Associations between social network characteristics and COVID-19 vaccination intention: the SaNAE study

Background Social networks, our social relationships, play a role in the spread of infectious diseases but also in infection prevention behaviors such as vaccination. Here, we aimed to assess which individual, interpersonal (social network characteristics), community and societal factors are associated with COVID-19 vaccination intention during the second wave of the COVID-19 pandemic. Methods The cross-sectional study utilized online questionnaire data collected between August and November 2020 in community-dwelling adults aged 40 years and older. COVID-19 vaccination intention was measured by assessing whether respondents were willing to receive a COVID-19 vaccination if the vaccines became available. At the time of data collection, vaccines were still in development. Associations between individual (sociodemographic variables, health, health concerns), interpersonal (social network characteristics including structure, function, and quality), community (social and labor participation) and societal factors (degree of urbanization), and the outcome variables COVID-19 vaccination intention (yes vs no, yes vs unsure, unsure vs no) were assessed in stepwise multivariable regression analyses. Results Of all participants (N=3,396), 59% reported a positive intention to vaccinate against COVID-19, 35% were unsure, and 6% had no intention. Men, individuals of older age, those with a college or university degree, and those concerned about their personal and family health were more likely to have the intention to vaccinate. Interpersonal factors associated included having a larger network size (social network structure) and a larger proportion of informational and emotional supporters (social network function). Living outside of urban areas, a societal factor was also associated with the intention to vaccinate. Conclusion In this study, we determined key characteristics of COVID-19 vaccination intention. Health promotion and vaccination communication strategies should focus not only on individual factors but also incorporate the social environment. Our findings highlight the importance of organizing social networks to mobilize social support for pandemic preparedness.