Willingness to Vaccinate Against COVID-19: The Role of Health Locus of Control and Conspiracy Theories

"Understanding the predictors of the willingness to get vaccinated against COVID-19 may aid in the resolution of current and future pandemics."

The vaccination campaign against COVID-19 was launched in December 2020 in the Czech Republic, with only half of the population willing to get vaccinated a month later. In light of vaccine hesitancy, researchers have investigated how individuals gather and interpret information about and the reason for or against the vaccines. In previous research, the authors of the present study found that COVID-19-related conspiracy theories were predicted by digital health literacy, dissociation tendencies, and cognitive reflection, and that the effect of the latter two was mediated by conspiracy mentality (CM). The present study extends these results with respect to vaccination intentions, studying the effects of health locus of control (HLOC) and conspiracy theories and their influence on the willingness to get vaccinated against COVID-19 (VAC) in the Czech Republic.

As outlined here, HLOC has three relatively independent dimensions: internal (the belief that health is determined by the internal factors and personal effort) and two external ones: the powerful others dimension,  the belief that health is determined by other persons, especially medical personnel and family members, and the chance dimension, the belief that health depends on chance, God, or destiny.

CM is related to the external locus of control and belief in COVID-19-related conspiracy theories. In those who perceive low support for COVID-19 vaccination in their social environment, CM has been found to predict low vaccination intentions. CM is itself predicted by dissociation (or disintegration of experiences, reducing awareness of intolerable information) and cognitive reflection (or ability to reflect on whether the result of an intuitive cognitive process is correct). Earlier research has also found COVID-19-related conspiracy theories to be associated with low digital health literacy.

In order to investigate how the three dimensions of HLOC and the readiness to believe conspiracy theories affect attitudes toward vaccination, the researchers conducted a cross-sectional study based on data from an online survey of a sample of Czech university students (n = 866). The data were collected during the second pandemic peak in the Czech Republic, between January 8 and January 21 2021, shortly after vaccines were introduced and before they were made available to the general population.

The results showed that 65.70% of the Czech students surveyed reported the probability they would get vaccinated against COVID-19 to be higher than 50%; the mean reported probability was 67.48%.

• A multiple regression model using belief in COVID-19-related conspiracies and three dimensions of HLOC as predictors explained 40.21% of the variance of willingness to get vaccinated. VAC was most strongly predicted by the belief that COVID-19 is a hoax, followed by the belief that COVID-19 was created and the powerful others dimension of the HLOC, while the other two dimensions of HLOC had no effect.
• A multiple regression model using CM, digital health literacy, and three dimensions of HLOC as predictors explained 17.23% of the variance of willingness to get vaccinated. VAC was most strongly predicted by the powerful others dimension, followed by CM, digital health literacy, and internal and chance dimensions of HLOC.
• A multiple regression model using experience with dissociation, cognitive reflection, digital health literacy, and three dimensions of HLOC as predictors explained 15.53% of the variance of the willingness to get vaccinated. VAC was most strongly predicted by the powerful others dimensions, followed by cognitive reflection, digital health literacy, and internal and chance dimensions of HLOC.

In short, the data support the hypotheses that the willingness to get vaccinated against COVID-19 is reduced by belief in COVID-19-related conspiracy theories and its predictors: CM, low digital health literacy, and low cognitive reflection. Vaccination intentions were strongly positively related to the powerful others dimension of HLOC and negatively to the chance dimension of HLOC. Contrary to the researchers' expectations, internal HLOC also reduced vaccination intentions, and the effect of internal HLOC was not moderated by CM or digital health literacy.

Given that previous research has found that the powerful others dimension of HLOC correlates with trust in the physicians, and that concerns related to side effects and safety of vaccines are among the top reasons for vaccine hesitation and refusal, the link between HLOC and willingness to get vaccinated may be mediated by trust in the medical professionals.

Action suggestions that emerge from these findings include:

• The positive link between the powerful others dimensions of HLOC and the willingness to get vaccinated suggests that campaigns promoting vaccinations should seek to reach those not connecting their health with other persons. Because the persuasiveness of health-related promotion campaigns is increased when matching the prevailing HLOC of an audience, the promotional messages should be created to appeal to audiences deriving their health from internal decisions ("Vaccination - your gift to yourself!") or chance and destiny ("Destined to get vaccinated!"), rather than to those connecting their health with powerful others ("Scientists and doctors say: get vaccinated!").
• Reducing propensity to believe in conspiracy theories by increasing analytical thinking and digital health literacy may increase willingness to comply with the recommendations to get vaccinated. In the short term, disproving COVID-19-related conspiracy theories may have a positive effect on the willingness to get vaccinated against COVID-19.
• Attempts to promote vaccination against COVID-19 should try to reach those with an intuitive rather than analytical cognitive style, given the lower vaccination intentions in those with low cognitive reflection.

In conclusion, HLOC, CM, and its predictors are valid predictors of a hesitancy to get vaccinated against COVID-19. Campaigns promoting vaccination should focus on reaching groups specifically vulnerable to conspiracy theories and lacking HLOC related to powerful others.