Lessons learned from COVID-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy

Yunshu Lu; Quanfang Wang; Shan Zhu; Sen Xu; Muhtar Kadirhaz; Yushan Zhang; Nan Zhao; Yu Fang; Jie Chang

doi:10.1016/j.socscimed.2023.116270

Lessons learned from COVID-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy

Soc Sci Med. 2023 Nov:336:116270. doi: 10.1016/j.socscimed.2023.116270. Epub 2023 Sep 26.

Authors

Yunshu Lu¹, Quanfang Wang², Shan Zhu³, Sen Xu¹, Muhtar Kadirhaz¹, Yushan Zhang¹, Nan Zhao¹, Yu Fang¹, Jie Chang⁴

Affiliations

¹ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an, China.
² Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Xi'an Municipal Health Commission, Xi'an, China.
⁴ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an, China. Electronic address: jiechang@xjtu.edu.cn.

PMID: 37778145
DOI: 10.1016/j.socscimed.2023.116270

Abstract

Background: Enhancing the public's vaccine literacy is critical for curbing vaccine hesitancy and enhancing society's pandemic preparedness, particularly in an era of infodemic. Evidence on vaccine literacy as an influencing factor of hesitancy is scarce. Lessons could be learned from COVID-19 vaccination implementation. Taking the COVID-19 vaccines as an example, the current study aimed to examine the relationship between vaccine literacy and hesitancy and the mediating role of psychological antecedents of vaccination on the relationship.

Methods: A baseline online questionnaire survey among the general public in China based on quota sampling was conducted in April 2021 to measure participants' vaccine literacy, psychological antecedents of vaccination, COVID-19 vaccination status, and vaccine hesitancy. A follow-up online survey tracked the updated COVID-19 vaccination status among those who hadn't taken COVID-19 vaccines at the baseline survey. Structural equation modeling has been applied to examine the direct and indirect effect of vaccine literacy on vaccine hesitancy. Time-to-event analysis was used to explore the effect of vaccine hesitancy on vaccination behavior.

Results: Lower vaccine hesitancy was associated with higher vaccine literacy. The "3Cs" psychological antecedents were important mediators between vaccine literacy and vaccine hesitancy. The pathway between critical/interactive vaccine literacy and vaccine hesitancy through the "3Cs" psychological antecedents played a more important role. Time-to-event analysis showed participants with a higher vaccine hesitancy were prone to have a longer delay in vaccination.

Conclusions: Improving the public's ability to obtain and evaluate vaccination information can fix the public's psychological determinants of vaccination, reducing vaccine hesitancy and promoting vaccination. Governments need to put more effort into guiding and regulating the media to disseminate evidence-based information, rectifying misinformation, and improving the public's vaccine literacy through education, especially the public's capability to critically discern mixed information.

Keywords: COVID-19 vaccination; China; Mediating role; Structural equation modeling; Vaccine hesitancy; Vaccine literacy.

Publication types

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

MeSH terms

COVID-19 Vaccines / therapeutic use
COVID-19* / prevention & control
Humans
Literacy
Vaccination
Vaccination Hesitancy
Vaccines*

Substances

COVID-19 Vaccines
Vaccines