Investigating the intention to receive the COVID-19 vaccination in Macao: implications for vaccination strategies

Oi Lam Ung, C.; Hu, Y.; Hu, H.; Bian, Y.

Importance: Understanding the intention of receiving COVID-19 vaccines is important for informing effective vaccination strategies especially for areas with low incidence. Objective: This study aimed to investigate the intention to receive COVID-19 vaccination, identify the key influencing factors, and determine the most important intention predictors using a theoretically principled model. Design, setting, and participants: This was a cross-sectional online survey study hosted by Survey Monkey and implemented for 10 days from May 14 2021. People who aged 18 years or above and had been residing in Macao for 12 months prior to the study were recruited through social media. Main outcomes and measures: Intention, the constructs of protection motivation theory (perceived severity, perceived susceptibility, maladaptive response reward, self-efficacy, response-efficacy, and response cost), constructs of health belief model (cues to action), social attitude, social norm, past experience and information seeking behavior, in addition to demographic variables. Results: Of the 552 respondents, 79.5% aged between 25 and 54 years old, 59.4% were female, and 88% had a bachelor degree or above. Overall, 62.3% of the respondents indicated their intention while 19.2% were hesitant and 18.5% did not have any intention. While 67.0% believed COVID-19 infection was life-threatening, only 19.0% thought they were at risk. Control variables such as age, gender, education level, and having travel plans were significantly correlated with intention. Significant associations were found between intention and all the measures (p<0.05). The most important positive predictors of intention were "being able to make arrangement to receive the vaccine" ({beta} = 0.333, P <0.001), "a sense of social responsibility" ({beta} = 0.326, P < 0.001), and "time off from work after vaccination" ({beta} = 0.169, P <0.001), whereas "concerns over vaccine safety" ({beta} = -0.124, P < 0.001) and "relying on online resources for vaccine information" ({beta} = -0.065, P <0.05) were negative predictors. Perceived severity was not a predictor of intention. Conclusion and relevance: Multi-component strategies that address various factors affecting intention are needed to formulate effective interventions. Health literacy, vaccination convenience, social responsibility, reasonable incentives and well-informed risk and benefit analysis are recommended consideration for future vaccination campaigns.