# What Drives Vaccine Uptake?—Investigating the Application of the Health Belief Model Through a Longitudinal Cohort Study During the COVID-19 Pandemic in Victoria, Australia

## TL;DR

This study explores how beliefs about the severity of COVID-19 influenced vaccine uptake over time in Victoria, Australia, during the pandemic.

## Contribution

The study provides new insights into how the Health Belief Model's constructs predict vaccine behavior in a longitudinal and policy-changing context.

## Key findings

- Perceived severity of COVID-19 was strongly linked to vaccine intentions and uptake after mandates were lifted.
- Perceived susceptibility to COVID-19 did not significantly affect vaccine outcomes.
- Older adults and those with chronic conditions had higher perceived severity, while high-income earners had higher perceived susceptibility.

## Abstract

Background/Objectives: Understanding the psychological determinants of vaccine uptake is critical for effective public health strategies, particularly during prolonged pandemics. The Health Belief Model is widely used to examine vaccine behavior, yet its applicability in longitudinal and policy-intensive contexts remains underexplored. This study assessed how two core Health Belief Model constructs—perceived severity of and susceptibility to COVID-19—related to vaccine intentions and uptake over time, and how these perceptions varied by demographic characteristics. Methods: Data came from Optimise, a longitudinal cohort study of adults in Victoria, Australia, conducted between September 2020 and August 2022. Perceived severity of and susceptibility to COVID-19 were measured monthly, alongside COVID-19 vaccine intentions and uptake. Generalized Estimating Equations evaluated associations between these two Health Belief Model constructs and vaccine outcomes over time. Separate models identified demographic predictors of perceived severity and susceptibility. Results: Perceived severity of COVID-19 was positively associated with intention to receive further COVID-19 vaccine doses (OR = 2.53, 95% CI: 1.26–5.07) and the total vaccine doses received (OR = 2.74, 95% CI: 1.58–4.76), with these associations changing over time as vaccine mandates were lifted and the pandemic context evolved. Perceived susceptibility to COVID-19 showed no significant associations with vaccine outcomes. Older age, presence of a chronic health condition, and lower employment status was associated with higher perceived severity. In contrast, perceived susceptibility was higher among high-income earners but lower among older adults and the unemployed. Conclusions: The predictive value of two Health Belief Model constructs was context- and time-dependent. Perceived severity consistently predicted vaccine uptake once mandates were lifted, while susceptibility did not. Our findings highlight the importance of context-sensitive behavioral frameworks when designing vaccine promotion strategies during extended public health crises.