The Role of Health Beliefs in the Relationship between Community Engagement and COVID-19 Vaccine Confidence Among Korean Americans

Background and Purpose: During the COVID-19 pandemic, vaccine confidence has emerged as a crucial issue for the success of vaccination programs. However, vaccination rates vary considerably among different racial/ethnic groups, with some communities exhibiting lower rates of vaccine confidence and uptake. It is thus important to understand the factors that influence vaccine confidence among these populations. The health belief model (HBM) is a theoretical framework that has been used to explain and predict health behaviors including vaccination. Using the HBM, this study examined the indirect effects of health beliefs on the relationship between community engagement and vaccine confidence during the COVID-19 pandemic. Specifically, the study investigated how the HBM constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action mediate the relationship between community engagement and vaccine confidence.

Methods: We utilized convenience sampling to recruit a community-based sample of Korean Americans (n=313) affiliated with a community organization in Philadelphia. The survey was conducted between March and May 2022, using both tablet and paper questionnaires based on participant preference. COVID-19 vaccine confidence was assessed using a standard 9-item scale that measured response efficacy, concern and misinformation perception, vaccine history, and intention to vaccinate. Community engagement was evaluated based on participation in COVID-19-related programs. Health beliefs were measured using an 18-item scale that assessed perceived susceptibility, severity, benefits, barriers, and communication cues on a 6-point Likert scale. Path analysis was performed using a bootstrapping method to estimate standard errors and confidence intervals of path coefficients.

Results: Our study found that perceived severity of COVID-19 (b = -0.3, p < .01), perceived benefits of vaccination (b = 0.7, p < .001), perceived barriers to vaccination (b = -0.21, p < .01), and cues in action (b = 0.78, p < .01) were significantly associated with vaccine confidence. Community engagement had significant associations with perceived severity (b = -1.4, p < .001) and cues to action (b = 0.93, p < .001). Indirect effect analysis showed that community engagement had a positive association with vaccine confidence through perceived severity (b = 0.42, p < .05) and cues to action (b = 0.72, p < .05).

Conclusion and implications: The findings of this study have potential applications in public health interventions that aim to alleviate vaccine hesitancy and bolster vaccination rates among underserved communities affected by the COVID-19 pandemic and beyond. Specifically, the findings indicate that community engagement can indirectly enhance vaccine confidence among Korean Americans by influencing their health beliefs, including their perceived severity of the disease and cues to action. To improve vaccine confidence in this population, community-based initiatives may be beneficial, such as providing education verbal and written communication on COVID-19 severity and vaccination benefits, as well as reminders for immunization. This study underscores the necessity of cultural and linguistic considerations when planning and executing effective vaccination programs for marginalized groups.