Understanding Vaccination Among Hesitant Adopters of the COVID-19 Vaccine Using the Increasing Vaccination Model

Abstract

The coronavirus disease (COVID−19) was the third leading cause of death in 2021 in the United States and has led to historic declines in life expectancy for Americans. While vaccination is an effective mitigation strategy for COVID−19, vaccine hesitancy remains a major barrier to individual and population-level protection. An emerging literature on hesitant adopters of COVID−19 vaccines highlights co-occurrence of hesitancy and vaccine uptake as an understudied phenomenon, with the potential to provide insight into factors that lead hesitant individuals to become vaccinated despite their hesitancy. We use qualitative interviews among hesitant adopters in Arkansas to examine vaccine hesitancy among this understudied group. Drawing on the Increasing Vaccination Model, we find that the most frequently reported motivations of hesitant adopters were within the domain of social processes, pointing to a critical focal point for targeted health communications intervening in this domain (e.g. social norms, social networks, and altruistic behavior). We find that recommendations from health care workers (HCWs) other than physicians/providers may serve as an effective influence to vaccinate. We also demonstrate negative effects of low provider and HCW confidence and weak recommendations on motivations to vaccinate among individuals expressing vaccine hesitancy. Additionally, we find individual information-seeking behaviors among hesitant adopters bolstered confidence in the efficacy of the COVID−19 vaccine. Based on these findings, clear, accessible, and authoritative health communication has a role in combatting the COVID−19 misinformation/disinformation infodemic.

Disclosure statement

Dr. Sheena CarlLee reports owning some Pfizer stock. All other authors declared no conflicts of interest.

Ethics Approval

The University of Arkansas for Medical Sciences Institutional Review Board approved all study procedures and materials (IRB# 262907).

Consent to Participate

Participants were provided information about the study when scheduling interviews, and the interviewer read a script for informed consent prior to data collection. Participants were given time to ask questions and confirm they wished to participate in an interview.

Data availability statement

The deidentified data underlying the results presented in this study may be made available upon reasonable request from the corresponding author, Dr. Pearl A. McElfish, at [email protected]

Authors’ Contributions

R.M.: Conceptualization, Methodology, Formal Analysis, Writing-Original Draft, Writing-Review & Editing; R.S.P.: Formal Analysis, Writing-Original Draft, Writing-Review & Editing; S.C.: Formal Analysis, Writing-Original Draft, Writing-Review & Editing; E.H.: Formal Analysis, Writing-Review & Editing; S.K.: Writing-Review & Editing; D.E.W.: Writing-Review & Editing; P.A.M.: Conceptualization, Methodology, Supervision, Project Administration, Funding Acquisition, Writing-Original Draft, Writing-Review & Editing

Additional information

Funding

The community engagement related to this research is supported by University of Arkansas for Medical Sciences funding awarded through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (UL1 TR003107); Rapid Acceleration of Diagnostics (RADx) (NIH 3 R01MD013852-03S2); and Community Engagement Alliance (CEAL) Against COVID-19 Disparities (NIH 10T2HL156812-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.