Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Ramy Mohamed Ghazy; Marwa Shawky Abdou; Salah Awaidy; Malik Sallam; Iffat Elbarazi; Naglaa Youssef; Osman Abubakar Fiidow; Slimane Mehdad; Mohamed Fakhry Hussein; Mohammed Fathelrahman Adam; Fatimah Saed Alabd Abdullah; Wafa Kammoun Rebai; Etwal Bou Raad; Mai Hussein; Shehata F Shehata; Ismail Ibrahim Ismail; Arslan Ahmed Salam; Dalia Samhouri

doi:10.3390/ijerph191912136

Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Int J Environ Res Public Health. 2022 Sep 25;19(19):12136. doi: 10.3390/ijerph191912136.

Authors

Ramy Mohamed Ghazy¹, Marwa Shawky Abdou², Salah Awaidy³, Malik Sallam^{4

5

6}, Iffat Elbarazi⁷, Naglaa Youssef⁸, Osman Abubakar Fiidow⁹, Slimane Mehdad¹⁰, Mohamed Fakhry Hussein¹¹, Mohammed Fathelrahman Adam¹², Fatimah Saed Alabd Abdullah¹³, Wafa Kammoun Rebai¹⁴, Etwal Bou Raad^{15

16}, Mai Hussein^{17

18}, Shehata F Shehata^{19

20}, Ismail Ibrahim Ismail²¹, Arslan Ahmed Salam²², Dalia Samhouri²³

Affiliations

¹ Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt.
² Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt.
³ Health Affairs, Ministry of Health, Muscat 100, Oman.
⁴ Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan.
⁵ Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan.
⁶ Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden.
⁷ Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, AlAin 15551, United Arab Emirates.
⁸ Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia.
⁹ School of Public Health and Research, Somali National University, Mogadishu P.O. Box 15, Somalia.
¹⁰ Physiology and Physiopathology Research Team, Research Centre of Human Pathology Genomics, Faculty of Sciences, Mohammed V University, Rabat BP 8007, Morocco.
¹¹ Occupational Health and Industrial Medicine Department, High Institute of Public Health, Alexandria University, Alexandria 21526, Egypt.
¹² Faculty of Pharmacy, University of Science and Technology, Khartoum P.O. Box 12810, Sudan.
¹³ Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt.
¹⁴ Institute Pasteur de Tunis, Tunis 2092, Tunisia.
¹⁵ Department of Epidemiology and Population Health, American University of Beirut, Beirut P.O. Box 110236, Lebanon.
¹⁶ School of Pharmacy, Lebanese International University, Beirut P.O. Box 146404, Lebanon.
¹⁷ Clinical Research Administration, Alexandria Directorate of Health Affairs, Egyptian Ministry of Health and Population, Alexandria 21554, Egypt.
¹⁸ Harvard Medical School, Boston, MA 02115, USA.
¹⁹ Department of Family and Community Medicine, King Khalid University, Abha 62529, Saudi Arabia.
²⁰ Biostatistics Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt.
²¹ Department of Neurology, Ibn Sina Hospital, Gamal Abdel Nasser Street, Sabah Medical Area, Safat 070001, Kuwait.
²² National Institute of Health, Islamabad 45320, Pakistan.
²³ Emergency Preparedness and International Health Regulations, WHO EMRO (DS), P.O. Box 7608, Naser City 11371, Egypt.

Abstract

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

Keywords: COVID-19 vaccine; East Mediterranean region; booster dose acceptance; health belief model; vaccine hesitancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Cross-Sectional Studies
Developed Countries
Health Knowledge, Attitudes, Practice
Humans
Immunization, Secondary
Vaccination

Substances

COVID-19 Vaccines

Supplementary concepts

COVID-19 vaccine booster shot

Grants and funding

This research received no external funding.