Psychosocial factors affecting COVID-19 vaccine uptake in the UK: a prospective cohort study (CoVAccS – wave 3)
Authors: Smith Louise E. , Sim Julius , Cutts Megan , Dasch Hannah , Amlôt Richard , Sevdalis Nick , Rubin G James , Sherman Susan M. 
Published: March 2022

Background

We investigated factors associated with COVID-19 vaccine uptake, future vaccination intentions, and changes in beliefs and attitudes over time.

Methods

Prospective cohort study. 1500 participants completed an online survey in January 2021 (T1, start of vaccine rollout in the UK), of whom 1148 (response rate 76·5%) completed another survey in October 2021 (T2, all UK adults offered two vaccine doses). Binary logistic regression analysis was used to investigate factors associated with subsequent vaccine uptake. Content analysis was used to investigate the main reasons behind future vaccine intentions (T2). Changes in beliefs and attitudes were investigated using analysis of variance.

Findings

At T2, 90·0% (95% CI 88·2%-91·7%) of participants had received two doses of a COVID-19 vaccine, 2·2% (95% CI 1·3%-3·0%) had received one dose, and 7·4% (95% CI 5·9%-8·9%) had not been vaccinated. Uptake was associated with higher intention to be vaccinated at T1, greater perceived vaccination social norms, necessity of vaccination, and perceived safety of the vaccine. People who had initiated vaccination reported being likely to complete it, while those who had not yet received a vaccine reported being unlikely to be vaccinated in the future. At T2, participants perceived greater susceptibility to, but lower severity of, COVID-19 (p<0.001), than T1. Perceived safety and adequacy of vaccine information were higher (p<0.001).

Interpretation

Targeting modifiable beliefs about the safety and effectiveness of vaccination may increase uptake.

Funding

Data collection was funded by a Keele University Faculty of Natural Sciences Research Development award and a King’s COVID Appeal Fund award.

Research in context

Evidence before this study

COVID-19 vaccination intention was high at the start of the vaccine rollout in the UK. Research suggests that psychosocial factors are associated with vaccine uptake. However, most research on uptake of the COVID-19 vaccine has investigated factors associated with vaccination intention, and used a cross-sectional design.

Added value of this study

We used a prospective cohort study (T1 conducted in January 2021, the start of the UK vaccine rollout; T2 conducted in October 2021, all UK adults offered two vaccine doses) to investigate factors associated with subsequent COVID-19 vaccination. Qualitative data on the main supporting reasons for future vaccination intentions in those partially or not vaccinated were analysed using content analysis. Changes in vaccine beliefs and attitudes (generally and COVID-19 specific) were also analysed.

Implications of all the available evidence

In our sample, more people reported having been vaccinated than had previously reported intending to be vaccinated. Vaccine uptake was strongly associated with previous vaccination intention, perceived social norms of vaccination, and greater perceived necessity and safety of vaccination. Those who had received at least one COVID-19 vaccine reported being likely to complete the schedule, whereas those who had not received a vaccine reported being unlikely to receive a vaccine.