key: cord-0827867-51ebgwri authors: Eberhardt, Judith; Ling, Jonathan title: Predicting COVID-19 Vaccination Intention Using Protection Motivation Theory and Conspiracy Beliefs date: 2021-09-07 journal: Vaccine DOI: 10.1016/j.vaccine.2021.09.010 sha: e93ef47bada0415f17f3fe25c62bd4b9fa07220f doc_id: 827867 cord_uid: 51ebgwri BACKGROUND: While COVID-19 vaccine uptake has been encouraging overall, some individuals are either hesitant towards, or refuse, the vaccine. Protection Motivation Theory (PMT) has been applied to influenza vaccine acceptance, but there is a lack of research applying PMT to COVID-19 vaccine acceptance. Additionally, prior research has suggested that coronavirus conspiracy beliefs and demographic factors may play a role in attitudes towards the vaccine. This study aimed to predict COVID-19 vaccination intention using PMT, coronavirus conspiracy beliefs, and demographic factors. Furthermore, vaccinated and unvaccinated individuals were compared in relation to their coronavirus conspiracy beliefs. METHODS: An online survey was administered to 382 (278 vaccinated, and 104 unvaccinated) individuals in the United Kingdom (77 males, 301 females, one non-binary/third gender, and three unstated). Respondents’ mean age was 43.78 (SD = 12.58). RESULTS: A hierarchical multiple linear regression was performed in three stages. Initially, four PMT constructs - severity, susceptibility, maladaptive response costs, and self-efficacy - emerged as significant predictors of COVID-19 vaccination intention. The final model accounted for 75% of the variance and retained two significant predictors from PMT - maladaptive response rewards and self-efficacy - alongside coronavirus conspiracy beliefs and age. An independent t-test established that unvaccinated individuals held greater coronavirus conspiracy beliefs than vaccinated ones. CONCLUSIONS: Interventions and campaigns addressing COVID-19 vaccine acceptance should employ strategies increasing individuals’ perceived severity of COVID-19, perceived susceptibility, and perceived ability to get vaccinated, while decreasing perceived rewards of not getting vaccinated. Additionally, coronavirus conspiracy beliefs should be addressed, as these appear to play a role for some vaccine-hesitant individuals. Efforts to vaccinate the world population against COVID-19 are ongoing. At the end of May 2 2021, around 1.86 billion doses had been administered worldwide [1] . The COVID-19 3 vaccine programme has been rolled out rapidly across the United Kingdom [UK] [2] . While 4 uptake has been encouraging [3], surveys have indicated that there are a significant number 5 of people who are sceptical of the vaccine, and who would either be hesitant to receive it, 6 or refuse it altogether [4] [5] [6] . In the UK, most of the people who have been hospitalised with 7 COVID-19 are those who have not been fully vaccinated [7] . Therefore, to reduce 8 hospitalisations and mortality rates, it is important that as many eligible individuals as 9 possible are fully vaccinated against COVID-19. attempts to explain motivation to respond to health threats such as COVID-19. According to 15 PMT, the likelihood of engaging in a protective behaviour -such as being vaccinated -when 16 faced with a threat is a product of the beliefs that individuals hold about engaging, or not 17 engaging, in this protective behaviour as well as about the threat itself (see Figure 1 ). 18 19 In PMT, intention most closely predicts behaviour. Intention itself is determined by both 20 threat appraisal and coping appraisal. Threat appraisal is the result of one's perceived 21 vulnerability to the negative consequences of the threat (susceptibility), how serious one 22 perceives these negative consequences to be (severity), and perceived benefits of engaging 23 in behaviour that is maladaptive in relation to the threat (maladaptive response rewards). 24 Manuscript, unmarked "clean" version Click here to access/download;Manuscript, unmarked "clean" version;REVISED unmarked manuscript.docx Click here to view linked References Coping appraisal is the product of confidence in one's perceived ability to successfully 25 engage in the preventative behaviour (self-efficacy), beliefs about how effective the 26 protective behaviour is at preventing the negative consequences of the threat (response 27 efficacy), and any barriers affecting performance of the protective behaviour (response 28 costs). PMT posits that, faced with a threat to their health, people are most likely to perform 29 a protective behaviour when they believe that not acting poses a threat to themselves (high 30 threat appraisal) and that engaging in the protective behaviour will reduce that threat (high 31 coping appraisal). 32 33 PMT has been applied to seasonal influenza vaccine acceptability and uptake (e.g., [10-13]), 34 and to predict COVID-19 vaccination intention among Chinese university students [14] . 35 However, no published studies examine the use of PMT to predict COVID-19 vaccination 36 intention in the general UK population. COVID-19 is affecting not just the general population 37 of the UK, but the global population. It is important that common theories of health 38 behaviour and health behaviour change, such as PMT, be applied to COVID-19 vaccination 39 intention in the general population, as this will allow for theory-based interventions to be 40 designed to reach as many as possible, to increase vaccine uptake. Conspiracy beliefs have been examined in relation to beliefs about COVID-19. These have 49 shown to be prevalent in a significant minority and to be associated with less adherence to 50 coronavirus government guidelines and lower willingness to take diagnostic or antibody 51 tests or get vaccinated [4, 6] . The role of conspiracy beliefs in intention to receive a COVID-52 19 vaccination has not yet been explored extensively, nor alongside PMT in vaccination 53 intention more broadly. As such beliefs are prevalent in a significant minority and may lower 54 vaccine uptake [4] , determining the extent of their influence on intention to get a COVID-19 55 vaccine is key to developing interventions for COVID-19 vaccine uptake. Qualtrics. The website provided background information on the study and respondents 169 were then invited to complete the anonymous online survey by clicking on the survey link. Respondents were presented with a consent form explaining the nature and aims of the 171 study and were then asked to tick a box confirming that they had read and understood the 172 information provided and that they would like to take part in the study. Descriptive Statistics 198 To assess relationships between the PMT constructs, Pearson's product-moment 199 correlations were performed (see Table 2 ). 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