Determinants of vaccination behavior among university students 20 months after the COVID-19 outbreak: Results of the COVID-19 German Student Well-being Study (C19 GSWS)

Figures & data

Table 1. Description of the ‘psychological antecedents of vaccination’ (5cs)-Scale.

Description of the items	Categories
Confidence: “I am completely confident that the COVID-19 vaccines are safe.”	Complete confidence in the safety (1), medium confidence in the safety (2–4) and no confidence in the safety (5–7)
Complacency: “Vaccination against COVID-19 is unnecessary because vaccine-preventable diseases are not common anymore.”	Vaccination is very necessary (1), vaccination is rather necessary (2–4), vaccination is not necessary (5–7).
Constraints: “Everyday stress prevents me from getting vaccinated against COVID-19.”	Everyday stress does not prevent vaccination (1), everyday stress rather prevents vaccination (2–4), everyday stress prevents vaccination (5–7).
Calculation: “When I think about getting vaccinated against COVID-19, I weigh benefits and risks to make the best decision possible.”	Weighting benefits and risks is not relevant (1), weighting benefits and risks is rather not relevant (2–4), weighting benefits and risks is relevant (5–7).
Collective responsibility: “When everyone is vaccinated against COVID-19, I don’t have to get vaccinated, too.”	If everyone vaccinated, vaccination for me still necessary (1), if everyone vaccinated, vaccination for me is rather necessary (2–4), if all vaccinated, no vaccination is necessary for me (5–7).

Table 2. Description of the ‘critical health literacy in a pandemic’-scale.

Description of the items	Categories
“How would you rate the current scientific knowledge on COVID-19 available to guide political decisions in Germany.”	Low complexity perception (1,5), high complexity perception (2–4).
“Overall, the challenges in this COVID-19 crisis are simple and decision-making is fairly straight-forward.”	Low complexity perception (1,2), high complexity perception (3–5).
“How important is it for you to understand the different interests and motivations among the key players in this crisis (e.g., the government, political parties, employer organizations, unions, health authorities, etc.)?”	Low importance (1,2), high importance (3–5).
“The biggest problem in this pandemic is with the high-risk groups (e.g., 65+; people with chronic health problems) – consequently the behavioral restrictions should apply only to them.”	Low understanding of the need for preventive restrictions (1,2), high understanding of the need for preventive restrictions (3–5).
“Independent of their social class or status, individuals are equally affected by the current pandemic.”	Low awareness of social class differences in the pandemic (1–2), high awareness of social class differences in the pandemic (3–5).

Table 3. Student characteristics (n = 6,580) stratified by vaccination status.

	Not vaccinated (n = 411)	Fully vaccinated (n = 6,169)
Socio-demographic information
Age
18–23 years	204 (50.0%)	3,497 (56.8%)
24–29 years	149 (36.4%)	1,982 (32.2%)
+30 years	56 (13.7%)	674 (11.0%)
Mean (SD)	24.7 (5.2)	24.0 (4.8)
Gender
Male	131 (32.2%)	1,893 (31.1%)
Female	275 (67.6%)	4,121 (67.7%)
Diverse	1 (0.3%)	72 (1.2%)
Migration background
No migration background	272 (68.0%)	4,820 (78.6%)
Migration background	128 (32.0%)	1,311 (21.4%)
Academic status of parents
Both parents without academic degree	103 (28.3%)	1,463 (25.1%)
At least one parent with academic degree	261 (71.7%)	4,370 (74.9%)
Present chronic disease
No present chronic disease	310 (82.2%)	4,889 (85.5%)
Present chronic disease	67 (17.8%)	828 (14.5%)
5C-Items
Confidence in the safety of the COVID-19 vaccine
No confidence in safety	281 (68.5%)	541 (8.8%)
Medium confidence in safety	123 (30.0%)	3,689 (59.9%)
Complete confidence in safety	6 (1.5%)	1,925 (31.3%)
Vaccination not necessary because COVID-19 is not common anymore
Vaccination is not necessary	37 (9.1%)	66 (1.1%)
Vaccination is rather necessary	263 (64.5%)	1,414 (23.0%)
Vaccination is very necessary	108 (26.5%)	4,667 (75.9%)
Everyday stress prevents me from getting vaccinated
Everyday stress prevents from vaccination	52 (12.8%)	146 (2.4%)
Everyday stress prevents rather not from vaccination	123 (32.6%)	1,015 (16.6%)
Everyday stress does not prevent from vaccination	223 (54.7%)	4,960 (81.0%)
Weight benefits and risks to make decision to get vaccinated
Weighting benefits and risks is relevant	379 (92.4%)	3,673 (59.9%)
Weighting benefits and risks is rather not relevant	26 (6.3%)	1,941 (31.7%)
Weighting benefits and risks is not relevant	5 (1.2%)	514 (8.4%)
If all are vaccinated, I do not need vaccination
If all vaccinated, no vaccination is necessary for myself	86 (21.3%)	131 (2.1%)
If all vaccinated, vaccination is rather necessary for myself	245 (60.6%)	1,269 (20.7%)
If all vaccinated, vaccination is still necessary for myself	73 (18.1%)	4,733 (77.2%)
CHL-P-Items
Rate the current scientific knowledge on COVID-19 available to guide political decisions
Low complexity perception	151 (37.1%)	933 (15.3%)
High complexity perception	256 (62.9%)	5,173 (84.7%)
Challenges in this crisis are simple and decision-making is fairly straight-forward
Low complexity perception	57 (14.0%)	781 (12.8%)
High complexity perception	349 (86.0%)	5,316 (87.2%)
Importance to understand the different interests and motivations among the key players in this crisis
Low importance	27 (6.7%)	317 (5.2%)
High importance	376 (93.3%)	5,765 (94.8%)
Greatest problems are the high risk groups (+65 years) - behavioral restrictions should only apply to the high risk groups
Little understanding of the need for preventive restrictions	180 (44.3%)	4,648 (76.3%)
High understanding of the need for preventive restrictions	226 (55.7%)	1,448 (23.8%)
All individuals are equally affected by pandemic, regardless of their social status or class
Low awareness of social class differences in the pandemic	207 (51.0%)	2,733 (44.7%)
High awareness of social class differences in the pandemic	199 (49.0%)	3,384 (55.3%)
Literature-based determinants
COVID 19-diagnosis
Negative	284 (69.8%)	5,420 (88.3%)
Positive (confirmed)	65 (16.0%)	409 (6.7%)
Suspected infection (not confirmed)	58 (14.2%)	312 (5.1%)
Confidence receiving necessary medical care in case of a severe course of infection
Not confident receiving medical care	91 (23.0%)	539 (8.8%)
Confident receiving medical care	304 (77.0%)	5,603 (91.2%)
Worries that doctors and hospitals will not have adequate medical supplies to handle the COVID-19 outbreak
Mean (SD)	3.6 (3.3)	5.1 (3.1)
Sufficient information about the COVID-19 vaccine
Poorly informed	120 (29.3%)	239 (3.9%)
Moderately informed	102 (24.9%)	804 (13.0%)
Very well informed	188 (45.9%)	5,114 (83.1%)

Results: Student characteristics stratified by vaccination status

Table 4. Results of the multiple logistic regression to quantify the association between the 5cs and four additional literature-based determinants and vaccination status as the dependent variable.

	OR	95% CI
Confidence in the safety of the COVID-19 vaccine
No confidence in the safety (ref.)	-	-
Medium confidence in the safety	5.76*	4.22–7.86
Complete confidence in the safety	50.60*	15.45–165.68
Vaccination not necessary because COVID-19 is not common anymore
Vaccination is not necessary (ref.)	-	-
Vaccination is rather necessary	0.86	0.43–1.73
Vaccination is very necessary	1.25	0.59–2.63
Everyday stress prevents me from getting vaccinated
Everyday stress prevents from vaccination (ref.)	-	-
Everyday stress prevents rather not from vaccination	2.82*	1.69–4.71
Everyday stress does not prevent from vaccination	2.95*	1.80–4.81
Weighing the benefits and risks of vaccination
Weighting benefits and risks is relevant (ref.)	-	-
Weighting benefits and risks is rather not relevant	5.19*	3.10–8.73
Weighting benefits and risks is not relevant	4.76*	1.14–19.92
If all are vaccinated, I do not need vaccination
If all vaccinated, no vaccination for myself is necessary (ref.)	-	-
If all vaccinated, vaccination is rather necessary for myself	1.56*	1.02–2.37
If all vaccinated, vaccination is still necessary for myself	4.71*	2.79–7.95
Literature-based determinants
Covid 19-Diagnosis
Negative (ref.)	-	-
Positive (confirmed)	0.52*	0.34–0.80
Suspected infection (not confirmed)	0.60*	0.39–0.95
Worries that doctors and hospitals will not have adequate medical supplies to handle the COVID-19 outbreak (metric)	1.12*	1.06–1.17
Confidence of receiving necessary medical care in case of a severe course of the infection
Not confident receiving medical care (ref.)	-	-
Confident receiving medical care	1.82*	1.23–2.69
Sufficient information about the COVID-19 vaccine
Poorly informed (ref.)	-	-
Moderately informed	1.70*	1.13–2.58
Very well informed	2.20*	1.51–3.21
Socio-demographic information
Age
18–23 years (ref.)	-	-
24–29 years	0.71*	0.52–0.97
+30 years	0.99	0.63–1.55
Gender
Male (ref.)	-	-
Female	1.38*	1.01–1.88
Diverse	2.56	0.32–20.55
Migration background
No migration background (ref.)	-	-
Migration background	1.67	0.84–1.62
Academic degree of parents
Both parents without academic degree (ref.)	-	-
At least one parent with academic degree	1.07	0.78–1.46
Chronic disease
Present chronic diseases (ref.)	-	-
No present chronic diseases	0.76	0.52–1.11

OR: odds ratio; CI: confidence interval; ref.: reference category; * p < .05.

Table 5. Results of the multiple logistic regression to quantify the association between the CHL-P and four additional literature-based determinants and vaccination status as the dependent variable.

	OR	95% CI
Rate the current scientific knowledge on COVID-19 available to guide political decisions
Low complexity perception (ref.)	-	-
High complexity perception	3.02*	2.26–4.04
Challenges in this crisis are simple and decision-making is fairly straight-forward
Low complexity perception (ref.)	-	-
High complexity perception	0.69	0.46–1.03
Importance to understand the different interests and motivations among the key players in this crisis
Low importance (ref.)	-	-
High importance	0.77	0.46–1.31
Greatest problems are the high risk groups (+65 years) - behavioral restrictions should only apply to the high risk groups
Low understanding of the need for preventive restrictions (ref.)	-	-
High understanding of the need for preventive restrictions	0.41*	0.32–0.53
All individuals are equally affected by pandemic, regardless of their social status or class
Low awareness of social class differences in the pandemic (ref.)	-	-
High awareness of social class differences in the pandemic	0.99	0.76–1.28
Literature-based determinants
COVID-19 diagnosis
Negative (ref.)	-	-
Positive (confirmed)	0,40*	0.28–0.59
Suspected infection (not confirmed)	0.41*	0.27–0.61
Worries that doctors and hospitals will not have adequate medical supplies to handle the COVID-19 outbreak (metric)	1.15*	1.10–1.20
Confidence of receiving necessary medical care in case of a severe course of the infection
Not confident receiving medical care (ref.)	-	-
Confident receiving medical care	2.69*	1.89–3.81
Sufficient information about the COVID-19 vaccine
Poorly informed (ref.)	-	-
Moderately informed	2.38*	1.64–3.47
Very well informed	8.47*	6.07–11.81
Socio-demographic information
Age
18–23 years (ref.)	-	-
24–29 years	0.82	0.62–1.08
+30 years	0.87	0.58–1.31
Gender
Male (ref.)	-	-
Female	0.92	0.69–1.21
Diverse	2.46	0.31–19.63
Migration background
No migration background (ref.)	-	-
Migration background	0.97	0.72–1.30
Academic degree of parents
Both parents without academic degree (ref.)	-	-
At least one parent with academic degree	1.04	0.78–1.38
Chronic disease
Present chronic diseases (ref.)	-	-
No present chronic diseases	0.87	0.62–1.23

OR: odds ratio; CI: confidence interval; ref.: reference category; * p < .05.