The association of individual, interpersonal and social support factors with willingness to vaccinate against COVID-19 in rural South Africa.
TL;DR
Emotional support showed a modest positive association with willingness, suggesting supportive social ties may help promote vaccination willingness, and vaccine willingness in this rural setting was shaped by both individual factors and network dynamics.
Abstract
Background
Trust in vaccines and those who deliver them is often shaped by personal social networks, yet empirical data on these dynamics remain limited in low-and middle-income settings. Social networks shape exposure to information, norms, and reinforcement processes that influence vaccine decision-making. We examined how rural South Africans' social network composition and content influence their willingness to receive a COVID-19 vaccine.
Methods
We analysed 2022-23 data from the Sixhumene social network study conducted primarily among young adults in three rural KwaZulu-Natal communities. Our primary outcome was a six-level ordinal measure combining past vaccination and hypothetical willingness. Using multivariable ordinal logistic regression, we evaluated associations between vaccine willingness and social network size, kinship composition, geographic proximity, gender homophily, support received, and respondent characteristics.
Results
Respondents were predominantly female with median age 21 years (IQR 18-28) and identified a median of three key social contacts, with networks characterised by strong kinship and local ties. Vaccine willingness varied by the geographic composition of networks. Compared with urban respondents whose networks were concentrated within the household, willingness was higher among those with more geographically dispersed networks, including urban respondents with alters in the same village (aOR 2.54, 95% CI 2.40-2.70) or outside the village (aOR 3.26, 95% CI 2.04-5.20). Similarly, among rural respondents, willingness was higher among those with household-based networks (aOR 1.95, 95% CI 1.57-2.41), village-based networks (aOR 1.63, 95% CI 1.40-1.90), and networks extending beyond the village (aOR 1.64, 95% CI 1.50-1.79). Emotional support was positively associated with willingness (per 30 contact-days: aOR 1.15, 95% CI 1.01-1.32), while physical support was inversely associated (aOR 0.84, 95% CI 0.72-0.98).
Discussion
Vaccine willingness in this rural setting was shaped by both individual factors and network dynamics. Emotional support showed a modest positive association with willingness, suggesting supportive social ties may help promote vaccination willingness.