Health Belief, Planned Behavior, or Psychological Antecedents: What predicts COVID-19 Vaccine Hesitancy better among the Bangladeshi Adults?
Authors: Hossain Mohammad Bellal , Alam Md. Zakiul , Islam Md. Syful , Sultan Shafayat , Faysal Md. Mahir , Rima Sharmin , Hossain Md. Anwer , Al Mamun Abdullah 
Published: April 2021

ABSTRACTBackgroundThis study aimed to determine the prevalence and investigate the constellations of psychological determinants of the COVID-19 vaccine hesitancy among the Bangladeshi adult population utilizing the health belief model-HBM (perceived susceptibility to and severity of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action), the theory of planned behavior-TPB (attitude toward COVId-19 vaccine, subjective norm, perceived behavioral control, and anticipated regret), and the novel 5C psychological antecedents (confidence, constraints, complacency, calculation, and collective responsibility). We compared the predictability of these theoretical frameworks to see which framework explains the highest variance in COVID-19 vaccine hesitancy.MethodsThis study adopted a cross-sectional research design. We collected data from a nationally representative sample of 1497 respondents through both online and face-to-face interviews. We employed multiple linear regression analysis to assess the predictability of each model of COVID-19 vaccine hesitancy.ResultsWe found a 41.1% prevalence of COVID-19 vaccine hesitancy among our study respondents. After controlling the effects of socio-economic, demographic, and other COVID-19 related covariates, we found that the TPB has the highest predictive power (adjusted R2 =0.43), followed by the 5C psychological antecedents of vaccination (adjusted R2 =0.32) and the HBM (adjusted R2 =0.31) in terms of explaining total variance in the COVID-19 vaccine hesitancy among the adults of Bangladesh.ConclusionsThis study provides evidence that theoretical frameworks like the HBM, the TPB, and the 5C psychological antecedents can be used to explore the psychological determinants of vaccine hesitancy, where the TBP has the highest predictability. Our findings can be used to design targeted interventions to reduce vaccine hesitancy and increase vaccine uptake.Key QuestionsWhat is already known?⍰There is a global-level insurgence of COVID-19 vaccine hesitancy, where the majority of studies come from western, educated, industrialized, rich, and democratic (WEIRD) countries.⍰To date, an online survey found that the prevalence of COVID-19 vaccine hesitancy in Bangladesh was 32.5%.⍰Few studies from WEIRD countries have adopted the Health Believe Model and/or the Theory of Planned Behavior to explore the predictors of COVID-19 vaccine hesitancy.What are the new findings?⍰This study found a 41.1% prevalence of COVID-19 vaccine hesitancy among a nationally representative sample of Bangladesh.⍰After controlling the effects of demographic, socio-economic, and other COVID-19 related covariates, we found that the TPB has the highest predictive power, followed by the 5C psychological antecedents and the HBM in terms of explaining total variance in the COVID-19 vaccine hesitancy among the adults of Bangladesh.What do the new findings imply?⍰Theoretical frameworks like the HBM, the TPB, and the 5C psychological antecedents can be used to explore the multitude of the psychological determinants of vaccine hesitancy, where the TPB has the highest predictability.⍰Findings can be used to design targeted interventions to reduce COVID-19 vaccine hesitancy and increase vaccine demand and uptake.