Demographic, psychosocial, and motivational factors associated with SARSCoV2 vaccine hesitancy among undergraduate students at a university in Johannesburg, South Africa, 2021

Abstract

Background This study examines COVID-191 vaccine hesitancy (VH) among young adults in South Africa, focusing on undergraduate students aged 18–35 years at the University of the Witwatersrand between December 2021 and February 2022. Young adults exhibited higher COVID-19 VH rates than other age groups, yet limited studies have focused on the factors shaping VH among young adults in South Africa. This study investigates the prevalence, reported reasons for, and socio-demographic factors associated with COVID-19 VH, as well as the applicability of the World Health Organization’s Behavioural and Social Drivers (BeSD) of Vaccination framework in this context. The BeSD framework conceptualises vaccine-related behaviours through four key drivers: ‘Thinking & Feeling,’ ‘Social Processes,’ ‘Motivation,’ and ‘Practical Issues.’ Methods A cross-sectional study surveyed 24,573 undergraduate students using an online self-administered questionnaire distributed via the university’s email Listserv. Data were collected between December 2021 and February 2022 using an adapted BeSD questionnaire. A total of 526 eligible responses were analysed. Descriptive statistics determined VH prevalence and socio-demographic characteristics. Exploratory factor analysis (EFA) identified latent constructs within the BeSD framework, while binary logistic regression assessed predictive and protective factors associated with COVID-19 VH. Results The study found 23.38% of respondents were COVID-19 VH, while 76.62% were vaccine accepting. The most frequently cited reasons for VH included concerns about vaccine safety, development, and necessity. Being aged 21–35 years and prior COVID-19 infection were predictive of VH, while prior adult vaccination, on-campus residence, and having no religious affiliation were protective factors. EFA revealed that the BeSD drivers did not function as independent constructs in this study population. Instead, four latent constructs—‘COVID-19 Vaccine Confidence,’ ‘COVID-19 Infection Concerns,’ ‘Social Norms,’ and ‘Negative Information about Vaccines’— were identified and showed that vaccine confidence, disease risk perceptions, and social norms were protective against VH. These findings suggest vaccination behaviours arise from an interrelated set of factors rather than distinct drivers. Conclusion This study provides insights into the prevalence, reasons for, and socio-demographic factors influencing COVID-19 VH in young adults in a tertiary education setting. The findings highlight the importance of vaccine confidence, social norms, and risk perceptions in shaping vaccine decisions. By applying the BeSD framework, this study enhances understanding of VH among young adults. The findings suggest that the BeSD framework provides a useful foundation for understanding VH, but its application may require further 1 For simplicity of understanding, SARS-CoV-2 will be referred to as COVID-19 throughout this text v testing or adaptation to capture the interrelated nature of the BeSD drivers and their influence on vaccination behaviour. These insights have implications for public health strategies, particularly in higher education settings, where addressing safety concerns, emphasising disease risks, and strengthening pro- vaccine social norms could further reduce VH among young adults in South Africa and similar contexts.