: median age 30 years (IQR:26.5;34), 47.2% female gender, median deprivation index 3.7 (IQR:-0.2;7.1), 75% working, 11.9% from the LGBTQ+ community. Regarding barriers, 31.9% rated fatigue in accessing the vaccine as significant, 10.4% feared a risk in receiving the vaccine. Among the people who did not want to vaccinate or did not know, 75% would do so by paying less than the normal amount, 21.6% if free, and 3.4% would not vaccinate anyway. Vaccination willingness was positively associated with female gender (OR:3.1; p = 0.026) and belonging to the LGBTQ+ community (OR:10.0; p:0.050) and negatively associated with working status (OR:0.19; p = 0.013). Conclusions Socioeconomic barriers appeared to play a significant role in the choice to vaccinate. Policies to reduce economic barriers could increase vaccination in an uncovered but still potentially sexually active population. Key messages • Coverage of HPV vaccine is not yet at optimal thresholds, yet people excluded from free vaccination programs could benefit from vaccination incentive policies. • Vaccination intention among heterosexual men is significantly lower than among women in the same age group, a symptom that there would still be room for awareness-raising interventions on the issue.

EHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study.

As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes "cues to action" that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts' chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention.

Empowering Professionals For Health to promote Newly Arrived Migrant vaccination uptake

Abstract Issue/Problem The imperative task of making access to vaccinations equitable and guaranteed for Newly Arrived Migrants (NAM) in Europe not only highlights a public health challenge but also offers a chance to tackle barriers within health systems. NAMs frequently encounter hurdles in accessing healthcare services, with vaccinations often ranking lower on their list of health priorities. The AcToVax4NAM project developed and implemented tailored interventions for Professionals FOR Health (PFH) working with NAMs in 8 EU countries. Description of the problem NAM often overlook vaccinations due to more immediate concerns, and health systems lack a comprehensive approach to vaccinations. Thus, piloted interventions were developed in consortium countries, working with PFH to tackle vaccination barriers. Over 3 months, each country implemented context-specific interventions to enhance health systems’ responsiveness using culturally appropriate tools. Key objectives included developing procedures, improving PFH cultural sensitivity communication skills, and assessing NAM vaccination intentions. Results Initial findings vary depending on the country’s context but generally show notable enhancements in PFH cultural competencies and increased willingness among NAM to get vaccinated. The pilots underscored the importance of tailoring strategies to specific contexts and fostering collaboration among stakeholders for a successful intervention. Lessons The results highlight the pivotal role of tailored interventions in addressing vaccination disparities among NAM. As PFH working with diverse populations, their role in implementing similar training programs in other settings facing similar challenges is invaluable to achieving equitable vaccination processes. Recommendations encompassing the lessons learned and challenges encountered throughout the pilot implementation will further facilitate the dissemination of this knowledge amongst relevant stakeholders.

Effects of religion, politics and distance to providers on HPV vaccine attitudes and intentions of parents in rural Utah.

Human papillomavirus (HPV) causes an estimated 300,000 high grade cervical dysplasias and 36,000 preventable cancers each year in the United States alone. Despite having a safe, effective and long lasting vaccine since 2006, the rate of uptake has been suboptimal, particularly in rural areas. In 2020, Utah ranked near last in teenage HPV vaccination rates with rural areas trailing urban areas by about 18 percent. In this study, we identified factors that affect the intent of rural Utah parents to vaccinate their children against HPV. A survey was distributed electronically to Utah residents in rural areas. Recruitment was carried out through targeted advertising, community organizations, and professional survey panels. The survey was open from Nov. 15, 2022 to April 15, 2023. A total of 410 respondents were used for analysis. Survey results were analyzed using exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. Distance to care was shown to negatively influence direct intent to vaccinate, while trust in government, general vaccine attitudes, and HPV knowledge positively influence intent to vaccinate. It was found that religious practice decreased vaccine hesitancy while cautious sexual attitudes, distance to care, and general negative vaccine attitudes increased vaccine hesitancy. Conservative political identity and high income were both shown to decrease vaccine hesitancy as covariates.

Assessing Vaccine Intentions, Knowledge, Self-Efficacy, and Trust: A Cross-Sectional Study on Perceptions of Monkeypox Vaccination and Public Health Risk Awareness in Makurdi, Benue State, Nigeria.

Introduction The global emergence of monkeypox has heightened public health concerns, particularly in regions with limited vaccine uptake. In Nigeria, understanding the factors influencing vaccination intentions is essential for developing effective public health strategies. Despite vaccine availability, hesitancy and varying degrees of acceptance persist, driven by factors such as self-efficacy, vaccine trust, and overall attitudes toward vaccination. Previous research highlights the importance of these factors in shaping health behaviors, particularly in vulnerable populations. In Benue State, where distinct health challenges affect key demographic groups such as people living with human immunodeficiency virus(PLHIV) and men who have sex with men (MSM), addressing vaccination intentions is critical for public health efforts. Objectives The objective was to assess the intention to receive the monkeypox vaccine, self-assessed knowledge levels, self-efficacy, and risk perception among the PLHIV, MSM, and the healthcare populationin Benue State, Nigeria. Additionally, the study aimed to evaluate public trust in vaccines and health authorities and to understand how these factors influence attitudes toward vaccination and overall perceptions of monkeypox-related health risks. Methodology A cross-sectional survey was conducted among 377 participants in Makurdi, Benue State, Nigeria, focusing onPLHIV, MSM, and healthcare workers. Participants were recruited using a snowball sampling technique, which leveraged social media platforms (WhatsApp, Facebook, and Telegram) and the Federal Medical Center in Makurdi. Data were collected using a structured questionnaire designed to assess self-efficacy, trust in vaccines, vaccination attitudes, and prior vaccination experiences. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY). Descriptive statistics were used to summarize the characteristics of the study population. Bivariate analyses, including chi-square tests and independent t-tests, were employed to explore the relationships between socio-demographic characteristics and vaccination intentions. Statistical significance was set at p < 0.05 for all analyses. Results The study revealed a significant positive relationship between self-efficacy and vaccination intention (p = 0.001). Trust in vaccinations and health authorities was also found to be a significant predictor of vaccination intention (p < 0.05). Furthermore, participants who had previously received the coronavirus disease 2019 (COVID-19) vaccine were more likely to express intention to receive the monkeypox vaccine (p = 0.000). However, the perception that the threat of monkeypox was exaggerated did not significantly impact vaccination intention (p = 0.4). Conclusion This study highlights the critical role of self-efficacy, trust in vaccines, and prior vaccination experiences in shaping the intention to receive the monkeypox vaccine in Benue State, Nigeria. The findings suggest that public health policies should prioritize enhancing trust in vaccines and health authorities, as well as boosting self-efficacy, to improve vaccination uptake. Addressing these factors may lead to more effective public health interventions against monkeypox and other infectious diseases.

Exploring the Influence of Interactive and Empathetic Chatbots on Health misinformation Correction and Vaccination Intentions

Chatbots are increasingly used to correct health misinformation. However, few studies have investigated whether and how certain design features could enhance their effectiveness. We developed four chatbots and conducted an experiment that examined whether chatbots with interactive and empathetic conversational cues could outperform a basic chatbot at correcting unvaccinated participants’ COVID-19 vaccination misperceptions and increasing their vaccination intentions. Perceived chatbot interactivity was associated with lower levels of misperception, which in turn were linked to greater vaccination intention. Perceived chatbot empathy did not reduce misperception, yet was directly and positively associated with vaccination intention. Implications of these findings are discussed.

Vaccine decision-making among pregnant women: a protocol for a cross-sectional mixed-method study in Brazil, Ghana, Kenya and Pakistan

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited from either 2 or 3 maternity hospitals and/or clinics that represent a diverse population in terms of socio-economic and urban/rural status. Data collection includes cross-sectional surveys in pregnant women and semi-structured in-depth interviews with both pregnant and postpartum women. The instruments were designed to identify attitudinal, behavioral, and social correlates of vaccine uptake during and after pregnancy, including the decision-making process related to COVID-19 vaccines, and constructs such as risk perception, self-efficacy, vaccine intentions, and social norms. The aim is to recruit 400 participants for the survey and 50 for the interviews in each country. Qualitative data will be analyzed using a grounded theory approach. Quantitative data will be analyzed using descriptive statistics, latent variable analysis, and prediction modelling. Both the quantitative and qualitative data will be used to explore differences in attitudes and behaviors around maternal immunization across pregnancy trimesters and the postpartum period among and within countries. Each country has planned dissemination activities to share the study findings with relevant stakeholders in the communities from which the data is collected and to conduct country-specific secondary analyses.

The Effects of Behaviorally Informed Messages on COVID-19 Vaccination Intentions and Behavior: Evidence from Randomized Survey Experiments in South Africa

With COVID-19 vaccination rates remaining below optimal levels, scalable interventions to shift vaccination intentions are needed. We embedded two randomized experiments in South Africa’s COVID-19 Vaccine Survey (CVACS) to investigate the potential to change vaccine intentions and behavior. In Experiment 1, 3510 unvaccinated South African adults were randomly assigned to a no-message control group, a social norm message, or a message highlighting that vaccines were free, available and easy to obtain. The free and easy message significantly increased vaccine intentions but did not increase other outcome measures. The social proof message was associated with an increase in self-reported vaccination status at follow-up (not significant at traditional statistical thresholds). In Experiment 2, 3608 unvaccinated South African adults were randomly assigned to a no-message control group, a message highlighting gaining greater freedoms, or a message highlighting being part of the solution to the pandemic. Neither value proposition message increased vaccination intentions. Light-touch and scalable messages informed by behavioral science and social marketing principles may increase vaccination intentions and uptake, However, more attention should be paid to understanding the behavioral barriers experienced by different population segments, and to tailoring and targeting messaging to those barriers and segments.

Socio-Demographic Factors Influencing Monkeypox Vaccination Intentions Among Healthcare Workers and the General Population of Makurdi, Nigeria: A Cross-Sectional Study.

Background Monkeypox, now known as mpox, is a viral zoonotic disease caused by the monkeypox virus (MPXV) and is endemic to parts of Central and West Africa. Historically considered a regional health issue, mpox has gained global attention due to recent outbreaks in non-endemic regions. In 2022, the World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC) following widespread transmission in countries where the virus had not been previously reported. This declaration was renewed in August 2024 after a surge in cases, particularly across Africa, including the Democratic Republic of Congo (DRC) and neighboring countries, where a more transmissible strain (Clade 1b) has rapidly spread, complicating efforts to control its transmission. Objective This study evaluated the socio-demographic factors that influenced monkeypox vaccination intentions among healthcare workers and the general population in Benue State, Nigeria. The findings provide insights into key determinants of vaccine hesitancy and acceptance, aimed at informing future public health interventions to improve vaccine uptake. Methodology This cross-sectional study, conducted from July to September 2024 in Makurdi, Benue State, Nigeria, evaluated socio-demographic factors influencing monkeypox vaccination intentions among healthcare workers (HCWs) and high-risk populations.The study, prompted by the WHO's declaration of monkeypox as a PHEIC, surveyed 377+ participants including HCWs, people living with HIV, and men who have sex with men. Results Key findings revealed significant differences in vaccination intentions based on marital status (p-value = 0.02), with no significant variations by gender or age. COVID-19 vaccination status was associated with monkeypox vaccination intentions. The 30-60 age group demonstrated the highest monkeypox awareness (75.2%). Healthcare workers showed high vaccination intent (83%) and were identified as the most reliable information source (p-value = 0.03). Higher education levels correlated with greater vaccine trust (p-value = 0.003), while lower education was linked to reduced awareness and increased stigma perceptions. Conclusion The study recommends enhancing HCW training, addressing socioeconomic barriers to vaccination, implementing targeted education campaigns, and focusing on trust-building strategies. Limitations include the study's urban focus and potential language barriers. In conclusion, socio-demographic factors significantly influence monkeypox vaccination intentions, underscoring the need for targeted interventions and improved vaccine access to mitigate the impact of monkeypox in Nigeria and affected regions.

COVID-19 vaccination intention among people who use drugs in France in 2021: results from the international community-based research program EPIC

BackgroundCOVID-19 vaccination is crucial to reduce the incidence of severe forms of the disease in the population. However, people who use drugs (PWUD) face structural and individual barriers to vaccination, and little is known about vaccination intention and factors associated with that intention among PWUD. This study aimed to estimate vaccination intention in PWUD and associated factors in the early stage of vaccination campaigns.MethodsWe conducted cross-sectional study in France among PWUD, as part of the international EPIC program, a community-based research study coordinated by Coalition PLUS. It included 166 unvaccinated PWUD attending harm reduction centers. A questionnaire collected data on sociodemographic characteristics, COVID-19 related difficulties, and mental health, among other things. Multivariate logistic regression was used to identify factors associated with low vaccination intention.ResultsOnly 19% of participants reported strong intention to get vaccinated against COVID-19. Factors independently associated with low vaccination intention were younger age (aOR = 0.90, 95%CI = 0.85–0.95), lower education level (aOR = 2.67, 95% CI = 0.95–7.55), and unstable housing (aOR = 6.44, 95% CI = 1.59–40.34). The most-cited reasons for low intention were mistrust in COVID-19 vaccines (66.1%), fear of side effects (48.7%), and non-belief in vaccinations in general (25.2%).ConclusionsThis study highlights the need for targeted COVID-19 information and interventions to increase vaccine uptake in PWUD, especially those living in precarity. Community-based interventions and targeted government assistance could play a crucial role in addressing vaccine hesitancy in this population, not only for COVID-19 but for future epidemics.

Factors associated with COVID-19 vaccination or intent to be vaccinated across three U.S. states

Objectives: Vaccine hesitancy represents an important challenge to the effective control of the COVID-19 pandemic. In prior research on seasonal influenza, childhood vaccination, and emergency vaccination programs, hesitancy has been associated with a wide range of demographic, psychological, and compliance factors.Methods: In January 2021, an online survey was distributed using the Qualtrics (Provo, UT) platform to a proportional quota sample of individuals in three states: Louisiana, New York, and Washington. Crude and adjusted risk differences and 95 % confidence intervals were calculated to describe the relationship between vaccination or intent to be vaccinated and demographic, psychological, compliance, and pandemic impact variables.Results: Of 812 respondents, 696 indicated their vaccination status or intent to be vaccinated. Sixty-six percent indicated they were vaccinated or intended to be when available (n = 457) and 34 % were not vaccinated and did not intend to be vaccinated (n = 239). In bivariate analysis, respondents who were older, male, married, white, and reported higher household incomes were more likely to be vaccinated or intend to be. Those who complied with mask wearing, social distancing, and avoided gatherings with people outside their household were also more likely to report vaccination or intention. In the multivariable model, backward elimination resulted in a model that retained sex, race, household income, and avoiding large gatherings.Conclusion: There are important demographic, behavioral, and other factors that influence vaccine acceptance. Identifying those factors is vital for targeted and effective messaging, education, and engagement to reach those most hesitant, increase vaccination coverage, and effectively address the COVID-19 pandemic.

HPV Vaccination Stages and Associated Factors Among Children of Immigrant Women.

This study aimed to identify key determinants by stage of implementation of human papillomavirus (HPV) vaccination among children of immigrant women in South Korea. Cross-sectional descriptive study. The sample comprised 262 Chinese, Vietnamese, and Korean-Chinese women with children living in South Korea. The survey was conducted using self-report questionnaires. The HPV vaccination levels in children were classified into four transition stages. Sequential logistic regression analysis was conducted to identify the factors affecting the transition of HPV vaccination status. Social norms had the greatest influence on the intention to vaccinate. Perceived barriers were a significant factor associated with intention or initiation of vaccination, whereas perceived severity and susceptibility were associated with the intention and initiation stages, respectively. Upon the initiation of HPV vaccination, low perception of discrimination in healthcare was associated with continued vaccination. Given the importance of completing multiple doses of the HPV vaccine within a given timeframe, it is important to provide culturally appropriate interventions in stages to prevent dropouts.

Analyzing Changes in Attitudes and Behaviors towards Seasonal Influenza Vaccination in Spain’s Adult Population over Three Seasons

Background/Objectives: The experience of the COVID-19 pandemic has turned the spotlight on the importance of public health measures and disease prevention. Despite this, the acceptance of influenza vaccination has remained low in most countries (and far from the 75% target set by the World Health Organization). The objective of this study has been to investigate how attitudes and behaviors regarding influenza vaccination in the Spanish adult population have changed over the last three years (from 2021 to 2024) in order to analyze trends in influenza vaccination. Methods: To this end, a cross-sectional study was conducted through 2206 telephone interviews, and the results were compared with those obtained in previous campaigns. Results: The findings indicate a significant decline in overall vaccination intent. Healthcare professionals remain the most influential factor in encouraging vaccination, yet there is a notable increase in the lack of vaccine recommendations, contributing to the decision not to vaccinate. This study also reveals low awareness of the influenza vaccine campaign, emphasizing the need for improved public health communication. Conclusions: To counteract these trends, this study recommends intensifying awareness campaigns, strengthening the role of healthcare providers in vaccine advocacy, and tailoring communication strategies. These efforts are crucial to enhancing vaccination coverage and protecting vulnerable populations against influenza.

Exploring differences in perceived barriers and facilitators to COVID-19 vaccine uptake and testing intention by vaccination status and testing hesitancy among rural Latino communities in Southwest Florida

ABSTRACT Background: Identifying factors impacting vaccination and testing for COVID-19 is crucial to reduce health disparities, especially for rural/agricultural, low access and high poverty Latino communities disproportionately affected by the pandemic. This study examined differences in perceived barriers and facilitators (such as values, beliefs, and concerns) to COVID-19 vaccine uptake and testing intention by vaccination status and testing hesitancy among rural Latino community members in Southwest Florida. Methods: Rural Latino community members (N = 493) completed a cross-sectional survey in Spanish (86.0%) or English (14.0%) on perceived COVID-19 vaccine/testing barriers and facilitators, as well as demographics, mental health, medical history, health perceptions, and health literacy. Results: At the time of the survey, approximately 43% of participants were unvaccinated and 46.4% were testing hesitant. Significantly more vaccinated participants acknowledged keeping their family (d = .25), community (d = .27), and themselves (d = .22) safe as facilitators to vaccination (ps < .001). Among the unvaccinated participants, the most common concerns for getting vaccinated were side effects (d = −.53) and lack of knowledge about how the vaccine works (d = −.35, ps < .001). Testing hesitant participants reported concerns including not knowing where to get tested (d = −.25, p = 0.01) and less confidence in a positive test result (d = −.40, p < 0.001). Doctors and faith leaders were ranked as the most trusted information sources across groups. In logistic regression models, vaccination was linked to age, gender, education, and protecting others, while concerns about needles and side effects reduced odds; testing was driven by education, anxiety, hope, and safety concerns. Conclusion: Promoting family and community safety may be effective facilitators influencing vaccine and testing intention in rural Latino communities. Enhanced education by trusted information sources, such as doctors and faith leaders may alleviate associated concerns. Our findings may inform actions for future pandemics. Further studies should determine the generalizability of our findings across other rural migrant communities and other vaccines.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany.

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

The Moderating Role of Proposed External Incentives on COVID-19 Vaccination Intentions in an Emerging Economy Context

The COVID-19 pandemic has highlighted the critical need for widespread vaccination to combat the spread of the virus and protect public health. This study aims to investigate the factors that influence COVID-19 vaccination intentions and examine the moderating role of proposed external incentives in an emerging economy context. Specifically, the study explores the impact of attitude, subjective norms (SN) and perceived behavioural (PB) control on vaccination intentions and examines how external incentives interact with these factors to strengthen vaccination intentions. Data was collected through 318 structured self-report questionnaires administered to individuals. The collected data underwent statistical analysis using partial least squares structural equation modelling (PLS-SEM) with SmartPLS 3.0. The analysis fulfilled all the necessary assumptions and criteria for data quality and model robustness. The findings indicate that attitude, SN and PB control significantly influence individuals’ intentions to get vaccinated against COVID-19. However, the main contribution of this study lies in its revelation that proposed external incentives positively impact the relationship between attitude and vaccination intentions. This suggests that external factors, such as monetary and non-monetary incentives, play a crucial role in attracting individuals towards preventive vaccination. The findings hold practical implications for policymakers and medical service providers, as they highlight the importance of external incentives in positively influencing vaccination intentions. These insights can aid in designing effective strategies to encourage vaccine uptake and reduce the likelihood of future pandemics.