The Psychometric Properties of Intention to Receive the COVID-19 Vaccine Scale Based on the Health Belief Model.

Acceptance of the SARS-CoV-2) COVID-19( vaccine is a very important factor to keep health workers safe. The study aimed to evaluate the psychometric properties of intention to receive the COVID-19 vaccine using a health belief model among health workers in Iran The study was a tools design study that was conducted in the period from February to March 2020, Iran Questionnaire items were designed using text review. The sampling method was multi-stage. Data were analyzed using descriptive statistics, confirmatory and exploratory factor analysis at a 95% confidence level using SPSS software version 16. The designed questionnaire had an appropriate content validity and internal consistency. Also, the exploratory factor analysis showed that a 5-factor structure was extracted and confirmatory factor analyses revealed that the conceptual five-factor structure of the measure had good fit indices. Reliability was evaluated using internal consistency. Cronbach Alpha coefficient was .82 and the intra-class correlation coefficient (ICC) was .9. It can be concluded that the instrument designed in the preliminary stage of psychometrics properties had good validity and reliability indicators. Also, the constructs of the health belief model well explain the determinants of the intention to receive the COVID-19 vaccine at the individual level.

Intention to receive COVID-19 vaccine and its health belief model (HBM)-based predictors: A systematic review and meta-analysis.

The purpose of the research was to pool the intention to receive the COVID-19 vaccine and its health belief model (HBM)-based predictors, which is helpful for decision-makers and program managers around the globe. The relevant database was searched and Joanna Briggs Institute (JBI) appraisal checklist was used to evaluate the studies. I2 test and funnel plot was utilized to check heterogeneity and publication bias, respectively. DerSimonian and Laird random-effects model was used. The overall pooled intention to receive COVID-19 vaccine globally was 67.69%. Higher levels of perceived susceptibility (AOR = 1.85), perceived severity (AOR = 1.45), perceived benefits (AOR = 3.10), and cues to action (AOR = 3.40) positively predicted the intention; whereas high level of perceived barrier negatively predicted it (AOR = 0.53). Health beliefs influenced COVID-19 vaccine intention globally. This implies that individuals need sound health education and publicity about vaccines before vaccination.

Investigating the effect of multimedia education based on the health belief model in preventing COVID-19 in pregnant women.

BACKGROUND: Pregnant women are considered one of the high-risk groups during the COVID-19 pandemic, so paying attention to preventive behaviors among them is highly important. This study aimed to examine the effect of multimedia education based on the Health Belief Model (HBM) in preventing COVID-19 among pregnant women. METHODS: This quasi-experimental intervention study was conducted on 120 pregnant women referring to Comprehensive Health Services Centers affiliated with East and West health centres of Ahvaz city, Iran, in 2021. Participants were divided into two control (n = 60) and intervention (n = 60) groups. A researcher-made questionnaire was used for data collection. The intervention group was given the required educational content using social networks virtually and multimedia in 12 sessions. Both groups were reinvestigated after two months. Data were analyzed using SPSS software version 24, independent t-test and paired t-test tests. RESULTS: The mean age and mean gestational age of participants were estimated at 28 years old and 18 weeks, respectively. Before the educational intervention, there was no significant difference in mean constructs of HBM. In contrast, the mean of all constructs increased significantly in the intervention group after intervention. The greatest change was related to the constructs of self-efficacy and perceived susceptibility, and the lowest change was related to the perceived barriers construct. CONCLUSION: Our findings suggest multimedia education using the HBM to COVID-19 preventive behaviors among pregnant women can benefit behavior change.

How Do Religious and Political Beliefs Predict COVID-19 Vaccination Behavior Among U.S. College Students? A Study Using the Health Belief Model.

PURPOSE: Predicting COVID-19 vaccination behavior among U.S. college students using the Health Belief Model (HBM). DESIGN: Cross-sectional survey. SETTING: Online. SAMPLE: A convenience sample of students in a public university in the U.S. (N = 411). MEASURES: Demographics; COVID-19 vaccination behavior as outcome variable; HBM variables (perceived threat of COVID-19, perceived individual benefit of vaccination, perceived community benefit of vaccination, perceived vaccine-safety barrier, perceived vaccination-cost barrier [time and effort], self-efficacy), and fear of COVID-19 as proximal predictors; religious beliefs and political beliefs as distal predictors. Questions/items measuring all variables in the survey data collection were taken from relevant and peer-reviewed publications and were modified to reflect the context of COVID-19. ANALYSIS: Structural equation modeling (SEM). RESULTS: The model fit the data very well (χ2/df = 2.27/5 = .45, p = .810; RMSEA = .000). Perceived individual benefit (ß = .489, p < .001), perceived vaccine-safety barrier (ß = -.151, p = .001), perceived vaccination-cost barrier (ß = -.152, p < .001), and political beliefs (ß = -.094, p = .029) are significant predictors of vaccination behavior. Effects of religious beliefs are completely, and effects of political beliefs are partially mediated by perceived individual benefit and the two barrier variables. CONCLUSION: Perceived individual benefit, the two barrier variables, and political beliefs are direct predictors, while religious beliefs are an indirect predictor, of COVID-19 vaccination behavior, suggesting that the HBM can effectively inform strategies to promote vaccination. Political beliefs are a much stronger predictor than religious beliefs. Students who are more religious or conservative tend to perceive less individual benefit and greater barriers to vaccination, making them less likely to get vaccinated. A limitation of this study is the disproportionate number of female participants (77.9%).

Health belief model and social media engagement: A cross-national study of health promotion strategies against COVID-19 in 2020.

Background: Using the Health Belief Model (HBM), this study analyzed tweets related to COVID-19 published by national health departments of the United States, the South Korea, the United Kingdom, Japan, Germany, and India to explore their differences in (1) the health measures against COVID-19, (2) the health promotion strategies, (3) the social media engagements that those measures and strategies have triggered. Method: We conducted a content analysis with 1,200 randomly selected COVID-19-related tweets from six national health departments' Twitter accounts from 1 January 2020 to 31 December 2020. We coded the six HBM constructs and 21 sub-themes of the HBM constructs for each tweet. Results: Results showed that all six HBM constructs were used in the full sample. The most commonly used HBM construct was cues to action, followed by susceptibility, benefits, self-efficacy, severity, and barriers. All the HBM constructs were positively related to Twitter engagement variables except barriers. Further analysis illustrated that people from the six countries responded differently to the HBM constructs and the HBM sub-themes. Twitter users in Germany, India, the U.S., and Japan positively reacted to the clear directions of "what to do against COVID-19" (cues to action), while Twitter users in the U.S. and Japan were also eager to know the justifications for such directions (benefits); people in South Korea and the U.K. were mainly seeking a diagnosis of the severity and susceptibility of COVID-19, instead of health measures, of COVID-19 in the year 2020. Conclusions: This study showed the use of HBM constructs is generally effective in inducing Twitter engagement. The further comparison illustrated a homogenization in the promotion strategies that the health departments implemented and the health measures they promoted, yet responses to such promotions varied across nations. This study broadened the scope of HBM applications from predicting health behaviors in surveys to guiding the design of health promotion messages online.

The Influence of the Health Belief Model on the Decision to Get the COVID-19 Vaccine: An International Survey Study of College Students.

To better prepare for a potential future pandemic, it is important to investigate factors that influenced responses to the recent COVID-19 pandemic. The aim of the present study was to investigate factors that influenced the decision to get the COVID-19 vaccine. The COVID-19 pandemic has affected almost everyone throughout the world. Vaccines are a significant factor in managing a pandemic. As vaccines are developed, governments develop vaccine roll-out plans. Unfortunately, vaccine hesitancies can slow the implementation of any vaccine program. A question arises as to the factors that are associated with the decision to get vaccinated. The present study explored associations between vaccine hesitancy, and the Health Belief Model (HBM) in student samples from the Czech Republic, Israel, and the United States. From August, 2021 through December, 2021, an online survey was distributed in Czech, Hebrew, and English. A total of 447 participants completed the survey. A binomial logistic regression was conducted to ascertain the influence of perceived susceptibility, severity, benefits, and barriers on the likelihood that participants are vaccinated. Results revealed that the factors of perceived severity and perceived benefits explained 52.6% (Nagelkerke R2) of the variance in vaccination. An analysis of Variance (ANOVA) found significant differences between countries for the 4 HBM factors. Based on these findings, it is recommended that policymakers put forth added emphasis on the severity of a virus and the benefits associated with the vaccine. Further, since there appears to be variability between countries in perceptions of the virus, and associated vaccine, governments should consider factors within their own environment when developing a strategy to combat a pandemic. More specifically, government could explore their own strengths, weaknesses, opportunities, and threats as they develop a pandemic strategy. Additional practical and theoretical implications are discussed.

The Influence of COVID-19 Pandemic on the Health Seeking Behaviors of Adults Living With Chronic Conditions: A View Through the Health Belief Model.

The COVID-19 pandemic resulted in disruption in every facet of life including health service delivery. This has threatened the attainment of global targets to improve health and wellbeing of all persons. In particular, for persons living with chronic diseases, who require consistent monitoring by health professionals and medication to enhance their health, understanding how the pandemic has disruption their access to health care delivery is critical for interventions aimed at improving health service delivery for all as well as preparedness for future pandemic. This study applied the constructs of the Health Belief Model, to explore the influences of the COVID-19 pandemic on the health seeking behaviors of persons living with chronic diseases. The design was exploratory descriptive. Semi-structured interviews were conducted to collect data among persons living with chronic diseases in the Cape Coast Metropolis of Ghana. Thematic analysis, both inductive and deductive, was conducted to unearth the findings. Awareness of increased susceptibility and risk of a more severe episode if they contracted COVID-19 as a result of the existing chronic diseases was identified. Lack of access to health professionals during the peak of the pandemic as well as the fear of contracting the virus while accessing their regular chronic disease clinic was the main barriers identified. Information in the media served as cues to action for adopting preventive health strategies. Behavior modifications; dietary and lifestyle, self-medication and adoption of COVID-19 related precautions were practiced. Susceptibility to contracting COVID-19 contributed to missed adherence to treatment appointment. The health belief model was a useful framework in exploring the health seeking behavior of the adults living with chronic conditions during the COVID-19 in this study setting. Intensifying targeted education for persons living with chronic diseases will contribute to the adoption of positive health seeking behaviors during future pandemic.

Predicting Covid-19 preventive behaviors based on constructs of health belief model.

INTRODUCTION AND OBJECTIVE: The prevalence of Covid-19 has become a clinical threat worldwide. However, knowledge about this new virus is limited. Therefore, this study was conducted to determine the preventive behaviors of Covid-19 based on the constructs of health belief model (HBM) in the clients of health centers in Zabol, Iran. METHODS: This descriptive-analytical (cross-sectional) study was performed on 160 people referring to health centers in Zabol by the available method. A researcher-made questionnaire was used to collect data. Data were analyzed using SPSS20 software and appropriate statistical tests. RESULTS: A positive and significant correlation was observed between preventive behaviors of Covid-19 and perceived benefit constructs (r = 0.29, P = 0.0001) and self-efficacy (r = 0.39, P = 0.0001). HBM constructs were able to predict about 36% of the variance of Covid-19 disease preventive behaviors, with self-efficacy (B = 0.134) being the strongest predictor. CONCLUSION: Since no specific and definitive treatment for Corona has been found yet, taking preventive measures can be the best way to prevent the spread of this disease in the community. Therefore, this can be achieved by raising awareness and preventive behaviors through health education.

Are parents' willing to vaccinate their children against COVID-19? A qualitative study based on the Health Belief Model.

In response to the COVID-19 pandemic, several countries have started implementing voluntary or involuntary mass vaccination programs. Although vaccine acceptance is high among adults, uncertainty about whether to vaccinate children against COVID-19 remains a controversial theme. To date, few qualitative studies have explored parents' views on this topic. A qualitative descriptive study design was used to collect data and individual in-depth interviews were conducted with 50 parents in the Makkah region of Saudi Arabia. The Health Belief Model (HBM) was used as a guide in developing the interview guide. Each question was related to a construct of the HBM. The data were then analyzed using thematic content analysis and interpreted using NVivo software. Two major themes emerged: motivation to vaccinate children, which was influenced by perceived benefits, perceived severity, perceived suitability, collective responsibilities, confidence, and cues to action; and barriers to vaccination in children, which included complacency, rapid vaccine development, and uncertainty about the long-term side effects of the vaccine. The findings of this study revealed that the public is not sufficiently informed about the efficacy or side effects of the COVID-19 vaccine, increasing the awareness of which will help parents make informed decisions regarding vaccinating their children and potentially increase vaccine acceptance.

Currently, the debate about whether children should be vaccinated for COVID-19 is ongoing worldwide. This research explored the thoughts of Saudi Arabian parents in this regard through in-depth interviews. The viewpoints were grouped into two themes: motivators and barriers toward vaccination. The motivators included factors such as parents' beliefs that the vaccine would help protect their children and the aged against the severity of the disease, especially those with existing conditions such as obesity. They also felt that the vaccination would help develop the society's herd immunity against the virus and felt an obligation to have their children vaccinated. Barriers toward vaccination included factors such as concerns about the long-term side effects of the vaccine on children, and the belief that children's immune systems are strong enough to fight the virus and that the vaccine might negatively affect their immune systems. This study showed that parents need to be educated on the benefits and side effects of COVID-19 vaccination for children. The results of this study will help health authorities and the government to increase the uptake and acceptability of the COVID-19 vaccine for children.

Factors Influencing SARS-CoV-2 Infection Control Practices of Nurses Caring for COVID-19 Patients in South Korea: Based on Health Belief Model.

This study aimed to verify the level of COVID-19 infection control practices and the factors affecting the COVID-19 infection control practices of Korean nurses based on the health belief model. The participants were 143 nurses experienced in caring for COVID-19 patients in South Korea. Questionnaires were used to measure health beliefs, confidence in practice, knowledge of COVID-19, infection protection environment, and COVID-19 infection control practices. Data were analyzed by performing descriptive statistics, an independent t-test, one-way analysis of variance, the Mann-Whitney test and multiple regression analysis. The mean score for infection control practices related to COVID-19 was 4.76 on a 5-point scale where a higher score indicates superior infection control performance. Multiple regression analysis revealed that the factors that influenced COVID-19 infection control practices were gender, marital status, perceived susceptibility, and confidence in practice related to COVID-19. With COVID-19 approaching endemic and to prevent infectious diseases, it is necessary to emphasize perceived sensitivity by providing accurate information on the risk of infection rather than simply inducing infection control to be divided into individual activities. In addition, nurses' infection control practices should be implemented with confidence with the nurses themselves feeling the need for infection control and not being forced by the social atmosphere or the hospital.

COVID-19 Vaccine Hesitancy in an Underrepresented Minority Community.

To assess factors influencing acceptability of COVID-19 vaccine in a population of predominantly indigent, minority, pregnant and non-pregnant people of reproductive age. Cross-sectional survey using a modified Health Belief model administered between January 2021 and January 2022 at four hospitals in Brooklyn. Participants included English-speaking reproductive aged persons attending clinics at the participating sites. Descriptive and univariate data analyses were used for analysis. 283 eligible reproductive persons were approached of whom 272 completed the survey (96%). Three quarters said they would take the vaccine under certain circumstances ("as soon as it is ready" [28.6%], "when my doctor recommends it" [21.3%] or "when enough people have received it to know if it works" [25%]), while 25% said they would never take the vaccine. When comparing persons that would take it under certain circumstances to those that never would, the "never" group was significantly more likely to note that, "they would not trust any COVID vaccine" (71.4% vs. 28.5%; p ≤ 0.0001). This greater level of distrust extended to greater distrust of doctors, government, family, newspapers, and media. However, 36% said they would be influenced by their doctor's recommendation. Pregnant participants were significantly more likely to wait until their doctor recommended it (17.6% of pregnant persons compared to 3.7% of non-pregnant p < 0.0001). Despite mistrust and other discouraging factors, many persons, under appropriate circumstances (e.g., reassurance about vaccine safety) may be motivated to take the vaccine. Even those who claimed that they wouldn't take the vaccine under any circumstance may be influenced by their health care providers.

Stay Socially Distant and Wash Your Hands: Using the Health Belief Model to Determine Intent for COVID-19 Preventive Behaviors at the Beginning of the Pandemic.

BACKGROUND: The COVID-19 pandemic has quickly spread around the world, and since currently no treatments that are safe and effective for large groups of people nor a vaccine are available, the best way to prevent the illness is to avoid being exposed to the virus causing it. The purpose of this study was to examine the predictive effects of both demographic and psychosocial factors originating with the Health Belief Model on reported intent to adhere to COVID-19 preventive behaviors (e.g., social distancing, hand washing, and not attending large gatherings). METHOD: A Qualtrics survey of 500 U.S. adults was conducted to explore the relationships of demographics and psychosocial factors with the intent to adhere to COVID-19 preventive measures. RESULTS: Gender was a predictor of taking preventive action, with women more likely to take action. Health Belief Model constructs predicted uptake of most COVID-19 preventive actions, but the constructs often appeared to work independent of the model. Race/ethnicity was an infrequent predictor, but when it did, minorities were less likely to report intent to adhere to COVID-19 preventive behaviors. CONCLUSION/IMPLICATIONS: While not a perfect model for this pandemic, the Health Belief Model and its constructs should continue to be considered for use by public health communicators focusing on preventive measure campaign design in both the COVID-19 pandemic era and beyond.

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.

Knowledge, attitude, acceptance, and practice of COVID-19 vaccination and associated factors complemented with constructs of health belief model among the general public in South Gondar, Ethiopia: A community-based study.

Introduction: Understanding the epidemiological dynamics of disease control, as well as the effectiveness, compliance, and success of the vaccination program requires an understanding of the local population's knowledge, attitude, and practice regarding the Corona Virus Disease of 2019 (COVID-19) vaccine. Thus, the objective of this study was to assess knowledge, attitude, and practice toward COVID-19 vaccination and associated factors among the general public. Methods: A cross-sectional study was conducted in the South Gondar Zone, among residents above the age of 18 years. The study used objective measures and the constructs of the Health Belief Model. Binary logistic regression was used and the result of the final model was presented in terms of adjusted odds ratio (AOR) and 95% confidence intervals (CI), and statistical significance was taken and considered at a P-value < 0.05. Results: The study was conducted on 1,111 study participants. The mean age is 30.83 ± 7.106. About 575 (51.8%) of the respondents have good knowledge about the COVID-19 vaccination and 43.4% have a positive attitude toward COVID-19 vaccination. About 361 (32.5%) of the respondents were willing to take the vaccine if it is available and 113 (10.2%) of them were vaccinated. Participants with a positive attitude and good knowledge, those with a secondary level of education AOR = 5.70, 95% CI (2.60-12.60), those with a monthly income of >2,000 birr AOR = 6.30, 95% CI (2.50-15.60), those having a television (TV), and those who use Facebook AOR = 17.70, 95% CI (10.10-30.90) had a higher level of acceptance of COVID-19 vaccination. The Health Belief Model's constructs of perceived susceptibility AOR = 1.53, 95% CI (1.26-1.85), perceived benefit AOR = 1.49, 95% CI (1.28-1.75), and cues to action AOR = 0.54, 95% CI (0.45-0.65) were all linked to COVID-19 vaccine acceptability. Conclusion: The level of acceptance of COVID-19 vaccination is much lower. Having a positive attitude score and good knowledge score, level of education, monthly income, presence of TV, the use of Facebook, and knowing the means of transmission of COVID-19 increase the level of acceptance of COVID-19 vaccination.

Health Belief Model and parents' acceptance of the Pfizer-BioNTech and Sinopharm COVID-19 vaccine for children aged 5-18 years Old: A national survey.

BACKGROUND: During the COVID-19 pandemic, several vaccines received approval for children aged 18 or younger. Parents' decisions to accept vaccines play an important role in the success of vaccination campaigns. The Health Belief Model (HBM) may explain its association with vaccine acceptance. This study examined parents' Pfizer-BioNTech and Sinopharm vaccine acceptance for their children and its association with HBM. METHODS: A cross-sectional study was conducted in March 2022 using an online survey. Respondents were parents of children aged 5-18 in public and private schools. The multistage random sampling technique was used to choose schools and respondents. Multivariable analysis was conducted to examine the association between vaccine acceptance and HBM. RESULTS: The response rate was 55 %. Of 1,056 respondents, 80.1 % were female, with a mean age of 41, and 95.8 % were not health professionals. Pfizer-BioNTech had a greater acceptance rate than Sinopharm (90 % v.s. 36 %). The Multivariable analysis shows that perceived benefits (aOR = 25.30, 95 %CI = 10.02-63.89 and aOR = 17.94, 95 %CI = 9.56-33.66 for Pfizer-BioNTech and Sinopharm, respectively) and perceived barriers (aOR = 0.06, 95 %CI = 0.01-0.50 and aOR = 0.20, 95 %CI = 0.11-0.40 for Pfizer-BioNTech and Sinopharm, respectively) were associated with vaccine acceptance for both vaccines. Education was associated with Pfizer-BioNTech vaccine acceptance (aOR = 0.96, 95 %CI 0.71-1.29). CONCLUSIONS: The respondents were more confident in Pfizer-BioNTech than Sinopharm. Perceived barriers and perceived benefits were strongly associated with the respondents' vaccine acceptance for both vaccines. During epidemics and pandemics, the government needs vaccines with high efficacy and safety for a higher chance of parents' vaccine acceptance. Future research should examine vaccine costs as perceived barriers for a newly out-of-pocket developed vaccine.

Development and validation of Health Belief Model based instrument to assess secondary school student's adherence to COVID-19 self-protective practices in Jimma, Oromia, Ethiopia.

BACKGROUND: The study aimed in developing and validating a Health Belief Model (HBM) based instrument used for cross-sectional studies among secondary school students in Jimma town, Oromia, Ethiopia. METHODS: A school-based cross-sectional study was conducted from May 25 to June 10, 2021. The sample size was 634, and students were randomly selected from public and private secondary schools. The 81 items were developed reviewing different literatures based on the constructs of HBM. The constructs were perceived severity, perceived vulnerability, perceived benefit, perceived barrier, self-efficacy, cues to action, perceived school support and self-protective practice. Data were collected using a self-administered questionnaire. The data were cleaned, entered into and analyzed using SPSS 23.0. A principal axis factoring with varimax rotation was carried out to extract items. Items with no loading factor or cross-loaded items were deleted. Items having factor loading coefficient of ≥0.4 were retained. An internal reliability was ensured at Cronbach's alpha >0.70. All items with corrected item-total correlation coefficient below 0.30 were deleted from reliability analysis. RESULTS: In this study, 576 respondents were participated making a response rate of 90.8%. A total of thirty items were extracted and loaded in to eleven factors with cumulative variance of 56.719%. Percieved social support, percieved benefit, percieved school responsibility, self-efficacy, and practice items were internally consistent. Percieved vurnerability was neither valid nor reliable construct. Similarly, from the extracted factors, attitude towards face mask use and percieved peer influence were not internally consistent. Lastly, percieved benefit, self-efficacy and percieved school responsibility significantly predicted student's adherence to COVID-19 self-protective practices. CONCLUSIONS: The study found that perceived benefit, perceived school support, social support, self-efficacy, perceived school environment cleanness, perceived school responsibility, perceived school health education, attitude to use face mask, perceived severity, cues to action and perceived peer influence were valid. Finally, perceived benefit, self-efficacy and perceived school responsibility significantly predicted student's adherence to COVID-19 self-protective practices.

Letter to the Editor Response: Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model.

The purpose of this submission to respond to a Letter to the Editor recently submitted regarding our manuscript, "Exploring COVID-19 Vaccine Hesitancy among Stakeholders in African American and Latinx Communities in the Deep South through the Lens of the Health Belief Model" published in the American Journal of Health Promotion in February, 2022. The manuscript reported on a study that had as its purpose to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest potential intervention strategies.

Acceptance of the COVID-19 vaccine booster dose and associated factors among the elderly in China based on the health belief model (HBM): A national cross-sectional study.

Background: The reluctance of individuals to obtain solid vaccine-induced immunity represents a fundamental challenge to containing the spread of SARS-CoV-2, including its highly mutated variants. We aimed to assess vaccination acceptance and associated factors for the COVID-19 vaccine booster dose among elderly people (≥60 years old) in China, providing a theoretical and practical reference for universal vaccination policy. Methods: A national anonymous survey was conducted in mainland China from May 25 to June 8, 2022, using a stratified random sampling method. Individuals 60 years of age and above were the target population. A chi-squared test and Cochran-Armitage test for trend were used to compare and examine vaccine acceptance rates by characteristics. Via a backward stepwise method, multivariable logistic regression models were established to assess factors associated with booster dose acceptance. Two-sided P < 0.05 was considered statistically significant. Results: Of 3,321 eligible participants, 82.8% (95% CI: 81.5-84.1%) were willing to receive COVID-19 vaccine booster shots. Concerns about contraindications (38.3%), vaccine safety (32.0%), and limited movement (28.0%) were the main reasons for vaccine hesitancy. Nearly one-third still believed that the booster dose was unnecessary after receiving the initial vaccination. Older adults with a low level of perceived barriers (aOR = 1.86, 95% CI, 1.03-3.38), a high level of perceived benefit (aOR = 2.31, 95% CI, 1.38-3.87), and higher cues to action (moderate, aOR = 2.22, 95% CI, 1.39-3.56; high, aOR = 5.46, 95% CI: 3.44-8.67) were more likely to accept the booster dose. Other major factors affecting the booster dose acceptance rate were occupation, time spent on social media, vaccination history, and a high knowledge score for COVID-19 and vaccines. In addition, for those over 70 years of age, rising awareness of susceptibility could be a better gateway for improving their willingness to get vaccinated. Conclusions: A total of 82.8% of recruited older adults were willing to receive the booster dose. Acceptance behaviors were closely related to occupation, time spent on social media, vaccination history, knowledge factors, perception of barriers, and benefit, as well as action cues. Targeted public health measures are a priority for improving the vaccination coverage of valid immunity among the elderly population, not only to prevent infection and poor prognosis caused by emerging variants but also to reduce the huge disease and economic burden caused by the long-term sequelae after SARS-CoV-2 infection.