The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia
Abstract
:1. Introduction
1.1. Background and Context of COVID-19 Vaccinations in Australia
1.2. Vaccine Intentions
1.3. Factors Associated with COVID-19 Vaccine and Booster Hesitancy
1.3.1. Sociodemographics
1.3.2. Beliefs and Attitudes about COVID-19
1.3.3. Information Consumption, Perceived Health Literacy and Related Factors
1.3.4. Psychological Characteristics
1.3.5. Political, Cultural and Social Attitudes
1.4. The Present Study
Aims and Hypotheses
2. Materials and Methods
2.1. Participants and Recruitment
2.2. Measures
Measure (Authors) | Number of Items and Response Scale | Scoring | Dimensions and Example Items | Internal Consistency (Previous Studies) |
---|---|---|---|---|
Demographics | ||||
Financial comfort | 1 item Sliding scale from 0 (not at all comfortable) to 100 (very comfortable) | 0–100 | ‘How would you rate your level of financial comfort currently?’ | - |
Education level | 1 item 1 = year 11 or below 2 = year 12 3 = trade certificate/apprenticeship 4 = diploma 5 = bachelor’s degree 6 = higher degree | 1–6 | “What is the highest level of education you have completed?’ | - |
COVID-related variables | ||||
Vaccination status | 1 item 0 = no doses 1 = one dose only 2 = two doses only [or three doses as primary course if immunocompromised] 3 = primary course and booster | 0–3 | ‘Have you received a COVID-19 vaccination?’ | - |
Booster willingness | 1 item 1 = definitely not 2 = probably not 3 = unsure 4 = probably 5 = definitely 6 = have already had booster | 1–6 Higher = more willing | ‘When a COVID-19 vaccine booster is available to you to boost your protection against COVID-19, will you get it?’ | - |
COVID-19 Beliefs (study specific, see Supplementary Materials) | 24 items (1) strongly disagree to (5) strongly agree | Factor scores (Bartlett Method) Higher = greater endorsement |
| - |
Vaccination Attitudes Examination Scale (modified) [68] | 13 items (1) strongly disagree to (6) strongly agree | Mean scores Higher = less support for vaccinations |
| 0.80 to 0.93 [68] |
Multidimensional COVID-19 Worry Index (study specific, see Supplementary Materials) | 19 items (1) never to (4) always | Mean scores Higher = more worried |
| - |
COVID-19 Readiness for Lockdown (study-specific, see Supplementary Materials) | 7 items (1) strongly disagree to (5) strongly agree | Mean score Higher = more ready | ‘Should another lockdown be needed, I will follow the rules’ | - |
Compliance Attitudes (study specific, see Supplementary Materials) | 5 items, repeated for two time periods: currently and before December 2021 Slider scale from (0) does not apply at all to (100) applies very much | Mean score Higher = more compliant with and understanding of rules/recommendations | ‘I adhere to the current COVID-19 rules or recommendations’ | - |
Reasons for getting vaccinations (study specific, see Supplementary Materials) | 10 items, repeated for primary vaccination (for those who had received at least two doses), and booster (either relating to reasons one got a booster for those who had received a booster dose, or why one would receive a booster if not yet done so) (1) strongly disagree to (6) strongly agree | Mean scores Higher = greater endorsement of reason |
| - |
Pandemic Fatigue Scale [32] and Neglect from the Brief Pandemic Fatigue Scale [69] (The Boredom subscale from the Brief Pandemic Fatigue Scale was not included due to its substantial overlap with the Informational Fatigue subscale.) | 9 items (1) strongly disagree to (7) strongly agree | Overall mean score (an exploratory factor analysis was run on the items. All items converged and loaded on a single factor; thus, an overall mean score was calculated based on these results.) Higher = more fatigued | Pandemic Fatigue Scale:
Brief Pandemic Fatigue Scale:
| 0.83 to 0.86 [32] 0.85 [69] |
Trust (study specific see Supplementary Materials) | 15 items (1) strongly distrust to (5) strongly trust | Mean scores Higher = greater trust |
| - |
OCEANS Coronavirus Conspiracy Scale [62] | 7 items (1) do not agree to (5) agree completely | Mean score Higher = greater belief in conspiracies | ‘The virus is a hoax’ | 0.94 [62] |
Information Sources (study-specific, see Supplementary Materials) | 10 items (1) never to (5) all of the time | Mean scores Higher = more frequent use of sources |
| - |
Check News | 1 item (1) never to (5) all of the time | Higher = more frequent | ‘How often do you check the news regarding COVID-19?’ | - |
Source Check | 1 item (1) never to (5) all of the time | Higher = more frequent | ‘How often do you check the legitimacy of the source of information about COVID-19?’ | - |
Share News | 1 item (1) never to (5) all of the time | Higher = more frequent | ‘How often do you share news about COVID-19 with family/friends?’ | - |
Psychological Variables | ||||
All Aspects of Health Literacy Scale [70] | 13 items | Overall summed score Higher = better health literacy |
| 0.75 [70] |
Mini International Personality Item Pool [71] | 20 items (1) very inaccurate to (5) very accurate | Summed scores Higher = higher on trait | Extraversion: ‘I am the life of the party’ Agreeableness: ‘I sympathize with others’ feelings’ Conscientiousness: ‘I get chores done right away’ Neuroticism: ‘I have frequent mood swings’ Intellect/Openness: ‘I have a vivid imagination’ | 0.65 to 0.82 [71] |
Esoteric Analogies Test [72] | 14 items | 0–100% | ‘FLAME is to HEAT as ROSE is to: (a) LEAVES; (b) SCENT; (c) THORN or (d) PETAL’ | 0.64 and 0.76 [73,74] |
Cognitive Reflection Test [75] | 4 items | 0–100% | ‘Jerry received both the 15th highest and the 15th lowest mark in the class. How many students are in the class?’ | 0.72 [75] |
Connor-Davidson Resilience Scale Short [76] | 10 items (0) not true at all to (4) nearly always true | Summed score Higher = more resilient | ‘I can deal with whatever comes’ | 0.85 [76] |
Intolerance of Uncertainty Scal [56] | 12 items (1) not at all characteristic of me to (4) entirely characteristic of me | Summed score Higher = greater intolerance | ‘Unforeseen events upset me greatly’ | 0.91 [56] |
Bullshit Receptivity Scale [42] | 10 items (1) not at all profound to (5) very profound | Mean score Higher = more receptive to pseudo-profound statements | ‘Hidden meaning transforms unparalleled abstract beauty’ | 0.82 to 0.96 [42] |
Hong Psychological Reactance Scale [77] | 14 items (1) strongly disagree to (6) strongly agree | Mean score Higher = more reactance | ‘Regulations trigger a sense of resistance in me’ | 0.75 to 0.80 [78] |
Political, Cultural, Social Attitudes | ||||
Social Conservatism Scale [79] | 3 items were selected from the 12-item scale. (1) fully disagree to (5) fully agree | Mean score Higher = more conservative | ‘We have to respect our history and tradition’ | 0.55 [37] |
Conspiracy Mentality Questionnaire [80] | 13 items (1) strongly disagree to (7) strongly agree | Mean score Higher = greater conspiracy mindset | ‘There are many very important things happening in the world about which the public are not informed’ | 0.84 [81] |
Persecution from the Persecution and Deservedness Scale [81] | 10 items (10) certainly false to (5) certainly true | Mean score Higher = greater persecutory thinking | ‘There are times when I worry that others may be plotting against me’ | 0.84 [81] |
Need for Chaos [82] | 7 items (1) strongly disagree to (7) strongly agree | Mean score Higher = greater need for chaos | ‘I get a kick when natural disasters strike in foreign countries’ | 0.90 [82] |
Cultural Tightness–Looseness [64] | 6 items (1) strongly disagree to (6) strongly agree | Mean score Higher = perceive culture as tighter | ‘There are many social norms that people are supposed to abide by in this country’ | 0.85 [64] |
Amoral Social Attitudes [83] | 6 items (1) fully disagree to (5) fully agree. | Mean score Higher = greater amorality | ‘I hate obligations and responsibilities of any kind’ | 0.64 [35] |
2.3. Statistical Analyses
3. Results
3.1. Sample Characteristics
3.2. Profile Selection
3.3. Interpretation of the Three-Class Solution
3.4. Profile Differences in Demographics and COVID-19 Variables
3.4.1. Demographics
3.4.2. COVID-19 Variables: Vaccination and COVID-19 Conspiracy Beliefs
3.4.3. Reasons for Getting Primary and Booster Vaccinations
3.5. Profile Differences in Information Gathering
3.6. Profile Differences in Psychological Measures
3.6.1. Psychological Characteristics and Cognitive Ability
3.6.2. Political, Cultural and Social Attitudes
4. Discussion
4.1. Differences in Demographics and COVID-Related Attitudes
4.2. Motivations behind Willingness to Get Vaccinated
4.3. Differences in Perceptions of Health Literacy
4.4. Differences in COVID-19 Information Gathering
4.4.1. Use of Official and Unofficial Information Sources
4.4.2. Trust in Information Sources
4.5. The Psychological Profiles of the Vaccine-Hesitant and -Resistant Groups
4.6. Implications
4.7. Limitations and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Classes | AIC | BIC | SABIC | Entropy | BLRT(p) | LogLik | LogLik(p) * |
---|---|---|---|---|---|---|---|
1 | 31,438 | 31,604 | 31,484 | 1 | - | −15,681 | - |
2 | 29,372 | 29,625 | 29,441 | 0.94 | 0.01 | −14,628 | <0.001 |
3 | 28,697 | 29,038 | 28,790 | 0.91 | 0.01 | −14,271 | <0.001 |
4 | 28,408 | 28,836 | 28,525 | 0.87 | 0.01 | −14,106 | <0.001 |
5 | 28,211 | 28,726 | 28,351 | 0.86 | 0.01 | −13,987 | <0.001 |
6 | 28,129 | 28,731 | 28,293 | 0.84 | 0.01 | −13,926 | <0.001 |
3-class solution | |||||||
Counts and proportions for latent classes | Average probability of class classification accuracy for each class | ||||||
Counts | Proportions | Class 1 | Class 2 | Class 3 | |||
Class 1 | 176 | 0.30 | 0.95 | 0.05 | 0.00 | ||
Class 2 | 353 | 0.61 | 0.04 | 0.96 | 0.00 | ||
Class 3 | 53 | 0.09 | 0.03 | 0.00 | 0.97 |
Mean (SD) | ANOVA | Pairwise Comparisons p-Value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
α | Class 1 Hesitant (n = 176) | Class 2 Acceptant (n = 353) | Class 3 Resistant (n = 53) | F | p-Value | η2 | c1-2 | c1-3 | c2-3 | |
Hesitant | Acceptant | Resistant | ||||||||
Demographics | ||||||||||
Age | - | 32.61 (10.9) | 35.78 (13.82) | 34.15 (10.53) | 4.14 | <0.05 | 0.05 | 0.01 | 0.62 | 0.58 |
COVID-19 variables: Vaccination and conspiracy beliefs | ||||||||||
Vaccination Status | - | 2.24 (0.63) | 2.58 (0.55) | 1.38 (1.1) | 45.37 | <0.001 | 0.42 | <0.001 | <0.001 | <0.001 |
COVID-19 Conspiracy | 0.89 | 1.42 (0.72) | 1.17 (0.45) | 2.32 (1.25) | 28.94 | <0.001 | 0.34 | <0.001 | <0.001 | <0.001 |
Reasons for getting primary vaccination doses | ||||||||||
Regaining Freedom/Work Requirements | 0.69 | 4.23 (1.21) | 3.96 (1.44) | 4.39 (1.29) | 3.47 | <0.05 | 0.07 | 0.07 | 0.77 | 0.16 |
External Pressures | 0.74 | 2.80 (1.21) | 2.09 (1.05) | 2.20 (1.06) | 21.6 | <0.001 | 0.33 | <0.001 | 0.01 | 0.85 |
Protecting Self and Others | 0.92 | 5.02 (0.70) | 5.75 (0.43) | 3.22 (1.17) | 149.75 | <0.001 | 0.79 | <0.001 | <0.001 | <0.001 |
Reasons for getting/would get a booster dose | ||||||||||
Regaining Freedom/Work Requirements | 0.70 | 4.4 (1.19) | 4.03 (1.49) | 4.13 (1.51) | 4.88 | <0.01 | 0.10 | 0.005 | 0.58 | 0.92 |
External Pressures | 0.75–0.80 | 2.74 (1.25) | 2.18 (1.27) | 2.01 (1.04) | 13.28 | <0.001 | 0.22 | <0.001 | 0.002 | 0.65 |
Mean (SD) | ANOVA | Pairwise Comparisons (p-Values) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
α | Class 1 (n = 176) | Class 2 (n = 353) | Class 3 (n = 53) | F | p-Value | η2 | c1-2 | c1-3 | c2-3 | |
Hesitant | Acceptant | Resistant | ||||||||
Official Sources | 0.80 | 2.42 (0.78) | 2.84 (0.79) | 2.20 (0.74) | 27.64 | <0.001 | 0.28 | <0.001 | 0.14 | <0.001 |
Unofficial Sources | 0.62 | 2.49 (0.68) | 2.52 (0.66) | 2.41 (0.70) | 0.56 | 0.57 | 0.01 | 0.89 | 0.75 | 0.56 |
Check News | - | 2.95 (1.01) | 3.51 (0.86) | 2.74 (1.09) | 27.64 | <0.001 | 0.30 | <0.001 | 0.42 | <0.001 |
Check Source | - | 2.98 (1.07) | 3.54 (1.12) | 3.26 (1.24) | 15.37 | <0.001 | 0.18 | <0.001 | 0.30 | 0.29 |
Share News | - | 2.42 (1.15) | 2.81 (1.17) | 2.43 (1.29) | 7.50 | <0.001 | 0.10 | <0.001 | 1.00 | 0.12 |
Mean (SD) | ANOVA | Pairwise Comparisons (p-Values) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
α | Class 1 (n = 176) | Class 2 (n = 353) | Class 3 (n = 53) | F | p-Value | η2 | c1-2 | c1-3 | c2-3 | |
Hesitant | Acceptant | Resistant | ||||||||
Psychological Characteristics | ||||||||||
Agreeableness | 0.81 | 14.55 (3.28) | 15.59 (3.16) | 14.34 (3.03) | 8.25 | <0.001 | 0.10 | 0.002 | 0.90 | 0.02 |
Conscientiousness | 0.68 | 13.6 (2.81) | 14.11 (3.39) | 14.26 (2.98) | 2.05 | 0.13 | 0.03 | 0.16 | 0.32 | 0.94 |
Extraversion | 0.80 | 9.96 (3.67) | 10.28 (3.75) | 9.92 (3.59) | 0.55 | 0.58 | 0.01 | 0.62 | 1.00 | 0.78 |
Neuroticism | 0.77 | 12.12 (3.33) | 12.14 (3.71) | 12.4 (3.45) | 0.14 | 0.87 | 0.00 | 1.00 | 0.86 | 0.87 |
Openness | 0.74 | 14.51 (3.04) | 15.21 (3.37) | 15.04 (3.19) | 2.96 | 0.05 | 0.04 | 0.04 | 0.53 | 0.93 |
Resilience | 0.92 | 24.19 (7.27) | 24.81 (7.51) | 24.34 (9.25) | 0.44 | 0.65 | 0.01 | 0.63 | 0.99 | 0.93 |
Intolerance | 0.91 | 27.64 (7.08) | 27.81 (7.27) | 29.19 (8.10) | 0.80 | 0.45 | 0.01 | 0.96 | 0.42 | 0.48 |
Reactance | 0.90 | 2.95 (0.60) | 2.45 (0.62) | 3.23 (0.60) | 58.33 | <0.001 | 0.45 | <0.001 | 0.01 | <0.001 |
Cognitive Ability and Decision Making | ||||||||||
EAT Accuracy | 0.72 | 62.62 (20.01) | 69.34 (18.6) | 61.45 (22.03) | 8.62 | <0.001 | 0.11 | <0.001 | 0.94 | 0.04 |
CRT Accuracy | 0.67 | 47.44 (35.26) | 50.42 (34.44) | 46.7 (37.35) | 0.56 | 0.57 | 0.01 | 0.63 | 0.99 | 0.77 |
Bullshit receptivity | 0.91 | 2.38 (0.90) | 2.22 (0.87) | 2.28 (0.88) | 1.77 | 0.17 | 0.02 | 0.14 | 0.76 | 0.89 |
Political, Cultural and Social Attitudes | ||||||||||
Conservatism | 0.62 | 3.31 (0.75) | 2.92 (0.91) | 3.51 (0.86) | 19.12 | <0.001 | 0.21 | <0.001 | 0.28 | <0.001 |
Conspiracy mentality | 0.83 | 4.36 (0.83) | 3.95 (0.90) | 4.89 (0.96) | 29.91 | <0.001 | 0.30 | <0.001 | 0.001 | <0.001 |
Persecution | 0.89 | 2.42 (0.94) | 2.03 (0.83) | 2.39 (0.88) | 12.53 | <0.001 | 0.15 | <0.001 | 0.98 | 0.02 |
Need for Chaos | 0.81 | 2.16 (0.98) | 1.65 (0.71) | 2.32 (1.15) | 25.49 | <0.001 | 0.29 | <0.001 | 0.63 | <0.001 |
Cultural Tightness | 0.67 | 4.1 (0.53) | 4.16 (0.61) | 4.59 (0.58) | 15.24 | <0.001 | 0.18 | 0.48 | <0.001 | <0.001 |
Amorality | 0.66 | 2.45 (0.60) | 2.11 (0.55) | 2.75 (0.61) | 38.34 | <0.001 | 0.36 | <0.001 | 0.005 | <0.001 |
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Share and Cite
Kleitman, S.; Fullerton, D.J.; Law, M.K.H.; Blanchard, M.D.; Campbell, R.; Tait, M.-A.; Schulz, J.; Lee, J.; Stankov, L.; King, M.T. The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia. Vaccines 2023, 11, 907. https://doi.org/10.3390/vaccines11050907
Kleitman S, Fullerton DJ, Law MKH, Blanchard MD, Campbell R, Tait M-A, Schulz J, Lee J, Stankov L, King MT. The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia. Vaccines. 2023; 11(5):907. https://doi.org/10.3390/vaccines11050907
Chicago/Turabian StyleKleitman, Sabina, Dayna J. Fullerton, Marvin K. H. Law, Matthew D. Blanchard, Rachel Campbell, Margaret-Ann Tait, Jennifer Schulz, Jihyun Lee, Lazar Stankov, and Madeleine T. King. 2023. "The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia" Vaccines 11, no. 5: 907. https://doi.org/10.3390/vaccines11050907