Behavioral intention and its predictors toward COVID-19 vaccination among people most at risk of exposure in Ethiopia: applying the theory of planned behavior model

ABSTRACT

Acceptance of a vaccine or hesitancy has great public health implications as these partly determine the extent to which people are exposed to infections that could have otherwise been prevented. There is a high need for a more updated understanding of the behavioral intention of the public toward COVID-19 vaccines and associated factors in light of the COVID-19 pandemic to give appropriate public health messages or actions. Thus, the study aimed to assess behavioral intention and its predictors toward COVID-19 vaccine among people most at risk of exposure in Ethiopia. A population-based anonymous online survey was conducted on individuals aged greater than 18 years from May 01, 2021 to June 30, 2021. The data were collected using a convenient sampling method through an online self-administered, structured questionnaire that was created onto Google survey tool (Google Forms) and disseminated to the public on different social media channels through online sharable platforms. Descriptive statistics were done. Bivariateand multivariable logistic regression was done to show the association of behavioral intention toward the COVID-19 vaccine. The associations of variables were declared with the use of 95% CI and P-value. A total of 1080 participants were included in this survey. Seven hundred one (64.9%) of the respondents had a behavioral intention to receive the COVID-19 vaccine. Males (AOR = 1.41 (95% CI = 1.004–2.53)), degree in level of education (AOR = 0.815 (95% CI = 0.254–0.916)), good knowledge (AOR = 4.21 (95% CI = 2.871–6.992)), attitude (AOR = 2.78 (95% CI = 1.654–4.102)), subjective norm (AOR = 1.214 (95% CI = 1.008–4.309)) and perceived behavioral control (AOR = 3.531 (95%CI = 1.689–5.201)) were found to be significantly associated with behavioral intention toward COVID-19 vaccine. Generally, the prevalence of behavioral intention in Ethiopia is low. Males, degree level of education, knowledge about vaccine, attitude toward vaccine subjective norm and perceived behavioral control were found to be significantly associated with intention to receive COVID-19 vaccine. Health education and communication from government sources are very crucial methods to alleviate the negative attitude, poor knowledge, and action need to improve or change the attitude and behavior of influential people within the community or organization to improve intention to take the vaccine.

KEYWORDS:

• COVID-19 vaccine
• behavioral intention
• theory of planned behavior
• predictors

Introduction

Coronavirus disease 2019 (COVID-19) is an emerging respiratory disease caused by a single-strand, positive-sense ribonucleic acid (RNA) virus.¹COVID-19 causes morbidity within the range of mild respiratory disease to severe complications characterized by acute respiratory distress syndrome, septic shock, and other metabolic and hemostasis disorders and death.^2,3

Although nations have been taking various intervention measures to prevent the rapid spreading of the virus, including travel bans and economic lockdowns, declaring states of emergencies to enforce the compulsory wearing of face masks, keeping social/physical distance, prohibition of public gatherings, and closure of faculties, community spread alongside pandemic fatigue have rendered a number of these interventions less effective and the need for vaccines is more beneficial than ever.⁴

The discovery of vaccination is taken into account as among the good human achievements when it involves maintaining public health.^5–8 Vaccination is the best strategy for controlling infectious diseases, yet success is challenged by individuals and groups who choose to delay or refuse vaccines.⁹ Intention to take vaccine or hesitancy has great public health implications as these partly determine the extent to which people are exposed to infections that could have otherwise been prevented.¹⁰ Hesitancy to be vaccinated can be caused by several reasons.^11,12

The acceptances differ between countries, which was 90% (in China) to 55% (in Russia). The acceptance surpassed 80% in Asian countries (China, South Korea, and Singapore).¹³ On the other way, the intention to receive the COVID-19 vaccine was 67%, 77.6%, 85.8%, and 90.6% in the US, France, Australia, and Chile, respectively.^14–17 In Malaysia 48.2%, 29.8%, and 16.3% of the respondents articulated certain, likely, and attainable intent to obtain the COVID-19 vaccine, respectively.¹⁸ The research done in Saudi Arabia showed that 64.7% of respondents have the intention to uptake the COVID-19 vaccine.¹⁹ From African countries, the tendency toward acceptance of vaccines reaches from 81.6% in South Africa to 65.2% in Nigeria.¹³ Such variation in willingness to accept a COVID-19 vaccine may end in a difference in vaccine coverage and delay global control of the pandemic.¹³ In Gondar city of Ethiopia, 54.8% of the participants had above the median rating of intention to be given the vaccine.²⁰

COVAX, the worldwide effort performing on equal access to the COVID-19 vaccine, is estimated to hide the doses for about 20% Ethiopian population.²¹ If this is the only amount of COVID-19 vaccine available to the population in the country, vaccination may be distributed based on the risk level.²⁰

The theory of planned behavior (TPB) is a psychological theory that links beliefs to behavior and assumes three interrelated factors of intention namely attitude, subjective norm, and perceived behavioral control. For individuals to carry out a targeted health behavior – in this case, receiving the COVID-19 vaccine – the Theory of Planned Behavior (TPB) model posits that they must believe in the positive consequences of their behavior, perceive familial and societal pressure to participate in the behavior, and believe that carrying out the behavior is within their control. Positive correlation with individuals’ attitudes, social norms, and perceived behavioral control are associated with greater intention to complete the health behavior. Therefore, this study aimed to assess behavioral intention and its predictors toward COVID-19 vaccine among people most at risk of exposure in Ethiopia.^22–25

Methods and Materials

Study design, participant, period, and setting

A population-based anonymous online survey was done on persons most at risk of exposure for COVID-19 infection in Ethiopia from May 01, 2021 to June 30, 2021. Because of their frequent contact with large gatherings of service seekers and clients, health-care workers, teachers at all levels of education, bank professionals, and telecom workers including bus drivers and their assistants in Ethiopia are assumed to be people relatively at a higher risk of acquiring COVID-19 among other segments of the society.¹² During the period of undertaking the survey, a campaign had already started to give COVID-19 vaccine to health-care workers and university instructors in the study area through enforcement with legal framework. As a result, health-care workers and university instructors were not included in the survey. Consequently, primary and secondary-level school teachers, telecom workers, and bank employees were considered in the study. The study was done based on the guidelines of the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) used for improving the excellent of online surveys.²⁶

Inclusion and exclusion criteria

Study participants included have been being Ethiopian residents, aged above 18 years old, having internet access and literate had been our inclusion criteria. Incomplete surveys, university instructors, health-care employees were excluded.

Sample size determination and sampling technique

The required sample size was calculated by using a single population proportion formula. Since there is no prior similar study about the COVID-19 vaccine in Ethiopia, we took (p) as 50% to get the maximum sample size for the current study.

$\mathrm{n}={\mathrm{z}}^2\mathrm{pq}/{\mathrm{d}}^2$

$\mathrm{n}=1.96^2\times 0.5\times \left(1-0.5\right)/{\left(0.05\right)}^2$

$\Rightarrow \mathrm{n}=384.16\approx 384$

Here, n = Sample size, z = 1.96 (with 95% confidence level), p = prevalence estimate (50%), q = (1-p), d = Sampling error (0.05). By adding a 10% non-response rate, the sample size becomes 422. However, the sample was increased to be more representative. The study participants were selected using a convenient sampling technique.

Data collection instrument and procedure

The data was collected through an online self-administered, structured questionnaire adapted from different literatures.^{12,20,25,27,28} Before distributing the questionnaire to the target population, the questionnaire validity was checked by doing a pretest on 88 participants. Modification of the tool was made based on the pretest result. Reliability analysis was done and Cronbach’s Alpha had been larger than 0.7, indicating good internal consistency in the responses. After the questionnaire validates, a template was created onto the Google survey tool (Google Forms) and disseminated to the public on different social media channels via online structures (Facebook, e-mail, telegram groups) or private Facebook, telegram& electronic mail accounts. Participants completed and submitted the questionnaire after approval on participation in the study (informed consent).

To increase the response rate, continuous follow-up & reminder messages were used. The tool consisted of the following sections: (1) socio-demographic predictor variables; (2) health-related predictor variables (3) knowledge-related variables (4) preventive behavior-related variables (5) TPB predictor variables (6) intention to receive COVID-19 vaccine.

Variables

Dependent variable

Intention to receive COVID-19 vaccine.

Independent variable

Socio-demographic measurements, health-related variables, knowledge-related variables, preventive behavior-related variables, and TPB constructs (attitude, subjective norm, perceived behavioral control).

Measurements

Knowledge about COVID-19 was measured by eleven items with three response categories (1 = yes, 2 = no and 3 = I don’t know). A correct answer was coded as 1 whereas; the incorrect and unknown answers were coded to zero. The higher summed score indicates higher knowledge about the COVID-19 vaccine and the mean score of the items was used to categorize the knowledge as good knowledge and poor knowledge if they were scored at or above mean and below mean, respectively.²⁰

Preventive health behavior was measured by five items with a 4-point scale: 1) rarely 2) sometimes 3) often and 4) always. The highest summed score indicates compliance of the participant with COVID-19 preventive practices and the mean score of the items was used to categorize the preventive health behavior toward COVID-19 as good practice and poor practice.²⁰

Intention to receive the COVID-19 vaccine was measured by one item with a five-point Likert scale. The mean score of the item was used to categorize the intention as intended and not intended if they were scored at or above the mean and below the mean, respectively. Each of the TPB constructs (attitude, subjective norm, and perceived behavioral control) toward intention to receive the COVID-19 vaccine was measured using items with five points of the Likert scale. For each construct, the response variables were calculated by summing up the responses obtained under their items (Table 1).

Table 1. Internal consistency and scoring of preventive behavior, knowledge, and TPB constructs

Components	Items	Scoring	Outcome	Cronbach’s Alpha
Preventive behavior	5	$\sum _{\mathit{i}=1}^5\mathit{PRVi}$	PRV score	0.78
Knowledge	11	$\sum _{\mathit{i}=1}^{11}\mathit{KNWi}$	knowledge score	0.90
Attitude	7	$\sum _{\mathit{i}=1}^7\mathit{DAi}$	Attitude score	0.84
Subjective norm	8	$\sum _{\mathit{i}=1}^8\mathit{DSNi}$	Subjective norm score	0.77
Perceived behavioral control	7	$\sum _{\mathit{i}=1}^7\mathit{DPBCi}$	Perceived behavioral control score	0.80
Intention	1

Data processing and analysis

After downloading the collected data from google forms, it was cleaned, sorted, edited, and coded in Excel and then was exported to SPSS version 25.0 for analysis. Descriptive statistics were done by computing summary statistics like frequency, mean, percentages, and standard deviation, and therefore the results were presented in tables and graphs. Binary logistic regression was done to assess the crude relationship between the independent variables and the dependent variable. All variables having a P ≤ of 0.2 were considered as a candidate for multivariable logistic regression to regulate for possible confounding effects. Multivariable logistic regression was applied to ascertain the independent effect of every variable on the resulting variable. Multi-collinearity among the independent variables was checked using VIF and Hosmer and Lemeshow test was wont to assess model goodness of fit. Final results of the association were presented based on the adjusted Odds Ratio at a 95% confidence level and p < .05 was considered statistically significant.

Ethical approval and consent to the participant

Ethical approval was obtained from the Institutional Review Board (IRB) of Wolaita Sodo University College of Health Science and Medicine. The study was conducted as per the Declaration of Helsinki. The participants were read the consent form and decided before filling in their responses. Confidentiality of the participants’ information was assured by not recording the identifying information.

Result

Sociodemographic status of respondents

The questionnaire was administered for 1168 people most at risk of exposure of the 1080 participants responded the questionnaire made 92.5% response rate. The mean ages of participants were 36.62 ± 8.68. More than half of the participants were males, married, degree level of education, had more than 6900 ETB monthly income, and were orthodox Christian followers with a percentage of 86.4%, 69.3%, 64.5%, 54.3%, 69.8%, respectively. About 78.4% of them had less than four family size. Regarding the occupation of participants; high-school teachers and bank professionals account for 33% and 24.3% respectively (Table 2).

Table 2. Sociodemographic status among people at highest risk of exposure in Ethiopia, 2021 (N = 1080)

Variables	Category	Frequency	Percent
Age	<39	707	65.5%
	≥39	373	34.5%
Sex	Male	933	86.4%
	Female	147	13.6%
Marital status	Married	748	69.3%
	Unmarried	332	30.7%
Education	Diploma	216	20%
	Degree	697	64.5%
	Masters and above	167	15.5%
Average Monthly Income	<5500	233	21.6%
	5500–6900	261	24.2%
	≥6900	586	54.2%
Occupation	Primary school teacher	216	20%
	Secondary school teacher	356	33%
	Telecom employee	247	22.8%
	Bank employee	261	24.2%
Religion	Orthodox Christian	754	69.8%
	Muslim	262	24.3%
	Others	64	5.9%
Family size	<4	846	78.3%
	≥4	234	21.7%

Health-related characteristics of participants

Regarding health-related characteristics of participants, the majority of participants were perceived as were healthy, not smoking, had no chronic diseases, overweight, and had past episodes of COVID-19 infection, accounted 85.2%, 88.1%, 86.1%, 83.9%, and 93.3%, respectively (Table 3).

Table 3. Health-related characteristics among people at highest risk of exposure in Ethiopia, 2021 (N = 1080)

Variables	Category	Frequency	Percent
Perceived health status	Healthy	920	85.2%
	Not healthy	160	14.8%
Chronic diseases (DM, HTN …)	Yes	150	13.9%
	No	930	86.1%
Smoking	Yes	129	11.9%
	No	951	88.1%
Overweight	Yes	174	16.1%
	No	906	83.9%
A past episode of COVID-19 infection	Yes	66	6.1%
	No	1014	93.9%

Preventive behavior against COVID-19 infection among people at most risk of exposure in Ethiopia

Concerning the preventive behavior of participants, 57.1% of them washed their hands regularly. However, only 8.6% wear facemasks regularly and none of them kept a distance at least 2 m from others regularly. Overall 65% 0f participants had poor prevention behavior against COVID-19 infection (Table 4).

Table 4. Preventive behavior against COVID-19 infection among people at highest risk of exposure in Ethiopia, 2021 (N = 1080)

Items	Response categories with frequency and percent
	Rarely	Sometimes	Often	Always
I put a tissue paper or bending elbow in the front of my mouth and nostril when coughing or sneezing.	471 (43.6%)	415 (38.4%)	102 (9.2%)	92 (8.5%)
I wash my hands frequently with cleaning soap and water for at least 20 seconds each hour.	106 (9.6%)	357 (33.1%)	306 (28.3%)	311 (28.8%)
I do not touch my eyes, nose, and mouth with unwashed hands.	195 (18.1%)	342 (31.7%)	258 (23.9%)	285 (26.4%)
I put on a facemask persistently each time I go out to my home.	725 (67.1%)	262 (24.3%)	84 (7.8%)	9 (0.8%)
I keep a distance of at least two meters from others.	881 (81.6%)	199 (18.4%)	0	0
Overall preventive behavior against COVID-19			Frequency	Percent
Good			378	35%
Poor			702	65%

Knowledge of COVID-19 vaccine

Knowledge of participants was assessed with 11 items. The internal consistency between items was 90%. The mean and the median was 17.26 and 17 respectively. Overall, about 61.9% of the participants had below mean score (poor knowledge) (Figure 1).

Figure 1. Figure1: Knowledge about COVID-19 vaccine among people most at risk of exposure in Ethiopia, 2021 (N=1080).

TPB model constructs

Seven hundred and one (64.9 %%) of the participants had the intent to receive the COVID-19 vaccine. Attitude, subjective norm, and perceived behavioral control had a mean score of 25.52 (SD 2.80), 27.3 (SD 4.25), and 20.73 (SD 3.93) respectively (Table 5).

Table 5. Descriptive data for the aspects TPB model and intention among people at highest risk of exposure in Ethiopia, 2021 (N = 1080)

Components	Items	Min	Max	Mean	Median	Standard deviation
Attitude	7	18	34	25.52	25.5	2.80
Subjective norm	8	18	37	27.3	27	4.25
Perceived behavioral control	7	10	31	20.73	21	3.93
Intention*	1	1	5	3.69	4	1.35
Intention category					Frequency	Percent
Intended					701	64.9%
Not intended					379	35.1%

*The variable is continuous.

Predictors of intention to receive COVID-19 vaccine

All sociodemographic, health-related knowledge and preventive behavior-related, and constructs of theory of planned behavior model variables were entered into bivariable logistic regression. Those crudely associated variables were entered into the multivariable logistic regression model. Males, degree level of education, knowledge about vaccine, attitude toward a vaccine, subjective norm, and perceived behavioral control were found to be significantly associated with intention to receive COVID-19 vaccine at p < .05. Study participants who were males were 1.41 times more likely to have the intention to receive the COVID-19 vaccine compared to females (AOR 1.41; 95% CI: 1.004–2.53). Study participants who had a degree in education were 18.5% less likely to have the intention to receive COVID-19 vaccine compared to those who had masters and above (AOR 0.815; 95% CI: 0.254–0.916). Participants who had good knowledge about the COVID-19 vaccine were 4.21 times more likely to have the intention to receive the COVID-19 vaccine compared to those who had poor knowledge (AOR 4.21;95% CI:2.871–6.992). A unit increase in the total score of attitude toward the COVID-19 vaccine was associated with an increase in the likelihood of intention to receive the COVID-19 vaccine by 2.78 (AOR 2.78; 95% CI: 1.654–4.102). A unit increase in the total score of the subjective norm was associated with an increase in the likelihood of intention to receive the COVID-19 vaccine by 1.214 (AOR 1.214; 95% CI: 1.008–4.309). A unit increase in the total score of perceived behavioral control was associated with an increase in the likelihood of intention to receive the COVID-19 vaccine by 3.531 (AOR 3.531; 95%CI: 1.689–5.201) (Table 6).

Table 6. Predictors of behavioral intention to receive COVID-19 vaccine among people at highest risk of exposure in Ethiopia, 2021 (N = 1080)

	Intention
Variables	Intended	Not intended	COR with (95% CI)	AOR with (95% CI)	p-Value
Sex
Male	619	314	0.64 (0.45–1.911)	1.41 (1.004–2.53)	.02*
Female	82	65	1	1
Marital status
Married	533	215	0.413 (0.316–2.540)	0.843 (0.213–1.689)	.823
Unmarried	168	164	1	1
Education
Diploma	115	101	1.247 (0.830–1.875)	3.45 (0.652–2.482)	.673
Degree	488	209	0.608 (0.429–0.861)	0.815 (0.254–0.916)	.002*
Masters and above	98	69	1	1
Knowledge
Good	248	164	1.393 (1.079–2.799)	4.21 (2.871–6.992)	.000*
Poor	453	215	1	1
Chronic disease
Yes	57	93	3.674 (2.569–5.255)	4.245 (0.987–6.012)	.652
No	644	286	1	1
A past episode of COVID-19 infection
Yes	17	49	5.974 (3.388–10.534)	6.012 (0.899–8.004)	.730
No	684	330	1	1
Attitude			1.097 (1.048–2.148)	2.78 (1.654–4.102)	.000*
Subjective norm			0.969 (0.940–2.998)	1.214 (1.008–4.309)	.000*
Perceived behavioral control			1.004 (0.973–2.036)	3.531 (1.689–5.201)	.000*

*Statistically significant at p < .05, COR – Crude Odds Ratio, AOR- Adjusted Odds Ratio.

Discussion

Vaccination is not the only, but the best solution to controlling infectious diseases. However, individuals and groups who choose to delay or refuse vaccines challenge a success.⁹ Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increased risk of vaccine-preventable disease outbreaks and epidemics.⁵ Vaccine hesitancy results from a complex decision-making process, influenced by a wide range of contextual, individual and group, and vaccine-specific factors, including communication and media, historical influences, religion/culture/gender/socioeconomic, politics, geographic barriers, experience with vaccination, risk perception, and design of the vaccination program.

This research assessed the predictors of intention to receive the COVID-19 vaccine among people in selected occupational categories that are presumably at a higher risk of exposure to COVID-19 due mainly to their daily contact with relatively large gatherings of clients or service seekers. In this case, teachers of primary and secondary schools, bank employees, and telecom workers were purposely selected to participate in the study.

The study indicated 64.9%% of the participants had the intention to accept the vaccine. This was consistent with the study done in Saudi Arabia and Nigeria.^13,19 It was higher than from findings in Gondar town Ethiopia, Sodo town Ethiopia, Ethiopia, Malaysia.^12,18,20,28 The disparity may be due to differences in the study population, sample size, study design, and socio-demographic features of the participants in the study. However, the result is lower than a study done at the global level, Asia nations, US, France, Australia, Europe, Italy, Israel, South Africa.^{13–17,27,29,30} The difference may be due to differences in the study population, sample size, study design, time of the study, and socio-demographic features of the participants in the study.

Findings from logistic regression analysis showed males, degree level of education, knowledge, attitude, subjective norm, and perceived behavioral control were significantly associated with intention to accept COVID-19 vaccine at p < .05.

Study participants who were males were 1.41 times more likely to have the intention to receive a vaccine compared to females. This was similar to a study done in Egypt, among the adult general population in Israel, and health-care workers in Israel.^25,27,31 This is believed to be because ladies are greater worried about damaging aspect results of the vaccine than contracting COVID-19.²⁹

Study participants who hold a degree in education were 18.5% less likely to have the intention to take vaccine compared with that of masters and above. This was similar to findings from Gondar town Ethiopia, Egypt, at the global level survey, US, Australia, and Israel.^{13,14,16,20,25,27} This is because education increases awareness of the health benefit of the vaccine. Different studies indicated that extended years of training were related to increasing acceptance of the COVID-19 vaccine.^13,14

Participants who had good knowledge about the COVID-19 vaccine were 4.21 times more likely to have the intention to take the vaccine compared to those who had poor knowledge. The finding was in line with a study done in a Gurage zone of Ethiopia, the UK, Hong Kong, and among Chinese university students in China.^32–35 This might be because knowing is a prerequisite to developing intention. If participants are aware of the advantages of vaccines through different outlets, this facilitates informed decisions and could be intended to take the vaccine.

Constructs of the TPB model were positively associated with behavioral intention to take the vaccine.

A unit increase in a total score of attitude was associated with an increase in the likelihood of intention to take vaccine by 2.78. This was in line with a study done among health-care workers in Israel, Chinese factory workers in China, Chinese university students in China, the US, and Ghana.^{31,32,36–38} According to the TPB model, attitudes develop reasonably from the beliefs people hold about the object of the attitude or we form beliefs about an object by associating it with certain attributes, i.e., with other objects, characteristics, or events. Each belief links the behavior to a certain outcome, or to some other attribute such as the cost incurred by performing the behavior. Since the attributes that come to be linked to the behavior are already valued positively or negatively, we automatically and simultaneously acquire an attitude toward the behavior.²³ In this case, as people develop a positive attitude toward the vaccine, they may be highly intended to accept it.

A unit increase in the total score of the subjective norm was associated with an increase in the likelihood of intention to take vaccine by 1.214. The finding was consistent with a study done in Israel, Chinese factory workers, Ghana, and Hong Kong.^27,35,36,38 This is because Subjective norms are the influence of the expectations held by family members, close friends, relatives, coworkers, or business partners on the actions of individuals upon certain targets or concepts.²³ Thus, this calls a need to take action to improve or change the attitude and behavior of influential people within the community or organization to improve the intention to take a vaccine.

A unit increase in the total score of perceived behavioral control was associated with an increase in the likelihood of intention to take vaccine by 3.531. The finding was in line among the adult population and health-care workers in Israel, Chinese factory workers in China, Ghana, and Hong Kong.^{27,31,35,36,38} According to the TPB model for behavior to perform a person should believe and be motivated by his/herself to comply with the behavior.²³

Limitation of study

Limitations should be considered while interpreting the result of this study. Firstly, since the study is cross-sectional it may not demonstrate direct cause and effect between dependent and independent variables. A longitudinal study has importance for such reports. Secondly, since the study was an e-based online self-reporting method it limits the participation of vulnerable groups, such as illiterate and rural people, having no internet access and online health information resources. Due to the shortage of vaccines in Ethiopia, (because the vaccine is supplied only by aid agencies) the target group of the population may change from time to time in the vaccination program in Ethiopia and its findings might vary after a time.

Conclusion and recommendation

The prevalence of behavioral intention among people most at risk of exposure toward COVID-19 infection in Ethiopia is low. Males, degree level of education, knowledge of vaccine, attitude, subjective norm, and perceived behavioral control had been observed to be significantly associated with intention to accept the vaccine.

Due to the nature of the work which requires routine contact with service seekers often gathered at a space, participants of the survey are not only at a higher risk of infection to COVID-19 but also are more likely to transmit the disease to other large numbers of people. Since Ethiopia is affected by the third wave of the pandemic, together with the country’s very limited economic capacity to purchase vaccines, it should at least cover its high risk for exposure population with available COVID-19 vaccines. Health education and communication from government sources are very crucial methods to alleviate the negative attitude, poor knowledge and action need to improve or change the attitude and behavior of influential people within the community or organization to improve intention to take a vaccine.

Authors’ contribution

All authors made considerable contributions to conception and design, acquisition of data, or evaluation and interpretation of data; took section in drafting the article or revising it significantly for necessary intellectual content; agreed to put up to the current journal; gave ultimate approval of the version to be published; and agree to be responsible for all elements of the work.

Acknowledgments

We are very grateful to the Woliata sodo University College of Health Science and Medicine for giving us the ethical clearance. We are also indebted to thank study participants for their cooperation during data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.