Predictors of COVID-19 vaccination intention among students in Ghana: An application of the Health Belief Model and Theory of Planned Behaviour

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Students are an important group in COVID-19 prevention, as their vaccination decisions influence peers and families and contributes to broader community protection. However, limited evidence exists on factors influencing their decisions to get vaccinated. This study examined COVID-19 vaccination intention and its associated predictors among students in Jasikan Municipality, Ghana, using the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB) to guide strategies for improving vaccine acceptance. A cross-sectional study was conducted between 25 July and 5 August 2022 using a multistage sampling technique to select participants from Senior High Schools. Using a pilot-tested questionnaire, data were collected on socio-demographics, COVID-19 protocol adherence, health-related characteristics, HBM and TPB constructs, and vaccination intention. The constructs were measured using Likert-scale items adapted from previous studies. Reliability was assessed using Cronbach's alpha (α = 0.63-0.86). Descriptive and inferential statistics were performed. Hierarchical binary logistic regression was used to assess the predictors of COVID-19 vaccination intention with statistical significance set at P < 0.05. We found that 206 (49.0%) of the 420 students interviewed were females, and 141 (33.6%) were aged 15-17 years. The mean age was 18.21 (±1.79) years. Overall, 257 (61.0%) students expressed intention to vaccinate against COVID-19. Previous COVID-19 experience (AOR = 3.26; 95%CI: 1.11-9.56), adherence to social distancing (AOR = 1.85; 95% CI: 1.17-2.91), attitude towards vaccination (AOR = 1.10; 95%CI: 1.03-1.18), subjective norms (AOR = 1.09; 95%CI: 1.04-1.15), and self-efficacy (AOR = 1.20; 95%CI: 1.11-1.31) were significant predictors of COVID-19 vaccination intention. These findings indicate that six in ten students were willing to receive the COVID-19 vaccine with intention influenced by prior COVID-19 experience, social distancing behaviour, and key constructs from HBM and TPB. School-based vaccination programs should prioritize attitude change interventions that leverage peer influence and teacher support while building students' confidence toward vaccination to improve vaccine uptake.

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