The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study

Abstract BackgroundSocial norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior. ObjectiveWe aimed to explore the association betwee...

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Main Authors: Qiang Wang, Ana Bolio, Leesa Lin
Format: Article
Language:English
Published: JMIR Publications 2025-04-01
Series:JMIR Public Health and Surveillance
Online Access:https://publichealth.jmir.org/2025/1/e66872
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author Qiang Wang
Ana Bolio
Leesa Lin
author_facet Qiang Wang
Ana Bolio
Leesa Lin
author_sort Qiang Wang
collection DOAJ
description Abstract BackgroundSocial norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior. ObjectiveWe aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy. MethodsA total of 44,339 participants aged 18 years and older were enrolled from 28 different countries between 2020 and 2022. We used the Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with a 5-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence. ResultsOf the participants, 21,968 (50.2%) were male and 18,957 (43.3%) had an education level of university or above. Vietnam exhibited the highest level of confidence (mean 13.31, SD 1.71) on COVID-19 vaccine and Slovakia had the lowest level (mean 9.52, SD 0.14). The higher levels of cultural tightness were positively linked to greater vaccine confidence (β=1.94, 95% CI 1.72-2.15; PPP ConclusionsLower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context.
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spelling doaj-art-628ba773476c4127bc01f2912488ded92025-08-20T03:10:34ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602025-04-0111e66872e6687210.2196/66872The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional StudyQiang Wanghttp://orcid.org/0000-0002-1393-2443Ana Boliohttp://orcid.org/0000-0003-4583-5303Leesa Linhttp://orcid.org/0000-0003-4123-4762 Abstract BackgroundSocial norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior. ObjectiveWe aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy. MethodsA total of 44,339 participants aged 18 years and older were enrolled from 28 different countries between 2020 and 2022. We used the Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with a 5-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence. ResultsOf the participants, 21,968 (50.2%) were male and 18,957 (43.3%) had an education level of university or above. Vietnam exhibited the highest level of confidence (mean 13.31, SD 1.71) on COVID-19 vaccine and Slovakia had the lowest level (mean 9.52, SD 0.14). The higher levels of cultural tightness were positively linked to greater vaccine confidence (β=1.94, 95% CI 1.72-2.15; PPP ConclusionsLower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context.https://publichealth.jmir.org/2025/1/e66872
spellingShingle Qiang Wang
Ana Bolio
Leesa Lin
The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
JMIR Public Health and Surveillance
title The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
title_full The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
title_fullStr The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
title_full_unstemmed The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
title_short The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study
title_sort association between cultural tightness and covid 19 vaccine confidence from 28 countries cross sectional study
url https://publichealth.jmir.org/2025/1/e66872
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