A Multifaceted Analysis Using Structural Equation Modeling
ResearchPosted on rand.org Jun 25, 2026Published in: Vaccine, Volume 78, 128196 (April 2026). DOI: 10.1016/j.vaccine.2026.128196
COVID-19 vaccine hesitancy (CVH) remains a global challenge to controlling the COVID-19 pandemic. This research examined the prevalence of CVH and its influencing factors.
In 2023, a multinational cross-sectional study was conducted using a 69-question survey presented in 33 languages to evaluate the relationships among demographics, knowledge, attitudes, experiences, psychological stress, and CVH. The Structural Equation Model (SEM) was used to explore the interrelations of CVH and potential factors.
The study, conducted across over 186 countries, obtained 102,407 valid responses, with an average age of 27.3 years, 57.9 % female, and high response rates in Asia and Africa. Participants regularly or consistently acquired knowledge about COVID-19 vaccines through social networks (56.9 %), colleagues/friends (43.8 %), and media (40.0 %). Participants' concerns hindering COVID-19 vaccination included the perceived mildness of COVID-19 (44.8 %), insufficient vaccine research (41.9 %), misinformation on social media (39.9 %), and disagreement with COVID-19 vaccination (33.1 %). The SEM results (RMSEA = 0.032/CFI = 0.955/TLI = 0.950) indicated that gender, education level, and family member's COVID-19 severity explained 48.5 % of the variance. Conversely, those with higher education and hesitancy related to vaccine reactions (HRVR) expressed increased concerns about COVID-19 vaccine information (CVI). Antisociality and egocentricity were associated with increased concern about HRVR (aOR: 1.08 and 1.12, 95 %CI: 1.06-1.09 and 1.10-1.14, respectively, p < 0.001), while callousness and egocentricity reduced concern about CVI (aOR: 0.76 and 0.97, 95 %CI: 0.75-0.77 and 0.96-0.98, respectively, p < 0.001).
Our research revealed that a third of participants disagreed with vaccination. Education level, gender, severity of family members' COVID-19 infection, and psychological stress significantly impact CVH.
This publication is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
