COVID-19 Vaccine Confidence in Zimbabwe and Sierra Leone: An Application of Health Behavior Change Constructs

Abstract Introduction Over the past three years, the global health community has been primarily focused on matters related to COVID-19, such as infection rates, mortality figures, and vaccination campaigns. While African countries, in general, experienced a milder COVID-19 impact compared to Western nations, they faced challenges in vaccine uptake. Specifically, Zimbabwe and Sierra Leone saw vaccine acceptance rates below global averages. This research delves into the underlying factors that influenced these disparities in vaccine acceptance in these two countries, using the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) as guiding frameworks. Methods This study utilized data from a cross-sectional survey encompassing 2,312 participants from areas where the Africa Christian Health Associations Platform (ACHAP) operates in Zimbabwe and Sierra Leone. The survey assessed respondents' views in line with core HBM and TPB constructs, in addition to their levels of vaccine acceptance. We then employed adjusted regression models to investigate the correlation between health behavior change theory constructs and vaccine confidence, taking into account variables like gender, age, education, and country of residence. Results Several associations were identified, including high vaccine confidence correlated with a heightened perceived threat of COVID-19, recognized benefits of vaccination, stronger perceived behavior control, and fewer perceived barriers to vaccination. Conversely, low vaccine confidence was linked to diminished perceived threats, an abundance of perceived barriers, weaker perceived behavior control, and heightened perceptions of barriers. Discussion Results underscore the significance and utility of theoretical constructs in understanding variations in vaccine confidence levels. They highlight the importance of relying on well-established theories to grasp decision-making mechanisms and to shape suggestions for behavior modification. Consequently, to boost vaccine acceptance, public health campaigns should focus on reshaping risk perceptions, addressing obstacles, emphasizing the advantages of getting vaccinated, and fostering a sense of self-efficacy within target communities.