# Perceived social support and self-stigma as factors of COVID-19 booster vaccination behavior and intention via cognitive coping and emotion regulation among people infected with COVID-19 in Hong Kong

## TL;DR

This study explores how social support and self-stigma influence the decision to get a booster vaccine for people who have had COVID-19 in Hong Kong.

## Contribution

It identifies new mediators—self-stigma, active coping, and maladaptive emotion regulation—in the relationship between social support and booster vaccination intention.

## Key findings

- Perceived social support was positively linked to booster vaccination intention.
- Self-stigma and active coping partially mediated the relationship between social support and vaccination behavior.
- Maladaptive emotion regulation did not significantly mediate the relationship.

## Abstract

It is imperative to promote behavior/intention of taking up booster COVID-19 vaccination (BI-BV) among people who have ever contracted COVID-19 (PECC). The aims were to investigate the prevalence of BI-BV and its associations with perceived social support. Guided by the stress coping theory, we tested mediators between perceived social support and BI-BV via self-stigma, active coping, and maladaptive emotion regulation (rumination and catastrophizing).

A random population-based telephone survey was conducted among adult PECC having completed the primary series of COVID-19 vaccination prior to the diagnosis; 230 participants were interviewed from June to August 2022 during the fifth (last) major outbreak in Hong Kong. The associations between the independent variables and BI-BV were tested by logistic regression analysis. A structural equation model (SEM) tested the indirect effects of the latent variables of self-stigma, active coping, and maladaptive emotion regulation between the latent variable of perceived social support and BI-BV.

The prevalence of BI-BV was 62.2%. It was associated with age, marital status, full-time employment, and chronic disease status. The logistic regression analysis found that BI-BV was positively associated with perceived social support (ORc = 1.31, 95% CI: 1.12– 1.54), active coping (ORc = 1.40, 95% CI: 1.10– 1.79), rumination (ORc = 1.75, 95% CI: 1.13– 2.70), and catastrophizing (ORc = 3.12, 95% CI: 1.49– 6.51) and negatively associated with self-stigma (ORc = 0.80, 95% CI: 0.72– 0.88). In the SEM analysis, the positive association between perceived social support and BI-BV was fully mediated: 1) via self-stigma (β = 0.07, 95% CI: 0.03– 0.14), 2) via active coping (β = 0.06, 95% CI: 0.02– 0.12), and 3) via self-stigma and then active coping (β = 0.01, 95% CI: 0.002– 0.04). Two of these indirect paths involved active coping. The indirect paths involving maladaptive emotion regulation were all non-significant.

Perceived social support was associated with BI-BV, and was mediated via self-stigma, active coping, and serially self-stigma then active coping but not emotion maladaptation. The data supported the stress cognitive coping model in explaining the association between perceived social support and BI-BV. Interventions promoting BI-BV may consider modifying the observed significant factors. Future longitudinal studies are warranted to confirm the findings.

The online version contains supplementary material available at 10.1186/s12889-025-21899-x.