Using the Social–Ecological Model to Assess Vaccine Hesitancy and Refusal in a Highly Religious Lower–Middle-Income Country

Rachael M. Chait, Anindrya Nastiti, Delfi Adlina Chintana, Putri Nilam Sari, Nabila Marasabessy, Muhamad Iqbal Firdaus, Mila Dirgawati, Dwi Agustian, Heidi West, Herto Dwi Ariesyady and Tomoyuki Shibata ()
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Rachael M. Chait: Miller School of Medicine, University of Miami, Miami, FL 33136, USA
Anindrya Nastiti: Faculty of Civil and Environmental Engineering, Bandung Institute of Technology (ITB), Bandung 40132, West Java, Indonesia
Delfi Adlina Chintana: Faculty of Medicine, Padjadjaran University (UNPAD), Jatinangor 45363, West Java, Indonesia
Putri Nilam Sari: Faculty of Civil and Environmental Engineering, Bandung Institute of Technology (ITB), Bandung 40132, West Java, Indonesia
Nabila Marasabessy: Faculty of Civil and Environmental Engineering, Bandung Institute of Technology (ITB), Bandung 40132, West Java, Indonesia
Muhamad Iqbal Firdaus: Faculty of Civil and Environmental Engineering, Bandung Institute of Technology (ITB), Bandung 40132, West Java, Indonesia
Mila Dirgawati: Faculty of Civil Engineering and Planning, National Institute of Technology (ITENAS), Bandung 40124, West Java, Indonesia
Dwi Agustian: Department of Public Health, Faculty of Medicine, Padjadjaran University (UNPAD), Bandung 40161, West Java, Indonesia
Heidi West: Global Environmental Health LAB, Los Angeles, CA 90034, USA
Herto Dwi Ariesyady: Global Environmental Health LAB, Los Angeles, CA 90034, USA
Tomoyuki Shibata: Global Environmental Health LAB, Los Angeles, CA 90034, USA

IJERPH, 2024, vol. 21, issue 10, 1-17

Abstract: (1) Background: The aim of this study was to understand the factors associated with vaccine hesitancy and refusal in Indonesia using the Social–Ecological Model (SEM). (2) Methods: Data on demographics, religiosity, family dynamics, and perceptions of public health efforts were collected through an online survey and compared to the rates of vaccine hesitancy and refusal. (3) Results: Income and sex were significantly associated with vaccine hesitancy. Based on a vaccine passport policy to enter public spaces, people who felt inhibited to enter public spaces or perceived privacy threats were twice as likely to exhibit vaccine hesitancy. Participants who believed that religious groups had a difficult time getting vaccinated were nearly twice as likely to exhibit vaccine hesitancy and three times more likely to exhibit vaccine refusal. However, participants who believed in a higher religious power were 58% less likely to exhibit vaccine hesitancy. Religious leaders significantly influenced participants to make the decision regarding vaccination. Individuals with vaccine refusal were more than twice as likely to share information with others without fact-checking. Notably, structural barriers such as distance and transportation were most strongly associated with vaccine hesitancy and refusal. (4) Conclusion: Cultural factors play a significant role in vaccine hesitancy and refusal. The SEM can be used to propose multi-level interventions with collaboration and communication among stakeholders to improve community health.

Keywords: immunization; health promotion; vaccine hesitancy; vaccine refusal; lower middle-income county; religion; family dynamics; Indonesia; Social–Ecological Model (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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