Effects of Individuals’ Cultural Orientations and Trust in Government Health Communication Sources on Behavioral Intentions During a Pandemic: A Cross-Country Study

Sung In Choi (PhD candidate), Sungsu Kim (PhD alum), Yan Jin, Chiara Valentini, Mark Badham, Elanor Colleoni, and Stefania Romenti (In press). “Effects of Individuals’ Cultural Orientations and Trust in Government Health Communication Sources on Behavioral Intentions During a Pandemic: A Cross-Country Study.” Health Communication.

Abstract: Public health messages disseminated by trusted government authorities are likely to have more influence over individuals’ intentions and behaviors. However, individuals worldwide have different levels of trust in government authorities, which leads to varying levels of compliance intentions. Additionally, these trust levels may vary during major public crises, such as pandemics. Based on a COVID-19 pandemic communication survey (N = 3,065) disseminated throughout six countries (Australia, Finland, Italy, South Korea, Sweden, and the United States), this study examined the association among trust in distinct government sources, cultural orientations, and health behavioral intentions. Findings indicated that trust in official health communication sources at four governmental levels (i.e., national government, the head of the national government, the national health authority, and the chief representative of the national health authority) was related to vaccination intentions and other behavioral compliance intentions (i.e., willingness to prevent COVID-19 infection in other ways). Meanwhile, these direct associations were mediated by the cultural orientations of power distance and uncertainty avoidance. Findings also revealed that the direct association of trust in government sources and the indirect relationship through the above cultural orientations varied by country. This study offers insight into the important role of credible sources and individuals’ cultural orientations in the domain of health communication aimed at influencing behavioral intentions.

Looking Ahead: Caregivers’ COVID-19 Vaccination Intention for Children 5 years old and younger

Abstract: Little research has been conducted to examine parents’ intention to vaccinate their young children for COVID19. An online survey with a national U.S. sample of 682 primary caregivers of children under age six assessed variables associated with intention to accept the COVID-19 vaccine for their children from November 13, 2020, to December 8, 2020. 

Caregivers whose child received a recent influenza vaccine, as well as those with previous experience COVID-19, were more likely to express COVID-19 vaccination intention for their young child. Identifying as female was associated with lower COVID-19 vaccination intention, while identifying as Hispanic or Latino was associated with higher intention. Health Belief Model variables of perceived severity of COVID-19 for their child, as well as vaccine confidence, were positive predictors of COVID-19 vaccine intention and mediated the relationship between prior behavior, demographic variables, and intention. The findings highlight the importance of early, proactive COVID-19 vaccination education efforts directed at caregivers with young children. Vaccines for young children will likely become a necessary part of ending the pandemic’s impact in school settings. Operationally, COVID-19 vaccination may also become a part of childhood vaccination schedules. Understanding the beliefs and intentions of caregivers of young children before vaccinations are recommended for children will enable public health officials and medical practitioners to prepare in advance. 

Trust and Cultural Factors Shaping COVID-19 Vaccination Intentions across Six Countries

Abstract: Based on a COVID-19 pandemic communication survey (N = 3,124) in Australia, Finland, Italy, South Korea, Sweden, and the United States, our study examined how trust in government sources affects the vaccination intention and how this translates into cross-national variations in the outcome. Our findings revealed that the direct effect of trust in government sources on vaccination intention and the indirect effect via power distance and uncertainty avoidance varied across the six countries.

Using Influenza Vaccination Location Data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to Expand COVID-19 Vaccination Coverage

Victoria Fonzi, Kiran Thapa, Kishor Luitel, Heather Padilla, Curt Harris, M. Mahmud Khan, Glen Nowak and Janani Rajbhandari-Thapa, Using Influenza Vaccination Location Data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to Expand COVID-19 Vaccination Coverage

Abstract: Effective COVID-19 vaccine distribution requires prioritizing locations that are accessible to high-risk target populations. However, little is known about the vaccination location preferences of individuals with underlying chronic conditions. Using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we grouped 162,744 respondents into high-risk and low-risk groups for COVID-19 and analyzed the odds of previous influenza vaccination at doctor’s offices, health departments, community settings, stores, or hospitals. Individuals at high risk for severe COVID-19 were more likely to be vaccinated in doctor’s offices and stores and less likely to be vaccinated in community settings. 

Adherence to Timely Vaccinations in the United States.

Abstract: To estimate 1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and 2) associations between schedule adherence, sociodemographic characteristics and up-to-date immunization status by 19-35 months of age. Methods: We used 2014 National Immunization Survey (NIS) provider-verified vaccination data to classify vaccination patterns as “recommended” (i.e., in line with ACIP dose- and agespecific recommendations), “alternate” (i.e., in line with either limiting the number of shots per visit or skipping at least one vaccine series) or “unknown/unclassifiable” (i.e., not in-line with ACIP recommendations nor clearly limiting shots per visit or vaccine series). We evaluated predictors of immunization schedule adherence patterns and estimated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. Results: The majority of children’s patterns were classified as “recommended” (63%), with 23% and 14% following alternate or unknown/unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19-35 months. Not being up-to-date was associated with alternate (prevalence ratio [PR] = 4.2, 95% confidence interval [CI] 3.9, 4.5) and unknown/unclassifiable (PR = 2.4, 95% CI 2.2, 2.7) vaccination patterns. Conclusion: Overall high vaccine coverage by 19-35 months of age may miss non-adherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.

The Global Vaccine Action Plan – insights into its utility, application, and ways to strengthen future plans.

Abstract: The pace of global progress must increase if the Global Vaccine Action Plan (GVAP) goals are to be achieved by 2020. We administered a two-phase survey to key immunization stakeholders to assess the utility and application of GVAP, including how it has impacted country immunization programs, and to find ways to strengthen the next 10-year plan.

Results: Global immunization stakeholders (n = 38) cite global progress in improving vaccine delivery (88%) and engaging civil society organizations as advocates for vaccines (83%). Among regional and national immunization stakeholders (n = 58), 70% indicated reaching mobile and underserved populations with vaccination activities as a major challenge. The top ranked activities for helping country programs achieve progress toward GVAP goals include improved monitoring of vaccination coverage and upgrading disease surveillance systems. Most respondents (96%) indicated GVAP as useful for determining immunization priorities and 95% were supportive of a post-2020 GVAP strategy. Conclusions: Immunization stakeholders see GVAP as a useful tool, and there is cause for excitement as the global immunization community looks toward the next decade of vaccines. The next 10-year plan should attempt to increase political will, align immunization activities with other health system agendas, and address important issues like reaching mobile/migrant populations and improving data reporting systems.


Development of a measure to assess vaccine confidence among men who have sex with men.

Abstract: Recent serogroup C meningococcal disease outbreaks led to meningococcal vaccine recommendations for Southern California men who have sex with men (MSM). Assessment of vaccine confidence is critical to improving vaccine coverage in the context of disease outbreaks wherein immunization(s) are recommended. Methods: We surveyed MSM using venue-based sampling and began development of the vaccine confidence index (VCI) with 30 survey items corresponding to trust- and safety-related perceptions. We performed exploratory factor analyses and computed the Cronbach’s alpha coefficient to assess internal consistency of the VCI. We created a categorical confidence variable (low, medium, and high confidence) and conducted bivariate and multivariate analyses to evaluate associations with reported confidence and immunization uptake. Results: Ten survey items were included in the final VCI and formed the confidence measure. Participants with low confidence had the lowest levels of reported uptake for both meningococcal vaccines. Confidence differed significantly (p <= 0.05) between MSM who indicated they received vaccines recommended within the context of the outbreak and those who did not. Conclusions: Our VCI is sensitive to a number of issues that may influence vaccine confidence. It is useful for assessing MSM trust and acceptance of recommended immunizations and may be used to inform intervention development.

A Social Networks Approach to Understanding Vaccine Conversations on Twitter: Network Clusters, Sentiment, and Certainty in HPV Social Networks

Abstract: Individuals increasingly rely on the Internet, and social media in particular, for health-related information. A recent survey reports that 80% of Internet users search for health information online. In the present study, we employ Twitter data to understand content characteristics and the patterns of content flow of the conversations about the HPV vaccine debate. Approaching the HPV vaccine conversations on Twitter as a social network, we can identify key self-formed subgroups—clusters of users who create “siloes” of interactions and information flow. Combining network analysis, computer-aided content analysis, and human-coded content analysis, we explored the communication dynamics within the groups in terms of group members’ affective and cognitive characteristics. Our findings show that positive emotion is positively correlated with cluster density, an indicator of strong ties and rapid information flow. In the case of negative emotion, we found that anger is a significant negative predictor for graph density. We also found a correlation between certainty and tentativeness; both at cluster as well as at tweet level, suggesting that clusters bring together people who are sure about the HPV vaccine and people who are exploring for answers.