Factors Affecting the Public Intention to Repeat the COVID-19 Vaccination: Implications for Vaccine Communication.

Although most of the pandemic-related mandatory restrictions have been lifted or eased, vaccination is still recommended as an effective measure to minimize the damage from COVID-19 infection. Since COVID-19 eradication is unlikely, it is necessary to understand the factors affecting the public's vaccination intention when COVID-19 vaccination is continuously recommended. This study aims to explore the factors that affect the intention to repeat the COVID-19 vaccination in South Korea. An online survey was conducted in January 2022 with adults living in Gyeonggi-do, South Korea. In a hierarchical logistic regression analysis, sociodemographic factors, COVID-19 infection-related factors, COVID-19 vaccination-related factors, sociocultural factors, and communication factors were taken into account. In this study, more than three-quarters (78.1%) of Koreans were willing to repeat the COVID-19 vaccination. People who had high-risk perceptions, had been vaccinated against COVID-19 at least once, had more authoritarian attitudes, regarded the vaccination as a social responsibility, and had positive attitudes toward health authorities' regular briefings were more likely to repeat the vaccination. In contrast, those who directly or indirectly experienced COVID-19 vaccine side effects and who showed psychological reactance against the government's vaccination recommendation were less likely to repeat the vaccination. Our research indicates that empathetic communication, promotion of the prosocial aspect of vaccination, and regular and transparent provision of vaccine information are essential for promoting the intention to repeat the COVID-19 vaccination.

THE CONTENT OF COVID-19 INFORMATION SEARCHES AND VACCINATION INTENTION: AN IMPLICATION FOR RISK COMMUNICATION.

OBJECTIVE: The main objective of this study was to examine the association between COVID-19 information search activities and vaccination intention. METHODS: Cross-sectional data were collected using online surveys. Independent variables included COVID-19 information search on the 1) science of viral effects of COVID-19 on the body, 2) origin of COVID-19, 3) symptoms and outcomes, 4) transmission & prevention, 5) future outbreak, and 6) policies/procedures to follow. The outcome variable was vaccination intention. Multivariable regression analysis was conducted. RESULTS: Participants (N= 501) had a mean age of 32.44±11.94 years, were 55.3% female, and 67.9% White. Most COVID-19 information search was on symptoms and outcomes (77.7%), and policies/procedures to follow (69.9%). Intention to vaccinate against COVID-19 was higher among participants who searched for information on the science of viral effects of COVID-19 on the body (ß=0.23, 95% Confidence Interval (95% CI)= 0.03-0.43; p=0.03) and policies/procedures to follow (ß =0.24, 0.03-0.41, p= 0.02). CONCLUSIONS: People who searched for information about 1) the science of viral effects of COVID-19 and 2) policies/procedures recommendations also reported higher vaccination intention. Risk communication seeking to increase vaccination should meet the consumer's information demand by prioritizing the scientific rationale for COVID-19 vaccination and clarifying what policies/procedures are recommended.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines.

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part III: COVID-19 vaccination intentions.

OBJECTIVES: This cross-sectional study was to determine the coronavirus disease 2019 (COVID-19) vaccination intention of clinical dental hygienists in South Korea and the factors that influence vaccination intention. METHODS: COVID-19 vaccination intention of the 500 participants was confirmed through a survey including the following options: 'I will vaccinate (VAC)', 'I will not vaccinate (NoVAC)' and 'I do not know if I should get vaccinated (UNK)'. A Chi-square test was performed to determine whether there were differences in COVID-19 vaccination intention according to the general characteristics of the participants, degree of infection control knowledge (Score-K) and practice (Score-P) in response to COVID-19, fears over COVID-19 (Fear-C) and the level of anxiety before (GADBefore ) and after (GADAfter ) the COVID-19 pandemic. Multiple logistic regression was performed to identify factors affecting VAC and NoVAC by setting the base category as UNK. The p-values of <0.05 were considered statistically significant. RESULTS: According to the analysis, 44.8%, 18.8% and 36.4% of participants selected VAC, NoVAC and UNK respectively. There were significant differences in vaccination intention according to age, monthly income, residential area, symptoms related to COVID-19, Score-K, Fear-C and GADBefore . Compared to UNK, < $2000 monthly income, Score-K and Fear-C variables significantly influenced the opinion of VAC. Compared to the answer UNK, monthly incomes of $2000 to $2360 and $2360 to $2730 in residential areas significantly influenced the opinion of NoVAC. CONCLUSIONS: The variables influencing vaccination intention were monthly income, residential area, Score-K and Fear-C.

The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults.

BACKGROUND: Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context. OBJECTIVE: This study aims to investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy support using COVID-19 vaccination chatbots. METHODS: This experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used a 2 (empathy/autonomy support expression: present vs absent) × 2 (chatbot expertise cues: expert endorser vs layperson endorser) between-subject design. Chatbot conversation quality was assessed through actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from -5 to 5 (VIS). RESULTS: There was a negative interaction effect of chatbot empathy/autonomy support expression and conversation fallback (CF; the percentage of chatbot answers "I do not understand" in a conversation) on PUA (PROCESS macro, model 1, B=-3.358, SE 1.235, t186=2.718, P=.007). Specifically, empathy/autonomy support expression had a more negative effect on PUA when the CF was higher (conditional effect of empathy/autonomy support expression at the CF level of +1SD: B=-.405, SE 0.158, t186=2.564, P=.011; conditional effects nonsignificant for the mean level: B=-0.103, SE 0.113, t186=0.914, P=.36; conditional effects nonsignificant for the -1SD level: B=0.031, SE=0.123, t186=0.252, P=.80). Moreover, an indirect effect of empathy/autonomy support expression on CPI via PUA was more negative when CF was higher (PROCESS macro, model 7, 5000 bootstrap samples, moderated mediation index=-3.676, BootSE 1.614, 95% CI -6.697 to -0.102; conditional indirect effect at the CF level of +1SD: B=-0.443, BootSE 0.202, 95% CI -0.809 to -0.005; conditional indirect effects nonsignificant for the mean level: B=-0.113, BootSE 0.124, 95% CI -0.346 to 0.137; conditional indirect effects nonsignificant for the -1SD level: B=0.034, BootSE 0.132, 95% CI -0.224 to 0.305). Indirect effects of empathy/autonomy support expression on VIS via PUA were marginally more negative when CF was higher. No effects of chatbot expertise cues were found. CONCLUSIONS: The findings suggest that expressing empathy/autonomy support using a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users' questions. The paper adds to the literature on vaccination chatbots by exploring the conditional effects of chatbot empathy/autonomy support expression. The results will guide policy makers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy.

Secondary Risk in COVID-19 Vaccination Intentions: A Theoretical Contribution to the Protection Motivation Paradigm.

This study presents an original model that features the emotion of fear of COVID-19 as a direct effect on vaccination intentions. A central research question addressed in the study is what roles do the emotion of fear of contracting COVID-19 and the threat posed by uptake of the COVID-19 vaccination play in levels of vaccination intention? The study used a structural equation model (SEM) and applied the SmartPLS 3.2.6 data analysis tool for model estimation and multivariate analysis variables. A key finding is that vaccination resistance is strongest when fear of COVID-19 is lower, and vaccination threat higher. Vaccination threat appraisal and vaccination intention were found to have a negative relationship. Response costs at higher levels lessen motivation for COVID-19 vaccination. Research implications include research-based targeting of differing segments by their primary fear, either fear of COVID-19 or of the preventative vaccine.

The effect of social media communication on intention to vaccinate against COVID-19: A relationship mediated by perceptions of vaccine efficacy and safety

Although previous literature has found significant effects of social media communication (SMC) on intention to vaccinate, the effect of the sources of SMC has not been explored. To fill this gap, this study investigates a) the effects of official sources and user-generated SMC on intention to vaccinate against COVID-19, and b) the mediating effects of perceived vaccine efficacy, safety, and risk perception on the relationship between SMC and intention to vaccinate against COVID-19. Online survey data (n = 428) was analysed using structural equation modelling (SEM). Results revealed that official sources SMC is positively associated with vaccine intention while user-generated SMC had no significant association. Mediation analysis revealed a partial mediation effect of perceived vaccine efficacy and safety in the relationship between official source SMC and intention to vaccinate against COVID-19, while a full mediation effect of perceived vaccine efficacy and safety was found between user-generated SMC and intention to vaccinate against COVID-19. The mediating effect of perceived risk was not found. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States.

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

What drives the vaccination intention against COVID-19? Application of EPPM, TAM, and theories of risk assessment.

Vaccines are widely used to fight against COVID-19. However, COVID-19 vaccine hesitancy appears as some individuals are concerned with COVID-19 vaccines. This study investigates the vaccination intention against COVID-19 in China with the Extended Parallel Process Model (EPPM), Technology Acceptance Model (TAM), and theories of risk information assessment. Results showed that the formation mechanism of vaccination intention could be considered a psychological process, as subjective knowledge was a primary influence on correspondents' weighting of both the potentially positive (usefulness) and negative effects (threat) of vaccination. This unequal consideration then resulted in different levels of fear arousal between subjects. Driven by usefulness/threat perception and fear, people conducted different decision strategies, so-called analytical assessment, and experiential assessment to make vaccination decision. In addition to the direct effects of experiential assessment on vaccination intention, two decision strategies and fear arousal also affected people's vaccination intention through the mediation role of vaccination attitude. For policymakers and stakeholders, this study provides a knowledge base for confidence-building, and emotional guidance concerning against COVID-19 vaccination.

Comparative Risk: Dread and Unknown Characteristics of the COVID-19 Pandemic Versus COVID-19 Vaccines.

This research characterizes risk perceptions of the COVID-19 pandemic and the COVID-19 vaccines based on the dread and unknown dimensions of the psychometric paradigm. We examine if mental risk comparisons of these two risk objects influence risk mitigation behaviors (vaccination intention; vaccine acceptance; preventive behaviors) and emotional responses among unvaccinated and vaccinated Americans. A survey (N = 1532) was conducted based on a nationally representative sample of U.S. adults in May 2021. Results reveal considerable impact of risk comparison, especially along the dread dimension, on the outcomes of interest. In essence, this research reveals critical insights regarding vaccine hesitancy and risk communication about vaccination.

Self-affirmation increases acceptance of information on COVID-19 vaccines and promotes vaccination intention.

Previous studies have shown that self-affirmation increases acceptance of a message and motivates health behavior change. The present study investigated whether self-affirmation increases the acceptance of persuasive messages on COVID-19 vaccines and promotes vaccination intention. A total of 144 participants were randomly assigned to the self-affirmation (n = 72) or control (n = 72) groups before reading a persuasive message on COVID-19 vaccines. The results revealed that the self-affirmation group showed significantly higher acceptance of persuasive information on COVID-19 vaccines than the control group. Additionally, the self-affirmation group also showed significantly higher post-experiment vaccination intention than the control group. Mediation analysis indicated that increased acceptance of persuasive information significantly mediated the beneficial effects of self-affirmation on post-experiment vaccination intention. The present study demonstrated that self-affirmation could be an effective strategy for increasing the acceptance of persuasive messages on COVID-19 vaccines and promoting vaccination intention.

The Association Between Quarantine Duration and Psychological Outcomes, Social Distancing, and Vaccination Intention During the Second Outbreak of COVID-19 in China.

Objectives: To examine the association between quarantine duration and psychological outcomes, social distancing, as well as vaccination intention during the second outbreak of COVID-19 in China. Methods: A cross-sectional online survey was conducted in January 2021. Participants were invited to complete the measurement of quarantine duration, social distancing, psychological distress, wellbeing (WHO-5), and vaccination intention. Multiple linear regression and logistic regression were performed to examine the relationship between quarantine duration and psychological distress, wellbeing, social distancing, and vaccination intention. Results: Of the 944 participants, 17.2% of the participants experienced quarantine. Quarantine for 1-7 days increased the social distancing (ß = 2.61 95% confidence interval (CI) 1.90-3.33) and vaccination intention (OR = 2.16 95% CI 1.22-3.82). Quarantine for >7 days was associated with the increased social distancing (ß = 3.00 95% CI 2.37-3.64) and psychological distress (ß = 1.03 95% CI 0.22-1.86), and decreased wellbeing (ß = 1.27 95% CI 0.29-2.26). Conclusion: Longer quarantine duration showed increased social distancing, increased psychological distress, and decreased wellbeing. Quarantine for 1-7 days was associated with increased vaccination intention.

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance.

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic's vast impact. Data were collected using a questionnaire designed according to the "survey tool and guidance" provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities' recommendations, being informed by HCWs or formal information sources, care for others, concern about the country's economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.

COVID-19 vaccination intention: The combined role of pathogen disgust and trust in government.

The present study aimed to investigate the joint effect of pathogen disgust and trust in government on COVID-19 vaccination intention and to examine the mediating role of COVID-19 worry. The data was collected from July to September 2021 in mainland China by using Questionnaire Star, 2,244 valid cases were obtained among a total of 2,251 participants investigated, with an effective rate of 89.37%. The results indicated the following: (1) Individuals' COVID-19 vaccination intention was significantly higher when "congruence was high" than when "congruence was low", given comparable levels of pathogen disgust and trust in government. (2) There were no significant differences in individual COVID-19 vaccination intention with incongruence levels of pathogen disgust and trust in government. (3) The combination of pathogen disgust and trust in government can influence COVID-19 vaccination intention through COVID-19 worry. Findings illustrate that individuals with high trust in government and pathogen disgust have higher intentions. Trust in government and pathogen disgust positively predicted COVID-19 worry and reinforced individuals' intention to COVID-19 vaccination. The results have important implications for the future prevention and control of the new coronavirus, as well as providing a new perspective on COVID-19 vaccination intentions.

Factors Affecting COVID-19 Vaccination Intentions among Patients Attending a Large HIV Treatment Clinic in Trinidad Using Constructs of the Health Belief Model.

Persons living with HIV are particularly vulnerable to COVID-19 and understanding the factors influencing their decision to take the COVID-19 vaccine are crucial. Using the Health Belief Model (HBM), our study examined the role of psychological factors in predicting vaccine intention in patients with HIV. The underlying concept of the HBM is that behaviour is determined by personal beliefs about a disease, and access to strategies to decrease its occurrence. A cross-sectional survey using a structured questionnaire was conducted between August and September 2021 at an HIV clinic in Trinidad. Data on the HBM constructs, namely patient's beliefs about the perceived severity and susceptibility to COVID-19, their perceived benefits of taking the vaccine, and external cues to action, i.e., factors that may motivate them to take the vaccine, were collected. Univariate and multivariable logistic regression analyses were used to examine associations and whether the HBM components were predictors of vaccination intention. In this study, 59.9% of patients indicated their intentions to take the vaccine. Females (OR 0.49, 95% CI 0.30-0.81) were less inclined to take the COVID-19 vaccine compared to males, while Indo-Trinidadian patients with HIV (OR 4.40, 95% CI 1.26-15.3) were more inclined to take the vaccine compared to Afro-Trinidadians. Health beliefs such as having confidence in the vaccine (p = 0.001) and believing in its perceived benefits (p = 0.001) were significant predictors of vaccination intention. Patients who were confident about the vaccine were six times more likely to take the vaccine (OR 6.45, 95% CI 2.13-19.5) than persons who were not confident in it. Having adequate information about the vaccine or the knowledge of others who received the vaccine (OR 1.48, 95% CI 1.03-2.11) were significant cues to action influencing their decision. Guided by the HBM, understanding patient's health beliefs is important in the design of tailored interventions to improve vaccine outcomes. The HBM may also be useful in the design of approaches to increase the uptake of critical HIV prevention, and treatment services.

Who is motivated to accept a booster and annual dose? A dimensional and person-centered approach.

The transmissibility of new COVID-19 variants and decreasing efficacy of vaccines led authorities to recommend a booster and even an annual dose. However, people's willingness to accept new doses varied considerably. Using two independent longitudinal samples of 4596 (Mean age = 53.6) and 514 (Mean age = 55.9) vaccinated participants, we examined how people's (lack of) vaccination motivation for their first dose was associated with their intention to get a booster (Sample 1) and an annual dose (Sample 2) several months later (Aim 1). We also aimed to capture the impact of the motivational heterogeneity on these intentions by capitalizing on participants' different motivational profiles collected at baseline (Aim 2). Across both samples, autonomous motivation, controlled motivation, and distrust-based amotivation were uniquely related to, respectively, higher, lower, and even lower booster and annual dose intentions. Further, a two-step clustering procedure revealed five profiles, with the profiles characterized by higher autonomous motivation (i.e. Good Quality and High Quantity profiles) reporting the highest vaccination intentions and the profile characterized by the highest number of obstacles (i.e. Global Amotivated profile) yielding the lowest vaccination intentions. These results stress the critical need to support citizens' volitional endorsement of vaccination to harvest long-term benefits with respect to COVID-19.

Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories.

The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

Dynamic norms for dynamic times? An experiment on the effects of dynamic and static norms messages on COVID-19 vaccination intention

Social norms messages may motivate COVID-19 preventive behaviors, such as getting vaccinated. To date, however, the research has mainly focused on the established concept of static norms and widely ignored the potential of dynamic norms. Dynamic norms convey information about how norms are developing over time and have been shown to promote change when the behavior is not yet the majority norm. The present study investigated the potential of dynamic norms in the context of the COVID-19 vaccination campaign. It examined (a) the effects of static and dynamic norms messages on vaccination intention, (b) the mechanisms through which dynamic norms may influence vaccination intention, and (c) the potential of dynamic norms to increase vaccination intention of vaccine-hesitant people. We conducted a preregistered online experiment with three conditions (static norm, dynamic norm, control message) among people who were not yet vaccinated (N = 2,289, 16–60 years) in May 2021, during the early vaccine roll-out period for the general population in Switzerland. We found no effects of exposure to the static or dynamic norms messages on vaccination intention and no specific influence mechanisms of dynamic norms (e.g., via perceived future norm) – neither for participants who were willing to get vaccinated nor for the vaccine-hesitant group. However, further analyses showed that, among vaccine-hesitant participants, the normative perception that formerly vaccine-critical people were changing their minds was elated with a stronger vaccination intention. We discuss potential reasons why social norms messages did not show an effect in our study and derive theoretical and practical implications. © Sarah Geber, Lukas Tribelhorn, Sara C. Hitchman, Thomas N. Friemel.

Attitudes toward the pandemic and COVID-19 vaccination intention among German university students and the general population: Results from two cross-sectional surveys.

Background: The COVID-19 pandemic has had an impact on nearly all people. Vaccines provide an effective tool to combat the pandemic, however, vaccination hesitancy remains an issue. This study aims to investigate (a) students' attitudes toward the pandemic, (b) potential differences in attitudes between university students and the general population, and (c) to examine predictors of vaccination intention in both samples. Methods: In this cross-sectional study data from two research projects were analyzed and compared. First, attitudes toward the COVID-19 pandemic in German university students were assessed within a cross-sectional anonymous online survey (March-April 2021, N = 5,639) and analyzed quantitatively and also qualitatively (free text field answers examined positive and negative aspects of the pandemic). Second, data from a cross-sectional survey within the COVID-19 Snapshot Monitoring project (COSMO; 29th wave of data collection, December 2020, N = 1,387) in the German general population was analyzed. Both samples, were compared in sharedly used variables, regarding attitudes toward the pandemic and vaccination intention, and factors associated with vaccination (logistic regression analyses). Results: In comparison to the general population, university students were significantly more likely to report being worried about/thinking about the coronavirus and to perceive the coronavirus as overrepresented in the media (all p < 0.001). University students reported a more supportive attitude toward vaccinations in general (students: M = 4.57, SD = 0.85; general population: M = 3.92, SD = 1.27) and a significantly higher vaccination intention (students: n = 4,438, 78.7%; general population: n = 635, 47.7%) than the general population (p < 0.001). Regression analyses revealed that in university students, vaccination intention was significantly predicted by not having children, a supporting attitude toward vaccinations in general, the belief that the coronavirus is overrepresented in the media, and less thinking about/worrying about the coronavirus (all p < 0.05). In the general population, vaccination intention was significantly associated with male gender, higher age, not having children, a supporting attitude toward vaccinations in general, and the belief that the coronavirus is overrepresented in the media (p < 0.05). The qualitative analysis among university students revealed that the most frequently stated positive aspect of the pandemic was to be more flexible due to digitalization (n = 1,301 statements, 22.2%) and the most frequently stated negative aspect was restriction in social life (n = 3,572 statements, 24.2%). Conclusion: The results indicate differences in the attitudes toward the pandemic between university students and the general population. In addition, differences regarding factors associated with vaccination intention were found in both samples. These results could be important to be considered when designing and targeting vaccination campaigns aiming at informing different population or age groups. Study registration: DRKS00022424.

What Motivates People to Receive Continuous COVID-19 Vaccine Booster Shots? An Expectation Confirmation Theory Perspective.

(1) Background: Abundant evidence has shown that the COVID-19 vaccine booster is highly effective against the Omicron variant. It is of great practical significance to explore the factors influencing the intention to receive COVID-19 booster shots. (2) Methods: We introduced expectation confirmation theory as the basis to construct a model of the factors of the vaccination intention for COVID-19 vaccine boosters. We obtained two batches of questionnaires through Chinese social platforms, with a valid sample size of 572. To test the model, we used SmartPLS3.0 software for empirical analysis. (3) Results: In terms of the characteristics of the vaccine itself, perceived vaccine efficacy and perceived vaccine safety had significant positive effects on expectation confirmation. Regarding vaccination services, perceived vaccination convenience also had a significant positive effect on expectation confirmation. Expectation confirmation positively affected the vaccination intention for the COVID-19 vaccine boosters. Furthermore, the results showed two moderating effects: first, health consciousness negatively moderated the positive effect of perceived vaccine safety on expectation confirmation; second, the time interval since the last dose negatively moderated the positive effect of perceived vaccine efficacy on expectation confirmation. (4) Conclusions: Our research demonstrated that there is an expectation confirmation process for previous COVID-19 vaccines before people consider whether to obtain a booster shot. Perceived vaccine efficacy and perceived vaccine safety remained important factors in receiving COVID-19 booster shots, and our conclusions were consistent with previous literature. In this study, multiple dimensions such as distance and cost were used to measure perceived vaccination convenience. This new variable improve the explanatory power of the convenience of the vaccination service and enrich the variables of the factor model of vaccination intention. In addition, the moderating effects of health consciousness and time interval were found. The findings can provide a theoretical reference for public health institutions to help them understand the formation process of people's intention to receive the COVID-19 vaccine booster.