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Background: Although several COVID-19 vaccines are available, the current challenge is achieving high vaccine uptake. We aimed to explore university students' intention to get vaccinated and select the most relevant determinants/beliefs to facilitate informed decision making around COVID-19 vaccine uptake. Methods: A cross-sectional online survey with students (N = 434) from Maastricht University was conducted in March 2021. The most relevant determinants/beliefs of students' COVID-19 vaccine intention (i.e., determinants linked to vaccination intention, and with enough potential for change) were visualized using CIBER plots. Results: Students' intention to get the COVID-19 vaccine was high (80%). Concerns about safety and side effects of the vaccine and trust in government, quality control, and the pharmaceutical industry were identified as the most relevant determinants of vaccine intention. Other determinants were risk perception, attitude, perceived norm, and self-efficacy beliefs. Conclusion: Our study identified several determinants of COVID-19 vaccine intention (e.g., safety, trust, risk perception, etc.) and helped to select the most relevant determinants/beliefs to target in an intervention to maximize COVID-19 vaccination uptake. Concerns and trust related to the COVID-19 vaccine are the most important targets for future interventions. Other determinants that were already positive (i.e., risk perception, attitudes, perceived norms, and self-efficacy) could be further confirmed.

BACKGROUND: Although several COVID-19 vaccines are available, the current challenge is achieving high vaccine uptake. We aimed to explore university students' intention to get vaccinated and select the most relevant determinants/beliefs to facilitate informed decision making around COVID-19 vaccine uptake. METHODS: A cross-sectional online survey with students ( N = 434) from Maastricht University was conducted in March 2021. The most relevant determinants/beliefs of students' COVID-19 vaccine intention (i.e., determinants linked to vaccination intention, and with enough potential for change) were visualized using CIBER plots. RESULTS: Students' intention to get the COVID-19 vaccine was high (80%). Concerns about safety and side effects of the vaccine and trust in government, quality control, and the pharmaceutical industry were identified as the most relevant determinants of vaccine intention. Other determinants were risk perception, attitude, perceived norm, and self-efficacy beliefs. CONCLUSION: Our study identified several determinants of COVID-19 vaccine intention (e.g., safety, trust, risk perception, etc.) and helped to select the most relevant determinants/beliefs to target in an intervention to maximize COVID-19 vaccination uptake. Concerns and trust related to the COVID-19 vaccine are the most important targets for future interventions. Other determinants that were already positive (i.e., risk perception, attitudes, perceived norms, and self-efficacy) could be further confirmed.

Use of fear appeals assumes that when people are emotionally confronted with the negative effects of their behavior they will change that behavior. That reasoning is simple and intuitive, but only true under specific, rare circumstances. Risk-perception theories predict that if people will experience a threat, they want to counter that threat. However, how they do so is determined by their coping efficacy level: if efficacy is high, they may change their behavior in the suggested direction; if efficacy is low, they react defensively. Research on fear appeals should be methodologically sound, comparing a threatening to a non-threatening intervention under high and low efficacy levels, random assignment, and measuring behavior as outcome. We critically review extant empirical evidence and conclude that it does not support positive effects of fear appeals. Nonetheless, their use persists, and is even promoted by health psychology researchers, causing scientific insights to be ignored or misinterpreted.

Funding Dominika Kwasnicka's work is carried out within the HOMING program of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund; grant number POIR.04.04.00-00-5CF3/18-00; HOMING 5/2018. Dimitra Kale and Olga Perski receive salary support from Cancer Research UK (C1417/A22962). Daniel Powell is funded by the Scottish Government's Rural and Environment Science and Analytical Services (RESAS) and by the School of Medicine, Medical Sciences, and Nutrition (SMMSN) at the University of Aberdeen. Felix Naughton's salary is covered by the Faculty of Medicine and Health Sciences at the University of East Anglia. Acknowledgments The review team would like to thank Dr Marta Marques for comments and suggestions on the initial version of the review protocol. The authors would like to thank the patient and public involvement representative who commented on the lay summary of our proposed plan, for their contribution to this research. ; Peer reviewed ; Publisher PDF

Acknowledgements This research was supported by the Health Foundation Improvement Science Award (grant number: GIFTS ID 7223 awarded to SP). JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. DK's work is carried out within the HOMING program of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund; grant number POIR.04.04.00-00-5CF3/18-00; HOMING 5/2018. We would also like to thank Lauren Basey for optimising the design of our included figure. ; Peer reviewed ; Publisher PDF

Funding Information: This research was supported by the Health Foundation Improvement Science Award (grant number: GIFTS ID 7223 awarded to Sebastian Potthoff). Tracy Finch, Tim Rapley, Sebastian Potthoff, Tom Saunders and Luke Vale are members of the NIHR Applied Research Collaboration North East and North Cumbria ( NIHR200173 ). Luke Vale is also a member of the NIHR Newcastle In Vitro Diagnostics Co-operative, NIHR School for Public Health Research, and Fuse, the Centre for Translational Research in Public Health . The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care . Jeremy M. Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Dominika Kwasnicka's work is carried out within the HOMING program of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund ; grant number POIR.04.04.00-00-5CF3/18-00 ; HOMING 5/2018. We would also like to thank Lauren Basey for optimising the design of our included figure. Funding Information: This research was supported by the Health Foundation Improvement Science Award (grant number: GIFTS ID 7223 awarded to Sebastian Potthoff). Tracy Finch, Tim Rapley, Sebastian Potthoff, Tom Saunders and Luke Vale are members of the NIHR Applied Research Collaboration North East and North Cumbria (NIHR200173). Luke Vale is also a member of the NIHR Newcastle In Vitro Diagnostics Co-operative, NIHR School for Public Health Research, and Fuse, the Centre for Translational Research in Public Health. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Jeremy M. Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Dominika Kwasnicka's work is carried out within the HOMING program of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund; grant number POIR.04.04.00-00-5CF3/18-00; ...