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COVID Fears and Long-Term Planning Play Key Roles in Vaccine Hesitancy

boy receives a vaccine shot from a woman
Photo credit: Heather Hazzan. Shared under a Creative Commons license. Click image for more information.

For Immediate Release

A recent study finds that concerns about the health effects of COVID-19 are a key variable in determining whether people are hesitant to get vaccinated against the virus. The study also found that an individual’s tendency to plan for the future plays a surprising role in people’s vaccine hesitancy.

At issue is a psychological trait called proactive coping that refers to a person’s tendency to think about and plan for the future.

“We found that the people who were least hesitant about getting vaccinated were people who were at least somewhat concerned about COVID-19 and had high scores on proactive coping,” says Shevaun Neupert, co-author of the study and a professor of psychology at North Carolina State University. “However, we also found that the people who were most hesitant about getting vaccinated also had high scores on proactive coping, but were not very concerned about contracting COVID-19.

“Basically, proactive coping seems to serve as an amplifier for vaccine hesitancy at both ends of the spectrum.”

For this study, researchers surveyed 534 adults in the United States, between the ages of 21 and 79. The survey was designed to assess people’s feelings of COVID-19 vaccine hesitancy and identify cognitive and behavioral predictors of that hesitancy. The researchers conducted the survey in October and November 2020. For context, the first COVID-19 vaccines were made publicly available in the U.S. in December 2020.

The researchers found that more than half of the study participants – 56.7% – were hesitant to get vaccinated.

“And the most powerful predictor of hesitancy was whether people had any anxiety about contracting COVID-19,” says Emily Smith, a co-author of the study and staff researcher at NC State. “The more anxiety people had about contracting COVID-19, the less likely they were to be hesitant about getting a COVID-19 vaccine.”

“We were surprised at the relationship we saw between anxiety and proactive coping,” Neupert says. “For example, people who scored high on proactive coping were much less likely to have vaccine hesitancy if they had even modest levels of concern about contracting COVID-19. And we did not expect proactive coping to amplify vaccine hesitancy in people who were not concerned about contracting COVID-19.”

The researchers note that all of the study results held true regardless of age, race, gender, educational background, how they rated their own health, or how much they felt they knew about COVID-19.

“Our findings can inform future efforts to increase vaccine uptake,” Smith says. “This study suggests that messaging should underscore the harms associated with contracting COVID-19, rather than focusing largely on vaccine safety and efficacy.”

The paper, “COVID-19 Vaccine Hesitancy: The Synergistic Effect of Anxiety and Proactive Coping,” is published in the open access journal Public Health Challenges. First author of the paper is MacKenzie Hughes, a Ph.D. student at Georgia Tech. Co-authors include Samuel Macy, a former undergraduate at NC State; Clara Coblenz of Georgia Tech; and Ann Pearman of MetroHealth Medical Center in Cleveland, Ohio.


Note to Editors: The study abstract follows.

“COVID-19 Vaccine Hesitancy: The Synergistic Effect of Anxiety and Proactive Coping”

Authors: MacKenzie L. Hughes and Clara W. Coblenz, Georgia Tech; Shevaun D. Neupert, Emily L. Smith and Samuel G. Macy, North Carolina State University; Ann Pearman, MetroHealth Medical Center (Cleveland, Ohio)

Published: March 5, Public Health Challenges

DOI: 10.1002/puh2.70

Background: This study sought to identify cognitive and behavioral predictors of COVID-19 vaccine hesitancy. Specifically, this study examined the effect of anxiety about developing COVID-19 and proactive coping behavior on the likelihood of reporting COVID-19 vaccine hesitancy in a sample of adults living in the United States.

Methods: An online survey of proactive coping strategies, anxiety related to developing COVID-19, and vaccine hesitancy was administered in October 2020 to 534 adults aged 21-79 years old. Age, gender, race, self-rated health, years of education, COVID-19 knowledge, and perceived constraints were included as covariates.

Results: Over half of the study participants (56.7%) were COVID-19 vaccine hesitant.. People who were less anxious about developing COVID-19 were more likely to be vaccine hesitant. A statistically significant COVID-19 Anxiety x Proactive Coping interaction showed the odds of vaccine hesitancy was highest among individuals with low anxiety about developing COVID-19 and high proactive coping, whereas vaccine hesitancy was lowest among individuals with high COVID-19 anxiety and high proactive coping.

Conclusion: Results support a future-oriented approach to public health outreach efforts regarding COVID-19 vaccines. Improvement of proactive coping skills and emphasis on the likelihood of contracting COVID-19 may be more effective in increasing vaccine uptake than simply restating scientific facts regarding safety or efficacy.