F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.122069.1 Research Article Articles Readiness and determinants of Vietnam's general public to receive the COVID-19 Vaccine: a national online cross-sectional study

[version 1; peer review: awaiting peer review]

 Thi Xuan Hoang Huong Conceptualization Formal Analysis Methodology Resources Supervision Validation Visualization Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0002-5248-0398 a 1 Abu-Odah Hammoda Supervision Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0002-8874-2599 2 3 Hoang Vu Anh Data Curation Formal Analysis Methodology Validation Writing – Original Draft Preparation Writing – Review & Editing 4 Van Nguyen Liep Formal Analysis Writing – Original Draft Preparation Writing – Review & Editing 1 Faculty of Nursing, PHENIKAA University, Hanoi 12116, Vietnam, Vietnam World Health Organization Collaborating Center for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Nursing and Health Sciences Department, University College of Applied Sciences (UCAS), Gaza, Palestinian Territory Faculty of Nursing, , DAI NAM University, , Hanoi, Vietnam, Vietnam huong.hoangthixuan@phenikaa-uni.edu.vn

No competing interests were disclosed.

 28 6 2022 2022 11 715 22 6 2022 Copyright: © 2022 Thi Xuan Hoang H et al. 2022 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Despite vaccinations’ efficacy in combating disease, people’s readiness to get the coronavirus disease 2019 (COVID-19) vaccine are substantially varied. This study aimed to assess Vietnamese people’s readiness, attitudes, and determinants for COVID-19 vaccination.

Methods: A web-based cross-sectional online survey was conducted using a convenience sampling approach. The Vietnamese population’s readiness to receive COVID-19 vaccinations was assessed using the 7C of vaccination readiness scale (7Cs). The scale was posted on Facebook and Zalo platforms. Descriptive statistics were calculated, and inferential analysis was applied to identify determinants predicting respondents’ vaccine readiness.

Results: Of the 1086 respondents invited to the study, 1026 completed the questionnaire. The Vietnamese population demonstrated a moderate level of readiness for COVID-19 vaccination uptake, with an average 7Cs score of 103.25±15.13. A high level was underscored in the complacency, constraints, collective responsibility, and compliance components, and a low level was reported in the calculation component. The Vietnamese population emphasized that the awareness of the significant adverse effects of COVID-19 vaccination was the primary factor influencing their readiness to get the vaccine ( p < 0.001). Worrying about the vaccine manufacturer and its origin was the second most crucial factor influencing their readiness to get the vaccine (p < 0.001).

Conclusions: Building confidence between people and the Vietnamese authorities is a high priority to enhance people’s readiness to get the COVID-19 vaccine. The authorities should focus on dispelling disinformation posted on social media and promoting the usefulness of COVID-19 vaccines.

 Vaccine readiness COVID-19 Asia vaccine hesitancy The author(s) declared that no grants were involved in supporting this work. Introduction

Coronavirus disease 2019 (COVID-19) is a significant public health problem globally, with the emergence of the different variants. 1 In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic due to increased COVID-19 infection rates. 2 The WHO recommends COVID-19 vaccination alongside preventative measures as the most effective strategy for fighting diseases and limiting the virus’s rapid spread. 3 However, people’s readiness/willingness to get the COVID-19 vaccine varies significantly due to the dissemination of false rumours and misinformation on social media. 4

Vaccination readiness is defined as components that determine an individual’s response to vaccination. 5 Governmental, national, and international organizations have attempted to persuade people to receive vaccines; 6 however, their vaccination rates remain low. Around 64.7% of the global population and just 14.8% of people in low- and middle-income countries (LMICs) have received at least one dose of COVID-19 vaccination. 7 In Vietnam, 75.9% of the population have received two doses of COVID-19 vaccine and 46% have got three doses of vaccine. 8 Nonetheless, a lack of data on the efficacy and long-term adverse effects of new vaccinations contributes to the population’s reluctance to get the COVID-19 vaccine. As a result, research on public readiness for COVID-19 vaccinations uptake is necessary to provide insight and solid evidence of data that will assist policymakers in developing a campaign to increase the percentage of vaccinated people. Furthermore, in the context that infectious disease outbreak and pandemics continually emerge and evolve over time, results from such studies will help policymakers quickly develop successful policies that allow vaccines to be administered rapidly – which, in turn, elicits the immune response during future outbreaks of other infectious diseases.

Vaccination readiness has received considerable attention in research; however, the research focus has been limited to specific populations such as medical health workers, medical/nursing students, 9 and those with comorbidities. 10 – 18 Recent studies on the general public have revealed that COVID-19 vaccine uptake varies significantly among nations. 19 These studies found that between 63% and 92.33% of people were willing to receive the COVID-19 vaccine. 20 – 22 Burke, Masters and Massey 19 also revealed that participants’ willingness to get COVID-19 vaccination is related to their trust in the vaccine’s effectiveness, age, and occupation. Despite the beneficial results of earlier studies, variations in the factors related to intentions to take COVID-19 vaccinations were observed among studies. Furthermore, most prior research used only two questions 23 , 24 or unvalidated scales to assess people’s readiness to get vaccines, making it difficult to generalize the findings.

Adopting proper scales is thus crucial for determining people’s readiness to receive the vaccine. Betsch, Böhm and Chapman 25 developed the five components (5C) scale to assess vaccination readiness on five different components: confidence (trust in the safety and effectiveness of the vaccines and health authorities), complacency (seeing a high need for vaccination due to a high perceived risk of the disease), constraints (not seeing any hurdles in everyday life that hamstring vaccination), calculation (comparing personal costs against the benefits of receiving a vaccination versus a non-vaccination), collective responsibility (willingness to protect others by getting vaccinated). Geiger et al. 23 recently expanded the scale by including two additional components : compliance (support for social monitoring and sanctioning of people who refuse vaccination), and conspiracy (a low belief in vaccination-related conspiracy theories and fake news). The updated scale consist of 7Cs (seven components) scale of vaccination readiness. 23 Measuring these components might assist policymakers in tailoring initiatives targeted at promoting vaccine uptake. Thus, this study was undertaken in Vietnam to assess the public’s readiness, attitudes, and determinants to receive the COVID-19 vaccine using the 7Cs scale.

 Methods Ethical considerations

The Institutional Review Board of the Nam Dinh University of Nursing (Approval number: 1681/GCN-HDDD) approved this study. The approval was granted following the World Medical Association’s Declaration of Helsinki. Participants were asked to electronically consent to taking the survey, which included a statement emphasizing the survey’s confidentiality and voluntary participation.

 Study design

A cross-sectional research study was applied to assess the Vietnamese population’s readiness to get the vaccine. The data was gathered through the use of an online survey. Online surveys were distributed through Qualtrics CoreXM and uploaded on Facebook and Zalo, the most popular social media platforms in Vietnam, from September to December 2021.

 Sample

The participants were recruited across the country using a convenience sample approach. Participants were eligible if they were Vietnamese citizens aged 18 years or older who had not previously received two doses of COVID-19 vaccination and agreed to participate in the study. For those who did not utilize social media, such as elderly citizens, a link to the questionnaire was sent to over 10 groups of elders to encourage them to participate in the study. The required sample size was determined to be 1068 participants using Thompson’s sample size calculation formula. 26 The sample size was determined using the total population of Vietnamese aged 18 years (71 million), with an error margin of 3% and a confidence level of 95%.

 Measures

Readiness to get COVID-19 vaccine

The 7Cs scale of vaccination readiness was utilized. 24 The 7Cs is a 21-items scale measuring seven readiness components (as presented in the Introduction). Each component consisted of three items graded on a seven-point Likert scale (7 being “strongly agree” and 1 being “strongly disagree”). High scores imply a high score of readiness among the participants. The 7Cs is a validated tool that has been used to assess the general population’s readiness for vaccination and has been translated into 12 languages. 23 The Vietnamese version was translated via a forward-backward method, and the scale’s Cronbach’s alpha was 0.87, indicating that the data set had an extremely high level of internal consistency.

Attitudes toward getting the COVID-19 vaccine

Participants were asked three questions about their attitudes toward COVID-19 vaccination: (1) “I believe I will be diagnosed with COVID-19 in the next 12 months”, (2) “COVID-19 will have a serious impact on my health”, and (3) “I believe the severity of the disease and the risk of developing complications will be reduced if a person is infected with COVID-19 even after receiving the vaccination”. These questions were used in previous studies that measured attitudes for COVID-19 uptake. 19 , 27 – 29 Each question was graded on a 4-point Likert scale, with 1 being “absolutely to” and 4 being “certainly not.” Each question’s mean score was calculated, with a higher mean reflecting positive attitudes toward the COVID-19 vaccine.

Determinants/reasons for COVID-19 vaccine uptake

Five questions were asked to ascertain the degree of agreement with frequent reasons for avoiding toreceive COVID-19 vaccinations. The common reasons were developed by reviewing the literature and an unpublished survey of 200 people. 19 , 27 , 29 Each question was on a seven-point Likert scale, with 7 being “Strongly disagree” and 1 being “Strongly agree.” The question’s highest score indicated the primary reason for non-vaccination.

Sociodemographic characteristics of the population

Participant characteristics were collected, including demographic factors such as age and gender, occupation, province (has COVID-19 cases and is now under semi-lockdown/lockdown or has no COVID-19 cases), history of chronic diseases, and COVID-19 vaccination status.

 Data analysis

The Statistical Package for the Social Science (SPSS) version 22 (IBM Corp., Armonk, NY, USA) was used for data analysis. Descriptive statistics were calculated to summarise the study participants’ characteristics, scale, and sub-components. Independent samples t-test and ANOVA test were used as appropriate to assess the difference between respondents’ readiness to get COVID-19 vaccines and their characteristics. Spearman’s correlation coefficient was used to measure the strength and direction of association between 7Cs score and agreement level with common reasons for not taking COVID-19 vaccines and attitude toward having COVID-19. A p-value of less than 0.05 was considered a significant level.

 Results Participants characteristics

Of the 1086 people survey invitees, 1026 completed the questionnaire and were included in the final analysis. The majority of participants (n=642, 62.3%) were female. Their ages ranged from 18 to 77 years, with a mean of 31.04 years (SD 13.2 years). Over a third of participants (n=367, 35.8%) were students. Most participants (n=732, 71.3%) lived in a province where COVID-19 cases were reported, and the province was placed on lockdown. Only 28.1% of participants (n=288) received the first dose of the COVID-19 vaccine, whereas 61.1% (n=627) were scheduled to receive the first dose. About 10.8% of participants (n=111) expressed a lack of readiness to receive the vaccine ( Table 1).

Participants' characteristics.
Participants (n=1026) %
Age group
≤30 594 57.9
>30 432 42.1
Average (min-max) 31.04 ± 13.2 (18-77)
Gender
Male 373 36.4
Female 642 62.5
LGBT 11 1.1
Occupation
Occupations that are regularly being close to people (such as driver, shipper, saleman, medical workers, teachers, business, freelancer) 330 32.7
Occupations that are not regularly being close to people (such as tecnician, farmer, lab researcher, administration, IT, retired) 313 31.0
Students 367 35.8
Location
Province that has COVID-19 cases and currently under semilockdown/lockdown 732 71.3
Province that hasn't COVID-19 cases 294 28.7
Having chronic diseases
No 819 79.8
Yes (Allergic history Metabolic disorders, thrombocytopenia, cardiovascular diseases, cancer, chronic obstructive pulmonary disease) 117 20.2
COVID-19 vaccination status
Do not want to receive any dose 111 10.8
Received one dose 288 28.1
Already book to receive the first dose 627 61.1
Readiness of participants to get COVID-19 vaccination

The average score for 7Cs was 103.25±15.13, ranging from 34 to 147, indicating that participants were moderately ready to receive the vaccine. Participants reported high scores in the components of complacency, restrictions, collective responsibility, and compliance, but low scores in the calculation component. The detailed descriptive statistics of readiness components and their items are presented in Table 2.

Readiness of participants toward taking Covid-19 vaccination.
Component Mean for the components No Item Mode
Confidence 4.71 ± 1.42 1. COVID-19 Vaccination side effects occur rarely and are not severe for me. 6
2. Political decisions about Covid-19 vaccinations are scientifically grounded. 6
3. I am convinced the appropriate authorities do only allow effective and safe COVID-19 vaccines. 6
Complacency 5.61 ± 1.14 4. I do not need COVID-19 vaccinations because infectious diseases do not hit me hard. (R) 1
5. COVID-19 Vaccination are unnecessary for me because I rarely get ill anyway. (R) 1
6. I get COVID-19 vaccinated because it is too risky to get infected. 6
Constraints 5.14 ± 1.08 7. I make sure to receive the most important COVID-19 vaccinations in good time. 6
8. Covid 19 Vaccinations are so important to me that I prioritize getting vaccinated over other things. 6
9. I sometimes miss out on COVID-19 vaccinations because vaccination is bothersome. (R) 2
Calculation 3.45 ± 1.24 10. I get COVID-19 vaccinated when I do not see disadvantages for me. (R) 6
11. I only get COVID-19 vaccinated when the benefits clearly outweigh the risks. (R) 6
12. For COVID-19 vaccine, I carefully consider whether I need it. (R) 2
Collective Responsibility 5.76 ± 1.33 13. I also get COVID-19 vaccinated because protecting vulnerable risk groups is important to me. 6
14. I see COVID-19 vaccination as a collective task against the spread of diseases. 6
15. I also get COVID-19 vaccinated because I am thereby protecting other people. 6
Compliance 5.15 ± 1.4 16. It should be possible to exclude people from public activities (e.g., concerts) when they are not vaccinated against COVID-19. 6
17. The health authorities should use all possible means to achieve high COVID-19 vaccination rate. 6
18. It should be possible to sanction people who do not follow the COVID-19 vaccination recommendations by health authorities. 6
Conspiracy 4.57 ± 1.11 19. COVID-19 Vaccinations cause diseases and allergies that are more serious than the diseases they ought to protect from. (R) 2
20. Health authorities knuckle down to the power and influence of pharmaceutical companies. (R) 4
21. COVID-19 Vaccinations contain chemicals in toxic doses. (R) 2
Overall score of readiness 103.25 ± 15.13 (34-147)

Note. All items were scaled on a Likert-type scale from 1 = strongly disagree to 7 = strongly agree. Items with (R) are reverse coded so that high values indicate high vaccination readiness.

 Attitudes toward getting the COVID-19 vaccine

The majority of participants believed that COVID-19 harmed their health (mean=1.77±0.72), which influenced their readiness to get the vaccine ( p < 0.001). They also thought that the severity of the disease and the chance of developing complications would be reduced if a person was infected with COVID-19 even after receiving the vaccination (mean= 1.74±0.63, p < 0.001).

 Determinants for COVID-19 vaccine uptake

The participants stated that being aware of the severe side effects of COVID-19 vaccination was the main leading cause of unwillingness of people to get the vaccine ( p < 0.001). The second key factor influencing their readiness to get the vaccine was their fear of the vaccine manufacturer and its origin ( p < 0.001), followed by the dispersion of the diverse information they posted on social media ( p < 0.001). People were also hesitant to get vaccines due to their mistrust of government advice on vaccine safety and effectiveness ( Table 3). For participants’ sociodemographic variable, findings reported no difference in the mean COVID19 vaccine readiness score by gender, occupation, or having chronic diseases (all p > 0.05).

Factor associated with COVID-19 readiness (7Cs).
Items Predictors Mean Mode SD r
# 1 Aware of serious adverse effects following COVID-19 vaccination a 4.09 5 1.47 -0.24 **
# 2 Cconcerning of the COVID-19 vaccine manufacturer or its place of origin a 3.99 4 1.5 -0.22 **
# 3 Waiting for a better vaccine a 3.89 4 1.55 -0.26 **
# 4 Confusing by different information of the COVID-19 vaccine a 3.94 4 1.55 -0.15 **
# 5 Don't believe in the advice of the government a 3.17 3 1.66 -0.36 **
# 6 I think I would be diagnosed with Covid-19 in the next 12 months b 2.43 2 0.65 0.21
# 7 Covid-19 will affect my health seriously b 1.77 2 0.72 0.86 **
# 8 I think the severity of the disease and the chance of developing complications would be reduced if a person is infected with COVID-19 even after receiving the vaccination b 1.74 2 0.63 0.25 **
# 9 Age (18-77) 31.04 13.2 -0.49
ANOVA test Mean SD p
# 10 Gender 0.22
# 11 Male 103.4 0.84
# 12 Female 103.37 0.56
# 13 LGBT 103.54 7.9
# 14 Comorbidities 0.82
# 15 No 103.36 15.4
# 16 Yes 102.25 13.4
# 17 Occupation 0.25
# 18 Occupations that are regularly being close to people (such as driver, shipper, salesmen, medical workers, teachers, business, freelancer) 102.7 14.38
# 19 Occupations that are not regularly being close to people (such as tecnician, farmer, lab researcher, administration, IT, retired) 101.62 16.09
# 20 Students 103.25 15.1

p<0.001.

items were scaled on a Likert-type scale from 1 = strongly disagree to 7 = strongly agree.

items were scaled on a Likert-type scale from 1 = definitely to 4 = definitely not.

 Discussion

This was the first study in Vietnam to use a validated questionnaire to assess the readiness and determinants associated with COVID-19 vaccinations. The majority of the Vietnamese sample population was willing to take the vaccine, which is consistent with a previous Vietnam study that found that 71.7% of participants were eager to take the COVID-19 vaccine. 30 It also matches the findings of an international survey conducted across 19 countries, which found a high degree of vaccine willingness. 24

Based on the 7Cs scale, our research revealed a moderate score of readiness for COVID-19 uptake. The discrepancy in the score of readiness and intention to take COVID-19 vaccinations might be explained by the moderate-low score in the 7Cs calculation and confidence components. Similar findings were found by other researchers. Jamison, Quinn and Freimuth 31 interviewed 119 American adults and found that most of them distrusted pharmaceutical companies and had poor trust in the government, both of which were seen as profit-driven. Safety concerns regarding COVID-19 vaccines have been raised in other studies. 14 , 32 , 33 The study’s authors were surprised by the low score for the calculation component because, at the time of data collection, Vietnam was coping with the fourth wave of COVID-19, causing over 12,000 cases per day and forcing practically all cities into lockdown. Because COVID-19 vaccines are freely distributed to the general public, the findings suggest that participants underestimate the benefits of vaccines.

The readiness of Vietnamese people to get vaccines was not associated with their sociodemographic variables. The findings corroborate what has been found in many earlier studies. For example, in Ethiopia, Afghanistan, and four Arab nations, age and occupation were unrelated to vaccine readiness. 20 , 21 , 34 In the study conducted by Oyekale, 21 the proportion of positive reactions to COVID-19 vaccinations in males and females was the same. However, a worldwide online survey found that the subjects’ age and jobs were associated with their participation in the COVID-19 vaccination program. Males were also considerably more likely than females to receive vaccination in other research. 20 , 34 According to a systematic study, age, educational status, gender, occupation, and marital status were all associated with willingness to get COVID-19 vaccinations. 9 The authors explained that individual sociodemographic characteristics were related to the perception of the threat of COVID-19, which influences vaccination intentions. 19 Findings also reported that having a chronic disease was not associated with the readiness to receive COVID-19 vaccines. 9 , 34 This is an intriguing finding because a COVID-19 patient with a chronic condition is more likely to acquire a severe illness, especially if they have underlying medical issues such as cardiovascular disease, diabetes, chronic respiratory disease, or cancer. 35

Our results underscored that awareness of the severe side effects, fear of COVID-19 vaccination, dispersion of the diverse information they posted on social media, and mistrust of government advice on vaccine safety and effectiveness affected people’s readiness to get the vaccine. The finding is in line with other studies. 4 , 12 , 19 , 27 , 31 For instance, Abu-Odah et al., 4 reported the unwillingness of Palestinians to get the COVID-19 vaccine due to the spread of false rumors, misinformation, and mistrust towards the vaccines that the government purchased. Misinformation and unsubstantiated rumors regarding COVID-19 vaccines have been shared on social media platforms even before releasing an effective vaccine, 4 , 36 causing confusion and vaccine hesitation. 4 , 37 The findings explained why the confidence and calculation components of the 7Cs in our study scored so low. There is a dire effort to mitigate these factors to increase Vietnam’s general public readiness to get the vaccine. For example, policymakers should promote trusted evidence for the COVID-19 vaccine’s safety and effectiveness to boost public vaccination readiness. A policy for preventing, correcting, and deleting COVID-19 vaccination disinformation must be devised and implemented to address this issue.

Strengths and limitations

The study has several advantages, including a large sample size and a validated questionnaire, which improves the study’s reliability. However, there are some limitations to this research. For instance, using social media for convenience sampling could lead to selection bias. Second, the causal relationship could not be determined in this cross-sectional investigation.

 Conclusions

The present study revealed a moderate score of readiness for COVID-19 vaccination among Vietnamese people, which was explained by a low score on the calculation and confidence components. Building confidence between people and the Vietnamese authorities is a high priority to enhance people’s readiness to get the COVID-19 vaccine. The authorities should focus on dispelling disinformation posted on social media and promoting the usefulness of COVID-19 vaccines.

 Data availability Underlying data

Dryad: Readiness and determinants of Vietnam’s general public to receive the COVID-19 Vaccine: a national online cross-sectional study, https://doi.org/10.5061/dryad.fn2z34txc. 38

This project contains the following underlying data:

Data_Vaccine-csv.csv

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

The 7Cs scale of COVID-19 vaccination readiness available at https://www.vaccination-readiness.com/measure/.

 Acknowledgments

The authors would like to express immense gratitude to the admins of group “Nhung nguoi yeu nhac Ha Anh Tuan”, “Hoi phu nu Phuong Nguyen Du” and our friends who always provided support for collecting data for this study.

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