Multilevel determinants of COVID-19 vaccination uptake among South Asian ethnic minorities in Hong Kong: cross-sectional online survey

Singh, Akansha; Lai, Angel Hor Yan; Wang, Jingxuan; Asim, Saba; Chan, Paul Shing-Fong; Wang, Zixin; Yeoh, Eng Kiong

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy was observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotion that caters to unique needs of South Asians in Hong Kong. OBJECTIVE: This study investigated the prevalence of COVID-19 vaccination uptake among a sample of South Asians in Hong Kong. We examined the effects of factors including socio-demographics and all three levels of factors based on the socio-ecological model. METHODS: A cross-sectional online survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or above living in Hong Kong, able to comprehend English, Hindi, Nepali or Urdu, and having access to a smartphone. Three community-based organizations (CBOs) providing services to South Asians in Hong Kong facilitated the data collection. CBO staff posted the study information in the WhatsApp groups involving South Asian clients, and invited them to participate an online survey. Logistic regression models were fit for data analysis. RESULTS: Among 245 participants, 33.1% (n=81) had taken up at least one dose of COVID-19 vaccination [one dose: n=62 (25.2%), and both doses: n=19 (7.9%)]. After adjusted for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccination uptake (AOR: 0.83, 95%CI: 0.71, 0.97, P=.02). On individual-level, having more positive attitudes toward COVID-19 vaccination (AOR: 1.31, 95%CI: 1.10, 1.55, P=.002), perceived support from significant others (AOR: 1.29, 95%CI: 1.03, 1.60, P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR: 2.63, 95%CI: 1.65, 4.19, P<.001) were associated with higher COVID-19 vaccination uptake, while a negative association was found between negative attitudes and the dependent variable (AOR: 0.73, 95%CI: 0.62, 0.85, P<.001). Knowing more peers who had taken up COVID-19 vaccination was also associated with higher uptake (AOR: 1.39, 95%CI; 1.11, 1.74, P=.01). On interpersonal-level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR: 0.54, 95%CI: 0.33, 0.86, P=.01). CONCLUSIONS: One third (81/245) of our participants received at least one dose of COVID-19 vaccination. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were determinants of COVID-19 vaccination uptake among South Asians. Future program should engage community groups, champions and faith leaders, and develop culturally competent interventions.