Using the health belief model to explain COVID-19 vaccination hesitancy in Dutch urban citizens under thirty.

BACKGROUND: Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. METHODS: We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16-30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. RESULTS: Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). CONCLUSIONS: Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

[Market vaccinations in Rotterdam]. / Marktvaccinaties in Rotterdam: Een voorbeeld van een campagne gestoeld op het equity-principe.

The COVID-19 vaccination rate is not evenly distributed across the Netherlands. In some neighborhoods, the vaccination rate is relatively low, causing individual health risks and a burden to the health care system. An explanation is the use of a national, general information campaign, while using a similar approach (equality approach) does not always lead to similar results. Therefore, we advocate the use of an equity approach instead, as defined by the WHO, which aims at achieving equal results by taking the specific needs of certain vulnerable groups into account. As an example, we describe an intervention that took place in Rotterdam, in which medical doctors, among which GPs, took the initiative to offer information about vaccinations and vaccination on the popular weekly markets of Rotterdam. Using interviews with medical volunteers who contributed to these market vaccinations, we outline the preconditions for successfully implementing such an outreach-based approach, and we make a number of practical recommendations.

Marktvaccinaties in Rotterdam : Een voorbeeld van een campagne gestoeld op het equity-principe Market vaccinations in RotterdamAn example of a campaign based on the equity principle

Samenvatting De COVID-19-vaccinatiegraad in Nederland is niet gelijk verdeeld: in sommige wijken blijft de vaccinatiegraad achter. Dat leidt tot individuele gezondheidsrisico’s en belasting van de zorgketen. Een verklaring hiervoor is dat een gelijke aanpak (equality-aanpak) niet altijd tot gelijke uitkomsten leidt, terwijl er op landelijk niveau wel gekozen is voor een algemene voorlichtingscampagne. Wij bepleiten daarom het inzetten van de equity-aanpak, zoals door de WHO gedefinieerd, gericht op het behalen van gelijke resultaten door in te spelen op de specifieke behoeften van kwetsbare groepen. Als voorbeeld beschrijven we een Rotterdamse interventie, waarbij Rotterdamse (huis)artsen het initiatief namen informatie over vaccins en vaccinatie aan te bieden op de drukbezochte markten van Rotterdam. Aan de hand van interviews met betrokken medische vrijwilligers schetsen wij daarnaast enkele randvoorwaarden voor het succesvol inzetten van een dergelijke op outreach gebaseerde aanpak en doen we enkele praktische aanbevelingen.