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

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