COVID-19 vaccine hesitancy continuum and its psycho-behavioral predictive models among general population: a cross-sectional study in Ethiopia.

BACKGROUND: The COVID-19 vaccine hesitancy continuum reflects an individual decision-making process regarding vaccination, ranging from fully willing to accept the vaccine to outright refusal. This study assessed COVID-19 vaccine hesitancy and compared the explanatory power of selected psycho-behavioral models for its variability among adults living in Southwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in Southwest Ethiopia from January 1 to 15, 2022. The calculated sample size was 879. A multistage sampling technique was used to select study participants. Data were collected using an interviewer-administered questionnaire comprising four sections: socio-demographic characteristics, COVID-19-related covariates, psycho-behavioral constructs, and a vaccine hesitancy scale. The data were entered into Epi-Data, and analysis was performed using Python in Jupyter Notebook. Descriptive statistics and hierarchical multiple linear regression were performed to compare the predictive ability of four psycho-behavioral models: the health belief model (perceived susceptibility, severity, benefit, barrier, and cues to actions); the theory of planned behavior (attitudes, subjective norms, behavioral control, and anticipated regret); five psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility); and vaccine conspiracy belief (conspiracy related to infection and the vaccine). Model comparison was done using adjusted R-squared and model selection criteria. RESULTS: The mean age of the participants was 31.63 ± 8.28, and 365 (44.3%) of them were female. The mean score of the COVID-19 vaccine hesitancy continuum was 5.11 ± 2.41. Among the respondents, 91 (11%) were fully willing to accept the COVID-19 vaccine, while 97 (11.8%) were completely resistant. The remaining 624 (77.18%) participants were hesitant to make a decision about vaccination. The vaccine conspiracy belief demonstrated the most predictive ability (adjusted R2 = 0.43), followed by the 5C psychological antecedent (adjusted R2 = 0.36), the theory of planned behavior (adjusted R2 = 0.26), and the health belief model (adjusted R2 = 0.20). CONCLUSION: COVID-19 vaccine hesitancy in Ethiopia is most predicted by vaccine conspiracy belief. Therefore, public health intervention should focus on addressing misinformation and conspiracy narratives.