Reasons for not getting COVID-19 vaccine in Ardabil, a Northwestern province in Iran: Based on an ecological approach

BACKGROUND: Understanding the reasons for not getting the COVID-19 vaccine can help to increase acceptability and tackle vaccine hesitancy and consequently reach high coverage for this new vaccine. Using an ecological approach, the reasons for not getting the vaccine in the Iranian population was investigated. METHODS AND MATERIAL: This study was conducted from October to December 2021 on 426 participants who had not received the COVID-19 vaccine. The following subsets of questions were included in the questionnaire: intrapersonal level factors, interpersonal level factors, group and organization, and society and policy-making. Multivariable logistic regression was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated for vaccine hesitancy (dependent variable) according to the reasons for not getting COVID vaccine scores (independent variable) using multivariable logistic regression in 3 different models, including Model 0: unadjusted, Model 1: adjusted for age, gender, and underlying disease, and Model 2: adjustment for age, gender, underlying disease, education, place of living, income, marital status, and employment. RESULTS: A significant difference was found regarding gender between likely and not likely groups (P = 0.016). A significant association was observed between the vaccine hesitancy and interpersonal (unadjusted model: OR = 0.833 (CI: 0.738–0.942), P for trend = 0.003; model 1: OR = 0.820 (CI: 0.724–0.930), P for trend = 0.002; model 2: OR = 0.799 (CI: 0.703–0.909), P for trend = 0.001) and group and organization (unadjusted model: OR = 0.861 (CI: 0.783–0.948), P for trend = 0.002; model 1: OR = 0.864 (CI: 0.784–0.952, P for trend = 0.003; model 2:OR = 0.862 (CI: 0.781–0.951, P for trend = 0.003). There was no significant association between vaccine hesitancy and intrapersonal and society and policy-making (P > 0.05). CONCLUSIONS: We found that a high score of “interpersonal” and “group and organization” factors were associated with lower intention to COVID vaccine. Moreover, women had higher vaccination intentions than men.