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Motivation, Cues to Action, and Barriers to COVID-19 Vaccine Uptake: A Qualitative Application of the Health Belief Model among Women in Rural Zambia
Kayla J. Kuhfeldt
Kayla J. Kuhfeldt
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
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Jeanette L. Kaiser
Jeanette L. Kaiser
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
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Allison J. Morgan
Allison J. Morgan
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
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Thandiwe Ngoma
Thandiwe Ngoma
Right to Care Zambia, Lusaka, Zambia;
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Davidson H. Hamer
Davidson H. Hamer
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts;
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Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts;
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Günther Fink
Günther Fink
Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
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Peter C. Rockers
Peter C. Rockers
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
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Benson Chirwa
Benson Chirwa
Right to Care Zambia, Lusaka, Zambia;
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Nancy A. Scott
Nancy A. Scott
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
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Vaccine hesitancy has played a major role in slowing the global COVID-19 response. Using cross-sectional, primarily qualitative data collected in four rural districts in Zambia, we aimed to explore community perceptions of COVID-19 disease and vaccines, including perceived motivators, cues to action, benefits, and barriers to vaccine uptake as guided by the Health Belief Model. In-depth interviews (IDIs) were conducted in late 2021 with women of reproductive age who were enrolled in an early childhood development study. Although two-thirds of the 106 respondents reported low perceived risk of catching COVID-19, they expressed concern that the COVID-19 pandemic had impacted their daily lives and feared effects of the disease. They had generally positive beliefs that the vaccine would be accepted among their communities when it became more widely available. Reported motivators to vaccine uptake included desire for protection against COVID-19 and understanding vaccine purpose, due to ongoing education from health personnel, neighbors, friends, radio, and church leaders. Misinformation or reported bad experiences served as cues away from vaccine uptake. Examples of misinformation included the vaccine causing COVID-19 or another disease and death and vaccines being associated with the devil and against Christian beliefs. Accounts of pain after receiving the vaccine also discouraged uptake. Perceived benefits included a desire to be protected from the disease, belief in the effectiveness of the vaccine, fear of catching COVID-19, and belief the vaccine would limit negative effects. Health system implementers and policy makers should consider recipient motivators and cues to action to further increase vaccination rates.
Author Notes
Financial support: The primary early childhood development evaluation was funded by the U.S. Agency for International Development (USAID) and Grand Challenges Canada (GCC) through their Saving Brains funding mechanism. There was no additional cost to the funders for inclusion of COVID-19 questions into the endline qualitative data collection for the overarching evaluation.
Disclosures: All authors report their institutions received grants directly or indirectly from USAID and GCC to conduct the work. This study was approved by the University of Zambia Biomedical Research Ethics Committee (Ref. No. 004-05-19) and the Boston University Medical Center Institutional Review Board (Ref. No. H-38950). Additionally, the National Health Research Authority; the Ministry of Health at the national, provincial, and district levels; and traditional chiefs in these districts granted official approvals to conduct the overarching study. Participants provided written informed consent in the language of their choosing at baseline and again at endline. Minors (15–17 years of age) provided assent and their legal guardians provided consent.
Authors’ contributions: Co-principal investigators N. A. Scott and T. Ngoma obtained funding for this study. N. A. Scott, T. Ngoma, D. H. Hamer, P. C. Rockers, and G. Fink designed the overarching cluster randomized controlled trial. J. L. Kaiser, N. A. Scott, and T. Ngoma designed the data collection instruments included in this mixed methods study. J. L. Kaiser and A. J. Morgan coordinated data collection and management. K. J. Kuhfeldt and J. L. Kaiser designed the qualitative codebook, coded the transcripts, and conducted the content analysis. K. J. Kuhfeldt, J. L. Kaiser, A. J. Morgan, and N. A. Scott drafted the original manuscript. T. Ngoma, D. H. Hamer, P. C. Rockers, G. Fink, and B. Chirwa provided critical input and revisions and approved the final version.
Current contact information: Kayla J. Kuhfeldt, Jeanette L. Kaiser, Allison J. Morgan, Peter C. Rockers, and Nancy A. Scott, Department of Global Health, Boston University School of Public Health, Boston, MA, E-mails: kaylakuh@bu.edu, jlkaiser@bu.edu, juntunen@bu.edu, prockers@bu.edu, and nscott@bu.edu. Thandiwe Ngoma, E-mail: ngoma.thandiwe@gmail.com. Benson Chirwa, Right to Care Zambia, Lusaka, Zambia, E-mail: ben.chirwa@righttocare-zambia.org. Davidson H. Hamer, Department of Global Health, Section of Infectious Diseases, National Emerging Infectious Diseases Laboratory, and Center on Emerging Infectious Diseases, Boston University School of Public Health, Boston, MA, E-mail: dhamer@bu.edu. Günther Fink, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mail: guenther.fink@swisstph.ch.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 0 | 0 | 0 |
| Full Text Views | 334 | 334 | 235 |
| PDF Downloads | 158 | 158 | 83 |