JMIR Publications

ABSTRACT

Background:

Social norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior.

Objective:

We aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy.

Methods:

A total of 44,339 participants aged over 18 years were enrolled from 28 different countries between 2020 and 2022. We used Vaccine Confidence Index to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence.

Results:

Vietnam exhibited the highest level of confidence on COVID-19 vaccine and Slovakia had the lowest level. The cultural tightness ranged from -0.60 (Hungary) to 0.73 (India). The higher levels of cultural tightness were positively linked to greater vaccine confidence (β: 0.286, 95% CI: 0.096, 0.475, P=0.018) after controlling individual- and national- level individuals. Age, sex, education level, religious beliefs, and individual perceptions were found to be associated with vaccine confidence. Individualism was found to be negatively associated with high vaccine confidence (β: -0.310, 95% CI: -0.547, -0.072, P=0.036).

Conclusions:

Lower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy.