Beyond perceived risk: COVID-19 vaccination more strongly linked to individual risk perception in wheat areas than rice areas

Vaccines save lives, but vaccine hesitancy remains a global health challenge. That makes it critical to explore the factors that influence whether people get vaccinated. Perceived risk is a pivotal factor in traditional theories of health behavior, such as the Risk Perception Attitude framework and the Health Belief Model. However, studies have found that these models are less predictive of COVID-19 vaccination in some cultures. Studies that test culture by comparing nations are useful, but nations have different healthcare systems and policies that are hard to equate and control for. We addressed this question by testing regional cultural differences in China. Drawing on the rice theory, we compared residents in China's historical rice-farming areas (which are more interdependent) with those in wheat-farming areas (which are more independent). Our survey data from 1872 participants in 29 provinces found that models of perceived risk explained COVID-19 vaccination mainly in historically wheat-farming areas. Conversely, in historically rice-farming areas, perceived risk did not explain vaccination behavior. These findings suggest that cultural factors that are rooted in historical farming practices influence vaccination behaviors. By comparing regions within the same country, we can rule out confounds of national policy and healthcare systems. These insights could help policymakers understand how to tailor vaccination campaigns to people from different cultures.