Integrating health behavior theories to predict COVID-19 vaccine acceptance: differences between medical students and nursing students in Israel

Rosental, H.; Shmueli, L.

Abstract Objectives: To explore behavioral-related factors predicting intention of getting a COVID-19 vaccine among medical and nursing students using an integrative model combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Methods: A cross-sectional online survey was conducted among medical and nursing students aged >18 years in their clinical years in Israel between August 27 and September 28, 2020. Hierarchical logistic regression considering sociodemographic and health-related factors as well as factors derived from HBM and TPB, was used to predict intention to receive COVID-19 vaccine. Results: A total number of 628 participants completed the survey. Medical students expressed higher intentions of getting vaccinated against COVID-19 than nursing students (88.1% vs. 76.2%, p<0.01). The integrated model based on HBM and TPB was able to explain 66% of the variance (adjusted R2 = 0.66). Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived susceptibility, benefits, barriers, cues to action, attitude, self-efficacy and anticipated regret. Two interaction effects revealed that male nurses had higher intention of getting vaccinated than did female nurses and that susceptibility is a predictor of the intention of getting vaccinated only among nurses. Conclusions: This study demonstrates that both models considered (i.e., HBM and TPB) are important for predicting the intention of getting a COVID-19 vaccine among medical and nursing students, and can help better guide intervention programs, based on components from both models. Our findings also highlight the importance of paying attention to a targeted group of female nurses, who expressed low vaccine acceptance. Keywords: COVID-19; Health Belief Model; Healthcare workers; Theory of Planned Behavior; Vaccine acceptance