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 (), Marwa Shawky Abdou, Salah Awaidy, Malik Sallam, Iffat Elbarazi, Naglaa Youssef, Osman Abubakar Fiidow, Slimane Mehdad, Mohamed Fakhry Hussein, Mohammed Fathelrahman Adam, Fatimah Saed Alabd Abdullah, Wafa Kammoun Rebai, Etwal Bou Raad, Mai Hussein, Shehata F. Shehata, Ismail Ibrahim Ismail, Arslan Ahmed Salam and Dalia Samhouri
Additional contact information
Ramy Mohamed Ghazy: Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
Marwa Shawky Abdou: Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
Salah Awaidy: Health Affairs, Ministry of Health, Muscat 100, Oman
Malik Sallam: Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
Iffat Elbarazi: Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, AlAin 15551, United Arab Emirates
Naglaa Youssef: Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
Osman Abubakar Fiidow: School of Public Health and Research, Somali National University, Mogadishu P.O. Box 15, Somalia
Slimane Mehdad: Physiology and Physiopathology Research Team, Research Centre of Human Pathology Genomics, Faculty of Sciences, Mohammed V University, Rabat BP 8007, Morocco
Mohamed Fakhry Hussein: Occupational Health and Industrial Medicine Department, High Institute of Public Health, Alexandria University, Alexandria 21526, Egypt
Mohammed Fathelrahman Adam: Faculty of Pharmacy, University of Science and Technology, Khartoum P.O. Box 12810, Sudan
Fatimah Saed Alabd Abdullah: Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
Wafa Kammoun Rebai: Institute Pasteur de Tunis, Tunis 2092, Tunisia
Etwal Bou Raad: Department of Epidemiology and Population Health, American University of Beirut, Beirut P.O. Box 110236, Lebanon
Mai Hussein: Clinical Research Administration, Alexandria Directorate of Health Affairs, Egyptian Ministry of Health and Population, Alexandria 21554, Egypt
Shehata F. Shehata: Department of Family and Community Medicine, King Khalid University, Abha 62529, Saudi Arabia
Ismail Ibrahim Ismail: Department of Neurology, Ibn Sina Hospital, Gamal Abdel Nasser Street, Sabah Medical Area, Safat 070001, Kuwait
Arslan Ahmed Salam: National Institute of Health, Islamabad 45320, Pakistan
Dalia Samhouri: Emergency Preparedness and International Health Regulations, WHO EMRO (DS), P.O. Box 7608, Naser City 11371, Egypt

IJERPH, 2022, vol. 19, issue 19, 1-16

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; booster dose acceptance; health belief model; vaccine hesitancy; East Mediterranean region (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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