School: Health Sciences

Degree Programme: Public health

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Assignment No. 1

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mode of study: distance

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TITLE: Understanding the Barriers to COVID-19 Vaccine Uptake in Rural Zambia

INTRODUCTION

COVID-19 pandemic has had a profound impact on global health, economies, and societies.
COVID-19 vaccination is the most effective way to prevent the spread of the disease and
minimize its impact (Dube, E., Gagnon, D., Nickels, E., & Jeram, S. 2015). However, low
vaccine uptake, particularly in rural areas of Zambia, poses a significant threat to the
achievement of herd immunity. In Zambia, COVID-19 vaccines have been widely available
since April 2021, and the country has received donations from various sources. Despite this, the
vaccine uptake in rural areas remains low, with many people hesitating to take the vaccine.

This study aims to understand the barriers to COVID-19 vaccine uptake in rural Zambia and
identify strategies to increase vaccine acceptance. The study will seek to identify the factors that
contribute to vaccine hesitancy in rural Zambia and determine the impact of misinformation and
conspiracy theories on vaccine hesitancy in these areas. The study will also explore the attitudes
and beliefs towards COVID-19 vaccines in rural areas of Zambia and identify the most effective
strategies to increase vaccine uptake.

The low vaccine uptake in rural Zambia is a critical public health concern. The consequences of
vaccine hesitancy include the continued spread of COVID-19, increased hospitalization rates,
and increased mortality rates Therefore, it is essential to understand the factors contributing to
vaccine hesitancy in rural areas and identify strategies to address this challenge.

The Health Belief Model will be used to guide this study. The model posits that a person's health
behavior is determined by their perceived susceptibility to an illness, the perceived severity of
the illness, and the perceived benefits and barriers to taking action(Hornsey, M. J., Harris, E. A.,
& Fielding, K. S. 2018). The study will use a mixed-methods design, with quantitative data
collected through a survey and qualitative data collected through focus group discussions.

Overall, this study's findings will provide critical insights into the factors contributing to
COVID-19 vaccine hesitancy in rural Zambia and identify strategies to increase vaccine uptake.
The study's outcomes will be of significant value to policymakers, healthcare providers, and
communities in Zambia, helping to reduce the spread of COVID-19 and its impact.
STATEMENT OF THE PROBLEM

Despite the availability of COVID-19 vaccines in Zambia, the vaccine uptake in rural areas
remains low. The World Health Organization (WHO) and the Zambian government have
prioritized vaccine distribution to remote and underserved communities. However, vaccine
hesitancy has hindered the uptake of vaccines in rural Zambia, where a significant proportion of
the population is hesitant to receive the COVID-19 vaccine. The reasons for vaccine hesitancy in
rural areas are complex and multifactorial, and addressing the problem requires an understanding
of the factors that contribute to vaccine hesitancy.

The COVID-19 pandemic has had a significant impact on Zambia, with a total of 206,455
confirmed cases and 3,611 deaths as of February 2023. The country's healthcare system is
already overstretched, and the pandemic has put additional strain on the system, particularly in
rural areas, where healthcare infrastructure is inadequate. The vaccine is the most effective tool
to prevent and control the spread of the virus, but vaccine hesitancy has been identified as a
significant barrier to vaccine uptake, particularly in rural areas.

The reasons for vaccine hesitancy in rural Zambia are complex and multifactorial. They include
concerns about the safety and efficacy of the vaccine, lack of trust in the government and
healthcare system, misinformation, and conspiracy theories. Additionally, cultural and religious
beliefs, language barriers, and a lack of access to accurate information have also contributed to
vaccine hesitancy. Addressing vaccine hesitancy in rural Zambia requires a comprehensive
understanding of the factors that contribute to vaccine hesitancy and effective strategies to
increase vaccine acceptance.

OBJECTIVES:

The main objective of this study is to identify the barriers to COVID-19 vaccine uptake in rural
Zambia and to develop effective strategies to increase vaccine acceptance. Specifically, the study
aims to:

1. Identify the factors contributing to vaccine hesitancy in rural Zambia.

2. Understand the attitudes and beliefs towards COVID-19 vaccines in rural areas.
 3. Determine the impact of misinformation and conspiracy theories on vaccine hesitancy in
rural Zambia.

4. Identify the most effective strategies to increase COVID-19 vaccine uptake in rural areas
of Zambia.

RESEARCH QUESTIONS:

This study will address the following research questions:

1. What are the main factors contributing to vaccine hesitancy in rural Zambia?

2. How do attitudes and beliefs towards COVID-19 vaccines differ between rural and urban
areas in Zambia?

3. To what extent does misinformation and conspiracy theories impact vaccine hesitancy in
rural areas of Zambia?

4. What are the most effective strategies to increase COVID-19 vaccine uptake in rural
areas of Zambia?

THEORETICAL FRAMEWORK:

The theoretical framework for this study draws on the Health Belief Model (HBM) and Social
Cognitive Theory (SCT) to explain vaccine hesitancy in rural Zambia. The HBM is a well-
established theoretical framework that explains health-related behaviors and decision-making
processes. The HBM posits that health-related behavior is determined by individual perceptions
of the threat posed by a health condition and the perceived benefits and barriers of taking action
to prevent or control the condition. The HBM also recognizes that individual characteristics,
such as socio-demographic factors, personality traits, and past experiences, influence health
behavior.

Social Cognitive Theory (SCT) complements the HBM by recognizing the role of social and
environmental factors in shaping health behavior. SCT posits that health behavior is influenced
by the interplay between personal factors, environmental factors, and behavior. SCT emphasizes
the importance of social support and observational learning in shaping health behavior. The
theory proposes that health behavior is learned through observation, imitation, and
reinforcement.

The HBM and SCT provide a useful framework for understanding vaccine hesitancy in rural
Zambia. The HBM explains how individual perceptions of the threat posed by COVID-19, the
perceived benefits and barriers of taking the vaccine, and individual characteristics influence
vaccine hesitancy. The SCT complements the HBM by recognizing the role of social and
environmental factors, such as social support, cultural beliefs, and access to information, in
shaping vaccine hesitancy. The theoretical framework will guide the design of the study and the
interpretation of the results, with the aim of developing effective strategies to increase vaccine
acceptance in rural Zambia.

STUDY DESIGN:

This study will use a mixed-methods design, which involves collecting both quantitative and
qualitative data. The survey will be administered to a random sample of residents in rural Zambia
to collect quantitative data, while focus group discussions will be conducted to collect qualitative
data. The survey will include questions on vaccine hesitancy, attitudes towards vaccines, and
sources of information. Focus group discussions will be held with a sample of vaccine-hesitant
individuals to understand their beliefs and attitudes towards vaccines.

DATA COLLECTION METHODS:

The survey will be conducted using a structured questionnaire, and it will be administered in
person. The survey will be conducted in Bemba and Chinyanja, which are the most common
languages spoken in rural Zambia. The focus group discussions will be conducted in person, and
the discussions will be conducted in Bemba and Chinyanja. A total of six focus group
discussions will be conducted, with each group consisting of six to eight participants.

DATA ANALYSIS:

Quantitative data will be analyzed using descriptive and inferential statistics. Qualitative data
from focus group discussions will be transcribed and analyzed thematically to identify key
themes and patterns. The findings from the quantitative and qualitative data will be integrated to
provide a comprehensive understanding of vaccine hesitancy in rural Zambia.
EXPECTED OUTCOMES:

The study's expected outcomes are twofold. Firstly, the study's findings will provide a
comprehensive understanding of the barriers to COVID-19 vaccine uptake in rural Zambia.
Secondly, the study will identify the most effective strategies to increase vaccine acceptance in
rural areas of Zambia. The study's outcomes will be of significant value to policymakers,
healthcare providers, and communities in Zambia, helping to reduce the spread of COVID-19
and its impact.
REFERENCES

1. World Health Organization. (2021). COVID-19 Vaccines. Retrieved from

https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON304

2. Ministry of Health, Zambia. (2021). COVID-19 Situation Report. Retrieved from

https://www.moh.gov.zm/covid-19/

3. Mohammadi, N., & Sulaiman, F. (2021). Understanding COVID-19 vaccine acceptance

and hesitancy: A comprehensive literature review. Risk Management and Healthcare
Policy, 14, 2603-2613.

4. Dube, E., Gagnon, D., Nickels, E., & Jeram, S. (2015). Mapping vaccine hesitancy--
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5. Lazarus, J. V., Ratzan, S. C., Palayew, A., Gostin, L. O., & Larson, H. J. (2021). A global
survey of potential acceptance of a COVID-19 vaccine. Nature Medicine, 27, 225-228.

6. Hornsey, M. J., Harris, E. A., & Fielding, K. S. (2018). The psychological roots of anti-
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7. Gagneur, A., Gosselin, V., Dubé, È., & Boulianne, N. (2020). Human Papillomavirus
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8. Berry, D. (2021). Covid-19 Vaccine Hesitancy: Understanding the Roots and Impact on
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9. Sallam, M., Dababseh, D., Eid, H., Al-Mahzoum, K., Al-Haidar, A., Taim, D., ... &
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10. Jones, L., Palumbo, M. V., Brown, C. M., Cates, J. R., & Forehand, M. (2020).
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