The spread of coronavirus disease 2019 (COVID-19) can be stopped or slowed by implementing several strategies such as mass vaccination, wearing masks, and usage of tracer apps. But the success of these strategies depends on the capacity and commitment of individuals to accept the strategies and change their behaviors accordingly.
Study: Predicting willingness to be vaccinated for Covid-19: evidence from New Zealand. Image Credit: Mirza Kadic/ Shutterstock
The failure to achieve high rates of COVID-19 vaccination can lead to repeated lockdowns and increased hospitalization due to severe COVID-19 infections. Therefore, the effectiveness of mass vaccination programs depends on the willingness of individuals to participate in the program.
Previous studies indicate that the beliefs and attitudes of people towards vaccination played an important role in people's acceptance of vaccines and their willingness to be vaccinated. The current study has culminated in the development of models such as the 5C model to explain vaccine hesitancy, where the five components stand for confidence, calculation, constraints, complacency, and collective responsibility. Since most of the components depend on awareness and beliefs, education and promotions were considered fundamental in changing these awareness, beliefs, and attitudes which would encourage more people to participate in vaccination programs. The current study implemented the I3 Framework to determine the willingness of New Zealanders to be vaccinated against COVID-19
The I3 Framework
The I3 Framework proposed that the response of people to policy measures can be guided by two ways, involvement with the relevant policy outcome and attitude towards the policy measure itself. The framework enabled decomposition of the overall involvement with a policy outcome and corresponding measures. It also helped to distinguish between the involvement of different measures. It provided a closer analysis of the role of beliefs held by individuals that serve as important context for attitudes.
The responses of people to policy could be divided into four quadrants. People from quadrant one had low involvement with both policy outcome and measure. They were also indifferent to confidence in vaccines. People from quadrant two had high involvement with the policy outcome but low involvement with the measure and were unsure or indifferent concerning confidence in vaccines.
People from quadrant three had high involvement with both the policy outcome and the measure. They could be polarized with respect to vaccine hesitancy. People in quadrant four exhibited low involvement with the policy outcome but high involvement with the measure and could be polarized regarding vaccine hesitancy.
Therefore, the I3 Framework helped predict people's compliance with policy measures such as willingness to participate in a mass vaccination program and provided ways to enhance that compliance. This Framework has been used to predict and understand compliance behavior in agriculture, rural and urban predator control, and community support for predator control.
COVID-19 in New Zealand
The first case of COVID-19 was detected on February 28, 2020, in New Zealand, following which the country closed its international borders to all except returning citizens and permanent residents. The government imposed a restrictive strategy along with several control measures to reduce the transmission of the virus.
The government started a mass vaccination program against COVID-19 in February 2021 that was campaigned using traditional and social media. The current study took place during the first and second week of March 2021, when full-fledged vaccination had begun.
A new study published in the pre-print server medRxiv* involved the I3 Response Framework for the prediction of how strongly New Zealanders were motivated to get vaccinated against COVID-19. The study investigated the stability and strength of New Zealander's attitudes towards vaccination. Also, it indicated the attentiveness of New Zealander's to education and promotional activities that would encourage people for mass vaccination programs.
About the study
The study involved respondents who had to fill out a questionnaire that was designed based on the I3 Response Framework. The involvement was measured by a specialized involvement scale where respondents had to rate two statements on each of the five components of involvement (functional, experiential, identity-based, risk-based, and consequence-based). The respondents could indicate their agreement with the help of a five-point rating that ranged from disagree (1) to strongly agree (5).
The strength of respondents' attitudes depended on the strength of their involvement, which was also measured. Other information such as demographic characteristics of the respondents, including their age, ethnicity, education, and willingness to get a vaccination, was also collected.
Furthermore, participation in the survey was voluntary; respondents were allowed to leave anytime they wanted. Also, the survey questions were optional and could be skipped. The questionnaire was distributed randomly by a few New Zealanders who belonged to an online consumer panel. A total of 1002 completed responses were reported, out of which 53 percent were from women and 47 percent from men.
The study took place from March 4 to March 15, 2021. Auckland was under Alert 2, where the people had to wear masks and maintain social distancing. The rest of the country was under Alert 1, where wearing masks and maintaining social distancing were not mandatory. Furthermore, the study assumed that most of the respondents were aware of COVID-19 and the government's intention to implement a mass vaccination program.
The study also reported some social desirability bias in self-reporting behaviors for both high and low involvement groups for COVID-19 elimination. However, further investigation is required on the interaction between involvement and social desirability. Finally, the involvement and attitude scores were calculated, and the respondents were classified into belief segments based on their agreement ratings.
The results indicated that most of the respondents showed moderate to high involvement with eliminating COVID-19 from New Zealand and getting vaccinated. Therefore, they were placed in quadrant three as per the I3 response Framework. However, a minority of participants showed low-to-mild involvement with getting vaccinated and thus were placed in quadrants 1 and 2.
Furthermore, most respondents showed a favorable attitude towards vaccination, while those in quadrants 1 and 2 were unsure about getting vaccinated. Additionally, some relationships were found between the I3 Framework and the 5C model. Comparison of respondents in quadrant three to those in quadrant one indicated that the latter was less confident about the safety of the COVID-19 vaccines, showed less complacency, believed the vaccination to be impractical, consulted fewer traditional and social media, and were unsure whether healthier and younger people need to be vaccinated.
The beliefs of respondents were investigated as they helped to guide the design of the policies. Modification of beliefs and attitudes that underlie compliance could influence compliance. The respondents were classified into belief segments based on the nature of COVID-19 and the advantages and disadvantages of COVID-19 vaccines.
The different segments included beliefs about COVID-19, eliminating COVID-19, and getting vaccinated for COVID-19. They were associated with demographic characteristics such as ethnicity, age, income, and education.
Belief segments for COVID-19
The respondents were divided into five belief segments. The beliefs of most of the respondents aligned with the scientific facts. They were classified as 'COVID-19 convinced' and 'COVID-19 moderates'. The beliefs of 'COVID-19 asymptomatics' mostly aligned with the scientific facts, but they disagreed that COVID-19 could spread by people coughing and sneezing or by contact with surfaces that infected people touched. 'COVID-19 ambivalents' were unsure about what to believe regarding COVID-19, while 'COVID-19 skeptics' believed COVID-19 to be a hoax.
Belief segments for eliminating COVID-19
The respondents were divided into four segments for eliminating COVID-19. Most of their beliefs aligned with seeking to eliminate COVID-19. They were classified as 'elimination enthusiasts' and 'elimination moderates.' 'Vaccination hopefuls' also wanted to eliminate COVID-19 from New Zealand but were unsure how long can COVID-19 be kept out of New Zealand indefinitely. At the same time, 'elimination skeptics' believed COVID-19 could not be eliminated indefinitely.
Belief segments for COVID-19 vaccination
The respondents were classified into five belief segments with respect to being vaccinated. Most of the respondents were classified as 'vaccine enthusiasts' and 'vaccine moderates.' They believed that for vaccinated individuals, the recovery from COVID-19 would be faster, and they would have weaker symptoms. They also believed that vaccination should be made compulsory and free.
The 'vaccination cautious' segment was concerned about the vaccine's side effects, and believed individuals at risk should not be vaccinated. The 'vaccination ambivalent' segment was unsure about the protection provided by the COVID-19 vaccines and their safety. The fifth segment, 'vaccination skeptics,' believed that vaccines were not beneficial.
Governments around the world are implementing mass vaccination programs to reduce the spread of COVID-19. The success of such programs depends on the commitment of individuals to respond and participate. The results of the current study in New Zealand highlight that beliefs strongly influenced the respondents' attitudes towards elimination COVID-19 about the effectiveness of an elimination strategy as well as confidence in vaccination. The willingness to get vaccinated was also influenced by beliefs about COVID-19 vaccination and involvement with and attitude towards vaccination.
The study had certain limitations. First, the attitude, behavior, and beliefs regarding preventing COVID-19 spread and vaccination might have changed over time. Second, there might be a presence of selection bias and social desirability bias. Third, adopting behaviors such as being vaccinated has been associated with a range of variables such as the local incidence rate of COVID-19, perceived risk of infection, and feelings of stress concerning COVID-19. All these variables were not included in the study.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.