The Effect of Psychological Antecedents of Vaccination to
Vaccination Behavior of Young Adult in Jabodetabek
Howard Ricardo, Bungarani Pramadefitra and Adhityawarman Menaldi
Faculty of Psychology, University of Indonesia, Depok, Indonesia
Keywords: Vaccine Behavior, Psychological Antecedents of Vaccination, Young Adults.
Abstract: The viral Covid-19 pandemic has affected public health, economic and well-being significantly throughout
the world. In order to reach herd immunity and prevent the transmission of the virus, the Indonesian
government launched a vaccination program in January 2021 and it is projected to last for 15 months. This
research focuses on understanding the psychological antecedents that affect young adult’s intention to be
vaccinated, since surveys found that several people in this age group are still vaccine hesitant. 214 online
questionnaires from young adults (18-25 years old) in Jabodetabek were analyzed using multiple linear
regression analysis. The result indicates that Psychological Antecedents of Vaccination has a significant effect
on vaccination behavior, F(12, 201) = 9.131, p < 0.01, R² = 0.353, with confidence, β = 0.246, t(201) = 3.445,
p = 0.001, collective responsibility, β = 0.342, t(201) = 4.250, p = 0.000 and Perceived Infection, β = 0.144,
t(201) = 2.364, p = 0.019 as the significant predictor. This research implies the importance of educating young
adults about the effectiveness and the trustworthiness of vaccines and communicating about social
responsibility in order to boost their participation in the vaccination program.
1 INTRODUCTION
At the end of December 2019 in the city of Wuhan,
Hubei Province, China, an outbreak similar to
pneumonia appeared and later affected the whole
world. This so-called Covid-19 pandemic has a much
higher mortality rate per year than the previous
coronavirus outbreaks, which are SARS in 2002-2003
and MERS in 2015 (Zhang & Holmes, 2020). In
Indonesia, the first case was found in early March 2020
and reached 1,099,687 cases with a total of 30,581
death patients by February 3, 2021 (WHO, 2021).
The Covid-19 pandemic has significantly affected
people's physical and mental health, especially for
those who were infected with severe symptoms
(WHO, 2020a). By December 2020, the global
economy also lost 375 billion US dollars, followed by
an increase of mortality rate (WHO, 2020b). People
are encouraged to adopt a new habit of washing hands
frequently, wearing face masks in public places and
social distancing. They are enforced to be tested
regularly to ensure confirmed cases can be treated and
traced immediately (Kemenkes, 2021).
WHO responded by establishing COVAX as a
center for Covid-19 vaccine development and
distribution. Vaccines can speed up the body's
immune response by introducing weakened or
inactivated pathogenic organisms (WHO, 2020c).
COVAX has a target of two billion doses of vaccine
circulated throughout the world, while the Indonesian
government targets 70% vaccine coverage or
181,554,465 people vaccinated (WHO, 2020d;
Saputra, 2021). Indonesian vaccination program has
started from 13th January 2021 and will last for 15
months in 4 waves (Azizah, 2021).
This program caused one hugely anticipated
problem, public vaccine acceptance. This problem
emerged because a person's behavior towards
vaccines is driven by a combination of several factors
such as environment, social influence and motivation
(WHO, 2020e). A survey conducted in 34 Indonesian
provinces from 19th to 30th September 2020 showed
that 27% of the respondents were not confident about
the government’s intention in spreading the vaccines
and 8% of the respondents stated that they didn’t want
to receive the vaccines (UNICEF, 2020). This
supports the other findings that public acceptance is
indeed a problem that is also present in various
countries with various factors (Detoc, et al., 2020;
Leng, et al., 2020; Vai, et al., 2020).
As of April 10, 2021, the initial stage of the
vaccination program has covered 24.39% of the first
and second wave target recipients (health workers,
public officials and elderly) (Saputra, 2021). Young
Ricardo, H., Pramadefitra, B. and Menaldi, A.
The Effect of Psychological Antecedents of Vaccination to Vaccination Behavior of Young Adult in Jabodetabek.
DOI: 10.5220/0010810700003347
In Proceedings of the 2nd International Conference on Psychological Studies (ICPsyche 2021), pages 213-218
ISBN: 978-989-758-580-7
Copyright
c
2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
213
adult population (18-25 years) will receive the
vaccine in the approaching third wave, however,
published studies that discuss the psychological
factors which shape this age group vaccine behavior
are still very few and hard to find. This study aims to
find the answer to the prior question, specifically in
Jabodetabek. The result of this study will add to the
scope of knowledge in the field of Health Psychology
and provide an overview to better understand
Indonesia's vaccination program.
2 LITERATURE REVIEW
2.1 Psychological Antecedents of
Vaccination
Psychological antecedents of vaccination are
psychological reasons that explain people's
acceptance of vaccines (Betsch, et al., 2018).
Psychological antecedents hereby refer to dimensions
of 5C, attitudes toward vaccines and perceived risk of
Covid-19 (Betsch, et al., 2018; Martin & Petrie, 2017;
Karlsson, et al., 2021).
The dimensions of 5C are confidence (a person's
belief in the vaccine and the system), complacency
(an estimation that vaccines are not a necessary
preventive measure), constraints (structural and
psychological barriers), calculation (individual’s
involvement in seeking more information) and
collective responsibilities (the desire to protect others
through herd immunity) (Betsch, et al., 2018; Betsch,
et al., 2020). The dimensions of attitudes toward
vaccines are mistrust of vaccine benefit (individual’s
perspective regarding the effectivity of vaccines),
worries about unforeseen future effects (individual’s
perspective regarding the safety and side-effects of
vaccine), concerns about commercial profiteering
(individual’s perspective regarding the government’s
intention), and preference for natural immunity
(individual’s perspective regarding another natural
immunity alternatives) (Martin & Petrie, 2017). The
dimensions of perceived risk of Covid-19 are
perceived likelihood of infection (a probability of
transmission for certain behavior), perceived severity
(perception regarding the severity of a disease that
can be caused by infection), and worry (individual’s
concern regarding certain disease) (Karlsson, et al.,
2021; Brewer, et al., 2007).
2.2 Vaccination Behavior
Vaccination behavior is a vaccine acceptance
behavior that is the result of another complex set of
behaviors or comes from a system that is related to
humans, government policies, funding and licensing
(Brewer, et al., 2018). The scope of vaccination
behavior involves complacency, convenience,
confidence (SAGE, 2014; Betsch, et al., 2018),
vaccine hesitancy (the stage of vaccination
motivation in which a person considers whether he
will accept or refuse the vaccine) (Brewer, et al.,
2018) and vaccination attitude (the attitude behind the
rejection or doubt about receiving vaccines and
predicting vaccination behavior) (Martin & Petrie,
2017). The term 'vaccination' here refers specifically
to Covid-19 vaccination and does not include other
general vaccinations such as polio, smallpox and
hepatitis vaccination.
3 RESEARCH METHOD
This research is a non-experimental quantitative
research with a correlational research design. Data
from participants aged 18-25 years who live in the
Jabodetabek area (Jakarta, Bogor, Depok, Tangerang
and Bekasi) was obtained from April 7, 2021 to May
23, 2021 through an online questionnaire platform by
using convenience sampling method. 138 participants
are needed to achieve a power of .95 with a medium
effect size (f2= .15) and = .05 based on power a priori
analysis of G*power 3.1.9.7 (Faul, Erdfelder, Lang,
& Buchner, 2007).
This study used the 5C Psychological Antecedents
of Vaccination instrument composed in 2018 which
consists of 15 items that are divided within five
dimensions (confidence, complacency, constraints,
calculation, collective responsibility). 5C has a good
reliability with Cronbach Alpha ranging from 0.71 -
0.85 and correlates with six previous vaccine
hesitancy / acceptance scales with p<.01 (Betsch, et
al., 2018; Betsch, et al., 2020). This study also used
the Vaccination Attitudes Examination (VAX) Scale
composed in 2017 to measure attitudes toward
vaccines which consists of four dimensions (mistrust
of vaccine benefit, worries over unforeseen future
effects, concerns about commercial profiteering, and
preference for natural immunity) (Martin & Petrie,
2017). VAX Scale has good reliability with Cronbach
Alpha ranging from 0.79 - 0.91 and good validity (r >
0.49) with related constructs (Wood, et al., 2019). This
study also used the Perceived Risk of Covid-19
instrument composed in 2021 which consists of 7 items
that are divided within three dimensions (perceived
likelihood of infection, perceived severity, and
worriness) (Karlsson, et al., 2021). All the
Psychological Antecedents of Vaccination instruments
ICPsyche 2021 - International Conference on Psychological Studies
214
were measured using 1-7 point Likert Scale (1 =
Strongly Disagree, 7 = Strongly Agree). Meanwhile,
the Vaccination Behavior instrument used in this study
was composed in 2021 and was measured using one
item by 1-5 point Likert Scale (1 = Very Likely, 5 =
Very Unlikely) (Karlsson, et al., 2021).
4 RESULT
218 participants filled out the questionnaire and 4 of
them were removed due to double submission. The
age range of participants was 18-25 years (M = 21,
SD = 1.585), where the highest number was found at
the age of 21 years at 32.7% (n = 70). 73.8% (n = 158)
of the participants were women and 54.2% (n = 116)
lived in Jakarta. Most of the participants’ occupations
were students at 78% (n = 167) and 71% (n = 152)
had completed the SMA/SMK (Senior high school)
education level.
Table 1: Overview of Research Variables (N=214).
Variable
Min
Max
Mean
SD
Vaccination
Behavior
1.00
5.00
4.63
0.718
Confidence
2.33
7.00
5.377
0.922
Complacency
1.00
6.67
2.517
1.028
Constraints
1.00
7.00
2.313
1.219
Calculation
2.67
7.00
5.446
1.088
Collective
Responsibility
2.00
7.00
6.117
0.887
VAX
1.33
5.58
3.466
0.893
Perceived
Infection
1.00
6.00
3.50
1.108
Perceived
Severity:
Personal
1.00
5.00
2.88
1.156
Perceived
Severity:
General
1.00
5.50
4.598
0.834
Perceived
Severity: Death
Likelihood
1.00
7.00
4.43
1.188
Worry: Ill
1.00
5.00
3.33
1.193
Worry:
Transmit
1.00
5.00
4.02
1.142
Table 2: Multiple Linear Regression to Predict Vaccination
Behavior (N=214).
Predictor
B
SE
P
Constant
1.914
0.600
0.002
Confidence
0.192
0.056
0.001
Complacency
0.088
0.056
0.115
Constraints
0.015
0.046
0.749
Calculation
-0.07
0.040
0.080
Collective
Responsibility
0.277
0.065
0.000
VAX
-0.11
0.063
0.074
Perceived
Infection
0.094
0.040
0.019
Perceived
Severity:
Personal
-0.02
0.040
0.662
Perceived
Severity:
General
0.015
0.068
0.822
Perceived
Severity: Death
Likelihood
0.004
0.039
0.923
Worry: Ill
0.012
0.046
0.799
Worry:
Transmit
0.025
0.043
0.561
Note: F(12,201) = 9.131, R² = 0.353, *p<0.05, **p<0.001,
DV = Vaccination Behavior
The results of the regression analysis showed that
there were three significant predictors F(12, 201) =
9.131, p < 0.01, with an R² of 0.353, which are
confidence (β = 0.246, t(201) = 3.445 , p = 0.001),
collective responsibility (β = 0.342, t(201) = 4.250, p
= 0.000) and perceived infection (β = 0.144, t(201) =
2.364, p = 0.019). This indicates that the 35.3%
variance of the Vaccination Behavior score was
predicted by the Psychological Antecedent of
Vaccination. The results of this analysis show a large
effect size because the R² value is higher than 0.26
(Cohen, 1988).
5 DISCUSSION
The results of the study showed that Psychological
Antecedents of Vaccination, especially confidence,
The Effect of Psychological Antecedents of Vaccination to Vaccination Behavior of Young Adult in Jabodetabek
215
collective responsibility and perceived infection,
significantly influence Vaccination Behavior of
young adults in Jabodetabek. This finding supports
several previous studies which also emphasize the
importance of psychological factors behind vaccine
acceptance, for example how providing information
regarding virus risk, vaccine safety, clarifying
misconceptions about vaccines, clinical details of
vaccine provision, framing and clarity of messages
can encourage vaccine acceptance (Lawes-Wickwar,
et al., 2021).
The research finding that the confidence
dimension has a significant effect on Vaccination
Behavior supports the research results in Italy, where
it was stated that a significant predictor of acceptance
of the Covid-19 vaccine was the level of trust in the
vaccination administration institution and also a
person's personal confidence in the safety of the
vaccine (Riccio, et al., 2021). Research in Jordan,
Kuwait and Saudi Arabia also shows how trusting the
vaccine-related conspiracies can lower public
acceptance of vaccines (Sallam, et al., 2021). The
Indonesian National Agency of Drug and Food
Control has maintained the quality and safety of
vaccines since the beginning of the vaccination
program by issuing lot release certificates for the
Sinovac vaccine, participating in monitoring the
development of vaccine clinical trials and conducting
evaluations in collaboration with other institutions
(Kemenkes, 2021a). By May 12, 2021, 80.8% people
in Indonesia were willing to receive the vaccine,
which reflects the importance of gaining people’s
confidence regarding vaccines (Kemenkes, 2021b).
The research finding that the level of collective
responsibility significantly influences vaccination
behavior supports previous research which states that
someone with a high prosocial level and who has an
awareness that he is responsible for the safety of
others will engage more in health behavior to protect
those around him (Kokkoris & Kamleitner., 2020;
O'Connor & Evans, 2020). People who were aware of
the consequences of the Covid-19 pandemic on their
health tended to have an awareness and emotional
obligation of their responsibility to adopt prosocial
behavior which would encourage them to engage in
altruistic and pro-vaccine behavior (Radic, et al.,
2021). It can be concluded that the participants of this
study have an understanding that the consequences of
their behavior regarding vaccination can endanger or
help others around them.
The research finding that the level of Perceived
Risk of Covid-19, especially Perceived Likelihood of
Infection dimension, significantly influences
vaccination behavior supports previous research
which states that perceived risk of transmission
significantly predicts vaccination behavior (Brewer,
et al., 2007). People who perceived themselves prone
to Covid-19 transmission would be more likely to
receive the vaccine (Karlsson, et al., 2021). Those
with low perceived risk of transmission also were
found to have a low intention to get vaccinated
(Thomson, et al., 2016).
The findings of this study where Complacency,
Constraints, Calculation, Attitudes Towards
Vaccines, Perceived Severity and Worriness did not
significantly influence Vaccination Behavior provide
an interesting insight about the dynamic of vaccine
behavior. Research showed that demographic factors,
such as gender, income, educational level and the
social media platform used, played a huge role in
predicting people’s vaccination behavior (Sallam, et
al., 2021). Another research in Japan stated that a
person’s intention to be vaccinated was influenced by
being elderly, living in rural areas or having
congenital diseases (Yoda & Katsuyama, 2021).
These findings from previous studies implied that
demographic factors provide various alterations in the
dynamic of people’s vaccine behavior, which
explained why the results of this age group specific
study were different.
6 CONCLUSIONS
Based on the results of research analysis, it can be
concluded that there is a significant effect of
psychological antecedents of vaccination on the level
of vaccination behavior in young adults in
Jabodetabek, where 35.3% of the variance of
vaccination behavior in this age group is influenced
by the level of psychological antecedents of
vaccination possessed. The first conclusion shows
that the confidence dimension has a significant effect
on vaccination behavior. This implies that the higher
a person's confidence in the safety and effectiveness
of the vaccine, as well as in the government
administering the vaccination, the higher the level of
acceptance of that person's vaccine intention. The
second conclusion shows that the dimension of
collective responsibility has a significant effect on
vaccination behavior. This implies that the higher a
person's awareness and responsibility for maintaining
personal health behavior because it can affect many
people, the higher the level of vaccine acceptance will
be. The third conclusion shows that the perceived
infection of Covid-19 has a significant effect on
vaccination behavior. This implies that the higher
people’s risk perception regarding Covid-19
ICPsyche 2021 - International Conference on Psychological Studies
216
transmission, the higher the level of vaccine
acceptance will be.
This research can be the basis for the development
of further research. Studies that show differences
between men and women regarding vaccination
receipts (Riccio, et al., 2021; Murphy, et al., 2021), as
well as survey findings where provinces such as Riau
(32.1%) and South Sumatra (31.7%) are still has a
high level of vaccine hesitancy (Facebook Company,
2021) providing insight that further research can
focus on this population and be carried out with
comparative study designs and cluster random
sampling or quota sampling techniques. Given the
results of studies that emphasize the importance of the
confidence dimension in young adult vaccine
acceptance, further research with an experimental
type can focus on this dimension. One of them is to
look at the form of media framing or what kind of
information sources can increase the confidence level
of this age group.
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