[2026-01-26] A Qualitative Study Exploring COVID-19 Vaccine Hesitancy and Refusal Among Unvaccinated Patients Visiting Family Physicians in Bangkok, Thailand

Veerachai Sachdev; Paichit Inpanya; Ekkachai Petchlorlian

doi:10.33165/rmj.2026.e275646

Authors

Veerachai Sachdev Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Paichit Inpanya Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0001-5409-0628
Ekkachai Petchlorlian Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0008-5329-0511

DOI:

https://doi.org/10.33165/rmj.2026.e275646

Keywords:

COVID-19 vaccine hesitancy and refusal, Infodemic, Qualitative methods, Primary care, Patient-centeredness

Abstract

Background: Vaccine hesitancy and refusal are critical barriers to achieving herd immunity against COVID-19. Despite widespread vaccine availability nationwide, some people remain unvaccinated.

Objective: To explore reasons for COVID-19 vaccine hesitancy and refusal among unvaccinated patients visiting family physicians at the Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital.

Methods: A qualitative study collected data using in-depth semi-structured telephone interviews between 24 March 2022 and 16 June 2022. All recruited participants had never received COVID-19 vaccination and were registered patients at the Family Medicine outpatient clinic, Ramathibodi Hospital. The interviews were conducted in Thai, digitally recorded, and transcribed verbatim. They were reviewed for accuracy and analyzed using thematic analysis.

Results: Thirteen participants, aged 55 to 83 years, were interviewed. Four themes were identified: 1) fear of vaccination, particularly concerns about side effects; 2) vaccine safety and effectiveness, safety and efficacy concerns, and perceptions of vaccines as "emergency vaccines"; 3) health information, especially negative vaccine/health content from social media and mainstream news; and 4) personal health beliefs, including reliance on self-care, hygiene, and Thai herbal medicine as alternatives. Most participants (92%) stated they would continue refusing vaccination despite availability.

Conclusions: Vaccine hesitancy and refusal were driven by fear of side effects, personal beliefs, and exposure to negative health information. Therefore, it is strongly recommended that health sectors develop a knowledge management platform to disseminate evidence-based health information that is widely accessible. This would enable patients to make well-informed and autonomous decisions.

References

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-160. doi:10.23750/abm.v91i1.9397

Rajatanavin N, Tuangratananon T, Suphanchaimat R, Tangcharoensathien V. Responding to the COVID-19 second wave in Thailand by diversifying and adapting lessons from the first wave. BMJ Glob Health. 2021;6(7):e006178. doi:10.1136/bmjgh-2021-006178

Tantrakarnapa K, Bhopdhornangkul B, Nakhaapakorn K. Influencing factors of COVID-19 spreading: a case study of Thailand. Z Gesundh Wiss. 2022;30(3):621-627. doi:10.1007/s10389-020-01329-5

Issac A, Radhakrishnan RV, Vijay VR, et al. An examination of Thailand's health care system and strategies during the management of the COVID-19 pandemic. J Glob Health. 2021;11:03002. doi:10.7189/jogh.11.03002

Marome W, Shaw R. COVID-19 Response in Thailand and its implications on future preparedness. Int J Environ Res Public Health. 2021;18(3):1089. doi:10.3390/ijerph18031089

Tangcharoensathien V, Sachdev S, Viriyathorn S, et al. Universal access to comprehensive COVID-19 services for everyone in Thailand. BMJ Glob Health. 2022;7(6):e009281. doi:10.1136/bmjgh-2022-009281

Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9(8):1763-1773. doi:10.4161/hv.24657

Shah A, Coiado OC. COVID-19 vaccine and booster hesitation around the world: a literature review. Front Med. 2023;9:1054557. doi:10.3389/fmed.2022.1054557

Department of Disease Control, Ministry of Public Health. Coronavirus 2019 (COVID-19). Updated 1 October 2025. Accessed 10 October 2025. https://ddc.moph.go.th/viralpneumonia/

Sirikalyanpaiboon M, Ousirimaneechai K, Phannajit J, et al. COVID-19 vaccine acceptance, hesitancy, and determinants among physicians in a university-based teaching hospital in Thailand. BMC Infect Dis. 2021;21(1):1174. doi:10.1186/s12879-021-06863-5

Remmel C, Tuli G, Varrelman TJ, et al. COVID-19 vaccine acceptance and uptake in Bangkok, Thailand: cross-sectional online survey. JMIR Public Health Surveill. 2023;9:e40186. doi:10.2196/40186

World Health Organization‎. WHO SAGE roadmap for prioritizing uses of COVID-19 vaccines in the context of limited supply: An approach to inform planning and subsequent recommendations based upon epidemiologic setting and vaccine supply scenarios. 20 October 2020. Accessed 10 October 2025. https://iris.who.int/server/api/core/bitstreams/bb682a5a-44ce-4c3b-a904-7b03901cefbd/content

Mathieu E, Ritchie H, Rodés-Guirao L, et al. Coronavirus (COVID-19) Vaccinations. Our World in Data; 2020. Accessed 10 October 2025. https://ourworldindata.org/covid-vaccinations

Lee KY, Dabak SV, Kong VH, et al. Effectiveness of chatbots on COVID vaccine confidence and acceptance in Thailand, Hong Kong, and Singapore. NPJ Digit Med. 2023;6(1):96. doi:10.1038/s41746-023-00843-6

World Health Organization. Ten threats to global health in 2019. 10 January 2019. Accessed 10 October 2025. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

World Health Organization. WHO lists 9th COVID-19 vaccine for emergency use with aim to increase access to vaccination in lower-income countries. 17 December 2021. Accessed 10 October 2025. https://www.who.int/news/item/17-12-2021-who-lists-9th-covid-19-vaccine-for-emergency-use-with-aim-to-increase-access-to-vaccination-in-lower-income-countries

Lohiniva AL, Pensola A, Hyökki S, Sivelä J, Härmä V, Tammi T. Identifying factors influencing COVID-19 vaccine uptake in Finland - a qualitative study using social media data. Front Public Health. 2023;11:1138800. doi:10.3389/fpubh.2023.1138800

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa

Chutiyami M, Salihu D, Bello UM, et al. Are Fear of COVID-19 and vaccine hesitancy associated with COVID-19 vaccine uptake? a population-based online survey in Nigeria. Vaccines. 2022;10(8):1271. doi:10.3390/vaccines10081271

Centers for Disease Control and Prevention. People With Certain Medical Conditions and COVID-19 Risk Factors. 11 June 2025. Accessed 10 October 2025. https://www.cdc.gov/covid/risk-factors/index.html

Siewchaisakul P, Sarakarn P, Nanthanangkul S, Longkul J, Boonchieng W, Wungrath J. Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand. PLoS One. 2022;17(6):e0270023. doi:10.1371/journal.pone.0270023

Abad N, Messinger SD, Huang Q, et al. A qualitative study of behavioral and social drivers of COVID-19 vaccine confidence and uptake among unvaccinated Americans in the US April-May 2021. PLoS One. 2023;18(2):e0281497. doi:10.1371/journal.pone.0281497

Kongkauroptham W, Ractham P, Kaewkitipong L, Chiu EMP. Health-related misinformation sharing on social media in Thailand: A case study during the Covid-19 pandemic. In: The 22nd International Conference on Electronic Business, Bangkok, Thailand. AIS Electronic Library (AISeL); 2022. Accessed 10 October 2025. https://aisel.aisnet.org/iceb2022/19

Razai MS, Oakeshott P, Esmail A, Wiysonge CS, Viswanath K, Mills MC. COVID-19 vaccine hesitancy: the five Cs to tackle behavioural and sociodemographic factors. J R Soc Med. 2021;114(6):295-298. doi:10.1177/01410768211018951

Wiysonge CS, Ndwandwe D, Ryan J, et al. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccin Immunother. 2022;18(1):1-3. doi:10.1080/21645515.2021.1893062

Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-251. doi:10.1016/j.puhe.2021.02.025

Yang F, Zhang Y, Tariq A, et al. Food as medicine: a possible preventive measure against coronavirus disease (COVID-19). Phytother Res. 2020;34(12):3124-3136. doi:10.1002/ptr.6770

Muhammad F. COVID-19 pandemic: the role of traditional medicine. Int J Infect. 2020;7(3):e107090. doi:10.5812/iji.107090

Thanapluetiwong S, Chansirikarnjana S, Sriwannopas O, Assavapokee T, Ittasakul P. Factors associated with COVID-19 vaccine hesitancy in Thai seniors. Patient Prefer Adherence. 2021;15:2389-2403. doi:10.2147/PPA.S334757

Lee J, Jang SN. Have changes in internet use during the COVID-19 pandemic affected older adults' self-rated health? a cross-sectional study of young-old and old-old populations in Korea. Geriatr Nurs. 2022;48:145-149. doi:10.1016/j.gerinurse.2022.09.012

Gwynne K, Ratwani R, Dixit R. Technology issues experienced by older populations responding to COVID-19 vaccine text outreach messages. JAMIA Open. 2023;6(3):ooad066. doi:10.1093/jamiaopen/ooad066

Rödl & Partner. Coronavirus: The government of Thailand tightens prevention measures. 14 July 2021. Accessed 10 October 2025. https://www.roedl.com/insights/covid-19/corona-thailand-tightens-prevention-measures

Ngamchaliew P, Kaewkuea N, Nonthasorn N, et al. Changes in preventive behaviour after COVID-19 vaccination in Thailand: a cross-sectional study. BMC Public Health. 2022;22(1):2039. doi:10.1186/s12889-022-14494-x

Chandok RS, Madar P, Majeed A. A qualitative study of factors influencing COVID-19 vaccine hesitancy among South Asians in London. JRSM Open. 2022;13(10):20542704221123430. doi:10.1177/20542704221123430