Barriers and motivators associated with COVID-19 vaccination—a vaccine acceptance scoring system based on a population survey in southern Sweden

Low vaccination coverage against SARS-CoV-2 (COVID-19) is a public health concern. The aim of this study was to identify barriers and motivators associated with COVID-19 vaccination and develop a vaccine acceptance scoring system. From the overall population residing in Skåne county Sweden in 2022 (n = 1 384 531), 3600 randomly selected individuals (aged ≥18 years) received a survey. Questions were grouped into six domains reflecting trust in vaccines and institutions, benefit-risk balance, injunctive and descriptive norms and accessibility. Responses were scored as either assenting (1 p) or dissenting (0 p) in relation to its domain. A score between 1 and 5 p was constructed for each domain and a total vaccine acceptance score was analysed. Internal consistency overall and within domains was assessed with Cronbach's alpha. Associations with vaccination status and vaccine acceptance scores in relation to domains were modelled with logistic regression. 820 responses were received, 646 vaccinated (response rate 36%), and 174 unvaccinated (response rate 10%), with relatively high internal consistency overall (α = 0.76). Domains markedly associated with vaccination were injunctive norms OR 5.06 (95% CI 3.27, 7.83), descriptive norms OR 2.64 (1.63, 4.30) and trust in vaccines OR 1.66 (1.15, 2.40). Vaccine acceptance was measured with sufficient reliability in a Swedish population. Norms, in this context, general perceptions of acceptable/unacceptable behaviours and notion on actual performed behaviours, were together with trust in vaccines most strongly associated with vaccination. Future pandemic responses should consider these aspects in communication strategies and targeted interventions to increase and equalize vaccination uptake.