Investigating the intention to receive the COVID-19 vaccination in Macao: implications for vaccination strategies

BACKGROUND: Understanding the intention of receiving COVID-19 vaccines is important to inform effective vaccination strategies. This study aimed to investigate such intention, identify the key influencing factors, and determine the most important intention predictors using a theoretically principled model. METHODS: An online, cross-sectional survey method was implemented in Macao in May 2021. People aged 18 years or above and residing in Macao for 12 months prior to the study were recruited through social media. Intention to receive COVID-19 vaccines and the main constructs of the protection motivation theory and the health belief model were the main measures encompassing threat appraisal, intrapersonal characteristics, cues to action, coping appraisal, past experiences and information seeking behavior. Descriptive statistics, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: A total of 552 valid responses were received. Among the respondents, 79.5% aged between 25 and 54 years old, 59.4% were female, and 88% had a bachelor degree or above; 62.3% of the respondents indicated their intention to receive COVID-19 vaccination while 19.2% were hesitant and 18.5% did not have any intention. While 67.0% believed COVID-19 infection was life-threatening, only 19.0% thought they were at risk of getting infected. Control variables such as age, gender, education level, and having travel plans were significantly correlated with intention. Significant associations between intention with perceived severity, perceived susceptibility, maladaptive response reward, self-efficacy, response-efficacy, response cost, social attitude, social norm, past experience and information seeking behavior were identified (P < 0.05). The most important positive predictors of intention were “being able to make arrangement to receive the vaccine” (β = 0.333, P < 0.001), “a sense of social responsibility” (β = 0.326, P < 0.001), and “time off from work after vaccination” (β = 0.169, P < 0.001), whereas “concerns over vaccine safety” (β = − 0.124, P < 0.001) and “relying on online resources for vaccine information” (β = − 0.065, P < 0.05) were negative predictors. Perceived severity in terms of COVID-19 being a life threatening illness was not a predictor of intention. CONCLUSION: This study reaffirmed that intention to receive COVID-19 vaccination is an ongoing concern in the combat of the pandemic. Multi-component strategies to enhance health literacy that supports well-informed decision-making, increase vaccination convenience, promote social responsibility, and provide time-off incentives are among the key considerations in designing and improve vaccination campaigns in Macao.