COVID-19 Vaccine Hesitancy: Disadvantaged Groups' Experience with Perceived Barriers, Cues to Action, and Attitudes

Abstract

Purpose: Drawing from the Health Belief Model, we explored how disadvantaged groups in the U.S., including Black, Hispanic, less educated and wealthy individuals, experienced perceived barriers and cues to action in the context of the COVID-19 vaccination.

Design: A cross-sectional survey administered in March 2021.

Setting: USA.

Subjects: A national sample of U.S. residents (n = 795) recruited from Prolific.

Measures: Perceived barriers (clinical, access, trust, religion/spiritual), cues to action (authorities, social circles), attitudes toward COVID-19 vaccination.

Analysis: Factor analysis and Structural Equation Model (SEM) were performed in STATA 16.

Results: Black and less educated individuals experienced higher clinical barriers (CI [.012, .33]; CI [.027, .10]), trust barriers (CI [.49, .92]; CI [.057, .16]), and religious/spiritual barriers (CI [.28, .66]; CI [.026, .11]). Hispanics experienced lower levels of clinical barriers (CI [-.42, .0001]). Clinical, trust, and religious/spiritual barriers were negatively related to attitudes toward vaccination (CI [-.45, -.15]; CI [-.79, -.51]; CI [-.43, -.13]). Black and less educated individuals experienced fewer cues to action by authority (CI [-.47, -.083]; CI [-.093, -.002]) and social ties (CI [-.75, -.33]; CI [-.18, -.080]). Lower-income individuals experienced fewer cues to action by social ties (CI [-.097, -.032]). Cues from social ties were positively associated with vaccination attitudes (CI [.065, .26]).

Conclusion: Communication should be personalized to address perceived barriers disadvantaged groups differentially experience and use sources who exert influences on these groups.

Keywords: COVID-19 vaccine hesitancy; HBM; barriers; cues to action; disadvantaged groups; health disparities; underserved populations; vaccine promotion.

Figure 1.

Results of the SEM model of COVID-19 Vaccine and Health Disparities: Barriers and Cue to Action. Note: N = 741, with 8 missing data. Blue paths indicate significant negative relationships, whereas red paths indicate significant positive relationships. Insignificant paths are not included for brevity. Correlation paths among the four barriers variables, correlation paths between the two cue to action variables, and the control variables: gender, age, party affiliation, perceived severity of COVID-19, perceived susceptibility of COVID-19, and self-efficacy are included in the full SEM model but not shown here for brevity.