An Integrated Theoretical Framework Predicting Covid‑19 Vaccine Behavioral Intention Among Unvaccinated Students: A Lesson for Health Educators in Future Pandemics Publisher



Soltani S ; Zamani F ; Khoshgoftar M ; Jafarzadeh Z ; Raei N ; Esmaeili Z ; Mirzaei Z
Source: Journal of Education and Health Promotion Published:2025

Abstract

BACKGROUND: The COVID‑19 pandemic has brought to light the significant challenge of vaccine non‑acceptance among certain individuals. Understanding the impact of demographic characteristics on individuals’ vaccination intentions is crucial for effectively addressing the issue of vaccine hesitancy. The objective of this study was to investigate the predictive factors of COVID‑19 vaccine behavioral intention among unvaccinated students. MATERIALS AND METHODS: This descriptive‑analytical cross‑sectional study was conducted in the academic year 2021‑2022. A localized online questionnaire based on the integrated theoretical framework was sent to participants via social media. A total of 432 unvaccinated students (66.5% female and 33.5% male) participated in this study. The questionnaire consisted of sections of demographic information, integration of the health belief model (HBM), extended parallel model (EPPM), and theory of planned behavior (TPB), and the messages received by participants about the Covid‑19 vaccine that changed their minds about vaccination. Descriptive statistics, t‑tests, and Chi‑square tests were performed with SPSS 24.0 for Windows. α was considered to be 0.05. RESULTS: Most respondents intended to get vaccinated. All exogenous latent variables were positively associated with vaccination intention. There were notable variations in the perceived susceptibility to and fear of COVID‑19 based on gender characteristics. Educational level and age were significantly associated with some of the latent variables such as response efficacy and perceived susceptibility. The study shed light on the key messages that influenced our participants’ vaccine‑related beliefs and attitudes. Notably, concerns were raised regarding “possible future side effects,” the “presence of smart chips in the vaccine,” the “lack of research, evidence, and WHO approval for emergency use,” as well as “political issues.” CONCLUSION: These findings can lead to a better understanding of the psychosocial factors underlying vaccine acceptance and assist public health agencies in developing educational programs specifically designed to promote student awareness of vaccination in pandemic situations. © 2025 Journal of Education and Health Promotion.