Predicting COVID-19 Vaccine Hesitancy through Integrated Protection Motivation Theory Constructs

OBJECTIVES: Despite the widespread availability of COVID-19 vaccines, there remains a segment of the population that is hesitant to get vaccinated, a phenomenon referred to as vaccine hesitancy. This study systematically reviews research that employs the Protection Motivation Theory (PMT) as a theoretical foundation to investigate the impact of PMT constructs (severity, susceptibility, maladaptive response cost, and self-efficacy) on COVID-19 vaccine hesitancy.

METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of literature related to COVID-19 vaccination hesitancy based on the PMT was conducted. The search spanned from January 1, 2019, to December 31, 2023, and included four databases.

RESULTS: From 348 records, 29 studies were included, with the majority being cross-sectional surveys. Key barriers to and enablers of vaccine acceptance were categorized using the PMT constructs. Notably, perceived severity and self-efficacy emerged as two significant predictors of vaccine hesitancy. The most frequently identified barriers to COVID-19 vaccination included concerns about vaccine safety, efficacy, speed of development, and mistrust in the public health response to COVID-19.

CONCLUSIONS: For effective intervention programs targeting COVID-19 vaccine hesitancy, it is recommended to employ strategies that enhance individuals' perceived severity of COVID-19 and self-efficacy. The PMT is a valuable framework for understanding vaccine hesitancy related to COVID-19. Nevertheless, there is notable variability in how the PMT constructs are operationalized and reported in the studies reviewed.