Inside the ‘black box’ of COVID-19 vaccination beliefs: Revealing the relative importance of public confidence and news consumption habits()

RATIONALE: President Biden's goal for 70% of U.S. adults to have received at least one vaccine by July 4, 2021 was not achieved. OBJECTIVE: The aim of this research was to assess the ‘black box’ of positive COVID-19 vaccination beliefs to determine the relative importance of each factor and thus inform well-targeted and tailored health promotion efforts. METHODS: A cross-sectional survey was conducted in a sample of U.S. adults (N = 1656), assessing the influence of demographic characteristics, cognitive effects, public confidence, and news source variety and evaluation on positive COVID-19 vaccination beliefs. RESULTS: Overall, the strongest predictor of positive beliefs was high confidence in public health officials and political institutions to handle the COVID-19 pandemic effectively, yet negative sentiments toward COVID-19 research and science and COVID-19 vaccine ambivalence reduced the likelihood that beliefs were positive. Cognitive effects and public confidence were identified as key predictors of positive COVID-19 vaccination beliefs over and above party identification. Importantly, high levels of confidence in science and government were mostly driven by positive evaluations of liberal news sources. High levels of COVID-19 science backlash were mostly driven by positive evaluations of conservative news sources. CONCLUSIONS: To motivate COVID-19 vaccination among hesitant or resistant groups in the population, health promotion efforts should seek to reinforce positive COVID-19 vaccination beliefs by increasing public confidence and by reducing COVID-19 science backlash, largely by choosing specific news media and social media platforms (e.g., Breitbart, Fox News, and Facebook) as channels for health promotion and health information dissemination.