Community Engagement, Health Belief Profiles, and Vaccine Confidence Among Korean Immigrants

Background and Purpose: Vaccine confidence among immigrant populations is often attributed to individual health beliefs; however, previous studies suggest that it is imperative to consider the roles of ethnic community engagement in shaping cognitive, motivational, and behavioral patterns of immigrants. The Health Belief Model (HBM) provides a useful framework that help understand how perceptions of susceptibility, severity, benefits, and barriers shape health-related attitudes and behaviors. Although the HBM has been widely used, most studies have employed variable-centered approaches, with fewer studies adopting person-centered methods to examine heterogeneity in belief patterns. This study identifies latent health belief profiles related to COVID-19 among Korean Americans and examine how these profiles are associated with community engagement and vaccine confidence. We examined: (1) What latent health belief patterns emerge from HBM constructs? (2) Is community engagement associated with specific belief profiles? (3) How do belief profiles differ in vaccine confidence?

Methods: Cross-sectional survey data were collected from Korean American adults (N=310) through an ethnic community organization in greater Philadelphia between March and May 2022. Measures included four HBM constructs, including perceived susceptibility (3 items), severity (3 items), benefits (3 items), and barriers (7 items); community engagement, measured by participation in any of six community programs related to the COVID-19 pandemic (e.g., mask-making campaign, vaccination committee); and vaccine confidence (9 items). Latent profile analysis was used to identify health belief profiles related to COVID-19. Multinomial logistic regression examined predictors of class membership, and linear regression assessed differences in vaccine confidence across classes.

Results: Four health belief profiles emerged: (1) Balanced / Low Activation (9.7%), (2) High Risk / Low Benefit (2.3%), (3) Benefit-oriented Majority (73.9%), and (4) High Benefit/Low Risk (14.2%). Compared to the benefit-oriented majority (reference group), the high risk / low benefit group reported significantly lower vaccine confidence (β = −6.93, p < .001), while the high benefit / low risk group showed significantly higher confidence (β = 6.54, p < .001). Community engagement was a significant protective factor. Participants in the ethnic community programs were significantly less likely to belong to the high severity/low benefit group (β = −3.70, p < .05).

Conclusions and Implications: This study revealed different health belief patterns regarding COVID-19 among Korean Americans. Community engagement through ethnic organizations plays a protective role in shaping those health belief profiles among Korean Americans regarding vaccination. The results showed that participation in COVID-19-related community programs was associated with reduced likelihood of high severity/low benefit patterns—the profile most strongly linked to lower vaccine confidence. This suggests community-embedded interventions may effectively shape the cognitive-motivational patterns underlying health decisions, rather than merely providing information. Public health strategies should leverage ethnic community organizations to deliver belief-targeted interventions.