How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

Abstract

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

Keywords: COVID-19; HBM; boosters; health belief model; primary series vaccines; systematic review; vaccination intention.

Figure 1

PRISMA flow diagram illustrating literature search.

Figure 2

Vaccination intention rate by population.

Figure 3

Health belief model constructs predicting primary series vaccination intention.

Figure 4

Health belief model constructs predicting booster vaccination intention.

Figure 5

Major HBM modifying variables associated with vaccination intention.

Figure 6

Health belief model constructs associated with vaccination intention by data collection year.

Figure 7

Health belief model constructs associated with vaccination intention by continent with five or more studies.

Figure 8

Health belief model constructs associated with vaccination intention by country with five or more studies.

Figure 9

Health belief model constructs associated with vaccination intention by study population.