Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Ramy Mohamed Ghazy 1, Marwa Shawky Abdou 2, Salah Awaidy 3, Malik Sallam 4 5 6, Iffat Elbarazi 7, Naglaa Youssef 8, Osman Abubakar Fiidow 9, Slimane Mehdad 10, Mohamed Fakhry Hussein 11, Mohammed Fathelrahman Adam 12, Fatimah Saed Alabd Abdullah 13, Wafa Kammoun Rebai 14, Etwal Bou Raad 15 16, Mai Hussein 17 18, Shehata F Shehata 19 20, Ismail Ibrahim Ismail 21, Arslan Ahmed Salam 22, Dalia Samhouri 23

Affiliations

doi: 10.3390/ijerph191912136

Abstract

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

Keywords: COVID-19 vaccine; East Mediterranean region; booster dose acceptance; health belief model; vaccine hesitancy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1 The flow chart of the sampling process.

Figure 1 The flow chart of the sampling process.

Figure 2 Acceptance of COVID-19 vaccine booster dose across different countries of the East Mediterranean Region based on their income level.

Figure 2 Acceptance of COVID-19 vaccine booster dose across different countries of the East Mediterranean Region based on their income level.

Figure 3 The leading causes behind COVID-19 booster dose vaccine rejection among the participants.

Figure 3 The leading causes behind COVID-19 booster dose vaccine rejection among the participants.

Figure 4 Forest plot of the adjusted odds ratio s; the dependent factor is vaccine acceptance.

Figure 4 Forest plot of the adjusted odds ratio s; the dependent factor is vaccine acceptance.

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