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Adv Biomed Res 2023,  12:121

Factors affecting COVID-19 vaccination decision: Findings from an online survey from India

1 Sant Hirdaram Medical College of Naturopathy and Yogic Sciences for Women, Madhya Pradesh, India
2 Sant Hirdaram Yoga and Nature Cure Hospital, Bhopal, Madhya Pradesh, India

Date of Submission05-Feb-2022
Date of Acceptance04-Oct-2022
Date of Web Publication15-May-2023

Correspondence Address:
Prof. Pradeep M K. Nair
Sant Hirdaram Yoga and Naturopathy Medical College and Hospital, Bhopal - 462 030, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/abr.abr_39_22

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How to cite this article:
Nair PM, Sharma H, Kumari A, Soni R, Tewani GR. Factors affecting COVID-19 vaccination decision: Findings from an online survey from India. Adv Biomed Res 2023;12:121

How to cite this URL:
Nair PM, Sharma H, Kumari A, Soni R, Tewani GR. Factors affecting COVID-19 vaccination decision: Findings from an online survey from India. Adv Biomed Res [serial online] 2023 [cited 2023 Jun 7];12:121. Available from:

To the editor,

Scientists worldwide contributed to bringing out vaccines against Coronavirus Disease 2019 (COVID-19), which were then made available to citizens through an emergency use approval. However, there exists a lot of skepticism among the various stakeholders regarding the safety and efficacy of the vaccine[1] despite the efforts by health authorities and governments to educate the citizens. Reports recommend using community support in vaccine policymaking, which presently remains just as a vision.[2] Although there is an increase in the acceptance and coverage of COVID-19 vaccines, there are only a few reports on the individual motivation behind the uptake of these vaccines.[3] Understanding the various factors and reasons that motivate the general public to opt for vaccination will help identify the strengths and gaps of the existing vaccine awareness campaign.[4]

A web-based cross-sectional survey was conducted using Google forms among all eligible adults (age ≥18 years) for COVID-19 vaccination in India from June 2, 2021–August 31, 2021. We used a survey instrument consisting of 16 questions in total; the first section consisted of 10 questions that included the consent and demographic details of the participants. The second part of the questionnaire had three questions that fetched vaccination status and co-morbidity status details. The third section had two questions that were designed to identify the motivation behind vaccination.

A total of 2,034 subjects from 27 different states/union territories of India participated in the study within the mean ± standard deviation (SD) age of 35.37 ± 13.89, of which 46.1% were male participants. The survey had at least one respondent from 27 states/union territories out of India's 36 states/union territories. Most respondents were vaccinated with the first dose (56.4%) or the first and second doses (24.5%). Around 66.3% of participants reported that they took the Covishield vaccine. Adherence to government guidelines was the motivation behind vaccination of 24.5% of respondents, whereas 20% of respondents took the vaccine owing to the health benefits of the vaccine, 16% vaccinated because of fear of infection, and the remaining 39% respondents had different reasons as tabulated in [supplemental Table 1].

Females are significantly less motivated for vaccination as compared to their male counterparts [OR 0.8; C.I 0.6 – 0.9, P = 0.020]. When the effect of all other factors such as socioeconomic status (SES), age, and marital status, were taken into account, the level of motivation wasfurther reduced [OR 0.7; CI 0.5–1.8, P = 0.001]. The age of participants has emerged as a key factor for the motivation of vaccination. Older adults between 40 and 65 years were more motivated to get vaccinated [OR 3.0; CI 2.3–4.1, P < 0.001]. A similar trend was observed [OR 3.8; CI 1.5–9.5, P = 0.005] for the geriatric population (age more than 65 years), compared to younger adults, aged 18 to 39 years.

We observed a consensus between the findings of univariate and multivariate analyses regarding the effect of age on motivation. Apart from smoking, our data did not show any statistically significant associations between SES, marital status, education, employment status, and prevalence of co-morbidities and motivation; however, smokers weremore prone to vaccination [OR1.8; CI 1.1–2.9, P = 0.023] in multivariate analysis in contrast to the borderline statistical significant finding of univariate analysis [OR1.6; CI 0.9–2.5, P = 0.050].

We also explored the association between perceived motivational factors, SES, and education. SES and education were significantly associated (all P < 0.001) with three perceived motivation factors: fear of getting infected, adherence to government guidelines, and health benefit of the vaccine. Middle SES participants are more likely to experience all above three motivational factors than extreme SES, i.e., upper and lower. In addition, highly educated participants, i.e., participants with PG or higher degrees, are more expected to perceive all three factors (all P < 0.001) of motivation than their comparatively less-educated counterparts.

The responses to open-ended questions lead to five themes, viz., health benefits—safety measures, precaution, prevention, fear of infection, boost immunity, avoid complications, previous underlying illness—(62%), as a policy mandate — pre-requisite to attend schools, colleges, or join back to work or due to their work demand being a front line worker, travel mandate, medical procedures—(9%), social responsibility—protect one's family and citizens—(14%), not convinced with the vaccine benefits—harms, side effects, and beliefs regarding artificial immunity—(9%), and attaining normalcy (6%).

The present study was conducted to understand the factors that motivate individuals to take vaccination against SARS COV-2 infection identified in various exciting findings. The majority of our respondents (80%) received at least one dose of COVID-19 vaccination, which shows a positive trend in vaccination uptake. Following government guidelines, fear of infection and being convinced by the health benefits of vaccination were identified as the primary motivation behind immunization. Fears of getting infected were also reported to be one of the most prominent motivators for vaccination. However, excess fear can be detrimental, leading to more health-related anxiety.[5] Therefore, it is essential to upscale the knowledge dissemination related to COVID-19 to eliminate unwarranted concerns that may result in inadequate vaccination coverage.

Our data suggest that females are less motivated to take vaccination than their male counterparts, which is further linked to their economic, educational, and marital status. This indicates the need for gender-specific awareness programs that may increase the uptake of COVID-19 vaccinations. Concurring with the previous report,[6] the present study also found that the older/geriatric population is highly motivated to take vaccination compared to the younger population. The inferences from this study necessitate the need for reaching out to the younger population with more effective strategies.

Respondents belonging to the middle-class strata of society and higher education status were highly motivated to take vaccination driven by fear of getting infected, adherence to government guidelines, or health benefits of the vaccine. This inference is identical to the multi-national survey conducted to appraise vaccine acceptance, showing that higher education and income are cardinal factors in increased vaccine acceptance.[7]

Nearly 10% of participants reported that their motivation to vaccinate is indirect pressure from educational institutions, employers, or the government. Though the percentage of this population is considerably small, the reported motivations need careful evaluation, as these respondents are not self-motivated but undertook vaccination by a perceived force. This may potentially impact the vaccine coverage, as self-motivation or voluntary choice to take up vaccination is regarded as the best strategy over-emphatic vaccination.[8] Similarly, 10% of the population did not accept the vaccine because of disbelief in vaccine efficacy or undue trust over natural immunity. This is more jeopardized by the existing vaccine conspiracy theories and misinformation.[9] Policymakers may have to adopt a more transparent and inclusive approach to increase voluntary vaccine uptake, as vaccine resistance is reported to increase with compulsory vaccination.[8]

The overall results depict an array of motivations behind vaccination. The majority were affirmative responses toward vaccine acceptance, and a few of them require policy-level interventions to make vaccination uptake a voluntary process. The results of this survey are essential in light of reported vaccine hesitancy among the general public and medical fraternities.[1],[10]There are demonstrable limitations in this study such as the survey respondents are those who know the English language, who got access to the internet, and who were aware ofresponding to a Google form. The limited sample size in this survey remains another limitation that questions the generalizability of results. Nevertheless, the insights from this survey may be helpful to design more inclusive, informative, and population-centric vaccination campaigns that can overcome vaccine resistance and make vaccination a voluntary health program.


The authors would like to thank Dr. Sriloy Mohanty, Aman Agarwal, AIIMS, New Delhi, Dr. Kinjal Dilipsinh Bhalavat, MDINYS, Gujarat, Dr. Swarna Ganesh, GMC, Coimbatore, Dr. Rita Vaz, AYUSH Doctor, South Goa District COVID Hospital, Goa, Dr. Cijith Sreedhar, CMO, Prakriti Shakti – Clinic of Naturopathy, Kerala and Dr. Hyndavi Salwa, Senior Research Fellow, Center for Chronic Disease Control, New Delhi for their support.

Ethical approval

The study was approved by Institutional Ethics Committee of Sant Hirdaram Medical College via SHMCNYS/IEC/2021-22/P17/234.

Patient consent

All the patients signed a digital consent before participating in the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jain J, Saurabh S, Kumar P, Verma MK, Goel AD, Gupta MK, et al. COVID-19 vaccine hesitancy among medical students in India. Epidemiol Infect 2021;149:e132.  Back to cited text no. 1
Dutta T, Agley J, Meyerson BE, Barnes PA, Sherwood-Laughlin C, Nicholson-Crotty J. Perceived enablers and barriers of community engagement for vaccination in India: Using socioecological analysis. PLoS One 2021;16:e0253318.  Back to cited text no. 2
Kumari A, Ranjan P, Chopra S, Kaur D, Kaur T, Upadhyay AD, et al.Knowledge, barriers and facilitators regarding COVID-19 vaccine and vaccination programme among the general population: A cross-sectional survey from one thousand two hundred and forty-nine participants. Diabetes Metab Syndr 2021;15:987-92.  Back to cited text no. 3
Elgendy MO, Abdelrahim MEA. Public awareness about coronavirus vaccine, vaccine acceptance, and hesitancy. J Med Virol 2021;93:6535-43.  Back to cited text no. 4
Olatunji BO, Etzel EN, Tomarken AJ, Ciesielski BG, Deacon B. The effects of safety behaviors on health anxiety: An experimental investigation. Behav Res Ther 2011;49:719-28.  Back to cited text no. 5
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al.A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 2021;27:225-8.  Back to cited text no. 6
Murphy J, Vallières F, Bentall RP, Shevlin M, McBride O, Hartman TK, et al.Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nat Commun 2021;12:29.  Back to cited text no. 7
Sprengholz P, Eitze S, Korn L, Siegers R, Betsch C. The power of choice: Experimental evidence that freedom to choose a vaccine against COVID-19 improves willingness to be vaccinated. Eur J Intern Med 2021;87:106-8.  Back to cited text no. 8
Islam MS, Kamal AM, Kabir A, Southern DL, Khan SH, Hasan SMM, et al.COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PLoS One 2021;16:e0251605.  Back to cited text no. 9
Bhargava R, Jain G, Bhargava A, Gupta S. COVID-19 vaccination drive: Impact on the acceptance of vaccine among the general population of India. J Manage Res Anal 2021;8:61-9.  Back to cited text no. 10


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