ArticleBMC public health2025
COVID-19 vaccine hesitancy continuum and its psycho-behavioral predictive models among general population: a cross-sectional study in Ethiopia.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe COVID-19 vaccine hesitancy continuum reflects an individual decision-making process regarding vaccination, ranging from fully willing to accept the vaccine to outright refusal. This study assessed COVID-19 vaccine hesitancy and compared the explanatory power of selected psycho-behavioral models for its variability among adults living in Southwest Ethiopia.
methodsA community-based cross-sectional study was conducted in Southwest Ethiopia from January 1 to 15, 2022. The calculated sample size was 879. A multistage sampling technique was used to select study participants. Data were collected using an interviewer-administered questionnaire comprising four sections: socio-demographic characteristics, COVID-19-related covariates, psycho-behavioral constructs, and a vaccine hesitancy scale. The data were entered into Epi-Data, and analysis was performed using Python in Jupyter Notebook. Descriptive statistics and hierarchical multiple linear regression were performed to compare the predictive ability of four psycho-behavioral models: the health belief model (perceived susceptibility, severity, benefit, barrier, and cues to actions); the theory of planned behavior (attitudes, subjective norms, behavioral control, and anticipated regret); five psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility); and vaccine conspiracy belief (conspiracy related to infection and the vaccine). Model comparison was done using adjusted R-squared and model selection criteria.
resultsThe mean age of the participants was 31.63 ± 8.28, and 365 (44.3%) of them were female. The mean score of the COVID-19 vaccine hesitancy continuum was 5.11 ± 2.41. Among the respondents, 91 (11%) were fully willing to accept the COVID-19 vaccine, while 97 (11.8%) were completely resistant. The remaining 624 (77.18%) participants were hesitant to make a decision about vaccination. The vaccine conspiracy belief demonstrated the most predictive ability (adjusted R2 = 0.43), followed by the 5C psychological antecedent (adjusted R2 = 0.36), the theory of planned behavior (adjusted R2 = 0.26), and the health belief model (adjusted R2 = 0.20).
conclusionCOVID-19 vaccine hesitancy in Ethiopia is most predicted by vaccine conspiracy belief. Therefore, public health intervention should focus on addressing misinformation and conspiracy narratives.
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