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Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Ghazy RM 1 , Abdou MS 2 , Awaidy S 3 , Sallam M 4 , Elbarazi I 5 , Youssef N 6 Show all authors , Fiidow OA 7 , Mehdad S 8 , Hussein MF 9 , Adam MF 10 , Abdullah FSA 11 , Rebai WK 12 , Raad EB 13 , Hussein M 14 , Shehata SF 15 , Ismail II 16 , Salam AA 17 , Samhouri D 18

Affiliations 

  • 1 Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
  • 2 Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
  • 3 Health Affairs, Ministry of Health, Muscat 100, Oman
  • 4 Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
  • 5 Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, AlAin 15551, United Arab Emirates
  • 6 Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
  • 7 School of Public Health and Research, Somali National University, Mogadishu P.O. Box 15, Somalia
  • 8 Physiology and Physiopathology Research Team, Research Centre of Human Pathology Genomics, Faculty of Sciences, Mohammed V University, Rabat BP 8007, Morocco
  • 9 Occupational Health and Industrial Medicine Department, High Institute of Public Health, Alexandria University, Alexandria 21526, Egypt
  • 10 Faculty of Pharmacy, University of Science and Technology, Khartoum P.O. Box 12810, Sudan
  • 11 Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
  • 12 Institute Pasteur de Tunis, Tunis 2092, Tunisia
  • 13 Department of Epidemiology and Population Health, American University of Beirut, Beirut P.O. Box 110236, Lebanon
  • 14 Clinical Research Administration, Alexandria Directorate of Health Affairs, Egyptian Ministry of Health and Population, Alexandria 21554, Egypt
  • 15 Department of Family and Community Medicine, King Khalid University, Abha 62529, Saudi Arabia
  • 16 Department of Neurology, Ibn Sina Hospital, Gamal Abdel Nasser Street, Sabah Medical Area, Safat 070001, Kuwait
  • 17 National Institute of Health, Islamabad 45320, Pakistan
  • 18 Emergency Preparedness and International Health Regulations, WHO EMRO (DS), P.O. Box 7608, Naser City 11371, Egypt
Int J Environ Res Public Health, 2022 Sep 25;19(19).
PMID: 36231447 DOI: 10.3390/ijerph191912136

Abstract

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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