# Integrating sociocultural theories to inform public health response: unique relationships between moral foundations, cultural cognition worldviews, and COVID-19 attitudes and behaviors

## TL;DR

This study explores how moral and cultural values influence attitudes and behaviors toward COVID-19 vaccination among unvaccinated U.S. adults.

## Contribution

The study uniquely integrates Moral Foundations Theory and Cultural Cognition Worldviews to explain health behaviors during the pandemic.

## Key findings

- Individualism was the strongest predictor of lower vaccination likelihood and distrust in government vaccines.
- Moral and cultural dimensions significantly predicted attitudes toward risk and protective behaviors.
- Political orientation and demographics had weak or non-significant effects in regression models.

## Abstract

Key variables from Moral Foundations Theory and the Cultural Theory of Risk were examined in relationship to COVID-19 attitudes and behaviors. Two surveys were conducted with unvaccinated U. S. adults (n = 1,025) that assessed five moral foundations (care, fairness, authority, loyalty, and purity), two dimensions of Cultural Cognition Worldviews (individualism-communitarianism and hierarchy-egalitarianism), COVID-19 vaccination likelihood and related attitudes (including measures of perceived risk, protective behavior, and trust), political orientation, and demographic characteristics. The individualism-communitarianism scale, derived from the Cultural Theory of Risk, was the most impactful predictor across surveys. When controlling for responses to all other measures, participants who placed greater emphasis on individualism tended to report a lower likelihood of getting a COVID-19 vaccination, to perceive a lower level of risk from COVID-19, and to express greater distrust in the safety of vaccines developed by the government. Many other moral and cultural worldview dimensions were uniquely predictive of COVID-19 attitudes as well, while political orientation and demographic characteristics were generally weak or non-significant in multiple regression models. Findings underscore the sociocultural foundations of health behavior.