People on both sides of the Covid-19 vaccine debate are passionate as to why some refuse to get vaccinated. Frustration abounds as each side pleads with the other for understanding, if not agreement. Why do some travelers refuse to get vaccinated? Why the vaccine hesitancy?
For that matter, why do some travelers choose to get vaccinated? Here’s a secret…it’s not about the facts. Rather than guessing, let’s look at what the psychological theory and research says about how people make health decisions. Read on…
Health Belief Model
“…the person’s beliefs about the availability and effectiveness of various courses of action, and not the objective facts about the effectiveness of action, determine what course he will take.”
-Rosenstock (1974)*
There are four key components of the Health Belief Model, one of the most widely researched theories to help us understand behaviors related to health prevention. According to the Health Belief Model, our health prevention depends on these key factors. The four components are assessment of threat, understanding of benefits and barriers, cues to action, and self-efficacy for a given behavior.
A thorough understanding of each of these areas will help us understand why some travelers refuse to get the Covid-19 vaccine. Let’s look at these terms using an example from the global pandemic to help clarify further.
Research & Theory for Why Some Refuse to Get Vaccinated for Covid-19
Susceptibility and Severity
Perceived severity of a particular illness is one of the factors of the Health Belief Model. Perceived severity refers to a person’s personal understanding of how bad the symptoms or problems would be should they get sick or injured. Do they think it will be really bad for them or just mild symptoms?
A related concept is perceived susceptibility. Essentially, this means a person’s estimate of how likely it is for them to acquire a particular illness or injury. Going without a vaccination because you don’t think you’re at-risk for getting Covid is an example of low perceived susceptibility. Why do a prevention if you don’t think it’s even needed? Conversely, why wouldn’t you get a vaccine if you think you’re highly likely to get Covid?
What about travelers that perceive the likehood of getting Covid-19 as rather high but figure the symptom severity would be low? How about if they estimate a low likelihood of acquiring the illness but think that the symptoms would be terrible if they did acquire it?
It’s these “in between” groups that may experience ambivalence about getting the vaccine. Some may refuse to get vaccinated.
Benefits versus Barriers
As you might already be thinking, sometimes things are not quite so simple. There’s more to our decisions than just if we think something is dangerous or not. You’re right. According to the Health Belief Model, additional factors to consider are perceived benefits versus perceived barriers to getting vaccinated.
“There’s more to our decisions than just if we think something is dangerous or not.”
– Psychology of Travel
With these two factors, you can really start to see what might influence travelers in this regard. There are substantial benefits of vaccination for travelers. Some of the most obvious are that you can travel to areas that otherwise would be prevented do to having vaccine mandates. You get the benefit of more flexible travel when you get the vaccine.
Cues to Action
A stimulus, or cue for action, must be present in order for a health prevention behavior to take place. In other words, there has to be awareness of a choice or option. So, in the context of choosing whether or not to get vaccinated, there has to be a cue to take action in this regard. Put simply, if you’ve never heard of the vaccine, then you won’t be getting one anytime soon. You aren’t even aware of the possibility to get vaccinated!
Cues can come in many forms, and these days there are more cues than ever through social media. Reminders and cues through television, public service announcements (e.g., CDC Guidelines), social media, radio, emails, friends, family, and even billboards can be used to help share information and serve as cues to action. If you don’t quite know how to use your smartphone to receive alerts, check out this helpful Seniors Guide to iPhone.
At the time of this writing, it’s hard to even imagine a day passing in which there were not an abundance of cues to action related to Covid. This can go both ways, of course, meaning the cues can propel someone to get vaccinated or reinforce a decision to not get vaccinated.
Hearing from Dr. Anthony Fauci of the CDC might constitute a cue to action to get a vaccine. Hearing a case report by a doctor treating someone for a side effect related to the vaccine could be a cue in the other direction. Clearly, cues to action are an important element of the Health Belief Model.
Cues for Travelers
For travelers, let’s look at some more specific cues to action. There are plenty of health advisories related to traveling, both domestically and internationally. Recommendations include keeping up with the latest from local governments and hospitality industry leaders regarding the most updated requirements or mandates. Cues to action may be indirect, including hearing about a travel restriction in another part of the world. This can be a reminder to you to consider your upcoming travel plans and how you may need to consider getting vaccinated in order to go.
You may also hear stories of unvaccinated travelers that enjoyed their recent travels and who highlight that they did (or did not) get sick with Covid-19. This example would be considered a form of a social cue.
“As you’re reading this post, consider that you are already being cued to take some stance related to vaccinations.”
– Psychology of Travel
Regardless of where or which format the cues to action arise from, the Health Belief Model posits that these cues directly influence your health prevention behaviors. So, be mindful of the cues to action you hear or see about Covid-19 and travel. Recognize how those cues affect you in bringing awareness about vaccination in this travel context. As you’re reading this post, consider that you are already being cued to take some stance related to vaccinations.
Self-Efficacy
Self-efficacy refers to the degree to which a person believes that they can perform a specific behavior without getting overwhelmed. It is in some ways a measure of confidence, though really reflects more about a person’s belief in their abilities rather than a binary “able” versus “not able” confidence state.
Self-efficacy applies to the Health Belief Model in several ways. First, you must believe that your actions have a plausible chance of success, or else you likely won’t try to do that behavior. So, if your health choice is to quit smoking, you must have at least an inkling of self-efficacy to start the process of quitting. For a great read on self-efficacy, check out the classic book by Albert Bandura titled Self-Efficacy: The Exercise of Control.
Also, self-efficacy can subtly influence other areas like your perception of benefits and barriers. High self-efficacy may lead to increased probability that you will take action to grasp an identified benefit or reduce that pesky barrier. Also, developing self-efficacy may be viewed as a skill to develop yourself, rather than relying on external factors like Cues to Action.
For all these reasons, take stock of your self-efficacy regarding the specific issue at hand. How much self-efficacy do you consider yourself to have when it comes to your ability to travel safely during Covid-19? How much self-efficacy do you consider yourself to have when it comes to going out and getting a vaccine? I can’t answer these questions for you, but pay attention to your thoughts about those questions and they may lead you to further development of self-efficacy.
A Tale of Two Health Beliefs
Let’s take a look at two examples demonstrating all four factors of the Health Belief Model.
Why Joe will Refuse to get Vaccinated
Joe loved to travel more than anyone you know. He loved it. Then came Covid-19, and Joe was told he could no longer travel to his favorite destination unless he got vaccinated. Well, Joe felt strongly that he should not be forced to get a vaccination and did not want one.
Joe’s perceptions about the likelihood that he could get Covid (his perceived susceptibility) was low. After all, he had gone over a year without acquiring the disease and felt that he knew how to protect himself without a vaccine.
Joe’s beliefs about the negative impact of getting Covid (his perceived severity) was also low. He’d heard that most people only have mild symptoms, and sometimes don’t even notice their symptoms at all! Joe’s perceptions about the benefits of a vaccine (perceived benefits) were similarly low. He did not believe that the vaccine was any more effective than the actions he was already taking like wearing a mask.
Joe’s perceptions about the barriers to getting a vaccine (perceived barriers) were high. He has heard about some severe reactions to the vaccine in a few cases and knew that most everyone experienced some temporary discomfort after taking the shot. Joe’s only recent cue to action was when he heard that he could no longer travel unless he got vaccinated. Otherwise, his family shared similar views along with Joe and he wasn’t active on social media.
Joe’s self-efficacy was also low. He didn’t have available transportation to get to the clinic and was not certain he had read enough information about the vaccine to make an informed choice.
Bottom line about Joe…he’s not gonna choose to get the vaccine.
Why Sally will Choose to Get Vaccinated
Now, let’s flip the script and tell a story about Sally.
Sally also loved to travel, and was frustrated to be told that she could no longer travel to her favorite destination unless she got vaccinated. Sally also felt strongly that she should not be forced to get a vaccination. However, Sally’s perceptions about the likelihood that she could get Covid (her perceived susceptibility) was high. She already has an underlying health condition and knows she is at-risk.
Sally’s perceptions about the negative impact of getting Covid (her perceived severity) was also high. She stays up to date on how many deaths there have been related to Covid-19.
Sally’s perceptions about the benefits of a vaccine (perceived benefits) were similarly high. She believed that the vaccine was much more effective than the actions she was already taking like wearing a mask.
Sally’s perceptions about the barriers to getting a vaccine (perceived barriers) were low. She figured all she had to do was swing by the local pharmacy and knew it was free.
Sally was surrounded by cues to action including travel-related health warnings, on social media, and hearing about all her traveling friends that have been vaccinated.
Sally’s self-efficacy was also high. She felt very informed and believed that she could successfully go to the pharmacy and get the vaccine.
In this case, Sally does go ahead and get the vaccine.
The Health Belief Model & Travel
Hopefully these contrasting stories help make these Health Belief Model terms more understandable. What about you? Can you relate to Joe or Sally, or perhaps parts of both stories?
To present a full picture, it should be noted that the Health Belief Model does have a handful of limitations. Boston University School of Public Health outlines several of these limitations. For example, it doesn’t account for individual differences including how our sociocultural histories and experiences can play into health decisions.
There are also some assumptions that everyone has access to similar information about a particular illness. Sometimes, our behaviors are based on social desirability or social acceptability rather than a more direct desire to prevent illness. All these issues should be considered in any exploration of health-related decisions and behaviors.
Still, the Health Belief Model offers a solid starting point in conceptualizing why some travelers take the vaccine while others do not. So ask yourself:
- How do your thoughts differ from those of a fellow traveler who may disagree with you?
- Can you understand their perspective better through the lens of the Health Belief Model?
- What are some ways you can express your opinions with these four factors in mind?
- Can these factors be a point of healthy discussion between you and other travelers?
In Closing
Hopefully, this information can spur health discussions moving forward between these two groups with a more grounded understanding of the other’s vantage point. In this way, we may help move forward as a world-wide community of healthy travelers for the best travel experiences for all!
For more, check out this post on the mental health benefits of travel, and sign up for the free Psychology of Travel Newsletter.
Comment below with your thoughts and tips for your fellow travelers!
Happy Travels,
Dr. L
Founder, PsychologyofTravel.com
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*Rosenstock, I. M. (1974). Historical origins of the health belief model. Health education monographs, 2(4), 328-335.