Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature"

Abstract

Vaccination has proven to be the most effective tool in controlling the COVID-19 pandemic. While pregnant individuals are considered to be a high-risk population and are more likely to experience adverse effects from COVID-19, vaccination rates among pregnant individuals are significantly lower than in the general population. The Health Belief Model (HBM), Theory of Planned Behavior (TPB), 3C model, 5C model, and 5A model have been used to assess vaccination hesitancy behaviors. In this paper, we review the use of each of these models to address vaccine hesitancy, with a focus on the pregnant population and the COVID-19 vaccine. The HBM, TPB, 3C model, and 5C model have demonstrated great versatility in their ability to evaluate, explain, and modify vaccine hesitancy and behavior. Up to date, the HBM and 3C models appear to be the most effective models to study and address vaccination hesitancy within the pregnant persons.

Keywords: 3C model; 5A model; 5C model; Vaccine hesitancy; health belief model; pregnancy; theory of planned behavior.

Figure 1.

The “Health Belief Model.” Figure reproduced from Rosenstock, Health Education Monographs, 1974. Model details the individual perceptions and modifying factors that influence the likelihood of action regarding vaccination behaviors.

Figure 2.

Theory of Planned Behavior. Figure reproduced from Ajzen, Organizational Behavior and Human Decision Processes, 1991. Figure details the relationship between various constructs and their ability to influence vaccination intention and overall behavior.

Figure 3.

SAGE Working Group Matrix of Vaccine Hesitancy. Figure reproduced from Larson, Jarrett, Eckersberger, Smith, and Paterson, Vaccine, 2014. Figure demonstrates the determinants of vaccine hesitancy as laid out by the SAGE Working Group.

Figure 4.

3C model. Figure reproduced from the World Health Organization’s SAGE vaccine hesitancy Working Group, Report of the SAGE working group on vaccine hesitancy, 2014. Figure demonstrates the factors that contribute to the 3C model.

Figure 5.

The 5C Model. Figure reproduced from Turner, Larson, Dubé, and Fisher, Journal of Allergy and Clinical Immunology: In Practice, 2021. Figure details the five factors of the 5C model and the various elements that contribute to their composition.