Cardiff Metropolitan University
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Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK

journal contribution
posted on 2021-09-20, 08:48 authored by Rhiannon PhillipsRhiannon Phillips, David Gillespie, Britt HallingbergBritt Hallingberg, Jennifer Evans, Khadijeh Taiyari, Anna Torrens-Burton, Rebecca Cannings-John, Denitza Williams, Elizabeth Sheils, Pauline Ashfield-Watt, Kathryn Hughes, Emma Thomas-Jones, Delyth JamesDelyth James, Fiona Wood


Using the Health Belief Model as a conceptual framework, we investigated the association between attitudes towards COVID-19, COVID-19 vaccinations, and vaccine hesitancy and change in these variables over a 9-month period in a UK cohort.


The COPE study cohort (n=11,113) were recruited via and online survey at enrolment March/April 2020. The study was advertised via the HealthWise Wales research registry and social media. Follow-up data were available for 6,942 people at 3-months (June/July 2020) and 5,037 at 12-months (March/April 2021) post-enrolment. Measures included demographics, perceived threat of COVID-19, self-efficacy, intention to accept or decline a COVID-19 vaccination, and attitudes towards vaccination. Logistic regression models were fitted cross-sectionally at 3- and 12-months to assess the association between motivational factors and vaccine hesitancy. Longitudinal change in motivational variables for vaccine-hesitant and non-hesitant groups were examined using mixed-effect ANOVA models.


Fear of COVID-19, perceived susceptibility to COVID-19 and perceived personal control over COVID-19 infection transmission decreased between the 3- and 12-month surveys.

Vaccine hesitancy at 12-months was independently associated with low fear of the disease and more negative attitudes towards COVID-19 vaccination. Specific barriers to COVID-19 vaccine uptake included concerns about safety and efficacy in light of its rapid development, mistrust of government and pharmaceutical companies, dislike of coercive policies, and perceived lack of relaxation in COVID-19 related restrictions as the vaccination program progressed.


Decreasing fear of COVID-19, perceived susceptibility to the disease, and perceptions of personal control over reducing infection-transmission may impact on future COVID-19 vaccination uptake.


We would like to thank Cardiff Metropolitan University, Cardiff University, HealthWise Wales, the Centre for Trials Research, and PRIME Centre Wales for providing internal resources to design, set up, and conduct the baseline and 3-month data collection. PRIME Centre Wales, HealthWise Wales, and the Centre for Trials Research are part of Health and Care Research Wales infrastructure, a networked organization supported by Welsh Government. A Sêr Cymru III Tackling COVID-19 grant (Project number WG 90) was awarded to cover our follow-up data collection, analysis, and dissemination activities for the period between 1 August 2020 to 31 March 2021


Published in

British Journal of Health Psychology




  • VoR (Version of Record)


Phillips, R., Gillespie, D., Hallingberg, B., Evans, J., Taiyari, K., Torrens‐Burton, A., Cannings‐John, R., Williams, D., Sheils, E., Ashfield‐Watt, P. and Akbari, A. (2022) 'Perceived threat of COVID‐19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK', British Journal of Health Psychology. DOI: 10.1111/bjhp.12606

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Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Rhiannon Phillips Britt Hallingberg Delyth James

Cardiff Met Research Centre/Group

  • Applied Psychology and Behaviour Change
  • Public Health and Wellbeing

Copyright Holder

  • © The Authors


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