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Network analysis identified the most important symptoms of fear and conspiracy beliefs about COVID vaccines nodes and the associations between them edges. In addition, the robustness of the network of these indicators of centrality and the possible differences in the structure and connectivity of the networks between the four countries were evaluated. The findings strongly support cross-cultural similarities in the networks across the four countries rather than differences. Although it was expected that a higher presence of symptoms of fear of COVID may lead people to compensate for their fear by believing in conspiratorial ideas about vaccines and, consequently, rejecting the COVID vaccine, the results do not clearly show this relationship. This could lead other researchers to generate evidence to explain the differences between Latin American countries and countries in other contexts in terms of vaccination rates. This evidence could be useful to develop policies favoring vaccination against COVID that are more contextualized to the Latin American region, characterized by social instability and economic recession during the pandemic. To try to mitigate the impact of COVID, all governments of the world have taken actions such as the implementation of quarantines, restrictions on the movement of people, as well as the closure of schools, churches, stores, and different industrial activities Lazarus et al. However, it has been suggested that these activities have had a significant impact on the mental health of the population worldwide Matranga et al. To date, the implementation of mass vaccination programs is considered to be the most effective strategy to overcome the pandemic and protect the population, reducing the mortality and morbidity rate, in addition to reactivating the world economy Graham, Vaccination campaigns have generated two types of reactions. On the other hand, a sector of the population refuses to receive the vaccine. This same percentage of people has been reported in a study of 20 LAC countries Urrunaga-Pastor et al. The population that refuses to receive the vaccine justifies its decision based on denials and conspiratorial beliefs Bertin et al. They are also responses to the psychological need to understand threatening events that are difficult to understand and predict Douglas et al. Indeed, during the current pandemic, conspiracy beliefs are important in public discourse, as are approval ratings Freeman et al. Regarding vaccines, it is believed that they do not work and are harmful, causing autism, autoimmune diseases, and infertility, among other consequences. In addition, vaccines are believed to be means of implanting traceable microchips Ullah et al. However, some degree of agreement with conspiracy beliefs about vaccines would lead to a decline in immunization rates. Due to health threats, it is important to examine some correlates of conspiracy beliefs. Likewise, conspiratorial beliefs mediated the relationship between fear of COVID with high levels of existential anxiety, which decreased the intention to vaccinate against the disease Scrima et al. From the dual defense process model, it is suggested that when people experience fear they can deal with it by directly and rationally eliminating the negative stimulus; while, if fear activates more distant defenses, irrational and unrealistic beliefs can appear, such as conspiracies, which help people make sense of their fear Scrima et al. The latter is related to the idea that people who fear COVID the most tend to adopt conspiratorial beliefs to mitigate their fears and justify the uncertain situation Stephens, In addition, it has also been reported that A network analysis approach is a methodology that would allow a better understanding of the relationship between conspiracy beliefs and fear of COVID Traditionally, symptoms e. Network analysis has gained popularity in recent years as a method to explore, understand, and visualize mental health problems as a complex system where symptoms form interrelated networks Borsboom, ; Robinaugh et al. Therefore, in network analysis, symptoms are not considered to be results of an underlying mental health problem. Both the symptoms and their relationships are the problem McNally et al. Likewise, relationships between two symptoms may be stronger and more influential than others Mullarkey et al. From a therapeutic perspective, it is suggested that the more central and connected nodes in the network will generate greater changes in the entire network. It is expected that network analysis will allow the identification of those symptoms that are most important in the development of a mental health problem Zavlis et al. In network analysis, the strong interconnectedness between symptoms may mean that the relationships between them can be self-sustaining and continue to reinforce each other synergistically Borsboom, This feedback loop initiates and maintains mental health problems that can lead to a major crisis. In these models, the presence of negative beliefs or expectations, such as concern about COVID infection, leads to information seeking related to the severity of COVID and how to cope with it. This information can confuse people and create health threats. Identifying this type of misinformation can exacerbate concerns about the threat of COVID, leading people to find new fear-inducing information that increases their initial concerns Taylor, ; Taylor et al. Specifically, it seeks to: a identify the main nodes and the relationship between them; and b compare the networks among the participating countries. In addition, a recent study involving these countries indicated that Peru had the highest average score of conspiracy beliefs about COVID vaccines compared to Colombia, Ecuador, and Bolivia. On the other hand, the relevance of this study lies in the fact that, although research has been carried out, with network analysis, that has analyzed conspiracy beliefs about COVID e. Therefore, it is important to identify the most central nodes or symptoms that define a network and report them to participating countries so their sanitary authorities focus their interventions on these symptoms. Therefore, convincing people to get vaccinated against COVID is an important task to defeat the pandemic. For this, different governments need to know about the factors related to the decision of getting vaccinated, such as fear of COVID and anti-vaccine conspiracy theories. This information could be an important part of the actions of the governments of the participating countries to avoid further refusal of vaccination against COVID keeping the population safe during the current pandemic. A total of 1, residents of Ecuador, Peru, Bolivia, and Colombia participated, selected by snowball convenience sampling. The inclusion criteria were: 1 to be of legal age in each of the countries, 2 to be natural and live in one of the participating countries and 3 to provide informed consent to be part of the study. During the pandemic, snowball sampling has been widely used since it allows for a greater number of responses Roy et al. A Monte Carlo simulation method was used to determine the sample size a priori Constantin et al. Therefore, in the present study, the suggested number of participants was greatly exceeded. Table 1 presents the sociodemographic characteristics of the study samples. An Ad Hoc sociodemographic form was constructed for this study to collect information on gender male and female , age, marital status single, married, cohabiting, divorced, widowed , and educational level primary and secondary. All items were positively worded and completed on a five-options Likert scale, ranging from 1 strongly disagree to 5 strongly agree. The sum of the item scores results in a total score for each dimension, where higher scores indicate higher levels of emotional and physiological fear. It is a measure with adequate psychometric properties among Latin American countries, consisting of seven items, which have seven response alternatives ranging from 1 strongly disagree to 7 strongly agree. Thus, higher scores would indicate greater agreement with conspiracy beliefs. Data were collected simultaneously and with the same procedure in the four countries between September 15 and October 25, The questionnaire was sent to participants who met the inclusion criteria through different social media platforms. These participants then recommended other potential participants. After reading the objectives and giving their informed consent, the people participated voluntarily in the research. The study followed the ethical recommendations of the Declaration of Helsinki World Medical Association, and the protocol received the approval of the Ethics Committee of the Universidad Privada del Norte, with registration number 20,, All analyzes were performed with R software in its RStudio environment. The recommendations of Fried et al. In addition, the reporting recommendations for cross-sectional psychological networks were followed Burger et al. The four individually estimated networks were inserted into a list. The communalities of the nodes were estimated considering the sping-glass algorithm. Network stability analysis of the four networks was implemented with the bootnet 1. For such purposes, a nonparametric case-type bootstrapping based on resamples was used. The CS should not be less than 0. Network centrality is estimated based on node strength. However, a modified version is used assuming that nodes are weakly connected, which is referred to as bridging strength Bereznowski et al. The bridge strength is a product of the sum of the absolute values of the edges of a given node to all other nodes. The mgm 1. The NetworkComparisonTest 2. A seed set in was used. An omnibus test was performed to investigate whether all network edges are identical. The NCT works with a two-tailed permutation test, where the difference between groups is the product of performing repetitions, for each person, randomly regrouped. Both networks are equal when the significance is less than 0. The response rates of the items in each country are shown in Table 1. It can be seen that in the case of the conspiracy thinking test questions, alternative 4 Neither agree nor disagree tends to be frequently chosen, and in the case of the COVID fear test, there is a clear tendency towards low response alternatives, with the vast majority choosing alternative 1 Strongly disagree. These response patterns are frequent in all four countries. Figure 2 shows the four networks estimated jointly. The density of the network was 0. The mean absolute edge weights were 0. The spin-glass algorithm detected three communities in the four country networks. The first community is composed of conspiracy beliefs; the second and third of affective and physiological fear responses to COVID The intra-community connectivity is composed of consistent edges; whereas the inter-community connectivity, i. The centrality of the nodes is clearer in Bolivia. The lack of width of the confidence intervals around the edge weights indicates that the four networks are stable. The predictability analysis demonstrated that the item vcbs6 People are misled about the safety of COVID vaccines is the most predictable item in conspiracy beliefs average predictability equals The average predictability for Bolivia, Colombia, Ecuador, and Peru was Initially, the correlation coefficient for the edge weights was calculated. It is observed that between all pairs of comparisons between the different countries there is a relationship greater than 0. Furthermore, the p-values were in all cases greater than 0. In recent years, network analysis has been used to identify and analyze statistical relationships between different multivariate mental health data Borsboom et al. To the best of our knowledge, this study is the first to characterize COVID fear symptom networks and conspiracy beliefs about vaccines against the disease in the general population of a group of South American countries. In this regard, the interconnectedness between nodes was first identified. Network theory in mental health emphasizes symptom interconnectivity; therefore, stronger edge weights between symptoms were expected. However, in the present study, conspiracy beliefs are found to have little connection with fear clusters toward COVID in each of the countries. Also, when comparing the networks according to the country of residence of those evaluated, it was reported that, in general, the networks do not vary and the matrices are similar. However, there are also some important differences to mention. Although it would be expected that the high presence of symptoms of fear of COVID could lead people to compensate for their fear by believing in conspiracy ideas about COVID vaccines and, consequently, rejecting them, the results do not show this relationship. However, our findings may be useful to identify possible variables that could be mediating the relationship between the variables analyzed in this study. In this way, our findings could lead other researchers to generate evidence to explain the difference between what is reported in Latin American countries and countries in other contexts. This evidence could be used to develop policies favoring vaccination against COVID that are more contextualized to the Latin American region, characterized by social instability and economic recession during the pandemic. Thus, for example, the findings seem to suggest that both fear of COVID and conspiracy beliefs about vaccines may impact intentions to vaccinate independently and are not necessarily related in these Latin American countries. It appears that when people in Ecuador, Bolivia, Peru, and Colombia experience fear, they cope with it by directly and rationally eliminating the dangerous stimulus in this case, vaccination against COVID and without the need to activate more distal defenses, such as the presence of irrational beliefs Scrima et al. This is related to evidence that people in Latin America are hesitant to receive the COVID vaccine due to structural, attitudinal, and informational factors Bates et al. For example, in Colombia, people seem to be more afraid of hunger, unemployment, violence, or lack of education than of COVID infection Idrovo, In Peru, it has been reported that approximately All of these previous studies have reported relationships, either positive or negative, based on direct score correlations, however, the present study allows us to observe the true relationship between conspiracy beliefs and COVID fear symptoms from a regularized method such as network analysis. Vaccination programs that fail to consider the possible independence between conspiracy beliefs about vaccines and fear of COVID could exacerbate existing disparities for COVID vaccines rather than placate them. Also, to address the fact that people tend not to perceive COVID as a health risk, communication strategies that address misconceptions about vaccination may be necessary. In addition, to ensure compliance with COVID prevention behaviors by the general population and full vaccination against the disease, information campaigns should emphasize that the fight against COVID is not yet over. In general, the findings call for further studies that allow a better understanding of this relationship, which seems to be not entirely clear in these four countries. On the other hand, we sought to identify the central and most predictable nodes in the network. These symptoms may thus be likely candidates for triggering or maintaining the other symptoms of fear of COVID Regarding this, it has been shown that the unprecedented amount of real-time information about COVID that is available to individuals may generate greater fear about the consequences of the disease, in addition to other mental illnesses Gao et al. Indirect exposure to mass trauma through the media may increase initial rates of post-traumatic stress disorder symptoms and the formation of risk perceptions Choi et al. This finding also seems to suggest that, the content of COVID information in the media with which people interact is important for the generation of discomfort in having thoughts associated with fear of COVID It has been suggested that feeling uncomfortable is one of the most significant indicators of fear of COVID Barrios et al. This is visible in all the countries evaluated, but even more so in Bolivia, where it has been indicated that greater exposure to information about Covid in social networks was associated with a greater perception of risk and fear of the disease Zeballos et al. Future studies should analyze in more detail the use of the media during pandemic situations in all countries involved Wheaton et al. Some suggest that restrictions be placed on the duration and frequency of media use and that people be kept informed through official websites of health institutions to distinguish facts from rumors Bendau et al. The predictability analysis can be interpreted as the clinical relevance of the correlations between the nodes Ramos-Vera et al. A previous study that evaluated the FCV S through a network analysis did not perform a predictability analysis but did conclude that this same item is one of the most networked items in a sample of Peruvian adults Ramos-Vera, This finding would indicate that sleep problems due to concern about being infected with COVID could be a clinically important indicator to identify people at risk of developing COVID fear symptoms and also could probably be considered for psychological treatment of fear symptoms. Pre-pandemic studies have also suggested a high prevalence of sleep problems in the Latin American population Blanco et al. Another explanation for this finding is that when a person is afraid of catching COVID, there is brain stimulation and excitement that causes difficulty sleeping, as well as reduced physical and cognitive performance Siddique et al. In this context, it has been suggested that fear of COVID reduced life satisfaction and increased sleep disturbances through psychological distress Duong, In addition, according to cognitive-mediated theory, fear can generate stress symptoms, which lead to sleep quality problems Siddique et al. Although the study does not allow us to know exactly whether the fear of COVID generated sleep problems or whether the sleep problems generated the fears about COVID, it has been suggested that this relationship is probably bidirectional Alvaro et al. This belief about vaccines could trigger or maintain the other. Different pediatric societies have recommended vaccination of children aged 5 years and older, which should reassure the population and parents regarding fears about pediatric vaccines Gallegos, Morgan et al. However, there is still a large group of people who do not want to vaccinate children. Benin et al. It is possible that, in Ecuador, this relationship may be mediated by other variables such as the perception of control over vaccination against COVID, family support received, having children with up-to-date vaccinations, the age of the child, the time of exposure to information about vaccination against COVID, among others Fani et al. Thus, this belief is the one most closely associated with the other conspiracy beliefs and the one that would be an important indicator for identifying people at risk of believing in conspiracies about COVID vaccines. The efficacy and safety of COVID vaccines are due to side effects and doubts due to the perceived rush with which people believe vaccines were developed Wonodi et al. The success of novel vaccines, such as those developed against COVID, is based on ensuring their safety. As trials of COVID vaccines have progressed, so have various claims about their safety, many of which are false. While various national and international health institutions have tried to debunk these misleading claims, the time between the emergence of such information and its debunking, in addition to the limited reach they may have had, may have led to the emergence of populations vulnerable to doubts about COVID vaccines Islam et al. This finding provides further support for the suggestion that improved acceptance of the COVID vaccine will depend on the implementation of awareness campaigns and messages in the four countries evaluated that are supported by solid evidence of vaccine safety and efficacy Hussain et al. Although the study has important findings, it also has some limitations. First, the selection of participants was done by non-probabilistic snowball sampling, which does not allow for the generalization of the results. However, in some cases, it is difficult to employ probability sampling, so the use of non-probability sampling techniques is preferred Fricker Jr et al. Second, the number of participants is different in each country due to the sampling technique; therefore, it is recommended that future studies work with equivalent groups. Third, the results were based on general population samples in each of the participating countries, where there were people with low levels of fear of COVID and low belief in conspiracy ideas about vaccines. Future studies should analyze the association networks between these variables in people with higher degrees of acceptance of conspiracy beliefs about vaccines. Fourth, in all countries the majority of participants were women and young people; therefore, the findings should be interpreted with caution. Fifth, it is important to note that network analyses, within prospective studies such as the present study, suggest but do not determine causality. This does not make it clear whether the most central symptom was the cause of other symptoms or vice-versa or both. The presence of significant edges could suggest causal relationships, but it is necessary to use longitudinal designs to establish causality between variables. In this sense, the results of network analysis could be a source of hypotheses about complex causal relationships between variables, which can be evaluated more specifically with appropriate designs. This generated a retrospective assessment, which may have caused method bias. Seventh, it has not been verified whether the participants had a history of mental health problems, which could have interfered with the network findings. Eighth, the study used data derived from self-report measures. In the future, studies should analyze the relationships between different variables through structured clinical interviews, which can identify specific symptoms during the COVID pandemic. Despite the limitations, the study presents important strengths. First, rather than considering fear of COVID and conspiracy beliefs about COVID vaccines as unitary constructs, this study presents a more complex view of how the fear symptoms and conspiracy beliefs of people in four Latin American countries are related. Second, although the study has been conducted in the context of the COVID pandemic and four countries, its pattern of relationships is likely to be similar in non-pandemic contexts and other Latin American countries. Third, the study included a relatively large sample of people, which contributed to the precision, stability, and robustness of the network estimates. Previously, it has been indicated that the low stability of the network may be a result of the presence of small sample sizes Jiang et al. The present study is, to the best of our knowledge of current literature, the first to use network analysis to assess the relationships between conspiracy beliefs about COVID vaccines and COVID fear symptoms. 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Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author s or other rightsholder s ; author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions. Curr Psychol 43 , — Download citation. Received : 25 May Revised : 02 August Accepted : 05 August Published : 07 September Issue Date : April Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Current Psychology Aims and scope Submit manuscript. Download PDF. Psychological antecedents toward COVID vaccination explain the high rates of vaccine rejection among the Libyan population 2 years after starting vaccination campaigns Article 03 January Use our pre-submission checklist Avoid common mistakes on your manuscript. Method Participants A total of 1, residents of Ecuador, Peru, Bolivia, and Colombia participated, selected by snowball convenience sampling. Table 1 Sociodemographic characteristics of the four countries Full size table. Results Descriptive statistics The response rates of the items in each country are shown in Table 1. Response rates for both tests. Full size image. Networks according to the countries under study. Stability of the networks of the four countries considering centrality indices. Accuracy of the networks of the four countries. Table 2 Correlation and significance values of the pairs of compared networks Full size table. Discussion In recent years, network analysis has been used to identify and analyze statistical relationships between different multivariate mental health data Borsboom et al. Limitations and strengths Although the study has important findings, it also has some limitations. Conclusion The present study is, to the best of our knowledge of current literature, the first to use network analysis to assess the relationships between conspiracy beliefs about COVID vaccines and COVID fear symptoms. References Ahmed, W. Google Scholar Taylor, S. Funding No funding was received. View author publications. Declaration of competing interest The authors declare that they have no conflict of interest. Informed consent Informed consent was obtained from all individual participants included in the study. 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