A recent study posted to the medRxiv* pre-print server investigated the preferences of younger Canadian adults towards coronavirus disease 2019 (COVID-19) vaccination.

Study: Using Best-Worst Scaling to investigate younger adult Canadians’ preferences for COVID-19 vaccination and public health measures: an observational study. Image Credit: Shark9208888/Shutterstock

To date, there have been 430 million confirmed cases of COVID-19, including 5.9 million deaths, globally. The advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has been crucial in containing the impact of the pandemic. However, negative notions about the vaccines and the subsequent vaccine refusal by younger adults have become a major cause of concern for public health.

About the study

The present study assessed the preferences of young adults in Canada towards preventive health measures related to COVID-19 and vaccination strategies, and also examined the impact of these preferences on vaccine acceptability.

A cross-sectional design combined with a web-based survey was used to perform the study on 18 to 39 years old Canadian adults, irrespective of their COVID-19 vaccination status. The participants answered questionnaires on devices like smartphones or computers.

Sociodemographic factors included continuous variables like age and categorical variables like gender, province, ethnicity, perception of self as a visible minority, religious beliefs affecting health-related decisions, language spoken at home, education level, and income. Variables of provinces or territories were re-categorized to include Central, Western, or Atlantic Canada; ethnic origins were re-categorized into North American, Asian, European, or Other; and gender identities were re-categorized into female, male, and gender diverse.

The survey also included questions regarding COVID-19 vaccine acceptability like the status of the healthcare professional, whether they were a caregiver of an older person, whether a flu vaccine was received in the last 12 months, and COVID-19-positivity status of oneself, family, or friends.

The Precaution Adoption Process Model (PAPM) was used to assess the acceptability of the COVID-19 vaccine by including five intention stages for the participants to select, namely, unengaged, undecided, decided not to vaccinate, decided to vaccinate, and vaccinated. Preferences for public health measures against COVID-19 and related vaccination were evaluated using case 2 of the Best-Worst-Scale (BWS) methodology. Two domains of preferences were considered for preventive health measures that evaluated preventive health behaviors and government mandates and two domains for vaccination that examined preferences for immunization-specific vaccines and motives for vaccination. The first three domains had 16 questions each while the last domain had nine questions, amounting to a total of 57 questions.          


In the period between 6 and 18 August 2021, a total of 266 participants were eligible for the study. Over 25% of the participants were hesitant to receive their vaccines, which included 7.5% of the individuals choosing unengaged interest in receiving the vaccines, 11.3% undecided participants, and 6.8% who decided not to receive the vaccine. Vaccine acceptance was exhibited by 74.4% of the participants among which 7.5% of individuals had decided to receive the vaccine while 66.9% were already vaccinated.

Among preventive health behavior showcased at the attribute level, physical distancing was the most preferred followed by the mandate to wear face masks, while the least preferred behavior was concerning the maintenance of better general hygiene and respiratory etiquettes. On the domain level, avoiding exposure to crowded or closed spaces was the most preferred behavior while the least preferred one was the mandate to wear face masks in open spaces. However, participants preferred wearing a mask while shopping or during transportation and in instances when a distance of two meters cannot be maintained in an open space. With respect to respiratory etiquette, participants preferred hand washing more than maintaining sneezing etiquette.

Among the government mandates, the most preferred behavior was the request to provide health proof, followed by the imposition of travel-related limitations, while measures undertaken to reduce viral transmission were the least preferred. Among attribute-related preferences for government mandates, provision of vaccination proof before entering Canada was the most preferred as compared to proofs for attending work or school while orders to stay at home in the evening or overnight were least preferred. Also, participants appreciated mandatory testing measures and quarantine required to enter Canada but did not prefer restrictions placed on travel between provinces.  

Among immunization-specific attributes tested, vaccine accessibility was the most preferred as compared to the vaccination status of fellow people and vaccine dosing, while the pairing of the flu vaccine with the COVID-19 vaccine was the least preferred attribute. On an attribute level in the immunization-specific domain concerning vaccine dosing, the highest and the lowest preferred attributes were receiving two doses of vaccine from the same brand and different brands, respectively.         


The study findings showed that the BWS approach in younger adults could be used to devise evidence-based guidelines as per public preferences while also motivating public compliance to preventive health measures and in turn improving COVID-19 vaccination rates.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.


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