Determinants of COVID-19 vaccine booster hesitancy among outpatients completing the primary scheme in Turkey

Objective: To examine the change in COVID-19 booster vaccine hesitancy according to descriptive characteristics, characteristics related to COVID-19, health literacy (HL) skills related to booster dose. Methods: The inclusion criterion was the completion of the primary scheme as two doses of COVID-19 vaccine. The study was conducted in January 2022 by applying face-to-face interview technique. Questions regarding HL were used to question the ability of individuals to access, understand, interpret and use information regarding the COVID-19 booster dose in their decisions. Results: A total of 1 210 people were included in this study with an mean age of (41.3±16.6) years, and 51.4% were women. In multivariate analysis, hesitation increased in the “moderately concerned” (a OR 2.65, 95% CI 1.09-6.45), “slightly concerned” (a OR 3.1, 95% CI 1.26-7.19), “not concerned at all” (a OR 5.69, 95% CI 2.27-14.28) groups compared to the group “extremely concerned” about COVID-19 transmission. Those with Sinovac-CoronaVac as their most recent vaccine had increased hesitation compared to those with Pfizer-BioNTech (a OR 3.68, 95% CI 2.05-6.61). The effect of HL skills including “accessing”, “understanding”, and “appraising” information on hesitation was not statistically significant ( P >0.05). HL skill of “applying” was assessed with ability of information to help decision making. Whether the information is helpful for decision-making, the risk of hesitancy increased for those who stated that it “sometimes helps” (a OR 2.55; 95% CI 1.31-4.99) and “never helps” (a OR 11.62; 95% CI 3.03-44.58) compared to those who stated that it “always helps”. Conclusions: The increased propability of hesitation in those less concerned about COVID-19 transmission shows the importance of appropriately guiding individuals’ concern levels with a health communication strategy based on risk communication. The fact that the only HL skill with a significant effect in the multivariate model was “applying”, shows the critical role of this skill in influencing behavioral changes.