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Understanding the heterogeneity of groups along the vaccine hesitancy continuum presents an opportunity to tailor and increase the impact of public engagement efforts with these groups. Audience segmentation can support these goals, as demonstrated here in the context of the 2009 H1N1 vaccine. In March 2010, we surveyed 1569 respondents, drawn from...
Context in source publication
Citations
... Factors influencing vaccine hesitancy are complex and include environmental, cultural, personal, and social factors (Ramanadhan et al., 2015). Individuals who are hesitant to vaccinate are more likely to seek and engage with information about vaccines and are more likely to change their attitudes and behaviors; therefore, exploring and addressing vaccine hesitancy is essential for promoting mass vaccination (Leask, 2011). ...
Purpose
This study aimed to examine the impact of a history of SARS-CoV-2 infection on the hesitancy of college students to receive additional COVID-19 vaccine booster doses.
Methods
A population-based self-administered online survey was conducted in July 2024 in Taizhou, China. A total of 792 respondents were included in this study. Logistic regression was conducted to identify factors associated with college students’ hesitation to receive booster doses of the COVID-19 vaccine.
Results
Of 792 respondents, 32.2 % hesitated to receive additional doses of the COVID-19 vaccine booster. Furthermore, 23.5 % of the respondents reported an increase in hesitancy to receiving additional COVID-19 vaccine booster doses compared to before they were infected with SARS-CoV-2. In the regression analyses, college students who had a secondary infection were more hesitant to receive additional COVID-19 vaccine booster doses (OR = 0.481, 95 % CI: (0.299–0.774), P = 0.003). Moreover, students with secondary infections who were male (OR = 0.417, 95 % CI: 0.221–0.784, P = 0.007), with lower than a bachelor’s degree (OR = 0.471, 95 % CI: 0.272–0.815, P = 0.007), in non-medical majors (OR = 0.460, 95 % CI: 0.248–0.856, P = 0.014), and sophomores or below (OR = 0.483, 95 % CI: 0.286–0.817, P = 0.007) were more hesitant to receive additional COVID-19 vaccine booster doses.
Conclusion
A history of SARS-CoV-2 infection affects college students’ hesitation to receive additional COVID-19 vaccine booster doses, which was higher in those who experienced secondary infections.
... Prior to the emergence of COVID-19, greater vaccine hesitancy had been documented among women compared to men. 12,13 Specific to COVID-19, a recent global meta-analysis reported lower vaccine intentions among women compared to men, but this varied by country. 14 The review did not examine non-binary gender populations, 14 but research shows COVID-19 may exacerbate structural inequalities for transgender and gender-diverse communities. ...
Objective
To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic.
Data source
Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science
Study inclusion and exclusion criteria
Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake.
Data extraction
Three authors screened studies and extracted data.
Data Synthesis
Univariate and multivariate results are summarized.
Results
A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men’s greater intentions to vaccinate compared to women, and men’s greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses.
Conclusion
Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.
... Prior quantitative research focused on the hesitancy continuum presents various thoughts and beliefs associated with vaccine hesitancy, but these studies do not relate beliefs to specific levels of hesitancy. 19,[37][38][39] The authors are unaware of any studies which characterize vaccine beliefs according to individuals' level of hesitancy. The present study aims to fill this gap in the ...
Vaccination is a strategy for mitigating the impact of coronavirus disease 2019 (COVID-19) at both the individual and population levels. Vaccine hesitancy is identified as a significant threat to global health by the World Health Organization (WHO). Vaccine hesitancy has been theorized as a continuum encompassing a range of attitudes, beliefs, emotional orientations, ideologies, and health-seeking behaviors. Individuals who received the COVID-19 vaccine but also indicated some level of hesitancy about vaccination, or "hesitant adopters," remain an understudied group. This study uses a qualitative descriptive design to understand motivations to receive the COVID-19 vaccine among hesitant adopters at various self-reported levels of hesitancy. We conducted interviews with hesitant adopters (n = 49) to analyze the elements of vaccine hesitancy corresponding to reported levels of COVID-19 vaccine hesitancy (i.e., "little hesitant," "somewhat hesitant," and "very hesitant"). Concerns about side effects are shared across the continuum but are articulated differently at each level of hesitancy. The "little hesitant" relate fears of side effects to their health and a lack of clear information to inform their health decision making, whereas the "very hesitant" articulate the risks of side effects within the frame of conspiracies related to the development, approval, and economics of the COVID-19 vaccine. Additionally, conspiracy theories generally increase in salience across the continuum, with the "very hesitant" reporting conspiracy theories as the most salient element of vaccine hesitancy. This research presents opportunities for developing targeted interventions for different levels of vaccine hesitancy.
... In the public-health field, cluster-based analyses have been used to identify segments of the population characterized by different kinds of health-related behaviors (Engl et al., 2019), but despite the advantages of such methods for the problem at hand, segmentation techniques have rarely been used to identify vaccine-hesitant groups (Vulpe & Rughiniş, 2021). There are a few exceptions, however, including one study of segments of vaccine hesitance in relation to the A(H1N1) virus in the United States (Ramanadhan et al., 2015), one study of attitudes to childhood vaccination among groups of parents (also in the United States) (Gust et al., 2005;Keane et al., 2005), and one study of beliefs about vaccine risks and vaccine hesitancy in European countries (Recio-Román et al., 2021;Vulpe & Rughiniş, 2021). In the case of Covid-19, the only example we are aware of is a report on clusters of vaccine-hesitant groups in the United States that was released by the nonprofit organization Surgo Ventures (2021). ...
The aim of this paper is to identify the most vaccine-hesitant groups in a contemporary democratic state, Sweden. We rely on two representative surveys that were conducted in 2020 and that asked Swedish citizens how likely they were to accept immunization with a Covid-19 vaccine if one were offered to them. Using clustering methods, we find a wide variety of vaccine-hesitant groups, with the highest levels of vaccine hesitancy among individuals who combine low personal health risks with political orientations and ideological convictions that are associated with antivaccinationist attitudes. The paper's findings have important implications for public-health policy and, more broadly, for theories of how governments can convince individual citizens to play their part in achieving important social goals.
... There were around 60.8 million cases of the H1N1 virus in the United States in 2009, and while the mortality rate was not as severe as that of COVID-19, H1N1 elicited dramatic nation-wide public health responses and involvement by high-levels of the federal government [6]. The H1N1 pandemic response also faced the problem of vaccine hesitancy [7]. At the beginning of the pandemic, approximately half of the public indicated they would receive the vaccine, but a year later, only 24% of adults had received the vaccine -a percentage that is even lower than the uptake rate of the seasonal influenza vaccine [7]. ...
... The H1N1 pandemic response also faced the problem of vaccine hesitancy [7]. At the beginning of the pandemic, approximately half of the public indicated they would receive the vaccine, but a year later, only 24% of adults had received the vaccine -a percentage that is even lower than the uptake rate of the seasonal influenza vaccine [7]. Political affiliation also played an important role in vaccine hesitancy during both pandemics. ...
... There is a sizable literature examining the potential factors that could have affected vaccine uptake during the H1N1 pandemic [7,[9][10][11], including pregnancy, socio-demographic characteristics such as race and gender, and level of trust towards the vaccine [10][11][12]. In this paper, we control for these individual characteristics and a rich set of others but focus on the role of state level public health spending, and highlight two main channels through which it affects vaccination, namely by increasing patient-doctor interaction and raising concerns about the pandemic. ...
The purpose of this study is to examine factors affecting the intent to vaccinate during the 2009 H1N1 pandemic and to leverage the results to inform public health policy decisions aimed at increasing vaccine uptake during the COVID-19 pandemic. Using the National 2009 H1N1 Flu Survey data and state-level administrative data, we employ logistic regression and mediation models to estimate the association between vaccine uptake and state level public health spending, political ideology, and H1N1 case and death rates as well as a set of individual and household characteristics. We find that higher public health spending can significantly increase the intent to vaccinate, mainly through raising concerns about the pandemic and promoting vaccine relevant doctor patient interactions. We conclude that physicians, especially primary care physicians, should play more important roles in the ongoing vaccination efforts against the COVID-19 virus.
... Vaccine hesitancy arises from various reasons or emotions. It would be illogical to expect that a one-size-fits-all approach could alter behaviours among one heterogeneous population [15]. Segmentation is therefore needed to increase vaccination uptake. ...
... Lau et al. [16] measured vaccine-related behaviours and attitudes along with demography among Hong Kong healthcare workers to divide nurses into segments of various levels of hesitancy, proposing unique strategies for each segment that pinpoint the respective barriers to seasonal influenza vaccination. Similarly, in addition to the demographic base, Ramanadhan et al. [15] also used psychographic (e.g., attitude towards vaccine) and behavioural (e.g., news consumption behaviour) bases to categorise vaccinehesitant individuals into three clusters and suggested corresponding, tailored communication strategies. Both Lau, Lee and Wong [16] and Ramanadhan et al. [15] demonstrate how segmentation can be used to gain a better understanding of the subgroups among the population, each with particular characteristics that lead to vaccine uptake intentions and behaviours. ...
... Similarly, in addition to the demographic base, Ramanadhan et al. [15] also used psychographic (e.g., attitude towards vaccine) and behavioural (e.g., news consumption behaviour) bases to categorise vaccinehesitant individuals into three clusters and suggested corresponding, tailored communication strategies. Both Lau, Lee and Wong [16] and Ramanadhan et al. [15] demonstrate how segmentation can be used to gain a better understanding of the subgroups among the population, each with particular characteristics that lead to vaccine uptake intentions and behaviours. Lau et al. [16] study on healthcare workers further suggests that heterogeneous segments could still be identified among nurses although they are seemingly homogeneous with similar socioeconomic status, thus reinforcing the significance of employing segmentation before developing a communication strategy to promote vaccine uptake. ...
In the response to the coronavirus pandemic, much attention has been invested in promoting COVID-19 vaccination. However, the impact of seasonal influenza should not be neglected, particularly during the winter influenza surge. Currently, most influenza vaccination campaigns target at healthcare workers or high-risk population groups, while COVID-19 vaccination programmes are targeting the whole population as a single homogeneous group. There is limited research on the promotion of influenza vaccination for university students who study, live, and socialise in close contact with a large variety of people on campus, resulting in a low vaccination rate among this underserved group. Thus, a vaccination programme tailored for university students should be developed to increase protection against influenza-like illnesses and complications, and to help achieve herd immunity across populations who spread viruses. WHO has advocated the potential value of social marketing in vaccination campaigns and highlighted the need for audience segmentation as a major prerequisite component of intervention design. This study aims to identify distinct and homogeneous groups of university students based on sociodemographic, psychographic, and behavioural attributes to inform interventions. Two-step cluster analysis was applied in a sample size of 530 university students and revealed four segments that demonstrate statistically significant differences in their attitudes, behaviours, intentions, and responses to promotion messages about seasonal influenza and COVID-19 vaccination. The findings provide a detailed understanding of segment characteristics among university students that can be applied to develop an effective social marketing campaign that can motivate influenza vaccination and cross-promote uptake of the COVID-19 vaccine.
... Mistrust in the healthcare system. Scepticism of vaccines and mistrust in physicians and the healthcare system were cited frequently by older adults from African American backgrounds [20,22,23,33,36]. Harris et al. acknowledged that mistrust in medical institutions was a product of historical abuses experienced by African Americans, historical medical injustice, and prior negative experiences with healthcare [23]. ...
... Harris et al. acknowledged that mistrust in medical institutions was a product of historical abuses experienced by African Americans, historical medical injustice, and prior negative experiences with healthcare [23]. Ramanadhan et al. described mistrust in vaccines amongst older adults from Hispanic backgrounds, but found they were more likely to be open to persuasion if given further information, compared to older people from African American backgrounds [33]. ...
Background
Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and have increased risk of mortality. Whilst an age-based vaccination approach prioritising older groups is being implemented worldwide, vaccine hesitancy is high amongst minority ethnic groups.
Methods and findings
We conducted a systematic review and convergent synthesis to systematically examine perceptions of vaccinations amongst older adults from minority ethnic backgrounds. We included studies that reported on perceptions, beliefs, and attitudes towards vaccinations in older adults aged ≥65 years from a minority ethnic background. We excluded studies of vaccinations in investigation or development, studies focused on specific medical conditions, studies where ethnic background or age group was unidentifiable, systematic reviews, editorials, and conference abstracts. We searched MEDLINE, Embase, Virtual Health Library, Web of Science, Cochrane Library, medRxiv, and PROSPERO databases from inception to 15 July 2021. Risk of bias for studies was assessed using the Mixed Methods Appraisal Tool. The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative research (GRADE–CERQual) framework. A total of 28 eligible studies conducted between 1997 and 2020 were included in the final analysis (17 quantitative surveys, 8 focus group or interview studies, 2 mixed methods studies, and 1 case–control study). The majority were US studies in English or Spanish, except for 6 studies set in Hong Kong, 2 studies in Japan, 1 study in Brazil, and 1 multi-centre study (including China, Indonesia, Turkey, South Korea, Greece, UK, Brazil, and Nigeria). In total, 28,262 individuals with an estimated mean age of 69.8 years were included, 63.2% of whom were female. We summarised the common concepts and themes across studies and populations using a convergent synthesis analysis. Thirteen themes categorised as barriers or facilitators were identified and grouped into structural factors—healthcare provider and system related, patient related, and policy and operational—and were analysed by minority ethnic group. The main limitation of the study was the predominance of studies from the US and East Asia.
Conclusions
In this systematic review, we found that factors influencing vaccination uptake involve healthcare provider and system, patient-related, and governance-level factors that are specific to the older ethnic minority community being served. The evidence included in this review is supported by high or moderate certainty and can be translated to practice and policy. A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact of widespread vaccination policies.
... Si bien parece que vacunar a la población reporta abundantes beneficios, no siempre se alcanzan los objetivos de cobertura deseables. Algunos autores atribuyen esta realidad a factores administrativos, personales u organizativos (2,6,7,8,9) . En relación con los primeros, destaca la baja prioridad que desde las políticas de Salud Pública se ha otorgado en ocasiones a la vacunación (2) , circunstancia paradójica ya que a los beneficios en términos de salud atribuibles a la vacunación también está demostrado un retorno económico (6) . ...
... En relación con los primeros, destaca la baja prioridad que desde las políticas de Salud Pública se ha otorgado en ocasiones a la vacunación (2) , circunstancia paradójica ya que a los beneficios en términos de salud atribuibles a la vacunación también está demostrado un retorno económico (6) . Por otro lado, existen factores personales, como por ejemplo, la falta de información que impide a las personas percibir la gravedad de la infección que puede ser prevenida mediante la vacunación (7,8) . Finalmente, la presencia de barreras ambientales u organizativas que dificultan el acceso a la vacuna (6,9) o que las campañas de vacunación emplean canales de difusión de la información a través de medios poco efectivos (8) . ...
Objective:
Influenza vaccination rates among adults over 65 years have not reached the minimum levels recommended by the health authorities in Asturias during previous vaccination campaigns. The objective of this study is to describe the characteristics of an influenza vaccination strategy and its effectiveness.
Methods:
Strategy developed during the 2019-2020 influenza vaccination campaign in the Área Sanitaria VII in the Servicio de Salud of the Principado de Asturias. The target population were people over 65 years. The strategy consisted of training sessions for professionals and the general population, information dissemination through the media, overt recommendations for the vaccination of hospital personnel and social recognition of the professionals involved. The vaccination rates were described and a two-tailed hypothesis test was used to determine the differences in the vaccination percentages.
Results:
The percentage of vaccination in the Área Sanitaria VII went from 56.29% in the 2018-2019 campaign to 65.82% in the 2019-2020 campaign (+9.53; p<0.001). During the same campaign, the percentage of vaccination in Asturias was 57,38%, that is, 8,44% less than in the intervened Área Sanitaria.
Conclusions:
The strategy proved effective in increasing the rates of influenza vaccination among adults over 65 years in the Área Sanitaria VII of the Principado de Asturias.
... Vaccine hesitancy can be conceptualized and measured on a continuum, from low to high [24]. At the same time, it is a multidimensional phenomenon [25], which depends on perceptions of vaccine risks, benefits, effectiveness, or usefulness at the social level, as well as on the dimensions that capture people's overall assessments of risk and benefits, thus generating attitudes towards vaccination, in general, and specific vaccines, in particular [26]. A closer look at vaccine hesitancy in a population will identify diverse configurations, types of beliefs, and attitudes, which better describe people's position in regard to vaccination than unidimensional estimates. ...
... A cluster analysis of US parents who rejected HPV vaccination resulted in five groups of reasons for vaccine rejection: ''pragmatic concerns about effects on sexual behavior, specific HPV vaccine concerns, moral concerns about sexual behavior, general vaccine concerns, and denial of need" [45], p. 108]. Three clusters of US people rejecting vaccination against A/ H1N1 were identified while examining their potential for attitude change: ''open to persuasion," ''informed unconvinced," and ''disengaged skeptics" [25]. Using latent profile analysis, three types for Australian parents active on social media were found: ''ac-cepters" (vaccine confident, intend to vaccinate), ''fence sitters" (believe in benefits of vaccines, reject mandatory vaccination), and ''rejecters"(reject all vaccines) [46]. ...
The article is available at: https://authors.elsevier.com/a/1cYTG_,cUWn3I6
Background: Despite lacking scientific support, vaccine hesitancy is widespread. While serious vaccine damage as a scientific fact is real yet statistically highly uncommon, emerging social and technological forces have amplified perceptions of risk for “probable vaccine damage”, making it a widely shared intersubjective reality.
Methods: Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis.
Results: The public beliefs in significant vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: hesitant, confident, and trade-off clusters. The hesitant type (approx. 11% of EU27-UK respondents) is defined by the perception that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with perceptions of probable vaccine damage. The vaccine-confident and the trade-off types have similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior.
Conclusions: The high proportion of varying public beliefs in significant vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Communication campaigns should take into account the social normality of the perceived risk of “probable vaccine damage” across various social types, and patterns of concomitant trust and mistrust in vaccination.
... A cluster analysis of US parents who rejected HPV vaccination resulted in five groups of reasons for vaccine rejection: "pragmatic concerns about effects on sexual behavior, specific HPV vaccine concerns, moral concerns about sexual behavior, general vaccine concerns, and denial of need" [45, p108]. Three clusters of US people rejecting vaccination against A/H1N1 were identified while examining their potential for attitude change: "open to persuasion," "informed unconvinced," and "disengaged skeptics" [46]. Using latent profile analysis, three types for Australian parents active on social media were found: "accepters" (vaccine confident, intend to vaccinate), "fence sitters" (believe in benefits of vaccines, reject mandatory vaccination), and "rejecters" (reject all vaccines) [47]. ...
Background: Despite lacking scientific support, vaccine hesitancy is widespread. While vaccine damage as a scientific fact is statistically highly uncommon, emerging social and technological forces have converted probable vaccine damage into an alternative fact. Methods: Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis. Results: The public beliefs in vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider vaccines are not rigorously tested before authorization, one-third believe vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe vaccines can cause serious side effects. We identified three belief configurations: the skeptical, the confident, and the trade-off clusters. The skeptical type (approx. 11 percent of EU27-UK respondents) is defined by the belief that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59 percent) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29 percent) combines beliefs that vaccines are effective, well-tested and useful, with beliefs of probable vaccine damage. Conclusions: Probable vaccine damage presently exists as an alternative fact in the public imagination, perceptively available for wide segments of the public, including those who trust medical science.
