The coronavirus disease 2019 (COVID-19) vaccination psychological antecedent assessment using the Arabic 5c validated tool: An online survey in 13 Arab countries

Marwa Shawky Abdou, Khalid A. Kheirallah, Maged Ossama Aly, Ahmed Ramadan, Yasir Ahmed Mohammed Elhadi, Iffat Elbarazi, Ehsan Akram Deghidy, Haider M. El Saeh, Karem Mohamed Salem, Ramy Mohamed Ghazy

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40 Citations (Scopus)


Background Following the emergency approval of the coronavirus disease 2019 (COVID-19) vaccines, research into its vaccination hesitancy saw a substantial increase. However, the psychological behaviors associated with this hesitancy are still not completely understood. This study assessed the psychological antecedents associated with COVID-19 vaccination in the Arab population. Methodology The validated Arabic version of the 5C questionnaire was distributed online across various social media platforms in Arabic-speaking countries. The questionnaire had three sections, namely, socio-demographics, COVID-19 related infection and vaccination, and the 5C scale of vaccine psychological antecedents of confidence, complacency, constraints, calculation, and collective responsibility. Results In total, 4,474 participants with a mean age of 32.48 ± 10.76 from 13 Arab countries made up the final sample, 40.8% of whom were male. Around 26.7% of the participants were found to be confident about the COVID-19 vaccination, 10.7% indicated complacency, 96.5% indicated they had no constraints, 48.8% had a preference for calculation and 40.4% indicated they had collective responsibility. The 5C antecedents varied across the studied countries with the confidence and collective responsibility being the highest in the United Arab Emirates (59.0% and 58.0%, respectively), complacency and constraints in Morocco (21.0% and 7.0%, respectively) and calculation in Sudan (60.0%). The regression analyses revealed that sex, age, educational degrees, being a health care professional, history of COVID-19 infection and having a relative infected or died from COVID-19 significantly predicted the 5C psychological antecedents by different degrees. Conclusion There are wide psychological antecedent variations between Arab countries, and different determinants can have a profound effect on the COVID-19 vaccine’s psychological antecedents.

Original languageEnglish
Article numbere0260321
JournalPLoS ONE
Issue number11 November
Publication statusPublished - Nov 2021

ASJC Scopus subject areas

  • General


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