Investigating the Relationship Between Intra-Individual Factors Influencing Covid-19 Vaccination Decisions in Isfahan, Iran: An Analysis Based on the Extended Parallel Process Model; [یسرربطابترالماوعنوردیدرفطبترمابماجناایمدعماجنانویسانیسکاوانورکردناهفصاربساسالدم دنیارفیزاومهعسوتهتفای] Publisher

Summary: Why do people hesitate over COVID vaccines? A survey found greater fear, reluctance and behavior-related scores among unvaccinated adults; other attitude scores did not differ. #Vaccines #PublicHealth

Molavi Vardanjani E ; Zamani F ; Shahnazi H ; Pirzadeh A ; Amidi Mazaheri M ; Eslami A A ; Rahimi M ; Fathian Z ; Tarahi M J ; Ahmadi L ; Mostafavi F
Source: Journal of Health System Research Published:2026

Abstract

Background: Vaccines are effective in preventing death and the contraction of diseases; therefore, the decision to accept or hesitate in receiving the coronavirus disease 2019 (COVID-19) vaccine is crucial for public health. The purpose of this research was to investigate the relationship between intra-individual factors influencing the decision to receive the COVID-19 vaccination in Isfahan Province, Iran, based on the extended parallel process model (EPPM). Methods: This study employed a cross-sectional design. The statistical population consisted of 500 individuals aged 18 and older who, according to data from the Isfahan Province Health Department, resided in cities with the lowest vaccination coverage. To collect data, participants completed a researcher-developed questionnaire based on the constructs of the EPPM online. The data were then analyzed using Kolmogorov-Smirnov test, independent t-test, chi-square test, and analysis of variance (ANOVA) in SPSS software. Findings: The dimensions of reluctance, fear, and behavior significantly differed between vaccinated and unvaccinated individuals (P < 0.001). Specifically, unvaccinated individuals scored higher in these dimensions. However, no significant differences were observed between vaccinated and unvaccinated individuals regarding the dimensions of necessity, doubt, support, and trust in this study (P = 0.910). Conclusion: The results of this study may be valuable in planning educational activities aimed at increasing acceptance of the COVID-19 vaccine and addressing the factors that contribute to vaccine hesitancy. Given the validity and reliability of the questionnaire used to measure attitudes toward COVID-19 vaccination in adults, experts can utilize these findings to design targeted interventions. By improving attitudes toward vaccination, these interventions can ultimately enhance vaccination behavior and increase overall COVID-19 vaccine coverage. © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved.