Why Do Chinese Older Adults in Hong Kong Delay or Refuse COVID-19 Vaccination? A Qualitative Study Based on Grounded Theory

40 Pages Posted: 16 Jun 2022

See all articles by Jiehu Yuan

Jiehu Yuan

University of Hong Kong School of Public Health

Wendy Wing Tak Lam

The University of Hong Kong - University of Hong Kong

Jingyi Xiao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Michael Yuxuan Ni

The University of Hong Kong - School of Public Health

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Qiuyan Liao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Date Written: April 8, 2022

Abstract

Background: Older adults have been disproportionately affected by the COVID-19 pandemic. While COVID-19 vaccines are effective for reducing mortality and severe complications, vaccine hesitancy remains a substantial concern particularly among older adults.

Objective: This was a qualitative study to explore the psychological and contextual factors that contribute to Chinese older adults’ delay or refusal of COVID-19 vaccines.

Methods: Semi-structured in-depth interviews were conducted with 27 older adults aged ≥60 years who had never received COVID-19 vaccines. Grounded Theory approach guided the selection of informants, data collection, data analysis and report writing.

Results: Participants who delayed or refused COVID-19 vaccination exhibited a spectrum of vaccine-resistant and vaccine-hesitant attitudes which were weaved into the contexts of lacking decisional support from doctors, family and the government, and attitude roots of negative perception of ageing, fatalistic risk attitudes, low health literacy, present time perspective and negative values on western biomedicine, and reliance on the peripheral processing of vaccine-related information. While participants refused or delayed COVID-19 vaccination, they turned to alternative coping strategies to regain self-control in the pandemic.

Conclusions: Interventions to address vaccine hesitancy in older adults should focus on addressing attitude roots and strengthening the connectivity of older people with family, doctors, and government to engage older people in the vaccination decision making. Risk communication should shift to provide more personal relevant information in a caring style, meet older adults’ preference for peripheral information processing, and address their existing misperceptions about COVID-19 vaccines.

Note:
Funding Information: This study was supported by funding from the Government of the Hong Kong Special Administrative Region, the Food and Health Bureau, The Hong Kong Special Administrative Region (Grant No.: COVID19F04) and the Health and Medical Research Fund, the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Grant No.: COVID19F11).

Conflict of Interests: BJC consults for AstraZeneca, Fosun Pharma, GSK, Moderna, Pfizer, Roche and Sanofi Pasteur. The authors report no other potential conflicts of interest.

Ethical Approval: Participants gave their verbal consents before the telephone-based in-depth interview started. This study has obtained ethical approval (Reference No.: UW 20-095).

Keywords: COVID-19, vaccine hesitancy, vaccine resistance, grounded theory, older adults

JEL Classification: I1

Suggested Citation

Yuan, Jiehu and Lam, Wendy Wing Tak and Xiao, Jingyi and Ni, Michael Yuxuan and Cowling, Benjamin J. and Liao, Qiuyan, Why Do Chinese Older Adults in Hong Kong Delay or Refuse COVID-19 Vaccination? A Qualitative Study Based on Grounded Theory (April 8, 2022). Available at SSRN: https://ssrn.com/abstract=4078966 or http://dx.doi.org/10.2139/ssrn.4078966

Jiehu Yuan (Contact Author)

University of Hong Kong School of Public Health ( email )

Wendy Wing Tak Lam

The University of Hong Kong - University of Hong Kong

Jingyi Xiao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Michael Yuxuan Ni

The University of Hong Kong - School of Public Health ( email )

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

7 Sassoon Road
Hong Kong
China
+852 3917 6711 (Phone)

Qiuyan Liao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

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