Skip to main content
Download PDF

Acceptance of COVID-19 vaccine booster doses among the Adult Population in Ghana: a cross-sectional study using the Health Belief Model

BMC Public Health volume 24, Article number: 2673 (2024) Cite this article

Abstract

Background

The Health Belief Model (HBM) is a widely utilised framework for understanding vaccination behaviour against COVID-19. This study assessed the acceptance of COVID-19 vaccine booster doses in Ghana and identified predictors using HBM domains, including perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action. Additionally, it examined the sources of information about COVID-19 vaccines.

Methods

We employed a cross-sectional quantitative design, using convenient and snowball sampling methods to recruit participants. Between March 20 and May 10, 2023, 822 Ghanaians completed a predesigned self-administered online survey via commonly used social media platforms (WhatsApp, Facebook, X (Twitter), and LinkedIn). The study used a binary logistic regression to predict COVID-19 booster dose acceptance.

Results

The respondents had a mean age of 29.3 ± 6.2, with 55.5 being males, 53.0% being single/never married, 93.7% having tertiary education, 83.0% being Christians, 59.1% were healthcare workers, 57.8% residing in urban areas, 95.5% having no chronic disease, 90.6% reporting negative COVID-19 history, and 78.3% reporting no reported relative/friend infected with COVID-19. The study showed that 81.1% [95% confidence interval (CI) = 78.4 − 83.8%] of respondents received the COVID-19 vaccine, and 58.3% [95% CI = 54.2 − 62.5%] of respondents were willing to accept the COVID-19 booster dose. The main reasons for non-acceptance of COVID-19 vaccine booster doses were personal reasons (41.7%) and experienced side effects or fear of side effects (32.4%). Regression analysis revealed that perceived benefits and perceived barriers (specifically worrying about serious risk factors) were the significant predictors of accepting COVID-19 booster doses in Ghana.

Conclusions

Many respondents were willing to receive the COVID-19 booster dose. Personal reasons, fear of side effects, and experienced side effects were the main reasons for refusing COVID-19 booster doses. Perceived benefits and perceived barriers predicted COVID-19 booster dose acceptance in Ghana. Policymakers should consider these factors in designing public health interventions to increase the patronage of COVID-19 booster doses.

Peer Review reports

Background

Since the global pandemic of coronavirus disease 2019 (COVID-19), it has caused devastating effects on individuals and economies worldwide [1,2,3,4]. As of 14 April 2024, there were confirmed 775,335,916 reported cases of COVID-19 worldwide, while confirmed 7,045,569 persons died from COVID-19 [5, 6]. On 5 May 2023, the World Health Organization (WHO) declared that COVID-19 no longer poses a global public health emergency [7].

Despite this declaration, it is important to acknowledge that the virus still causes a threat and can lead to fatalities if preventive measures, such as vaccination, are not maintained [1]. As of December 31, 2023, a total of 13.64 billion COVID-19 vaccines have been administered globally to help reduce the spread of the virus [8]. The WHO continues to emphasise vaccination as a key strategy for maintaining progress in COVID-19 control, as outlined in its Strategic Preparedness and Response Plan for April 2023–April 2025 [9].

Research has shown that COVID-19 vaccine booster doses effectively combat variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the disease [10, 11]. As of November 26, 2023, an estimated 5,602,516,381 individuals worldwide have received at least one dose of the COVID-19 vaccine, while 2,493,620,878 individuals have received at least one booster dose [8]. As of April 7, 2024, Ghana has reported 172,075 confirmed cases of COVID-19, resulting in 1,462 confirmed deaths [12]. As of December 31, 2023, approximately 6,691,825 individuals in Ghana have received at least one COVID-19 vaccine booster [12].

Studies have shown that one of the 10 threats to global health is vaccine hesitancy (VH), which was widely prevalent in the context of COVID-19 vaccination [13,14,15]. VH is defined as the “delay in acceptance or refusal of vaccination despite the availability of vaccination services” [16]. This attitude represents a threat hindering progress in combating vaccine-preventable illnesses [17]. Previous studies have identified several predictors of acceptance of COVID-19 vaccine booster doses, including socio-demographic characteristics (such as age, sex, educational level, and profession), health-related factors (including vaccination history, chronic illness status, and previous COVID-19 positive tests), and trust in government [18,19,20]. Also, studies have identified sources of information about COVID-19 (information from the Ministry of Health), perceptions towards the COVID-19 vaccine, and health belief model (HBM) constructs (perceived susceptibility, severity, and risks of side effects about COVID-19) as factors influencing the acceptance of COVID-19 vaccine booster dose [18,19,20].

Though there are studies in Ghana on the acceptance of COVID-19 vaccines [21,22,23,24,25,26], only one study focused on the acceptance of COVID-19 vaccine booster doses [18]. Storph and colleagues’ study found that factors such as being male, testing positive for COVID-19, high trust in the government, experiencing side effects from primer dose, and having positive perceptions about COVID-19 vaccines were predictors of acceptance of COVID-19 vaccine booster doses [18]. Also, to the best of our knowledge, no study in Ghana has used the HBM constructs to predict acceptance of acceptance of COVID-19 vaccine booster doses in Ghana. The HBM aids in the explanation and prediction of individuals’ health-related behaviours based on their beliefs and attitudes.

Therefore, to bridge this knowledge gap, this study examined the extent of COVID-19 vaccine booster doses acceptance and its predictors in Ghana using the HBM constructs. Also, the study examined the source of information regarding COVID-19 vaccines and perceptions about COVID-19 vaccine booster doses. HBM is one of the most popular models for analyzing individuals’ behaviour against vaccination for COVID-19 [27]. The model hypothesises that several variables influence the individual’s health-related behaviour, such as cues to action, self-efficacy, perception of susceptibility, severity, benefits, and barriers [28]. The findings of this study will inform the development of strategies to enhance acceptance of COVID-19 vaccine booster doses in Ghana.

Methods

Study Design and sampling procedure

This study used a cross-sectional study design to examine the acceptance and predictors of acceptance of COVID-19 vaccine doses in Ghana. Convenience and snowball sampling methods were used to select respondents for this study. A self-administered online survey was created using Google Forms and disseminated across various social media platforms, including Meta (WhatsApp), Facebook, X (formerly Twitter), and LinkedIn, by a team of researchers. Additionally, participants were encouraged to share the online survey with their eligible family members, friends, and colleagues.

The study population is persons aged 18 years or older residing in Ghana. The study applied specific inclusion criteria to determine participants’ eligibility. Respondents were eligible if they were 18 years or older, residents of Ghana, had internet access, and provided consent to participate. Individuals with communication challenges, such as blindness that could interfere with completing the questionnaire were excluded.

The Epi Info software was used to estimate the minimum sample size for our study. We based the population size on Ghana’s estimated population of 30.8 million as of 2021. An acceptance rate of 50% for the COVID-19 booster dose and a design effect of 2 was assumed, following estimates from a previous study on booster dose acceptance in Ghana [18]. A 95% confidence level was applied, resulting in an estimated minimum of 768 respondents. The final sample size included in the study was 822 participants giving an expected non-response rate of 15%.

Study setting

Ghana is located in Africa, specifically West Africa. It shares a boundary with Burkina Faso on the North, Togo on the East, the Gulf of Guinea on the South, and Cote d’Ivoire on the West. Ghana is a lower-middle-income country with 16 administrative regions. Accra is Ghana’s capital in the Greater Accra region [29]. The Greater Accra and Ashanti regions are the most populous regions in Ghana, with estimated populations of 17.7 million and 17.6 million, respectively [29]. In 2023, the Government of Ghana commissioned the National Vaccine Institute to develop its vaccine [30].

In Ghana, the Ministry of Health is responsible for providing policy direction for all stakeholders involved healthcare delivery across the country [31]. The varied stakeholders involved healthcare delivery in Ghana include Ghana Health Service (public), faith-based organisations, private not-for-profit organisations, and private for-profit organisations [32]. In Ghana, the healthcare system is structured at four levels: tertiary, regional, district and sub-district levels. Ghana Health Service is responsible for the provision of primary health care services at the regional, district and sub-district levels [33]. At the tertiary level, boards of various tertiary hospitals ensure the implementation of policies to ensure the provision of quality care to patients [33].

Description and conceptualisation of variables

Dependent variable

The dependent variable for this study is acceptance of the COVID-19 booster dose, and it was measured by asking respondents who had ever received the COVID-19 vaccine whether they will receive a COVID-19 booster dose. The responses were “yes” and “no”. A “yes” response indicates willingness to accept a COVID-19 booster dose, while a “no” response means unwillingness to accept a COVID-19 booster dose. The measurement of acceptance of the COVID-19 booster dose in this study is similar to a previous study in Ghana [18]. Storph et al.’s [18] study among 812 adult Ghanaians evaluated the factors associated with the acceptability of the COVID-19 booster dose in Ghana.

Independent variables

The independent variables for this study included socio-demographic characteristics, source of information, and HBM. The socio-demographic characteristics were age, sex (male and female), residence (urban and rural), education (before tertiary and tertiary), marital status (married and non-married), employment status (employed and unemployed), religion (Christian, Islam, and other), and chronic disease (yes and no). Regarding the source of information, respondents were asked whether they received information regarding the COVID-19 vaccine from health workers, and the responses were “yes” and “no.” The HBM captures six dimensions: perceived susceptibility to COVID-19 infection, perceived severity of COVID-19, perceived benefit of COVID-19 booster, a perceived barrier to receiving COVID-19 booster doses, cues to actions, and self-efficacy.

Data collection

The data for this study was collected from 20 March to 10 May 2023. A pre-dsigned questionnaire previously used by Ghazy et al. [20] was adapted for this study (see supplementary file 1). The online survey had three sections. The first section covered the socio-demographic characteristics of respondents (i.e., age, sex, education, marital status, religion, employment status, history of chronic disease, previous COVID-19 infection, COVID-19 among relatives, and immunocompromising diseases). The second section addressed participants’ COVID-19 vaccination status, sources of information about COVID-19 vaccines, and their willingness to receive COVID-19 booster doses, including reasons for any refusal.

The third section included HBM questions, featuring 13 items designed to assess respondents’ perceptions of COVID-19 infection and booster vaccination. The perceived susceptibility to COVID-19 infection, perceived severity of COVID-19, and cues to actions had 2 items each. Also, the perceived benefit of COVID-19 booster and perceived barrier to receiving COVID-19 booster doses had 3 items each. In addition, self-efficacy had one item. According to HBM, behaviour is more likely to happen among people who may think there will be little or no obstacles to adopting behaviours, that it will lower the chance of a negative health outcome, that it will have a significant negative impact on their health, and if they think they are vulnerable to it [34].

Statistical analysis

The SPSS (Statistical Package for Social Science Software) Armonk, NY: IBM Corp version 27.0 was used to analyze the data of the study. Descriptive statistics, such as frequency and percentages, were used to describe the socio-demographic characteristics of respondents, the source of information regarding COVID-19 vaccines, and the COVID-19 vaccine status of respondents. Pearson’s chi-square test was used to examine the association between acceptance of COVID-19 booster doses and respondent’s socio-demographic characteristics, source of information regarding COVID-19 vaccines, and perception of COVID-19 booster doses respectively. Furthermore, a binary logistic regression was conducted to evaluate factors influencing COVID-19 booster dose acceptance. The dependent variable was COVID-19 booster dose acceptance, with two response categories: “Yes” and “No.” Variables that showed significant associations in the bivariate analysis were included in the model. The Enter method in SPSS software was employed, allowing all selected variables to be simultaneously incorporated into the model. To assess the strength and precision of the associations between predictors and willingness to accept the booster dose, odds ratios (OR) and 95% confidence intervals (CI) were calculated. Significance was considered when p ≤ 0.05.

Ethical considerations and approval

The study followed ethical guidelines concerning collecting data from human subjects. Ethical approval was sought and received from the ethical committee of the High Institute of Public Health, Alexandria University (IRB number 00013692). The study’s objectives were presented on the front page of the online survey. Respondents provided written informed consent by selecting either “I agree to participate” or “I do not agree to participate.” Only those who selected “I agree to participate” were allowed to proceed to the online questionnaire. All participant information was managed confidentially and anonymously to ensure privacy.

Results

The mean age of the respondents was 29.97 ± 6.24, 55.5% were males, 93.7% had tertiary education, 83.0% were Christians, 59.1% were healthcare workers, 57.8% resided in urban areas, and 53.0% were single or never married (53%) (Table 1). The majority of respondents had no chronic disease (95.5%), no previous history of SARS-CoV-2 infection (90.6%), and no relative or friend infected with COVID-19 (78.3%).

Table 1 Socio-demographic characteristics of the studied sample
Full size table

Sources of information regarding COVID-19 vaccines

Healthcare workers (62.9%) and social media (61.7%) were the primary sources of information about COVID-19 vaccines (Fig. 1). Fewer than half of the respondents (48.3%) cited scientific websites as a source, while approximately one-fifth relied on relatives or friends (20.6%) and literature articles (19.0%) for information on COVID-19 vaccines.

Fig. 1
figure 1

Sources of information regarding COVID-19 vaccines

Full size image

COVID-19 vaccine situation among the studied sample

Table 2 represents the COVID-19 vaccine situation among respondents. Of the total sample, 81.1% (95% CI = 78.4 – 83.8%) of respondents received the COVID-19 vaccine. Over half of the respondents (52.2%) had received a COVID-19 vaccine booster dose. Among the 259 respondents who had not received the COVID-19 vaccine booster dose, 58.3% (95% CI = 54.2 – 62.5%) were willing to receive the COVID-19 vaccine booster dose.

Table 2 COVID-19 vaccine situation among the studied sample
Full size table

Figure 2 shows that 41.7% of respondents cited personal reasons for refusing the COVID-19 vaccine booster dose. Also, 32.4% of respondents were concerned about potential side effects or feared severe side effects of COVID-19 vaccine booster dose. Additionally, 9.3% of respondents felt the pandemic was over, so they did not need the COVID-19 vaccine booster dose. Other reasons (Scared or experienced side effects from vaccines, thinking vaccination is a political game, seeing that the pandemic is over or having personal reasons) were cited by 16.7% of the respondents.

Fig. 2
figure 2

Reasons for refusing COVID-19 booster dose

Full size image

Acceptance of COVID-19 vaccine booster dose was higher among males than females (54.8% vs. 45.2%); this sex difference was not statistically significant (P = 0.795) (Table 3). Respondents who accepted the COVID-19 vaccine booster dose were older than those who rejected the booster dose (31.27 ± 5.38 vs. 30.24 ± 6.63). However, this difference was not statistically significant (P = 0.094) as well. The COVID-19 vaccine booster dose acceptance among respondents in rural areas was higher than in urban areas (51.2% vs. 49.8%). More respondents in urban areas rejected the COVID-19 vaccine booster dose than those residing in rural areas (59.3% vs. 40.7%), and the difference did not show statistical significance (P = 0.077). Being married was significantly associated with COVID-19 vaccine booster dose acceptance despite equal numbers of married and unmarried respondents who accepted the COVID-19 vaccine booster doses. Education, working status, industry, presence of chronic disease, previous COVID-19 infection, and having a relative or friend infected with COVID-19 were not statistically associated with COVID-19 vaccine booster dose acceptance. Healthcare workers as a source of information about COVID-19 vaccination was significantly associated (P = 0.001) with accepting or rejecting the COVID-19 vaccine booster doses. Most respondents (71.2%) who received information about COVID-19 vaccines from healthcare workers accepted the COVID-19 vaccine booster dose compared to those who did not receive information from healthcare workers. Neither social media, relatives/friends, scientific websites, nor literature as a source of information about the COVID-19 vaccine were statistically associated with COVID-19 vaccine booster dose acceptance.

Table 3 Comparison of different characteristics among accepting and rejecting COVID-19 booster dose participants (n = 542)
Full size table

Perception of COVID-19 vaccine booster doses based on HBM

With exception to second point of perceived severity, third point of perceived barriers and cues to action, all other domains of HBM (i.e., perceived susceptibility, perceived severity, perceived benefit, perceived barriers, and perceived efficacy) were significantly associated with accepting and rejecting COVID-19 vaccine booster dose (P < 0.05) (Table 4).

Table 4 Perception of COVID-19 vaccine booster doses based on the health belief model
Full size table

Predictors of COVID-19 vaccine booster dose acceptance

Respondents who expressed neutrality regarding concerns over serious adverse reactions showed more acceptance of the booster vaccine (p < 0.001, OR = 3.9, 95% CI: 1.83–8.32) (Table 5). Additionally, there was a marginally significant association between believing that the vaccines are effective against early circulating strains and increased vaccine acceptance (p = 0.042, OR = 3.56, 95% CI: 1.04–12.1). Overall, belief in the safety of the COVID-19 vaccines was a significant predictor of COVID-19 vaccine booster dose acceptance, with respondents who considered the vaccines safe being much more likely to accept them (p < 0.001). The regression model was statistically significant (p < 0.001), explaining 84.1% of variability with R2 = 35.0%.

Table 5 Regression analysis of predictors affecting COVID-19 vaccine booster dose acceptance
Full size table

Discussion

This study examined the magnitude of acceptance of COVID-19 vaccine booster doses and its predictors in Ghana using HBM constructs. The discussion is organized into these thematic sections: pattern of acceptance of COVID-19 vaccine booster doses, COVID-19 vaccination, reasons for refusal of COVID-19 vaccine booster dose, sources of information about COVID-19 vaccine, and predictors of acceptance of COVID-19 vaccine booster doses.

Prevalence comparison of acceptance of COVID-19 vaccine booster dose

The study found that the prevalence of acceptance of COVID-19 vaccine booster dose was 58.3%. The acceptance of COVID-19 vaccine booster dose in this study was higher than those reported in previous studies conducted in emerging economies, such as Ghana and Algeria, which ranged between 22.8% and 51.6% [18, 19, 35, 36]. However, the acceptance of COVID-19 vaccine booster dose in this study was lower than studies in developed economies, such as Germany and the United States of America, which ranged between 81.2% and 92.6% [37,38,39]. Several factors may explain these discrepancies. First, the characteristics of the study participants can greatly influence acceptance. The current study included the general adult population, whereas previous studies focused on specific groups like university students or employees, who may have different levels of education, access to information, and health literacy [37]. Variations in evaluation techniques, such as survey design and question-wording, can also influence reported acceptance rates. The cultural environment and societal norms may also influence how respondents interpret questions concerning vaccine acceptance. Furthermore, the time of data collection is critical, as public opinions regarding vaccines can change quickly due to new knowledge, adjustments in vaccine availability, or changes in government regulations.

Prevalence comparison of COVID-19 vaccine

Also, most respondents (81.1%) had received the COVID-19 vaccine, which is higher than what was reported in other studies in Ghana [25, 40]. The difference in the COVID-19 vaccine uptake could be attributed to several factors, including sample size, geographical area, and year of data collection. For example, Forkuo et al.’s [25] study was conducted among 325 outpatient department attendants at a public health facility in the Bono region of Ghana in 2021, and it found that 9.8% of respondents had received the COVID-19 vaccine. Also, Sampene et al.’s [40] found that among 400 adult Ghanaians, 4.5% of respondents had received the COVID-19 vaccine. This finding suggests that authorities should enhance public health initiatives about COVID-19 in order to maintain recent gains in vaccine uptake. During COVID-19 public health initiatives, the public should be educated on the value of taking booster doses of the vaccine to improve COVID-19 control.

Reasons for refusal of COVID-19 vaccine booster dose

The main reasons for refusing the COVID-19 vaccine booster dose were personal (41.7%), fear of side effects, and experienced side effects (32.4%). This finding supports previous studies that found that the experience of side effects hindered the acceptance of the COVID-19 booster dose [19, 20, 39, 41, 42]. To promote uses of the COVID-19 booster dose, policymakers should address the population’s concerns about it, particularly its side effects, through public health education and promotion.

Sources of information about COVID-19 vaccine

Similar to previous studies [18, 20, 43], this study revealed that healthcare workers, social media, and scientific websites were important sources of information about COVID-19. Previous studies have indicated that right-leaning media outlets contributed to COVID-19-related misinformation, reflecting the stance of Republican leadership, which minimised the necessity for government interventions to control the virus’s spread [5, 6]. So, policymakers need to use these sources of information about COVID-19 to enhance the uptake of COVID-19 vaccine booster doses.

Predictors of acceptance of COVID-19 vaccine booster doses

Several items of HBM including perceived benefits and barriers were significantly affecting the willingness to receive COVID-19 booster doses in Ghana. Respondents who were neutral to the statement “I am worried about serious adverse reaction after vaccination” were more willing to receive a COVID-19 booster dose. Thus, respondents who were uncertain regarding the perhaps presence of serious adverse reactions after vaccination were more likely to receive a COVID-19 booster dose. This finding supports previous studies that found adverse reactions after COVID-19 vaccination as a barrier to acceptance of COVID-19 vaccine booster dose [41, 42]. Perceived benefits and thinking that the COVID-19 vaccine boosters are safe were also predicting the acceptance of booster doses. This was also supported by other studied which found that both perceived benefits and perceived risk factors affecting the choice of participants to accept booster doses [21, 44].

Limitations of study

This study has some limitations. First, it was cross-sectional, so we cannot establish causality among the variables of interest. Second, only respondents with internet access could participate in this study, so the findings may not represent the entire country. Third, convenient and snowballing sampling methods were used to recruit respondents for the study, so the findings may not be representative and should be interpreted cautiously. Despite these limitations, the study contributes to the limited studies on the acceptance of COVID-19 booster doses in Ghana, and it will help policymakers design interventions to increase the uptake of COVID-19 booster doses in the country.

Conclusions

This study demonstrated that acceptance of COVID-19 vaccine booster dose was moderate. Also, the study highlighted that HBM, specifically the perceived benefits and barriers to receive COVID-19 vaccine booster doses were significant predictors of acceptance of COVID-19 vaccine booster doses in Ghana. Policymakers should consider these factors in designing public health interventions to increase the patronage of COVID-19 vaccine booster doses.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding at reasonable request.

Abbreviations

CDC:

Centers for Disease Control and Prevention

COVID-19:

Coronavirus disease 2019

GHS:

Ghana Health Service

HBM:

Health belief model

MOH:

Ministry of Health

NPIs:

Non-pharmaceutical interventions

SPSS:

Statistical Package for the Social Sciences

V.H.:

Vaccine hesitancy

WHO:

World Health Organization

References

  1. Xiang L, Tang M, Yin Z, Zheng M, Lu S. The COVID-19 pandemic and economic growth: Theory and Simulation. Front Public Health. 2021;9:741525.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ridhwan MM, Rezki JF, Suryahadi A, Ramayandi A. A The Impact Of Covid-19 Lockdowns On Household Income, Consumption, And Expectation: Evidence From High. Work Pap [Internet]. 2021 [cited 2024 May 11]; https://ideas.repec.org//p/idn/wpaper/wp072021.html

  3. Liu WP, Chu YC. FinTech, economic growth, and COVID-19: International evidence. Asia Pac Manag Rev [Internet]. 2024 [cited 2024 May 11]; http://www.scopus.com/inward/record.url?scp=85181887253&partnerID=8YFLogxK

  4. Nichols E, Petrosyan S, Khobragade P, Banerjee J, Angrisani M, Dey S, et al. Trajectories and correlates of poor mental health in India over the course of the COVID-19 pandemic: a nationwide survey. BMJ Glob Health. 2024;9(1):e013365.

    Article  PubMed Central  PubMed  Google Scholar 

  5. World Health Organisation. COVID-19 cases | WHO COVID-19 dashboard [Internet]. WHO COVID-19 dashboard. [cited 2024 May 11]. https://data.who.int/dashboards/covid19/cases

  6. World Health Organisation. COVID-19 deaths | WHO COVID-19 dashboard [Internet]. WHO COVID-19 dashboard. [cited 2024 May 11]. http://data.who.int/dashboards/covid19/cases

  7. World Health Organization. Statement on the fifteenth meeting of the IHR. (2005) Emergency Committee on the COVID-19 pandemic [Internet]. 2023 [cited 2023 Nov 15]. https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

  8. World Health Organisation. COVID-19 vaccines | WHO COVID-19 dashboard [Internet]. WHO COVID-19 dashboard. [cited 2024 May 11]. http://data.who.int/dashboards/covid19/vaccines

  9. World Health Organization. From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic [Internet]. 2023. https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1

  10. Choi A, Koch M, Wu K, Chu L, Ma L, Hill A, et al. Safety and immunogenicity of SARS-CoV-2 variant mRNA vaccine boosters in healthy adults: an interim analysis. Nat Med. 2021;27(11):2025–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Yue L, Zhou J, Zhou Y, Yang X, Xie T, Yang M et al. Antibody response elicited by a third boost dose of inactivated SARS-CoV-2 vaccine can neutralize SARS-CoV-2 variants of concern. Emerg Microbes Infect. 10(1):2125–7.

  12. Ghana Health Service. COVID-19 Latest Update | Ghana [Internet]. [cited 2024 May 11]. https://www.ghs.gov.gh/covid19/latest.php

  13. Sallam M. COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines [Internet]. 2021 Feb [cited 2023 Nov 15];9(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920465/

  14. Sallam M, Al-Sanafi M, Sallam M. A Global Map of COVID-19 Vaccine Acceptance Rates per Country: an updated Concise Narrative Review. J Multidiscip Healthc. 2022;15:21–45.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Fajar JK, Sallam M, Soegiarto G, Sugiri YJ, Anshory M, Wulandari L, et al. Global prevalence and potential influencing factors of COVID-19 vaccination hesitancy: a Meta-analysis. Vaccines. 2022;10(8):1356.

    Article  PubMed Central  PubMed  Google Scholar 

  16. MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.

    Article  PubMed  Google Scholar 

  17. World Health Organization. Ten threats to global health in 2019 [Internet]. [cited 2023 Nov 15]. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

  18. Storph RP, Essuman MA, Duku-Takyi R, Akotua A, Asante S, Armah R, et al. Willingness to receive COVID-19 booster dose and its associated factors in Ghana: a cross-sectional study. Health Sci Rep. 2023;6(4):e1203.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lounis M, Bencherit D, Rais MA, Riad A. COVID-19 vaccine Booster Hesitancy (VBH) and its drivers in Algeria: National Cross-sectional Survey-based study. Vaccines. 2022;10(4):621.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Ghazy RM, Abdou MS, Awaidy S, Sallam M, Elbarazi I, Youssef N, et al. Acceptance of COVID-19 vaccine booster doses using the health belief model: a cross-sectional study in low-middle-and high-income countries of the East Mediterranean region. Int J Environ Res Public Health. 2022;19(19):12136.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Alhassan RK, Aberese-Ako M, Doegah PT, Immurana M, Dalaba MA, Manyeh AK, et al. COVID-19 vaccine hesitancy among the adult population in Ghana: evidence from a pre-vaccination rollout survey. Trop Med Health. 2021;49(1):96.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Agyekum MW, Afrifa-Anane GF, Kyei-Arthur F, Addo B. Acceptability of COVID-19 vaccination among Health Care workers in Ghana. Adv Public Health. 2021;2021:e9998176.

    Article  Google Scholar 

  23. Afrifa-Anane GF, Larbi RT, Addo B, Agyekum MW, Kyei-Arthur F, Appiah M, et al. Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: a qualitative study. PLoS ONE. 2022;17(8):e0272876.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Kyei-Arthur F, Kyei-Gyamfi S, Agyekum MW, Afrifa-Anane GF, Amoh BA. Parents’ and guardians’ acceptability of COVID-19 vaccination for children in Ghana: an online survey. PLoS ONE. 2022;17(8):e0272801.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Forkuo BT, Osarfo J, Ampofo GD. COVID-19 vaccine acceptance and its determinants in the Bono Region of Ghana. Ghana Med J. 2022;56(4):239–45.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Okai GA, Abekah-Nkrumah G. The level and determinants of COVID-19 vaccine acceptance in Ghana. PLoS ONE. 2022;17(7):e0270768.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Patwary MM, Bardhan M, Disha AS, Hasan M, Haque MZ, Sultana R, et al. Determinants of COVID-19 Vaccine Acceptance among the Adult Population of Bangladesh using the Health Belief Model and the theory of Planned Behavior Model. Vaccines. 2021;9(12):1393.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Limbu YB, Gautam RK, Pham L. The Health Belief Model Applied to COVID-19 vaccine hesitancy: a systematic review. Vaccines. 2022;10(6):973.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Ghana Statistical Service. 2021 Population and housing census general report: Population of regions and districts, vol. 3A. 2021.

  30. Ministry of Health. President Akufo-Addo Commissions National Vaccine Institute. 2023; https://www.moh.gov.gh/president-akufo-addo-commissions-national-vaccine-institute/

  31. Role. and Function of MOH [https://www.moh.gov.gh/the-ministry/]

  32. Tenkorang EY. Health provider characteristics and choice of health care facility among Ghanaian health seekers. Health Syst Reform. 2016;2(2):160–70.

    Article  PubMed  Google Scholar 

  33. Republic of Ghana. Ghana Health Service and Teaching hospitals Act, 1996 (Act 525). Accra: Republic of Ghana; 1996.

    Google Scholar 

  34. Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun. 2010;25(8):661–9.

    Article  PubMed  Google Scholar 

  35. Klugar M, Riad A, Mohanan L, Pokorná A. COVID-19 vaccine Booster Hesitancy (VBH) of Healthcare Workers in Czechia: National Cross-sectional Study. Vaccines. 2021;9(12):1437.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Wirawan GBS, Harjana NPA, Nugrahani NW, Januraga PP. Health beliefs and socioeconomic determinants of COVID-19 Booster Vaccine Acceptance: an Indonesian cross-sectional study. Vaccines. 2022;10(5):724.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Wong LP, Alias H, Siaw YL, Muslimin M, Lai LL, Lin Y et al. Intention to receive a COVID-19 vaccine booster dose and associated factors in Malaysia. Hum Vaccines Immunother. 18(5):2078634.

  38. Attia S, Mausbach K, Klugar M, Howaldt HP, Riad A. Prevalence and drivers of COVID-19 Vaccine Booster Hesitancy among German University students and employees. Front Public Health. 2022;10:846861.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Neely SR, Scacco JM. Receptiveness of American adults to COVID-19 vaccine boosters: a survey analysis. PEC Innov. 2022;1:100019.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Sampene AK, Li C, Oteng Agyeman F, Brenya R. Socioeconomic and demographic characteristics influencing the hesitancy and refusal of COVID-19 vaccine in Ghana. Ther Adv Vaccines Immunother. 2023;11:25151355221149336.

    PubMed Central  PubMed  Google Scholar 

  41. Yoshida M, Kobashi Y, Kawamura T, Shimazu Y, Nishikawa Y, Omata F, et al. Factors associated with COVID-19 vaccine booster hesitancy: a retrospective cohort study, Fukushima vaccination community survey. Vaccines. 2022;10(4):515.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. George G, Nota P, Strauss M, Lansdell E, Peters RP, Brysiewicz P, et al. Examining the uptake of COVID-19 vaccine booster doses among healthcare workers in South Africa: a mixed-methods study. PLOS Glob Public Health. 2023;3(11):e0002639.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Brackstone K, Atengble K, Head M, Boateng L. COVID-19 vaccine hesitancy trends in Ghana: a cross-sectional study exploring the roles of political allegiance, misinformation beliefs, and sociodemographic factors. Pan Afr Med J. 2022;43(1).

  44. Lai X, Zhu H, Wang J, Huang Y, Jing R, Lyu Y, Zhang H, Feng H, Guo J, Fang H. Public perceptions and acceptance of COVID-19 booster vaccination in China: a cross- sectional study. Vaccines. 2021;9(12):1461.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

The authors extend their appreciation to the Deanship of Research and Graduate Studies at King Khalid University for funding this work through a Large Research Project under grant number RGP2/440/45, academic year 1445.

Funding

We did not receive any funding for the publication of this study.

Author information

Authors and Affiliations

  1. Seventh-Day Adventist Hospital, Agona-Asamang, Ashanti Region, Ghana

    Gilbert Eshun

  2. Department of Environment and Public Health, University of Environment and Sustainable Development, Somanya, Eastern Region, Ghana

    Frank Kyei-Arthur

  3. Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt

    Marwa Shawky Abdou

  4. Institute for Educational Research and Innovation Studies, University of Education, Winneba, Central Region, Ghana

    Martin Wiredu Agyekum

  5. School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK

    Michael Sarfo

  6. Municipal Health Directorate, Ghana Health Service - Krachi West, Kete-Krachi, Volta Region, Ghana

    John Kwame Agbenyeavu

  7. Department of Science, Department of Educational Administration and Management, University of Education, Winneba, Central Region, Ghana

    Sylvia Agyeman Addai

  8. University of Ghana Medical Center, Legon-Accra, Greater Accra Region, Ghana

    Jeremiah Akuffo Adjei

  9. Ahmadiyya Muslim Hospital, Techiman, Bono East Region, Ghana

    Nelson Obeng

  10. Department of Biomedical Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana

    Justice Kwadwo Turzin

  11. Family and Community Medicine, College of Medicine, King Khalid University, Abha, Asir Province, Saudi Arabia

    Ramy Mohamed Ghazy

Authors
  1. Gilbert Eshun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Kyei-Arthur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marwa Shawky Abdou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Wiredu Agyekum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Sarfo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John Kwame Agbenyeavu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sylvia Agyeman Addai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeremiah Akuffo Adjei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nelson Obeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Justice Kwadwo Turzin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ramy Mohamed Ghazy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, G.E., F.K.A. and R.M.G.; Methodology: G.E., M.S.A., and R.M.G; Data Analysis: M.S.A and R.M.G; Data Curation, G.E., M.W.A., M.S., J.K.A., S.A.A., J.A.A., N.O., and J.K.T.; Writing—Original Draft Preparation, G.E., F.K.A., M.S.A, M.S. and J.K.A; Writing—Review and Editing: G.E., F.K.A. and R.M.G.; Visualization, M.S.A. All authors critically reviewed, revised the article, and gave final approval for publication.

Corresponding author

Correspondence to Frank Kyei-Arthur.

Ethics declarations

Ethical approval and consent to participate

The study observed all ethical guidelines concerning data collection from human subjects. Ethical approval was sought and received from the ethical committee of the High Institute of Public Health, Alexandria University (#00013692). Participation in the study was voluntary, and all respondents provided written informed consent before participating.

Consent for publication

Not applicable.

Competing interests

Gilbert Eshun has no competing interests. Frank Kyei-Arthur has no competing interests. Marwa Shawky Abdou has no competing interests. Martin Wiredu Agyekum has no competing interests. Michael Sarfo has no competing interests. John Kwame Agbenyeavu has no competing interests. Sylvia Agyeman Addai has no competing interests. Jeremiah Akuffo Adjei has no competing interests. Nelson Obeng has no competing interests. Justice Kwadwo Turzin has no competing interests. Ramy Mohamed Ghazy is a member of the BMC Public Health editorial board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eshun, G., Kyei-Arthur, F., Abdou, M.S. et al. Acceptance of COVID-19 vaccine booster doses among the Adult Population in Ghana: a cross-sectional study using the Health Belief Model. BMC Public Health 24, 2673 (2024). https://doi.org/10.1186/s12889-024-20201-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-20201-9

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us