Correlates of COVID-19 vaccination intentions: Attitudes, institutional trust, fear, conspiracy beliefs, and vaccine skepticism

Abstract

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18-74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated.

Keywords: COVID-19; Conspiracy beliefs and denial of COVID-19; Fear of COVID-19; Institutional trust; Skepticism toward vaccines; Theory of planned behavior; Vaccination intentions.

Fig. 1

Models specified to test hypotheses H1–H19. Solid black arrows indicate direct relationships between constructs. Dashed black arrows (Model 2) indicate moderation of relationships. Solid gray arrows (Model 3) indicate direct relationships between background factors and vaccination intention (not expected to be significant based on the TPB).

Fig. 2

SEM results (standardized coefficients), model 1: n = 3507, model 2: n = 3507, model 3: n = 3110. Different sample sizes are due to missing values on indicators (model 1 and model 2) and predictors (model 3). For clarity, correlations among predictors are not shown and only significant paths are shown for model 3. *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001.