The Willingness toward Vaccination: A Focus on Non-mandatory Vaccinations

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Human Vaccines and Public Health".

Deadline for manuscript submissions: closed (31 July 2024) | Viewed by 24299

Special Issue Editors


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Guest Editor
Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, 40138 Bologna, Italy
Interests: epidemiology; vaccines; survey research; perceptions on public health; social studies; panel analysis; machine learning

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Guest Editor
Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, 40138 Bologna, Italy
Interests: epidemiology; vaccines; machine learning; clinical decision support systems; health services research

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Guest Editor
1. Department of Health Promotion, Maternal and Child Care, Internal Medicine and Excellence Specialties, University of Palermo, 90127 Palermo, Italy
2. Vaccination Unit, University Hospital of Palermo, Palermo, Italy
Interests: vaccination; vaccines; vaccine hesitancy; vaccine outreach; vaccine communication; paediatric vaccination; adolescent vaccination; adult vaccination; elderly vaccination
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Guest Editor
Department of Health Promotion, Maternal and Child Care, "G. D'Alessandro", University of Palermo, 90133 Palermo, Italy
Interests: vaccination; vaccine hesitancy; adolescents vaccination; pediatric vaccination; adult vaccination; mental health; infectious disease epidemiology; surveillance; infectious disease control and prevention; evidence based medicine; screening cancer; screening childhood obesity; obesity; health; cancer epidemiology

Special Issue Information

Dear Colleagues,

In loving memory of Dr. Elisa Maietti, our first-invited editor for this Special Issue. She was a cherished colleague, exceptional statistician, and devoted researcher who played a crucial role in shaping this article. Her intellect, passion, and steadfast dedication to scientific rigor have left a lasting impression on our work and approach to science. We are deeply grateful for her contributions and honored to have had the opportunity to collaborate with her. Dr. Maietti’s presence will be profoundly missed in our academic community, but her spirit will live on through her enduring impact on the field. To honor her memory, we have chosen to list her as the first-invited editor here. Rest in peace, Elisa.

The decision to receive non-mandatory vaccinations is left to the choice of the individual. Even if they are offered free of charge, these vaccinations can be overlooked by the general population, whose judgment is heavily influenced not only by individual characteristics, but also by numerous reasonable and unreasonable external factors.

When governments do not coerce citizens to get vaccinated, the full effect of vaccine hesitancy can be observed, eventually bringing the level of herd immunity to zero.

To further explore the topic of willingness to get vaccinated, as well as vaccine hesitancy, in this Special Issue, we would like to encourage the submission of articles that explore how external and internal factors can influence the decision-making process of every individual in one way or another.

Whether the COVID-19 pandemic has had an effect on willingness toward other vaccinations, especially non-mandatory ones such as influenza and HPV vaccines, is still debated, and therefore, papers that compare the actual vaccination rate or intentions with historic, pre-COVID-19 data for a particular non-mandatory vaccine are welcomed.

Dr. Angelo Capodici
Dr. Francesco Sanmarchi
Dr. Claudio Costantino
Dr. Nicole Bonaccorso
Guest Editors

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Keywords

  • willingness
  • hesitancy
  • risk factors
  • COVID
  • society
  • herd immunity

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Published Papers (11 papers)

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Editorial

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4 pages, 191 KiB  
Editorial
The Willingness toward Vaccination: A Focus on Non-Mandatory Vaccinations
by Angelo Capodici, Francesco Sanmarchi, Nicole Bonaccorso, Claudio Costantino and Elisa Maietti
Vaccines 2023, 11(4), 828; https://doi.org/10.3390/vaccines11040828 - 11 Apr 2023
Cited by 2 | Viewed by 1282
Abstract
The Special Issue “The Willingness toward Vaccination: A Focus on Non-mandatory Vaccinations”, published in the journal Vaccines, has the main aim of gathering more data on vaccine hesitancy and the willingness of individuals to receive vaccinations, particularly in the context of non-mandatory vaccines. [...] Read more.
The Special Issue “The Willingness toward Vaccination: A Focus on Non-mandatory Vaccinations”, published in the journal Vaccines, has the main aim of gathering more data on vaccine hesitancy and the willingness of individuals to receive vaccinations, particularly in the context of non-mandatory vaccines. The aim is to address vaccine hesitancy and improve vaccine coverage rates, in addition to identifying the determinants of vaccine hesitancy itself. This Special Issue garners articles that examine the external and internal factors that can influence the decision-making process of individuals regarding vaccination. Given that vaccine hesitancy is present in a significant part of the general population, it is crucial to have a better analytical understanding of the areas where hesitancy arises to determine appropriate strategies to address this issue. Full article

Research

Jump to: Editorial

14 pages, 1504 KiB  
Article
Trends in Influenza Vaccination Rates among a Medicaid Population from 2016 to 2021
by Behzad Naderalvojoud, Nilpa D. Shah, Jane N. Mutanga, Artur Belov, Rebecca Staiger, Jonathan H. Chen, Barbee Whitaker and Tina Hernandez-Boussard
Vaccines 2023, 11(11), 1712; https://doi.org/10.3390/vaccines11111712 - 11 Nov 2023
Viewed by 1681
Abstract
Seasonal influenza is a leading cause of death in the U.S., causing significant morbidity, mortality, and economic burden. Despite the proven efficacy of vaccinations, rates remain notably low, especially among Medicaid enrollees. Leveraging Medicaid claims data, this study characterizes influenza vaccination rates among [...] Read more.
Seasonal influenza is a leading cause of death in the U.S., causing significant morbidity, mortality, and economic burden. Despite the proven efficacy of vaccinations, rates remain notably low, especially among Medicaid enrollees. Leveraging Medicaid claims data, this study characterizes influenza vaccination rates among Medicaid enrollees and aims to elucidate factors influencing vaccine uptake, providing insights that might also be applicable to other vaccine-preventable diseases, including COVID-19. This study used Medicaid claims data from nine U.S. states (2016–2021], encompassing three types of claims: fee-for-service, major Medicaid managed care plan, and combined. We included Medicaid enrollees who had an in-person healthcare encounter during an influenza season in this period, excluding those under 6 months of age, over 65 years, or having telehealth-only encounters. Vaccination was the primary outcome, with secondary outcomes involving in-person healthcare encounters. Chi-square tests, multivariable logistic regression, and Fisher’s exact test were utilized for statistical analysis. A total of 20,868,910 enrollees with at least one healthcare encounter in at least one influenza season were included in the study population between 2016 and 2021. Overall, 15% (N = 3,050,471) of enrollees received an influenza vaccine between 2016 and 2021. During peri-COVID periods, there was an increase in vaccination rates among enrollees compared to pre-COVID periods, from 14% to 16%. Children had the highest influenza vaccination rates among all age groups at 29%, whereas only 17% were of 5–17 years, and 10% were of the 18–64 years were vaccinated. We observed differences in the likelihood of receiving the influenza vaccine among enrollees based on their health conditions and medical encounters. In a study of Medicaid enrollees across nine states, 15% received an influenza vaccine from July 2016 to June 2021. Vaccination rates rose annually, peaking during peri-COVID seasons. The highest uptake was among children (6 months–4 years), and the lowest was in adults (18–64 years). Female gender, urban residency, and Medicaid-managed care affiliation positively influenced uptake. However, mental health and substance abuse disorders decreased the likelihood. This study, reliant on Medicaid claims data, underscores the need for outreach services. Full article
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18 pages, 3086 KiB  
Article
Opinions, Attitudes and Factors Related to SARS-CoV-2 Vaccine Uptake in Eight South American Countries
by Analía Urueña, Ricardo Machado, Juarez Cunha, Clara López Colmano, Carolina Rancaño, Renato Kfouri, Catalina Pírez, Pablo Bonvehí, Mario Calvo, Robinson Cuadros, Greta Muñoz, Mónica Rodríguez, Jaime Torres, Florencia Cahn and Isabella Ballalai
Vaccines 2023, 11(11), 1660; https://doi.org/10.3390/vaccines11111660 - 30 Oct 2023
Cited by 2 | Viewed by 1854
Abstract
This article presents attitudes and practices regarding COVID-19 vaccination in the South American population. The study collected data from a self-administered survey distributed through social media platforms between February and April 2022 (N = 6555). The survey included questions related to participants’ [...] Read more.
This article presents attitudes and practices regarding COVID-19 vaccination in the South American population. The study collected data from a self-administered survey distributed through social media platforms between February and April 2022 (N = 6555). The survey included questions related to participants’ sociodemographic background, flu vaccination practices, sources of information about COVID-19, and opinions regarding pandemic management and vaccination against SARS-CoV-2. The respondents agreed with the statement that COVID-19 vaccines were necessary (86.4%), effective (79.8%), safe (79.1%), and should be mandatory (64%). Overall, 83.4% accepted vaccination and 12.3% refused it completely. Main rejection reasons were safety (65.8%) and efficacy (54.9%) issues, and rushed development and approvals (49.1%). Vaccine uptake was associated with being ≥60 years, being a healthcare worker, previous influenza vaccine uptake, adherence to preventive measures, the death of ≥1 close people from COVID-19, and being informed through mass media or health authorities’ channels. Vaccine uptake inversely correlated with male gender, low educational level, and use of closed social networks for COVID-19 information purposes. This study provides valuable insights into COVID-19 vaccination attitudes and practices in South America that may be used to promote vaccine uptake in the region. Higher COVID-19 vaccination acceptance among people with previously acquired prevention habits reinforces the importance of routine health promotion strategies. Full article
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20 pages, 4349 KiB  
Article
Stakeholders’ Understanding of European Medicine Agency’s COVID-19 Vaccine Information Materials in EU and Regional Contexts
by Indiana Castro, Marie Van Tricht, Nicole Bonaccorso, Martina Sciortino, Juan Garcia Burgos, Claudio Costantino and Rosa Gonzalez-Quevedo
Vaccines 2023, 11(10), 1616; https://doi.org/10.3390/vaccines11101616 - 19 Oct 2023
Cited by 2 | Viewed by 1763
Abstract
The COVID-19 pandemic posed challenges to communicating accurate information about vaccines because of the spread of misinformation. The European Medicines Agency (EMA) tried to reassure the public by communicating early on about the development and approval of COVID-19 vaccines. The EMA surveyed patients/consumers, [...] Read more.
The COVID-19 pandemic posed challenges to communicating accurate information about vaccines because of the spread of misinformation. The European Medicines Agency (EMA) tried to reassure the public by communicating early on about the development and approval of COVID-19 vaccines. The EMA surveyed patients/consumers, healthcare professional organizations, and individual stakeholders, both at the EU level and in an Italian regional context. The objectives of the study were to see if the EMA’s core information materials were informative and well-understood and which communication channels were preferred by the public. The main findings showed that individual patients/consumers generally prefer to obtain information about COVID-19 vaccines from the internet or mass media, while organizations and individual healthcare professionals prefer to obtain information from national and international health authorities. Both at EU and local levels, participants had a good understanding of the key messages from regulators and found the materials useful and relevant. However, some improvements were recommended to the visual, text, and dissemination formats, including publishing more information on safety and using a more public-friendly language. Also, it was recommended to maintain the EMA’s approach of using media, stakeholder engagement, and web-based formats to communicate about COVID-19 vaccines. In conclusion, user-testing of proactive communication materials aimed to prebunk misinformation during a public health crisis helps to ensure that users understand the development and safety of novel vaccine technologies. This information can then be used as a basis for further evidence-based communication activities by regulators and public health bodies in an emergency context. Full article
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17 pages, 340 KiB  
Article
Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States
by Lijiang Shen and Daniel Lee
Vaccines 2023, 11(10), 1597; https://doi.org/10.3390/vaccines11101597 - 15 Oct 2023
Cited by 1 | Viewed by 1386
Abstract
This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. [...] Read more.
This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. Vaccine hesitancy is a major obstacle in the fight against infectious diseases such as COVID-19 and influenza. Predictors of vaccination intention are identified using the reasoned action approach and the integrated behavioral model. Data from two national samples (N = 1131 for COVID-19 and N = 1126 for influenza) were collected from U.S. Qualtrics panels. Tobit regression models were estimated to predict percentage increases in vaccination intention (i.e., confidence) and the probability of vaccination uptake (i.e., intention reaching 100%). The results provided evidence for the reasoned approach and the IBM model and showed that the predictors followed different patterns for COVID-19 and influenza. The implications for intervention strategies and message designs were discussed. Full article
11 pages, 257 KiB  
Article
Determinant Factors of Voluntary or Mandatory Vaccination against COVID-19: A Survey Study among Students at Albanian University
by Elona Kongo, Kleva Shpati, Aida Dama, Sibela Ymeraj, Ema Murati, Uels Veliaj and Sonela Xinxo
Vaccines 2023, 11(7), 1215; https://doi.org/10.3390/vaccines11071215 - 7 Jul 2023
Cited by 1 | Viewed by 2359
Abstract
Introduction: The world faced serious health and socioeconomic issues with the advent of COVID-19. Along with handwashing, social distancing, and the wearing of masks, vaccination was considered by medical authorities as a key way to curb the spread of the virus. One of [...] Read more.
Introduction: The world faced serious health and socioeconomic issues with the advent of COVID-19. Along with handwashing, social distancing, and the wearing of masks, vaccination was considered by medical authorities as a key way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations is the mandatory policy. The purpose of this study was to compare the determinants of voluntary and mandatory vaccination among students at Albanian University. Methodology: This cross-sectional study, conducted by means of an online survey, was conducted among students enrolled at the private Albanian University, Tirana, Albania during the last week of the winter semester, 7–14 February 2022. Results: In sum, 878 students participated in this study, among whom 612 (69.7%) were females and 266 (30%) were males. Of the participants, 506 (57%) were enrolled in medical science (MS) and 372 (42.3%) were in the non-medical science (Non-MS) group. A total of 773 (88%) were vaccinated against COVID-19, and 105 (11.8%) were not vaccinated. A total of 466 (53%) reported voluntary vaccination, and 412 (46.9%) reported mandatory vaccination. Among the students who were vaccinated voluntarily, 266 (57%) were from the MS group and 200 (42.9%) were from the Non-MS group. A total of 237 (57.5%) of students in the mandatory vaccination group were from the MS group, and 175 (42.4%) were from the Non-MS group. Conclusions: Vaccine safety and efficacy were hindering factors in vaccination. Additionally, based on the results of this study, the students felt encouraged by the academic staff to vaccinate. This clearly demonstrates that the staff does not lack the skills to enhance students’ knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence students’ attitudes as much as possible toward vaccination, comprehensive educational programs, including modifications of existing curricula, should be considered. Full article
34 pages, 4691 KiB  
Article
The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia
by Sabina Kleitman, 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
Vaccines 2023, 11(5), 907; https://doi.org/10.3390/vaccines11050907 - 27 Apr 2023
Cited by 5 | Viewed by 3510
Abstract
COVID-19 booster vaccinations have been recommended as a primary line of defence against serious illness and hospitalisation. This study identifies and characterises distinct profiles of attitudes towards vaccination, particularly the willingness to get a booster dose. A sample of 582 adults from Australia [...] Read more.
COVID-19 booster vaccinations have been recommended as a primary line of defence against serious illness and hospitalisation. This study identifies and characterises distinct profiles of attitudes towards vaccination, particularly the willingness to get a booster dose. A sample of 582 adults from Australia completed an online survey capturing COVID-related behaviours, beliefs and attitudes and a range of sociodemographic, psychological, political, social and cultural variables. Latent Profile Analysis (LPA) identified three subgroups: Acceptant (61%), Hesitant (30%) and Resistant (9%). Compared to the Acceptant group, the Hesitant and Resistant groups were less worried about catching COVID-19, used fewer official COVID-19 information sources, checked the news less, were lower on the agreeableness personality dimension and reported more conservatism, persecutory thinking, amoral attitudes and need for chaos. The Hesitant group also reported checking the legitimacy of information sources less, scored lower on the openness to new experiences personality dimension and were more likely than the Resistant and Acceptant groups to report regaining freedoms (e.g., travel) and work requirements or external pressures as reasons to get a booster. The Resistant group were higher on reactance, held more conspiratorial beliefs and rated their culture as being less tolerant of deviance than the Hesitant and Acceptant groups. This research can inform tailored approaches to increasing booster uptake and optimal strategies for public health messaging. Full article
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14 pages, 262 KiB  
Article
A Qualitative Investigation on COVID-19 Vaccine Hesitancy in Neurodivergent Communities
by Laila N. Khorasani, Asal Bastani, Tammy Shen, Gurlovellen Kaur, Nilpa D. Shah, Lucia Juarez, Michelle Heyman, Julie Grassian, An-Chuen Cho and Emily Hotez
Vaccines 2023, 11(5), 895; https://doi.org/10.3390/vaccines11050895 - 25 Apr 2023
Cited by 2 | Viewed by 2856
Abstract
Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization [...] Read more.
Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization and death due to COVID-19, highlighting the need for further research specifically on ND communities. We conducted a qualitative analysis using in-depth interviews with medical professionals, non-medical health professionals and communicators, and ND individuals or their caregivers. Using a thematic coding analysis methodology, trained coders identified major themes according to 24 distinct codes spanning across the categories of (1) barriers to vaccination; (2) facilitators to vaccination; and (3) suggestions for improving vaccine confidence. Qualitative findings identify misinformation, perception of vaccine risk, sensory sensitivities, and structural hardship as the most significant barriers to COVID-19 vaccination. We highlight the importance of accommodations to vaccination for the ND community alongside coordinated efforts by healthcare leaders to direct their communities to accurate sources of medical information. This work will inform the direction of future research on vaccine hesitancy, and the development of programs specific to the ND community’s access to vaccines. Full article
12 pages, 858 KiB  
Article
COVID-19 Vaccine Hesitancy in China: An Analysis of Reasons through Mixed Methods
by Yao Sun, Xi Li and Difan Guo
Vaccines 2023, 11(3), 712; https://doi.org/10.3390/vaccines11030712 - 22 Mar 2023
Cited by 4 | Viewed by 1910
Abstract
This study aims to investigate the causes of COVID-19 vaccine hesitancy among the Chinese population. The LDA model and content analysis were used to analyze the content of COVID-19 vaccine hesitancy expressed by the Chinese on Weibo from 2020 to 2022, the leading [...] Read more.
This study aims to investigate the causes of COVID-19 vaccine hesitancy among the Chinese population. The LDA model and content analysis were used to analyze the content of COVID-19 vaccine hesitancy expressed by the Chinese on Weibo from 2020 to 2022, the leading causes of vaccine hesitancy, and the changes in the reasons for vaccine hesitancy over time. The study found that when the Chinese expressed vaccine hesitancy, it usually involved themes such as information access (18.59%), vaccination services (13.91%), and physical illness (13.24%), and topics such as vaccination process (6.83%), allergic diseases (6.59%), and international news (6.43%). Constraints (35.48%), confidence (17.94%), and calculation (15.99%) are the leading causes of vaccine hesitancy on Weibo. These findings provide a comprehensive picture of how the Chinese express vaccine hesitancy in social media and the reasons and changes for vaccine hesitancy, which can help inspire public health experts, health organizations, or governments in various countries to improve the phenomenon of vaccine hesitancy. Full article
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9 pages, 232 KiB  
Article
COVID-19 Vaccine Booster Dose Acceptance among Older Adults
by Mehmet Akif Sezerol and Selin Davun
Vaccines 2023, 11(3), 542; https://doi.org/10.3390/vaccines11030542 - 24 Feb 2023
Cited by 6 | Viewed by 1982
Abstract
This study aimed to determine the factors that cause individuals between the ages of 65 and 75 to not receive the third dose of a COVID-19 vaccination, to advise those who are hesitant, and to learn their thoughts about taking the third dose. [...] Read more.
This study aimed to determine the factors that cause individuals between the ages of 65 and 75 to not receive the third dose of a COVID-19 vaccination, to advise those who are hesitant, and to learn their thoughts about taking the third dose. (1) Material and Methods: This cross-sectional study was conducted between April and May 2022 among 2383 older adults aged between 65–75 who had never received a COVID-19 booster vaccination, according to the records of the District Health Directorate in the Sultanbeyli district of Istanbul. A three-part questionnaire prepared by researchers was given to the older adults via telephone. For statistical analysis of the data, the Chi-square test was used to compare variables; p < 0.05 was considered statistically significant. (2) Results: This research was completed with 1075 participants, reaching 45% of people aged 65–75 who did not receive the third dose of the COVID-19 vaccine in the region. In total, 64.2% of the participants were female and 35.8% were male, and the mean age was 69.33 ± 2.88. Those who had previously received an influenza vaccine were 1.9 times (95% CI 1.22–2.99) more likely to seek vaccination. Educational status also played a role, as older adults who were uneducated were 0.5 times (95% CI 0.42–0.76) less likely to seek vaccination. In addition, those who stated that lack of time was the reason for not vaccinating were 1.4 times (95% CI 1.01–1.98), and those who did not have it due to forgetting, 5.6 times (95% CI 2.58–12.24), more likely to seek vaccination. (3) Conclusion: This study shows, in detail, the importance of informing older adults, who have not received the third dose of vaccine for COVID-19 and who are in the risk group, as well as those who are not fully vaccinated, about the risks of not being vaccinated. We believe that it is important to vaccinate older patients; further, since immunity conferred by vaccination may decline over time, mortality rates decrease with the administration of additional doses. Full article
9 pages, 656 KiB  
Article
Digital Media Exposure and Health Beliefs Influencing Influenza Vaccination Intentions: An Empirical Research in China
by Qingting Zhao, Hao Yin and Difan Guo
Vaccines 2022, 10(11), 1913; https://doi.org/10.3390/vaccines10111913 - 12 Nov 2022
Cited by 3 | Viewed by 1475
Abstract
The purpose of this study was to investigate whether/how digital media exposure influences people’s intention to influenza vaccination. Through an anonymous online survey, we collected data on Chinese people’s exposure to influenza and influenza vaccine information on digital media platforms and their attitudes [...] Read more.
The purpose of this study was to investigate whether/how digital media exposure influences people’s intention to influenza vaccination. Through an anonymous online survey, we collected data on Chinese people’s exposure to influenza and influenza vaccine information on digital media platforms and their attitudes toward influenza vaccines (N = 600). The structural equation model analysis results strongly support to the research hypotheses and the proposed model. The findings reveal three major themes: (1) digital media exposure significantly influence the susceptibility and severity of influenza. (2) After exposure to digital media, it is helpful to understand the vaccine’s benefits, reduce the barriers to vaccination, and finally improve the intention to vaccination. (3) Users receive cues to action from digital media, and their vaccination intention tends to be positive. These findings explore how digital media exposure influences influenza vaccination intention and may provide insights into vaccine promotion efforts in countries. Research has shown that digital media exposure contributes to getting vaccinated against influenza. Full article
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