Why do Chinese older adults in Hong Kong delay or refuse COVID-19 vaccination? A qualitative study based on Grounded Theory.

OBJECTIVES: Older adults have been disproportionately affected by the COVID-19 pandemic. While COVID-19 vaccines are effective for reducing mortality and severe complications, vaccine hesitancy remains a substantial concern particularly among older adults. This was a qualitative study to explore how Chinese older adults reached a decision to delay or refuse the COVID-19 vaccines in Hong Kong. METHODS: Semi-structured in-depth interviews were conducted with 27 older adults aged ≥60 years who had never received COVID-19 vaccines. Grounded Theory approach guided the selection of informants, data collection, data analysis and report writing. RESULTS: Older adults' vaccine hesitancy and resistance weaved into the context of lacking sufficient decisional support and attitude roots of negative perception of ageing, fatalistic risk attitudes, present-oriented time perspectives, and negative values on western biomedicine. Attitude roots were used as decisional anchors to further shape older adults' peripheral processing of vaccine-related information, resulting into a spectrum of vaccine-resistant and vaccine-hesitant attitudes. While participants refused or delayed COVID-19 vaccination, they engaged in alternative coping strategies to regain self-control and justify their vaccination disengagement in the pandemic. DISCUSSIONS: Interventions to address vaccine hesitancy in older adults should focus on addressing attitude roots and strengthening the connectivity of older adults with family, doctors, and government to engage older adults in the vaccination decision making. Risk communication should shift to provide more personal relevant information in a caring style, meet older adults' preference for peripheral information processing, and address their existing misperceptions about COVID-19 vaccines.

Learning public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage in China: an analysis of social media data

BACKGROUND: Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioural compliance. China has experienced the unprecedented epidemic of coronavirus disease 2019 (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. OBJECTIVE: This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on analysis of data from Sina Weibo, a major social media platform in China. METHODS: Weibo data relevant to COVID-19 from December 1, 2019 to January 31, 2020 were retrieved. Engagement data (Likes, Comments, Shares and Followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis (LCA) was employed to further explore main content patterns while Chi-square for trend examined how proportions of main content patterns changed by time within the study timeframe. RESULTS: Public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier on Weibo than the government. Online users generally had low engagement with posts relevant COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situation, general knowledge of the new disease, and policies, guidelines and official actions. However, personal posts more likely showed empathy to affected people (chi-square=13.3, P<.001), attributed blame to other individuals or government (chi-square=28.9, P<.001), and expressed worry about the epidemic (chi-square=32.1, P<.001) while government posts more likely shared instrumental support (chi-square=32.5, P<.001) and praised people or organizations (chi-square=8.7, P=.003). As the epidemic evolved, sharing situation update (chi-square for trend=19.7, P<.001), and policies, guidelines and official actions (chi-square for trend=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (chi-square for trend=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising and empathy in government posts (chi-square for trend=9.0, P=.003). CONCLUSIONS: The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation update and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns. CLINICALTRIAL: Not applicable.