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. 2025 Feb 18;25(1):659.
doi: 10.1186/s12889-025-21899-x.

Perceived social support and self-stigma as factors of COVID-19 booster vaccination behavior and intention via cognitive coping and emotion regulation among people infected with COVID-19 in Hong Kong

Xiaoying Zhang #  1 , Yiming Luan #  2 , Yihan Tang  3 , Mason M C Lau  4 , Yanqiu Yu  5 , Jing Gu  6 , Joseph T F Lau  7   8   9
Affiliations

Perceived social support and self-stigma as factors of COVID-19 booster vaccination behavior and intention via cognitive coping and emotion regulation among people infected with COVID-19 in Hong Kong

Xiaoying Zhang et al. BMC Public Health. .

Abstract

Background: It is imperative to promote behavior/intention of taking up booster COVID-19 vaccination (BI-BV) among people who have ever contracted COVID-19 (PECC). The aims were to investigate the prevalence of BI-BV and its associations with perceived social support. Guided by the stress coping theory, we tested mediators between perceived social support and BI-BV via self-stigma, active coping, and maladaptive emotion regulation (rumination and catastrophizing).

Methods: A random population-based telephone survey was conducted among adult PECC having completed the primary series of COVID-19 vaccination prior to the diagnosis; 230 participants were interviewed from June to August 2022 during the fifth (last) major outbreak in Hong Kong. The associations between the independent variables and BI-BV were tested by logistic regression analysis. A structural equation model (SEM) tested the indirect effects of the latent variables of self-stigma, active coping, and maladaptive emotion regulation between the latent variable of perceived social support and BI-BV.

Results: The prevalence of BI-BV was 62.2%. It was associated with age, marital status, full-time employment, and chronic disease status. The logistic regression analysis found that BI-BV was positively associated with perceived social support (ORc = 1.31, 95% CI: 1.12- 1.54), active coping (ORc = 1.40, 95% CI: 1.10- 1.79), rumination (ORc = 1.75, 95% CI: 1.13- 2.70), and catastrophizing (ORc = 3.12, 95% CI: 1.49- 6.51) and negatively associated with self-stigma (ORc = 0.80, 95% CI: 0.72- 0.88). In the SEM analysis, the positive association between perceived social support and BI-BV was fully mediated: 1) via self-stigma (β = 0.07, 95% CI: 0.03- 0.14), 2) via active coping (β = 0.06, 95% CI: 0.02- 0.12), and 3) via self-stigma and then active coping (β = 0.01, 95% CI: 0.002- 0.04). Two of these indirect paths involved active coping. The indirect paths involving maladaptive emotion regulation were all non-significant.

Conclusions: Perceived social support was associated with BI-BV, and was mediated via self-stigma, active coping, and serially self-stigma then active coping but not emotion maladaptation. The data supported the stress cognitive coping model in explaining the association between perceived social support and BI-BV. Interventions promoting BI-BV may consider modifying the observed significant factors. Future longitudinal studies are warranted to confirm the findings.

Keywords: Active coping; Booster COVID-19 vaccines; Catastrophizing; Emotion regulation; Mediation; Perceived social support; Rumination; Self-stigma; Stress coping model.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (No. SBRE-21–0778). Informed consent was obtained from all subjects involved in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The structural equation model testing the mediation effects. Note: Standardized coefficients are presented. BI-BV = Behavior/intention of taking up booster COVID-19 vaccination
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