Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Ramy Mohamed Ghazy, Marwa Shawky Abdou, Salah Awaidy, Malik Sallam, Iffat Elbarazi, Naglaa Youssef, Osman Abubakar Fiidow, Slimane Mehdad, Mohamed Fakhry Hussein, Mohammed Fathelrahman Adam, Fatimah Saed Alabd Abdullah, Wafa Kammoun Rebai, Etwal Bou Raad, Mai Hussein, Shehata F. Shehata, Ismail Ibrahim Ismail, Arslan Ahmed Salam, Dalia Samhouri

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01–1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79–6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21–2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137–3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19–0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population’s acceptance of booster vaccination.

Original languageEnglish
Article number12136
JournalInternational Journal of Environmental Research and Public Health
Issue number19
Publication statusPublished - Oct 2022


  • COVID-19 vaccine
  • East Mediterranean region
  • booster dose acceptance
  • health belief model
  • vaccine hesitancy

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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