Drivers of COVID-19 Vaccination among Eligible Adults in Abuja, Nigeria: A Mixed-Methods Study Using the WHO Behavioral and Social Drivers of Vaccination Framework

Despite the availability of COVID-19 vaccines, Nigeria still faces significant COVID-19 vaccine hesitancy, with only 60.7% of the eligible population fully vaccinated as of 20 March 2023. Our study, part of a community-based effort to improve knowledge and uptake of the COVID-19 vaccine in the Gwagwalada Area Council of Abuja, the Federal Capital Territory (FCT) of Nigeria, utilized the WHO's Behavioral and Social Drivers (BeSDs)-of-vaccination framework to examine the drivers of COVID-19 vaccination among eligible adults. This was a mixed-method study with focus group discussions (FGDs) and in-depth interviews (IDIs) involving 40 purposively sampled participants. We triangulate qualitative findings with data from a household survey of 1512 eligible adults identified using a two-stage systematic cluster sampling approach. All data were collected from the 1-18 November 2022. The household survey showed 46% COVID-19 vaccine uptake, with Pearson chi-square and Fisher's exact test showing significant associations between vaccine uptake and gender, religion, and education. Multivariate logistic regression showed that confidence in vaccine safety, knowing vaccination sites and family/friends' endorsement of COVID-19 vaccination were the strongest items associated with vaccine uptake in the thinking-and-feeling, practical-issue, and social-process domains, respectively. Multiple items measuring these domains aligned with BeSD priority question, demonstrating the robustness of the pared-down framework. Qualitative data corroborated these findings. To address vaccine hesitancy and increase uptake, community-driven approaches to improve trust in vaccine safety and benefits and promote positive vaccination norms are needed. In addition, service delivery strategies to make vaccination services easily accessible and identifiable should be developed and tailored to community needs.