Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

Carly Meyer; Louis Goffe; Vivi Antonopoulou; Fiona Graham; Mei Yee Tang; Jan Lecouturier; Aikaterini Grimani; Paul Chadwick; Falko F Sniehotta

doi:10.1016/j.vaccine.2023.02.047

Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

Vaccine. 2023 Apr 6;41(15):2466-2475. doi: 10.1016/j.vaccine.2023.02.047. Epub 2023 Feb 17.

Authors

Carly Meyer¹, Louis Goffe², Vivi Antonopoulou³, Fiona Graham², Mei Yee Tang², Jan Lecouturier², Aikaterini Grimani⁴, Paul Chadwick³, Falko F Sniehotta⁵

Affiliations

¹ NIHR Policy Research Unit in Behavioural Science - Health Psychology Research Group, Department of Clinical, Education and Health Psychology, University College London, UK. Electronic address: carly.meyer@ucl.ac.uk.
² NIHR Policy Research Unit in Behavioural Science - Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
³ NIHR Policy Research Unit in Behavioural Science - Health Psychology Research Group, Department of Clinical, Education and Health Psychology, University College London, UK.
⁴ NIHR Policy Research Unit in Behavioural Science - Behavioural Science Group, Warwick Business School, University of Warwick, UK.
⁵ NIHR Policy Research Unit in Behavioural Science - Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK; Department of Public Health, Preventive and Social Medicine, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Germany.

Abstract

Background: COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19.

Purpose: To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England.

Methods: An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making.

Results: Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London).

Conclusions: Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

Keywords: Booster vaccination; Coronavirus; Health belief model; Precaution adoption process model; Theory of planned behaviour; Vaccine hesitancy.

Publication types

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

MeSH terms

COVID-19 Vaccines*
COVID-19* / prevention & control
Cross-Sectional Studies
England / epidemiology
Humans
London
Vaccination

Substances

COVID-19 Vaccines

Grants and funding

PR-PRU1217-20501/DH_/Department of Health/United Kingdom