ATTITUDE AND PERCEIVED RISK TOWARDS COVID-19 IMMUNIZATION
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International Journal of Innovative Research and Publications (2021) 1(4): 1-10
https://doi.org/10.51430/IJIRP.2021.14.001
Article
ATTITUDE AND PERCEIVED RISK TOWARDS COVID-19
IMMUNIZATION
Dr. Raihana Islam Falguni1,*, Dr. Mahfuja Begum Shumi2, Dr. Shahana Ahmed3
Received: 11 October 2021 / Accepted: 19 November 2021 / Published online: 30 December 2021
Abstract
Several vaccines have been approved against COVID-19 infectious disease and are being given to pop-
ulations in different regions of the world. But, the number of people getting vaccines are quite less than
the targeted population for whom the vaccines are being kept for immunization purpose. Therefore, the
study aimed to investigate the attitude and perceived risk towards COVID-19 vaccination decision in
Bangladesh. An exploratory population-based survey was conducted among 186 general individuals
chosen purposively from the metropolitan area of Dhaka. The survey was conducted using a structured
and self-administered questionnaire. Multiple linear regression technique was performed to determine
the variables predicting immunization decision. The findings reflect a significant positive attitude along
with insignificant risk-taking behaviour towards COVID-19 immunization decision among the general
population in Bangladesh.
Keywords: Attitude, Perceived Risk, Covid-19 immunization decision, Bangladesh
_________________________________________________________________________________________________________________________
1
Assistance Professor, Pharmacology, Diabetic Association Medical Collage, Faridpur
2
Lecturer, Department of Physiology, MH Samorita Hospital & Medical Collage, Dhaka
3
Associate professor, Department of Obst & Gynae, Diabetic Association Medical Collage,
Faridpur
*
Corresponding Email: fahmifalguni@gmail.com
To cite this article:
Falguni, R. I., Shumi, M. B., & Ahmed, S. (2021). Attitude and Perceived Risk Towards Covid-19 Im-
munization. International Journal of Innovative Research and Publications, 1(4), 1-10.
https://doi.org/10.51430/IJIRP.2021.14.001
© 2021 by the authors. Licensee: MAC Arts & Communication. This article
is an open access article distributed under the terms and conditions of the
Creative Commons Attribution (CC BY-SA) license. (https://creativecom-
mons.org/licenses/by/4.0/)International Journal of Innovative Research and Publications www.ijirp.com
Introduction
Covid-19 has impacted the lives of every human being on earth. Because of the unprecedented
nature since its inception in late 2019, this virus has devasted billions and took millions of
human lives till date. Covid-19 which began in China spread reasonably everywhere in the
world (Huang, 2020). On the 11th of March 2020 WHO announced COVID-19 outbreaks as a
pandemic (WHO, 2020). COVID-19 pandemic brought about by extreme intense respiratory
condition which referred to as Covid 2 (SARS-CoV-2), is a significant danger worldwide (Lim
et al., 2020; Chhetri et al., 2020; Bhutta et al., 2020). Although it has become weaker now a
days, but not over yet. Some countries are still following norms by taking extensive safety
measures such as regularly washing of hands, maintaining social distancing among family,
friends and peers, wearing face masks, and so on (Haleem et al., 2020; Jin et al., 2020; Camp-
bell, 2020).
Bangladesh as a South Asian country also hit by covid-19 pandemic experienced sev-
eral health crisis that threatened the survival and well-being of Bangladeshi people. The corona
virus has spread rapidly, similar to the influenza virus, which is through the respiratory drops
from sneezing and coughing. Exposure and the start of symptoms are usually around five days,
and likely to range between two to fourteen days (Rothan & Byrareddy, 2020). Common symp-
toms include cough, fever, fatigue, muscle pain and difficulty in breathing. Furthermore, it can
induce severe inflammatory lungs, septic shock, sepsis, respiratory distress syndrome and
death. Specific individuals who are infected possibly might not show clinical signs, so health
officers advise the public so that those who have a close relationship with a person who is
infected and confirmed to be covid-19 positive to be under surveillance and undergo examina-
tions to confirm infection. Recently, there has been remarkable worldwide attention, participa-
tion, and utilization of clinical researches, empowering us to act at speed to stop individuals
from dying in Covid-19 and protect livelihood through vaccination.
Literature Review
Developing a vaccine in a traditional way needs to follow five stages which takes around 10
years and costs $500 million. In the light of how lethal and problematic Covid-19 is, it was
necessary to discover approaches to accelerate the typical vaccination improvement approach.
An extraordinary exertion of exploration and worldwide coordination, which has brought about
a fast cycle of the advancement of vaccines and other clinical items considered key in the battle
against covid-19, is obvious (Defendi et al., 2021). However, some clinical specialists are rais-
ing a yellow banner. Given the stakes that the infection has caused more than 100,000 deaths
in the U.S., among over 350,000 around the world, thus they're alerted that the way toward
developing a vaccine ought to be eased back down, not accelerated (Hiltzik, 2020). Boodman
(2020) said that “I don’t think proving this in an animal model is on the critical path to getting
this to a clinical trial”. When a vaccine development process takes about 10-15 years long
through different complex procedures, the authorization for clinical use of Covid-19 vaccines
sponsored by Pfizer/BioTech and Moderna is remarkable (Adedokun et al., 2021). Dr Williams
Moss noted, “They overlapped preclinical studies with the early phases of the trials. One of the
reasons we are even talking about vaccines now just 10 months later is that some of the phases
in which vaccine development normally occurs were overlapped rather than done sequentially."
When it was asked to Dr Gagandeep Kang, one of India's best-known vaccine experts, “How
can a coronavirus vaccine be cleared for emergency use by millions of vulnerable people in a
"clinical trial" mode”? He replied, “No idea” (Biswas, 2021).
Vaccination antipathy is one of the ten most significant well-being hazards today
(WHO, 2019). Vaccine aversion can be characterized as hesitance or refusal to inoculate despite
its convenience (MacDonald, 2015). Building public trust and enthusiasm to immunize against
2International Journal of Innovative Research and Publications www.ijirp.com
Covid-19 is pretty much as significant as developing a viable vaccine. A critical minority of
people, in general, is reluctant to take a Covid-19 vaccine when accessible (Thaker, 2021).
Reasoning toward immunizers can be characterized as the statement of help or aversion across
various vaccines (Yaqub et al., 2014). Sonawane et al., (2021) conducted an enormous amount
of online survey in the UK to find out the general vaccination attitudes and intention to receive
Covid-19 vaccine from 32,361 adults. They found, more than 33% of the members revealed
unwillingness or vulnerability with respect to the Coronavirus inoculation. Prominently, fe-
males, members living with youngsters, and those with low-pay have all the earmarks of being
at higher danger of Coronavirus vaccine refusal. Harapan et al., (2020) found that 93.3% of
respondents among 1,359 respondents of Indonesia, (1,268/1,359) might want to be immunized
for a 95% effective immunization for free of cost, yet this acknowledgment diminished to
67.0% (911/1,359) for a vaccine with half effectiveness.
Another region of concern is the rejection of some particular gatherings in clinical pre-
liminaries. People with late SARS-CoV-2 contamination, asymptomatic, immune compro-
mised, pediatrics, pregnant, and breastfeeding ladies were excluded during adequacy testing.
The immunizations can be impractical for these gatherings of the facility with no clinical re-
sults. According to Adedokun et al. (2021), no detailed data found yet on the possible results
concerning inoculating these gatherings of people. The Covid-19 pandemic compromises all
of us, at any place we are, which has forced another comprehensive way to deal with vaccine
improvement. Perhaps the best countermeasures against irresistible illnesses direct towards an
efficacious vaccine which is viewed as pivotal to containing the Covid-19 pandemic (Sharpe
et al., 2020). When question arises, how difficult it is to develop a Covid-19 vaccine, Robin
Shattock, who is driving a Coronavirus immunization preliminary set to start in June at Impe-
rial College London, said at the BBC that creating a vaccine ought to be moderately simple on
the grounds that, in contrast to flu and HIV, the Coronavirus infection appeared to be generally
steady (BBC, 2020). Vaccine advancement started in a few exploration habitats and drug or-
ganizations when SARS-CoV-2 was distinguished as the causative specialist, and the primary
genome succession was distributed. On March 16, 2020, the principal Covid-19 vaccine up-
and-comer, an mRNA-based immunization created by Moderna Inc, entered a Phase 1 clinical
preliminary (NCT04283461) in the US, and later a non-repeating vector-based vaccine, created
by China's CanSino Biologics was additionally tried in China (ChiCTR2000030906) (Lurie et
al.,2020). Other immunization up-and-comers, including DNA-based vaccines, inactivated,
live weakened, sub-unit, and duplicating viral vector-based immunizations, are additionally
being created (Lurie et al., 2020). It is indistinct how successful these immunizations will be.
On the off chance that the Covid-19 vaccination takes after a flu antibody, adequacy could be
half or lower (CDC, 2020). The World Health Organization has reported that 83 potential Coro-
navirus competitor immunizations are being surveyed (as at 23 April), including seven that
have now been affirmed for human testing through clinical preliminaries (WHO, 2020). India's
regulators gave the vaccine an emergency approval in January while the third phase, has an
efficacy rate of 81% preliminary data from its phase 3 trial, of the trial was still under way,
sparking skepticism and questions from experts (BBC, 2021). In order to implement the most
effective vaccination strategy in Bangladesh, we need to know the attitude and perceived risk
of Bangladeshi people about COVID-19 vaccinations. In such a scenario, people’s attitudes
and perceived risks toward COVID-19 immunization are crucial information for Government
and policy makers to address all barriers to a successful vaccination of all types of people who
needs it.
There are very little information available on the attitude and perceived risk towards
Covid-19 immunization till date. Therefore, the objective of this study is to identify the level
of attitude and perceived risk of general people among all social groups on Covid-19
3International Journal of Innovative Research and Publications www.ijirp.com
immunization decision in Bangladesh. Bangladesh has been chosen as study setting for achiev-
ing the purpose of this study. The following hypotheses are formulated based on the previous
literature review to guide this research:
H1: Attitude of people has a significant positive effect on Covid-19 immunization decision.
H2: Perceived risk of people has a significant negative effect on Covid-19 immunization
decision.
Methods
The purpose of this study was to identify the effects of Bangladeshi people’s attitude and per-
ceived risk towards Covid-19 vaccination. There are four unique types of methods for reason-
ing (pragmatism, positivism, realism and interpretivism) which symbolize how information
can be created and the idea of that information can be generated (Saunder et al., 2000). A re-
searcher’s duty is to be responsive of the philosophical affirmation with settling on decisions
of research system, since it has a significant effect on what research ought to be done, why it
requires and how to do (Johnson and Clark, 2006). Therefore, a positivism approach has been
undertaken by considering the relevant research theories and a model has been designed to test
it. To get a dependable outcome, a bigger measure of information will be vital to gather. Con-
sequently, a quantitative research technique has been embraced here. Field survey is appropri-
ate as a research design (Sekaran, 2003). Survey allows the researcher to develop statistical
analysis of the data and generalize it to a larger population.
To distinguish the connection between individual’s attitude and perceived risk on vac-
cination, all the questionnaires utilized in this research has been estimated utilizing different
studies adjusted from past examinations. Burton, Lichtenstein, Netemeyer and Garretson
(1998) developed a scale for measuring consumer’s attitude with 6 items which has been used
here. Perceived risk is a multi-dimensional construct. Stone and Grønhaug (1993) measured
perceived risk with 10 items which has been used here. For Covid-19 immunization decision,
this study adapted the measure used by Islam et al., 2021 with 6 items.
Sample size characterized by the quantity of responses which are valid, and not the
quantity of total distribution (Bartlett et al., 2001). In this study, a convenience sample of gen-
eral people who are above 18 years old and residents of Bangladesh has been chosen from a
populace of 165 million. The questionnaires were randomly distributed to the respondents
based on sampling selection criteria and the completed questionnaires were collected back after
10 days. A total of 220 questionnaires were distributed among the respondents and a total of
186 completed questionnaires were collected back after making several follow-up efforts
through phone calls, e-mails, and WhatsApp messages. This provided a valuable response rate
of 84%. The sample respondents were selected from the metropolitan territory of Dhaka in
Bangladesh. The respondents were being found on various week-days and ends of the week to
cover a wide cross-area of the network. Social distancing has been maintained while collecting
the responses.
In designing the questionnaire, the literature review provided a broad range of useful
measures. To effectively measure the research constructs, information from the theoretical and
empirical research studies in consumer behaviour and Covid-19 vaccination were used. To ac-
complish targets of this investigation, a self-controlled, close ended, organized survey has been
intended to accumulate essential information from respondents (Vancelik et al., 2007). The
survey questionnaires are comprised of a five-point Likert type answer scale going from 1
(strongly disagree) to 5 (strongly agree) in printed copies. Each of the survey questionnaire set
includes two parts, part A contains respondent’s demographic information and part B contains
general information about the subject matter queries. A series of questions in different formats
were used to get the data. These also include multiple choices. In the questionnaire set,
4International Journal of Innovative Research and Publications www.ijirp.com
questions 1 to 6 related to attitude, questions 7 to 16 related to perceived risk, questions 17 to
22 related to behaviour of Bangladeshi people towards Covid-19 immunization decision were
presented in the said sequence after 8 multiple choices with demographic questions.
After collecting the questionnaires from respondents and keying in the data, the find-
ings were analyzed using IBM’s Statistical Package for Social Science (SPSS). The research
instrument (questionnaire) was tested for mean and standard deviation to see the difference
between variables. To check sampling adequacy, KMO and Bartlett's Test has been done. Factor
analysis has been conducted to assess the nature of relationships existing among the constructs.
For testing reliability, Cronbach’s Alpha has been computed. AVE and CR values were also
computed to see the reliability and validity of the constructs. Analysis of variance (ANOVA)
has been computed for finding variances among the study variables (constructs) to identify the
strength of relationships existing among the constructs. Finally, multiple regression analysis
has been done to check the relationships.
Results
Among the respondents, the majority were male (56.1%), 37.3% were in their youth age (26 to
35 years old), 43% were SSC passed, 55.4% were married, 31.7% were student, 59.7% belongs
to rural area, 58.1% were having a fair health status and 53% did not receive any vaccinations
before. In this study, the valid sample size (N) is 182 means there are some missing values
among the total sample size (N) of 186 which is negligible. All the skewness and kurtosis are
within the valid range of ±2.5 (Hair et al., 2017).
Exploratory Factor Analysis
After running dimension reduction in SPSS from the KMO and Bartlett’s test (Table 1), the
sampling adequacy was found 0.759 which is adequate. The significance value is 0.000 which
means at least one relation among the variables is significant. Using principle component anal-
ysis extraction method, 67.2% of total variance was explained by the initial Eigenvalues which
is satisfactory. The initial extraction of values for communalities also represent satisfactory as
all values were more than (0.3).
Table 1. KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .759
Bartlett's Test of Sphericity Approx. Chi-Square 1741.359
df 231
Sig. .000
After running the data again in SPSS through fixed number of Factors (3) and suppress-
ing coefficient values less than 0.5, we can see the Component Correlation Matrix is orthogo-
nal. Again, we checked the varimax option in SPSS for analyzing orthogonal matrix and found
the rotated component matrix (Table 2). Two indicator items (Att06 and Vac01) were dropped
from the list due to bad loadings.
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Table 2. Rotated Component Matrixa
Component
Variables 1 2 3
Att01 .632
Att02 .602
Att03 .794
Att04 .708
Att05 .616
PR01 .651
PR02 .720
PR03 .694
PR04 .745
PR05 .614
PR06 .630
PR07 .693
PR08 .721
PR09 .676
PR10 .706
Vac02 .676
Vac03 .843
Vac04 .745
Vac05 .685
Vac06 .605
Extraction Method: Principal Component Analysis.
Rotation Method: Varimax with Kaiser Normalization.
a. Rotation converged in 5 iterations.
Reliability and Validity Test
For checking the reliability and validity of the constructs, the Cronbach’s Alpha values were
tested beside Composite Reliability and Convergent Validity. Table 4 represents the Alpha, CR
and AVE values which are satisfactory for further analysis.
Table 3. Alpha, CR and AVE values
Covid-19 Vac-
Attitude Perceived Risk
cination
Cronbach's Alpha 0.74 0.88 0.80
N of Items 5 10 5
AVE 0.545 0.571 0.511
CR 0.805 0.899 0.838
Multiple Regression Analysis
For multiple regression analysis in SPSS, first we have computed the mean of each constructs
to target variables (Attitude, Perceived_Risk and Vaccination). Then we applied multiple linear
regression technique using Enter method on the IVs to predict DV for better estimates. The
results are presented in Table 4, 5 and 6.
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Table 4. Model Summaryb
Std. Change Statistics
Ad- Error
justed of the R Dur-
R R Esti- Square F Sig. F bin-
Model R Square Square mate Change Change df1 df2 Change Watson
1 .402a .162 .153 .573 .162 17.664 2 183 .000 1.512
a. Predictors: (Constant), Perceived_Risk, Attitude
b. Dependent Variable: Vaccination
Table 5. ANOVAa
Sum of
Model Squares df Mean Square F Sig.
1 Regression 11.586 2 5.793 17.664 .000b
Residual 60.018 183 .328
Total 71.605 185
a. Dependent Variable: Vaccination
b. Predictors: (Constant), Perceived_Risk, Attitude
Table 6. Coefficientsa
Unstandardized Standardized Collinearity Statis-
Coefficients Coefficients tics
Std.
Model B Error Beta t Sig. Tolerance VIF
1 (Constant) 2.575 .326 7.897 .000
Attitude .383 .069 .378 5.578 .000 .996 1.004
Perceived_Risk -.112 .067 -.114 -1.682 .094 .996 1.004
a. Dependent Variable: Vaccination
The ANOVA table represents residual values, degrees of freedom, strength of variance
with significance level which shows substantial contribution in the model. The Coefficients
table represents the standardized estimates, collinearity, t and p values for each IV (Attitude
and Perceived Risk) to predict DV (Vaccination). From this table, it is shown that the t-value
for Attitude →Vaccination is positively significant with p value less than 0.05 that means the
null-hypothesis is rejected. Again, the t-value for Perceived Risk →Vaccination is negative but
not significant with p value more than 0.05 that means the null-hypothesis is not rejected. The
hypotheses test results are summarized in Table 7.
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Table 7. Hypotheses Test Results
Statements of Hypotheses Results
H1 Attitude of people has a significant positive effect on Supported
Covid-19 immunization decision.
H2 Perceived risk of people has a significant negative Not Supported
effect on Covid-19 immunization decision.
Discussion
The COVID-19 vaccine has been framed as the perfect cure for halting the current pandemic.
A vast number of vaccine candidates are being developed, and many clinical trials have recently
been reported with encouraging outcomes, leading to the acceptance of new vaccines for use
in vaccination systems in a number of countries. The government of Bangladesh has also begun
the roll-out of the COVID-19 vaccine, offering hope as part of a pandemic response. Despite
the fact that Bangladesh has several vaccination programs, the complete newness of the
COVID-19 vaccination roll-out creates doubts regarding vaccine delivery and acceptance. It
also raises concerns about the general public's views and expectations of the COVID-19 vac-
cine and its implementation.
The results of a novel study conducted in Bangladesh to examine behaviors and expec-
tations about COVID-19 vaccination decisions are presented in this article. Since our results
represent a wide variety of socio-demographic influences that affect behaviors and beliefs re-
garding COVID-19 vaccines, they will be important in improving COVID-19 vaccination-re-
lated recognition and health education initiatives. Importantly, the majority of patients had a
favorable impression of the COVID-19 vaccine. As a result, it's critical to provide community
members with clear access to reliable, evidence-based vaccine knowledge. Participants with a
higher degree of education have a more optimistic outlook about COVID-19 vaccine decisions,
according to our findings, which is also confirmed by previous studies (Wand et al., 2020; Chou
and Budenz, 2020).
People who had recently been vaccinated against influenza were more likely to consider
the COVID-19 vaccine, according to a new report in China (Wand et al., 2020), which was also
shown in a study in Hong Kong (Chan et al., 2015). This phenomenon in people may be at-
tributed to prior favorable vaccine experiences. According to a survey conducted in China, 48
percent of respondents deferred vaccination until the vaccine's efficacy was confirmed (Wang
et al., 2020), suggesting their uncertainty about vaccine protection. Worryingly, the unexpect-
edly fast speed of vaccine production, as well as the skepticism of some science and health
experts, could raise concerns about the COVID-19 vaccine (Chou and Budenz, 2020).
Limitations
There are certain shortcomings that should be considered when interpreting the results of this
analysis. The sample size was limited to less than 200, which cannot be representative of the
target population. A prospective research with bigger sample size is critical in this regard. Sec-
ond, the survey was done in the one major city (Dhaka) in Bangladesh during the vaccination
period, so the results may differ for other cities as well. However, this is among the first analysis
of community assessments of Covid-19 vaccination decision in Bangladesh, and it would be
important for health authorities and planners who want to vaccinate as many of the population
as possible to minimize the risk of illness.
8International Journal of Innovative Research and Publications www.ijirp.com
Implication for Future Research
Future researchers should investigate the indirect relationships by accommodating more factors
like culture, perceived value, vaccination knowledge, health literacy to predict Covid-19 vac-
cination decision among general population. More theoretical framework will add the compre-
hensiveness of research findings towards theoretical and practical contribution. Also, compar-
ative studies with other South Asian countries can add more insights.
Conclusion
The COVID-19 pandemic continues to inflict global disorder on lives and livelihoods, and the
COVID-19 vaccine represents a possible light of hope for the future. The present study revealed
positive attitudes of Bangladeshi people towards COVID-19 vaccinations with less significant
perceived risk factors. The findings suggest boosting vaccination programs to be organized
with a more rapid distribution policy by respective health authorities for every social group in
the community. No one should left behind. Policymakers should ensure adequate knowledge,
positive attitudes and perceptions towards COVID-19 vaccinations to reduce vaccine hesitancy
among Bangladeshi people.
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