Prevalence and factors of COVID-19 vaccine refusal among solid cancer patients in China: an application of the health belief model

Zhaomin Xie; Joseph Tak-Fai Lau; Yuanke Liang; Qiaolei Ouyang; Junjia Chen; Si Lin; Kaitao Yao; Xuanyin Hu; Haoyu Lin; Yanqiu Yu; De Zeng

doi:10.3389/fpubh.2023.1236376

Prevalence and factors of COVID-19 vaccine refusal among solid cancer patients in China: an application of the health belief model

Front Public Health. 2023 Aug 3:11:1236376. doi: 10.3389/fpubh.2023.1236376. eCollection 2023.

Authors

Zhaomin Xie^{1

2

3}, Joseph Tak-Fai Lau^{4

5

6

7}, Yuanke Liang⁸, Qiaolei Ouyang⁹, Junjia Chen⁹, Si Lin⁹, Kaitao Yao⁹, Xuanyin Hu⁹, Haoyu Lin⁸, Yanqiu Yu¹⁰, De Zeng^{2

3}

Affiliations

¹ School of Public Health, Shantou University, Shantou, China.
² Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
³ Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
⁴ School of Mental Health, Wenzhou Medical University, Wenzhou, China.
⁵ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
⁶ School of Public Health, Zhejiang University, Hangzhou, China.
⁷ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
⁸ Department of Thyroid and Breast Surgery, Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China.
⁹ Shantou University Medical College, Shantou, China.
¹⁰ Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China.

Abstract

Introduction: It is essential to protect cancer patients from contracting COVID-19 through vaccination. A majority of cancer patients are recommended by international health authorities to take up the vaccines. COVID-19 vaccine refusal among cancer patients during the pandemic period is under-researched. This study investigated factors of vaccine refusal based on the Health Belief Model (HBM).

Methods: A cross-sectional study was conducted among female breast cancer patients, male/female thyroid cancer patients, and gynecological cancer patients in Shantou, China from April to August 2022 (n = 1,115). Multinomial logistic regression analysis adjusted for socio-demographics was conducted to test factors of COVID-19. Adjusted odds ratios of the two models comparing vaccine refusal vs. "vaccine non-refusal" and vaccine refusal vs. ever-vaccination were derived and presented.

Results: Of all the participants, the prevalence of vaccine refusal, "vaccine non-refusal," and ever-vaccination was 25.9, 22.2, and 51.8%, respectively. In both multinomial logistic regression models, significant factors of vaccine refusal included socio-demographics (age, education level, employment status, monthly household income, cancer type, duration since cancer diagnosis, current treatment status) and some vaccine-related HBM (perceived benefits, perceived barriers, cue to action, and self-efficacy). Perceived severity of COVID-19 was significant only in the vaccine refusal vs. ever-vaccination model. In neither model, perceived susceptibility to contract COVID-19 was statistically significant.

Conclusion: About ¼ of the participants expressed vaccine refusal. Interventions are warranted. Future longitudinal studies are needed to verify this study's findings. Pilot interventions should also be launched to test effectiveness of interventions modifying the significant HBM factors found in this study.

Keywords: COVID-19; cancer patients; health belief model; vaccine; vaccine refusals.

Publication types

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

MeSH terms

Breast Neoplasms*
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
China / epidemiology
Cross-Sectional Studies
Female
Health Belief Model
Humans
Male
Prevalence

Substances

COVID-19 Vaccines