Acceptance of a COVID-19 vaccine and associated factors among pregnant women in China: a multi-center cross-sectional study based on health belief model

Figures & data

Table 1. Acceptance of a COVID-19 vaccine of pregnant women in China by sociodemographic characteristics, health status and knowledge factors

Characteristics	Total (%)	Acceptance of a COVID-19 vaccine		p value
		n (%)	95% CI
Total	1392 (100.0)	1077 (77.4)	75.1–79.5
Sociodemographic characteristics
Age group (year)				0.04*
≤25	197 (14.2)	161 (81.7)	75.9–86.6
26–30	574 (41.2)	449 (78.2)	74.7–81.5
31–35	460 (33.0)	357 (77.6)	73.6–81.2
36–40	137 (9.8)	94 (68.6)	60.5–75.9
>40	24 (1.7)	16 (66.7)	46.8–82.8
Region				<0.01*
Eastern	704 (50.6)	499 (70.9)	67.4–74.1
Central	404 (29.0)	328 (81.2)	77.2–84.8
Western	284 (20.4)	250 (88.0)	83.9–91.4
Education				<0.01*
Less than high school	238 (17.1)	186 (78.2)	72.6–83.0
High school or some college	654 (47.0)	532 (81.3)	78.2–84.2
Bachelor ‘s degree	434 (31.2)	316 (72.8)	68.5–76.8
Postgraduate degree	66 (4.7)	43 (65.2)	53.2–75.8
Occupation				0.06
Housewife	505 (36.3)	405 (80.2)	76.6–83.5
Employed	887 (63.7)	672 (75.8)	72.9–78.5
Monthly household income per capita (RMB)				0.11
≤3000	208 (14.9)	168 (80.8)	75.0–85.7
3001–5000	468 (33.6)	374 (79.9)	76.1–83.4
5001–10000	505 (36.3)	376 (74.5)	70.5–78.1
>10000	211 (15.2)	159 (75.4)	69.2–80.8
Health status
Gravidity				0.84
1	537 (38.6)	417 (77.7)	74.0–81.0
≥2	855 (61.4)	660 (77.2)	74.3–79.9
Parity				0.93
0	726 (52.2)	561 (77.3)	74.1–80.2
≥1	666 (47.8)	516 (77.5)	74.2–80.5
Gestational trimester				<0.01*
First trimester (1–13 week)	396 (28.4)	263 (66.4)	61.7–70.9
Second trimester (14–28 week)	383 (27.5)	307 (80.2)	75.9–83.9
Third trimester (≥28 week)	613 (44.0)	507 (82.7)	79.6–85.5
History of adverse pregnancy outcomes				0.92
Yes	445 (32.0)	345 (77.5)	73.5–81.2
No	947 (68.0)	732 (77.3)	74.5–79.9
History of chronic disease				0.92
Yes	32 (2.3)	25 (78.1)	61.8–89.6
No	1360 (97.7)	1052 (77.4)	75.1–79.5
History of influenza vaccination				0.09
Yes	122 (8.8)	102 (83.6)	76.3–89.4
No	1270 (91.2)	975 (76.8)	74.4–79.0
Gestational complications				<0.01*
Yes	327 (23.5)	272 (83.2)	78.8–86.9
No	1065 (76.5)	805 (75.6)	72.9–78.1
Knowledge factors
Total knowledge score on COVID-19				<0.01*
Low	434 (31.2)	309 (71.2)	66.8–75.3
Moderate	471 (33.8)	371 (78.8)	74.9–82.3
High	487 (35.0)	397 (81.5)	77.9–84.8

Figure 1. The trends in the acceptance of a COVID-19 vaccine and the total knowledge score on COVID-19 by locally weighted scatterplot smoothing regression analysis

Table 2. Comparison of the acceptance of a COVID-19 vaccine by health beliefs (n = 1392)

Dimensions of Health Belief Model	Item	Response	Total (%)	Acceptance of a COVID-19 vaccine		p value
				n (%)	95% CI
Susceptibility	Are you concerned about getting COVID-19	Not concerned	148 (10.6)	94 (63.5)	55.6-70.9	<0.01*
		Concerned	1244 (89.4)	983 (79.0)	76.7-81.2
	Are you concerned about unborn baby getting COVID-19	Not concerned	121 (8.7)	74 (61.2)	52.3-69.5	<0.01*
		Concerned	1271 (91.3)	1003 (78.9)	76.6-81.1
Severity	If a pregnant woman gets COVID-19, she is more likely to have severe illness	Disagree	50 (3.6)	33 (66.0)	52.3-77.9	0.05
		Agree	1342 (96.4)	1044 (77.8)	75.5-80.0
	If a pregnant woman gets COVID-19, the illness could harm her unborn baby	Disagree	17 (1.2)	9 (52.9)	30.3-74.6	0.02*
		Agree	1375 (98.8)	1068 (77.7)	75.4-79.8
Barriers	Vaccine can cause a person to get sick with COVID-19	Disagree	456 (32.8)	372 (81.6)	77.8-84.9	<0.01*
		Agree	936 (67.2)	705 (75.3)	72.5-78.0
	Vaccine is not safe during pregnancy	Disagree	142 (10.2)	130 (91.5)	86.1-95.3	<0.01*
		Agree	1250 (89.8)	947 (75.8)	73.3-78.1
	Vaccine is not an effective way to prevent a pregnant woman from getting COVID-19	Disagree	230 (16.5)	203 (88.3)	83.6-91.9	<0.01*
		Agree	1162 (83.5)	874 (75.2)	72.7-77.6
Benefits	Giving vaccine to a pregnant woman will benefit her fetus and baby	Disagree	86 (6.2)	49 (57.0)	46.4-67.1	<0.01*
		Agree	1306 (93.8)	1028 (78.7)	76.4-80.9
	Getting vaccine during pregnancy is a benefit for the pregnant woman	Disagree	67 (4.8)	36 (53.7)	41.8-65.3	<0.01*
		Agree	1325 (95.2)	1041 (78.6)	76.3-80.7
	Vaccine could protect the baby during the first months of life	Disagree	77 (5.5)	41 (53.2)	42.2-64.1	<0.01*
		Agree	1315 (94.5)	1036 (78.8)	76.5-80.9
Cues to action	If doctors recommended vaccine, I would get vaccinated	Disagree	96 (6.9)	32 (33.3)	24.5-43.1	<0.01*
		Agree	1296 (93.1)	1045 (80.6)	78.4-82.7
	If family members recommended vaccine, I would get vaccinated	Disagree	132 (9.5)	58 (43.9)	35.7-52.5	<0.01*
		Agree	1260 (90.5)	1019 (80.9)	78.6-83.0

Response of “not sure” was combined into “disagree” and “very concerned “or “moderate concerned” was combined into “concerned” in this table.

Figure 2. The acceptance of a COVID-19 vaccine by five dimensions of health beliefs model (n = 1392)

Table 3. Factors associated with the acceptance of a COVID-19 vaccine (n = 1392)

Characteristics	n	Multivariable regression model
		Adjusted OR (95% CI)	p value
Sociodemographic characteristics
Age group (year)
≤35	1231	1.87 (1.20–2.93)	0.01*
>35	161	1 (Reference)
Region
Eastern	704	1 (Reference)
Central	404	1.29 (0.89–1.86)	0.18
Western	284	2.73 (1.72–4.32)	<0.01*
Education
Less than high school	238	2.49 (1.13–5.51)	0.02*
High school or some college	654	2.85 (1.45–5.59)	<0.01*
Bachelor ‘s degree	434	1.58 (0.83–3.03)	0.17
Postgraduate degree	66	1 (Reference)
Occupation
Housewife	505	1.06 (0.73–1.54)	0.75
Employed	887	1 (Reference)
Monthly household income per capita (RMB)
≤3000	208	1 (Reference)
3001–5000	468	0.99 (0.61–1.61)	0.96
5001–10000	505	0.94 (0.57–1.55)	0.81
>10000	211	1.29 (0.71–2.34)	0.41
Health status
Gravidity
1	537	1 (Reference)
≥2	855	0.87 (0.53–1.43)	0.58
Parity
0	726	1 (Reference)
≥1	666	0.98 (0.63–1.52)	0.93
Gestational trimester
First trimester (1–13 week)	396	1 (Reference)
Second trimester (14–28 week)	383	1.39 (0.94–2.04)	0.09
Third trimester (≥28 week)	613	1.49 (1.03–2.16)	0.04*
History of adverse pregnancy outcomes
Yes	445	1.11 (0.76–1.62)	0.58
No	947	1 (Reference)
History of chronic disease
Yes	32	0.66 (0.26–1.69)	0.39
No	1360	1 (Reference)
History of influenza vaccination
Yes	122	1.30 (0.74–2.28)	0.36
No	1270	1 (Reference)
Gestational complications
Yes	36	1.18 (0.80–1.74)	0.40
No	1356	1 (Reference)
Knowledge and health belief factors
Total knowledge score on COVID-19	1392	1.05 (1.01–1.10)	0.01*
Susceptibility
Low	148	1 (Reference)
Moderate	609	1.47 (0.94–2.30)	0.09
High	635	2.18 (1.36–3.49)	<0.01*
Severity
Low	22	1 (Reference)
Moderate	514	0.97 (0.33–2.84)	0.95
High	856	1.17 (0.39–3.45)	0.78
Barriers
Low	181	4.76 (2.23–10.18)	<0.01*
Moderate	1052	2.20 (1.28–3.77)	<0.01*
High	159	1 (Reference)
Benefit
Low	61	1 (Reference)
Moderate	976	1.14 (0.57–2.27)	0.72
High	355	2.20 (0.95–5.07)	0.07*
Action
Low	113	1 (Reference)
Moderate	822	4.92 (3.00–8.05)	<0.01*
High	457	15.70 (8.28–29.80)	<0.01*

*p < 0.05.

Figure 3. Reasons for responding “No” or “Not sure” regarding intend to be vaccinated with a COVID-19 vaccine (n = 315)