{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:38:37Z","timestamp":1782315517449,"version":"3.54.5"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2021-04665"],"award-info":[{"award-number":["2021-04665"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2019-00198"],"award-info":[{"award-number":["2019-00198"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Governmental Funds for Clinical Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Low vaccination coverage against SARS-CoV-2 (COVID-19) is a public health concern. The aim of this study was to identify barriers and motivators associated with COVID-19 vaccination and develop a vaccine acceptance scoring system. From the overall population residing in Sk\u00e5ne county Sweden in 2022 (n\u2009=\u20091\u2009384\u2009531), 3600 randomly selected individuals (aged \u226518\u2009years) received a survey. Questions were grouped into six domains reflecting trust in vaccines and institutions, benefit-risk balance, injunctive and descriptive norms and accessibility. Responses were scored as either assenting (1 p) or dissenting (0 p) in relation to its domain. A score between 1 and 5 p was constructed for each domain and a total vaccine acceptance score was analysed. Internal consistency overall and within domains was assessed with Cronbach\u2019s alpha. Associations with vaccination status and vaccine acceptance scores in relation to domains were modelled with logistic regression. 820 responses were received, 646 vaccinated (response rate 36%), and 174 unvaccinated (response rate 10%), with relatively high internal consistency overall (\u03b1\u2009=\u20090.76). Domains markedly associated with vaccination were injunctive norms OR 5.06 (95% CI 3.27, 7.83), descriptive norms OR 2.64 (1.63, 4.30) and trust in vaccines OR 1.66 (1.15, 2.40). Vaccine acceptance was measured with sufficient reliability in a Swedish population. Norms, in this context, general perceptions of acceptable\/unacceptable behaviours and notion on actual performed behaviours, were together with trust in vaccines most strongly associated with vaccination. Future pandemic responses should consider these aspects in communication strategies and targeted interventions to increase and equalize vaccination uptake.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf030","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T23:39:21Z","timestamp":1744933161000},"page":"477-483","source":"Crossref","is-referenced-by-count":2,"title":["Barriers and motivators associated with COVID-19 vaccination\u2014a vaccine acceptance scoring system based on a population survey in southern Sweden"],"prefix":"10.1093","volume":"35","author":[{"given":"Adam","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Division of Occupational and Environmental Medicine , Lund University , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Family Medicine and Community Medicine , Lund University , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5566-6350","authenticated-orcid":false,"given":"Fredrik","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University , Lund,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Litins\u2019ka","sequence":"additional","affiliation":[{"name":"Department of Law, Lund University , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Almgren","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Malmqvist","sequence":"additional","affiliation":[{"name":"Clinical Studies Sweden, Forum S\u00f6der, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per-Olof","family":"\u00d6stergren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Social Medicine and Global Health, Lund University , Malm\u00f6,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2995-1312","authenticated-orcid":false,"given":"Malin","family":"Inghammar","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University , Lund,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1883-2000","authenticated-orcid":false,"given":"Jonas","family":"Bj\u00f6rk","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Division of Occupational and Environmental Medicine , Lund University , Lund,","place":["Sweden"]},{"name":"Clinical Studies Sweden, Forum S\u00f6der, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Bennet","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Family Medicine and Community Medicine , Lund University , Lund,","place":["Sweden"]},{"name":"Clinical Studies Sweden, Forum S\u00f6der, Sk\u00e5ne University Hospital , Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"2025062607185130800_ckaf030-B1","author":"ECSR","year":"2020"},{"key":"2025062607185130800_ckaf030-B2","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.amepre.2021.01.008","article-title":"Willingness to vaccinate against COVID-19 in the U.S.: representative longitudinal evidence from April to October 2020","volume":"60","author":"Daly","year":"2021","journal-title":"Am J Prev Med"},{"key":"2025062607185130800_ckaf030-B3","doi-asserted-by":"crossref","first-page":"e000437","DOI":"10.1136\/bmjph-2023-000437","article-title":"COVID-19 vaccine uptake in Skane county, Sweden, in relation to individual-level and area-level sociodemographic factors: a register-based cross-sectional analysis","volume":"2","author":"Mitchell","year":"2024","journal-title":"BMJ Public Health"},{"key":"2025062607185130800_ckaf030-B4","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.15585\/mmwr.mm6942e1","article-title":"Race, ethnicity, and age trends in persons who died from COVID-19 - United States, May-August 2020","volume":"69","author":"Gold","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025062607185130800_ckaf030-B5","first-page":"44","author":"UN CRC"},{"key":"2025062607185130800_ckaf030-B6","author":"Folkh\u00e4lsomyndigheten"},{"key":"2025062607185130800_ckaf030-B7","doi-asserted-by":"crossref","first-page":"445","DOI":"10.3390\/healthcare8040445","article-title":"Addressing healthcare gaps in sweden during the COVID-19 outbreak: on community outreach and empowering ethnic minority groups in a digitalized context","volume":"8","author":"Valeriani","year":"2020","journal-title":"Healthcare (Basel)"},{"key":"2025062607185130800_ckaf030-B8","author":"World Health Organization. Tailoring Immunization Programmes","year":"2018"},{"key":"2025062607185130800_ckaf030-B9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/2372732215600716","article-title":"Using Behavioral Insights to Increase Vaccination Policy Effectiveness","volume":"2","author":"Betsch","year":"2015","journal-title":"Policy Insights Behav Brain Sci"},{"key":"2025062607185130800_ckaf030-B10","doi-asserted-by":"crossref","first-page":"e0208601","DOI":"10.1371\/journal.pone.0208601","article-title":"Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination","volume":"13","author":"Betsch","year":"2018","journal-title":"PLoS One"},{"key":"2025062607185130800_ckaf030-B11","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1529100618760521","article-title":"Increasing vaccination: putting psychological science into action","volume":"18","author":"Brewer","year":"2017","journal-title":"Psychol Sci Public Interest"},{"key":"2025062607185130800_ckaf030-B12","author":"World Health Organization"},{"key":"2025062607185130800_ckaf030-B13","first-page":"209","article-title":"Understanding the behavioural and social drivers of vaccine uptake WHO position paper","volume":"97","author":"World Health Organisation","year":"2022","journal-title":"Weekly Epidemiol Record"},{"key":"2025062607185130800_ckaf030-B14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ypmed.2018.01.006","article-title":"A survey instrument for measuring vaccine acceptance","volume":"109","author":"Sarathchandra","year":"2018","journal-title":"Prev Med"},{"key":"2025062607185130800_ckaf030-B15","doi-asserted-by":"crossref","first-page":"4165","DOI":"10.1016\/j.vaccine.2015.04.037","article-title":"Measuring vaccine hesitancy: the development of a survey tool","volume":"33","author":"Larson","year":"2015","journal-title":"Vaccine"},{"key":"2025062607185130800_ckaf030-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0950268822000425","article-title":"Surveillance of COVID-19 vaccine effectiveness\u2014a real-time case-control study in southern Sweden","volume":"150","author":"Bj\u00f6rk","year":"2022","journal-title":"Epidemiol Infect"},{"key":"2025062607185130800_ckaf030-B17","doi-asserted-by":"crossref","first-page":"2200121","DOI":"10.2807\/1560-7917.ES.2022.27.9.2200121","article-title":"Risk of severe COVID-19 from the Delta and Omicron variants in relation to vaccination status, sex, age and comorbidities\u2014surveillance results from southern Sweden","volume":"27","author":"Kahn","year":"2022","journal-title":"Euro Surveill"},{"key":"2025062607185130800_ckaf030-B18","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s10654-009-9350-y","article-title":"The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research","volume":"24","author":"Ludvigsson","year":"2009","journal-title":"Eur J Epidemiol"},{"key":"2025062607185130800_ckaf030-B19","doi-asserted-by":"crossref","first-page":"e0253969","DOI":"10.1371\/journal.pone.0253969","article-title":"Reweighting a Swedish health questionnaire survey using extensive population register and self-reported data for assessing and improving the validity of longitudinal associations","volume":"16","author":"Nilsson","year":"2021","journal-title":"PLoS One"},{"key":"2025062607185130800_ckaf030-B20","doi-asserted-by":"crossref","first-page":"e2025594","DOI":"10.1001\/jamanetworkopen.2020.25594","article-title":"Factors associated with us adults' likelihood of accepting COVID-19 vaccination","volume":"3","author":"Kreps","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025062607185130800_ckaf030-B21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10865-023-00413-x","article-title":"Injunctive social norms and perceived message tailoring are associated with health information seeking","volume":"47","author":"Foust","year":"2024","journal-title":"J Behav Med"},{"key":"2025062607185130800_ckaf030-B22","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10900-021-01037-5","article-title":"Motivations to vaccinate among hesitant adopters of the COVID-19 vaccine","volume":"47","author":"Moore","year":"2022","journal-title":"J Community Health"},{"key":"2025062607185130800_ckaf030-B23","doi-asserted-by":"crossref","first-page":"100012","DOI":"10.1016\/j.lanepe.2020.100012","article-title":"Attitudes towards vaccines and intention to vaccinate against COVID-19: implications for public health communications","volume":"1","author":"Paul","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"2025062607185130800_ckaf030-B24","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511616037","volume-title":"The Grammar of Society: The Nature and Dynamics of Social Norms","author":"Bicchieri","year":"2005"},{"key":"2025062607185130800_ckaf030-B25","first-page":"201","volume-title":"Advances in Experimental Social Psychology","author":"Cialdini","year":"1991"},{"key":"2025062607185130800_ckaf030-B26","author":"UN CRC"},{"key":"2025062607185130800_ckaf030-B27","author":"UN CRC"},{"key":"2025062607185130800_ckaf030-B28","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.vaccine.2024.02.015","article-title":"COVID-19 vaccine perspectives and uptake among university students three years into the pandemic","volume":"42","author":"Kuter","year":"2024","journal-title":"Vaccine"},{"key":"2025062607185130800_ckaf030-B29","doi-asserted-by":"crossref","first-page":"100331","DOI":"10.1016\/j.lanepe.2022.100331","article-title":"The social patterning of Covid-19 vaccine uptake in older adults: a register-based cross-sectional study in Sweden","volume":"15","author":"Spetz","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"2025062607185130800_ckaf030-B30","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1177\/14034948211022429","article-title":"The Danish Health and Wellbeing Survey: study design, response proportion and respondent characteristics","volume":"50","author":"Rosendahl Jensen","year":"2022","journal-title":"Scand J Public Health"},{"key":"2025062607185130800_ckaf030-B31","doi-asserted-by":"crossref","first-page":"9186","DOI":"10.3390\/ijerph17249186","article-title":"Factors associated with survey non-response in a cross-sectional survey of persons with an axial spondyloarthritis or osteoarthritis claims diagnosis","volume":"17","author":"Callhoff","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025062607185130800_ckaf030-B32","doi-asserted-by":"publisher","first-page":"em303","DOI":"10.29333\/ejgm\/11012","article-title":"Validation of a scale to measure the perception of SARS-CoV-2 vaccines acceptance: the VAC-COVID-19 scale","volume":"18","author":"R Mejia","year":"2021","journal-title":"Electron J Gen Med"},{"key":"2025062607185130800_ckaf030-B33","doi-asserted-by":"crossref","first-page":"3801","DOI":"10.1038\/s41467-022-31441-x","article-title":"Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021","volume":"13","author":"Lazarus","year":"2022","journal-title":"Nat Commun"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/35\/3\/477\/62950824\/ckaf030.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/35\/3\/477\/62950824\/ckaf030.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T11:19:02Z","timestamp":1750936742000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/35\/3\/477\/8115704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,17]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,4,17]]},"published-print":{"date-parts":[[2025,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckaf030","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,4,17]]}}}