JMIR Publications

ABSTRACT

Background:

Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy.

Objective:

This study was aimed to quantify the co-occurrence of reasons and their relative importance in motivating or demotivating COVID-19 vaccination using a network approach.

Methods:

We conducted a series of random-digit dialling telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5,559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were first coded to generate main categories of motivators and demotivators for COVID-19 vaccination based on the 5C model of vaccine hesitancy. Network analysis was conducted to quantify the co-occurrence and relative importance of reasons for motivating and demotivating for COVID-19 vaccination.

Results:

The co-occurrence network analysis found that perception of personal risk to the disease and the social responsibility to protect others were the most important co-mentioned reasons for motivating COVID-19 vaccination, while lack of vaccine confidence and complacency (perceived low disease risk and low importance of vaccination) were the most important co-mentioned reasons for demotivating COVID-19 vaccination. For older people, protecting others was a more important motivator while concerns about poor health status was a more important demotivator; and for young people, recovering life normalcy and vaccine mandates were the more important motivators while complacency was a more important demotivator, for COVID-19 vaccination uptake.

Conclusions:

When disease risk is perceived to be high, promoting the social responsibility to protect others for boosting vaccination acceptance, but when disease risk is perceived to be low and complacency exists, addressing confidence in vaccines for addressing vaccine hesitancy, become more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age.