Will they, or Won't they? Examining patients' vaccine intention for flu and COVID-19 using the Health Belief Model

Background: The twindemic of influenza and COVID-19 places pharmacists in a position of high-impact to inform and manage vaccination uptake. Given prior vaccine hesitancy in the US and the current high impact of COVID-19 on the population, it is imperative to understand and address factors that drive perceptions and intention to get vaccinated.

Objectives: The objectives of the study were to 1) determine impact of the COVID-19 pandemic on influenza vaccine uptake, on patient perceptions of vaccinations, vaccine intention, and health behaviors and 2) determine vaccine intention through the Health Belief Model.

Methods: An IRB-approved prospective Qualtrics-based survey was administered online to eligible respondents: non-pregnant panel respondents 18 years or older within the United States who could independently complete the entire questionnaire in English. Data analyses included descriptive statistics, psychometric analyses of the 5C and CoBQ tools, one-way ANOVA to compare demographic groups and vaccine intention items with survey scores, and mapping and path analysis of the HBM with one added domain (Decision Making Determinant, DMD).

Results: 525 respondents completed the survey from October 23-29, 2020. Respondents aged 18-49, making less than $20,000 or an undisclosed income, and not having anyone close to them directly affected by COVID-19 showed a significant, negative impact of COVID-19 on health behavior and a significantly lower vaccine acceptance. The 5C and CoBQ showed moderately strong reliability. Mapping for the HBM revealed significant correlations between all modifying factors with Individual Perceptions except for Race/Ethnicity. Of the Individual Perceptions, Perceived Benefits (-.114) and Perceived Barriers (.307) significantly predicted DMD and directly impacted Vaccine Intention. DMD was not a significant mediator of Vaccination Intention.

Conclusions: Vaccination messaging should focus on a simple yet balanced view of benefits and risks, targeting those under age 50 and living in low-income households, to motivate uptake of influenza and COVID-19 vaccines.