Could e-health literacy and vaccine literacy help reduce vaccine hesitancy?

Abstract

This study aims to reveal the relationship between e-health literacy, vaccine literacy, and vaccine hesitancy. Method: This research is a cross-sectional survey study. The survey form consists of demographic characteristics, the e-health literacy scale, the vaccine literacy scale, and the vaccination hesitancy scale. The research was conducted on undergraduate students studying at public universities in İzmir, Türkiye, and participants were selected using a convenience sampling method. 389 valid questionnaires were obtained. The validity of the scales was evaluated using exploratory factor analysis, and their reliability and internal consistency were assessed using Cronbach's Alpha coefficient. The relationship between the scales and their sub-dimensions was examined using correlation and regression analysis. Results: It’s found that e-health literacy positively influences vaccine literacy and its two sub-dimensions. And e-health literacy increases the benefit and protective value of the vaccine, which is a sub-dimension of vaccine hesitance. Vaccine Literacy decreases vaccine hesitance, and its sub-dimensions, vaccine repugnance, and legitimization of vaccine hesitancy (p<0.05). Conclusion: E-health literacy increases vaccine literacy, and both reduce vaccine hesitancy. The positive impact of vaccine literacy on vaccine hesitancy is greater than e-health literacy. Increasing e-health literacy and vaccine literacy may be an effective strategy to combat vaccine hesitancy.

Keywords

• E-health literacy
• Vaccine hesitancy
• Vaccine literacy
• Undergraduate students.

Supporting Institution

Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Project Number

TÜBİTAK 2209-A University Students Research Projects Support Program, 1st term of 2023

Ethical Statement

Ethics committee permission for the research was obtained by the decision of the İzmir Bkırçay University Non-Interventional Clinical Research Ethics Committee dated 25.10.2023 and numbered 1267

Thanks

We would like to thank TÜBİTAK

E-SAĞLIK OKURYAZARLIĞI VE AŞI OKURYAZARLIĞI AŞI TEREDDÜDÜNÜ AZALTMAYA YARDIMCI OLABİLİR Mİ?

Abstract

Bu çalışma, e-sağlık okuryazarlığı, aşı okuryazarlığı ve aşı tereddüdü arasındaki ilişkiyi ortaya koymayı amaçlamaktadır. Yöntem: Bu araştırma, kesitsel bir anket çalışmasıdır. Anket formu, demografik özellikler, e-sağlık okuryazarlığı ölçeği, aşı okuryazarlığı ölçeği ve aşı tereddüdü ölçeğinden oluşmaktadır. Araştırma, Türkiye İzmir’de faaliyet gösteren kamu üniversitelerinde öğrenim gören lisans öğrencileri üzerinde yapılmış olup, katılımcılar kolay örnekleme yöntemiyle seçilmiştir. 389 geçerli anket elde edilmiştir. Ölçeklerin geçerliliği keşifsel faktör analizi ile, güvenilirlikleri ve iç tutarlılıkları ise Cronbach Alfa katsayısı ile değerlendirilmiştir. Ölçekler ve alt boyutları arasındaki ilişki korelasyon ve regresyon analizi ile incelenmiştir. E-sağlık okuryazarlığının aşı okuryazarlığını ve iki alt boyutunu olumlu yönde etkilediği bulunmuştur. Ayrıca, e-sağlık okuryazarlığı, aşı tereddüdünün bir alt boyutu olan aşının fayda ve koruyucu değerini artırmaktadır. Aşı okuryazarlığı ise aşı tereddüdünü ve aşı tereddüdünün alt boyutları olan, aşı isteksizliği ve aşı tereddüdünün meşrulaştırılmasını azaltmaktadır (p<0.05). E-sağlık okuryazarlığı, aşı okuryazarlığını artırmaktadır ve her ikisi de aşı tereddüdünü azaltmaktadır. Aşı okuryazarlığının aşı tereddüdü üzerindeki olumlu etkisi, e-sağlık okuryazarlığından daha büyüktür. E-sağlık okuryazarlığı ve aşı okuryazarlığının artması, aşı tereddüdüyle mücadelede etkili bir strateji olabilecektir.

Keywords

• E-sağlık okuryazarlığı
• Aşı tereddüdü
• Aşı okuryazarlığı
• Lisans öğrencileri.

Project Number

TÜBİTAK 2209-A University Students Research Projects Support Program, 1st term of 2023

References

1. Aharony, N., & Goldman, R. (2017). E-health literacy and the vaccination dilemma: An Israeli perspective. Information Research, 22(2). https://informationr.net/ir/22-2/paper751.html
2. Alan, Ş., Sünbül, F., & Güzel, Ş. (2018). The effect on Kilis healthcare of refugees. Journal of Health Management and Leadership, 1, 48–58. https://doi.org/10.35345/johmal.518977
3. Aslan, R., Yaltagil, E. I., Arslan, A., & Alim, A. (2023). The role of COVID-19 vaccine literacy in the effect of e-health literacy on vaccine attitude. Cumhuriyet Science Journal, 44(3), 474–484. https://doi.org/10.17776/csj.1310731
4. Badua, A. R., Caraquel, K. J., Cruz, M., & Narvaez, R. A. (2022). Vaccine literacy: A concept analysis. International Journal of Mental Health Nursing, 31(4), 857–867. https://doi.org/10.1111/inm.12988
5. Biasio, L. R. (2019). Vaccine literacy is undervalued. Human Vaccines & Immunotherapeutics, 15(11), 2552–2553. https://doi.org/10.1080/21645515.2019.1609850
6. Ceylan, S. S., Turan, T., & Erdoğan, Ç. (2022). Examination of the relationship between parents’ confidence in vaccinations and levels of vaccine e-health literacy. Kırşehir Ahi Evran University Journal of Health Sciences, 6(3), 154–164.
7. Conceição Silva, F., De Luca, P. M., & Lima-Junior, J. da C. (2023). Vaccine development against infectious diseases: State of the art, new insights, and future directions. Vaccines, 11(11), 1632. https://doi.org/10.3390/vaccines11111632
8. Dib, F., Mayaud, P., Chauvin, P., & Launay, O. (2022). Online mis/disinformation and vaccine hesitancy in the era of COVID-19: Why we need an eHealth literacy revolution. Human Vaccines & Immunotherapeutics, 18(1), 1–3. https://doi.org/10.1080/21645515.2021.1874218

9. Eskola, J., Duclos, P., Schuster, M., MacDonald, N. E., Liang, X., Chaudhuri, M., Dubé, E., Gellin, B., Goldstein, S., Larson, H., Manzo, M. L., Reingold, A., Tshering, K., Zhou, Y., Guirguis, S., & Hickler, B. (2015). How to deal with vaccine hesitancy? Vaccine, 33(34), 4215–4217. https://doi.org/10.1016/j.vaccine.2015.04.043
10. Freeman, B., Kelly, B., Baur, L., Chapman, K., Chapman, S., Gill, T., & King, L. (2014). Digital junk: Food and beverage marketing on Facebook. American Journal of Public Health, 104(12), e56–e64. https://doi.org/10.2105/AJPH.2014.302167
11. Gusar, I., Konjevoda, S., Babić, G., Hnatešen, D., Čebohin, M., Orlandini, R., & Dželalija, B. (2021). Pre-vaccination COVID-19 vaccine literacy in a Croatian adult population: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(13), 7073. https://doi.org/10.3390/ijerph18137073
12. Gust, D. A., Strine, T. W., Maurice, E., Smith, P., Yusuf, H., Wilkinson, M., Battaglia, M., Wright, R., & Schwartz, B. (2004). Underimmunization among children: Effects of vaccine safety concerns on immunization status. Pediatrics, 114(1), e16–e22. https://doi.org/10.1542/peds.114.1.e16
13. Kline, R. B. (2015). Principles and Practice of Structural Equation Modeling (4th ed.). The Guilford Press. https://doi.org/10.25336/csp29418
14. Krishnamoorthy, Y., Kannusamy, S., Sarveswaran, G., Majella, M. G., Sarkar, S., & Narayanan, V. (2019). Factors related to vaccine hesitancy during the implementation of Measles-Rubella campaign 2017 in rural Puducherry: A mixed-method study. Journal of Family Medicine and Primary Care, 8(12), 3962–3970.
15. Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M. D., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150–2159. https://doi.org/10.1016/j.vaccine.2014.01.081
16. MacDonald, N. E., Eskola, J., Liang, X., Chaudhuri, M., Dubé, E., Gellin, B., Goldstein, S., Larson, H., Manzo, M. L., Reingold, A., Tshering, K., Zhou, Y., Duclos, P., Guirguis, S., Hickler, B., & Schuster, M. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036
17. McClure, C. C., Cataldi, J. R., & O’Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003
18. Michel, J.-P., & Goldberg, J. (2020). Public health literacy in the face of the COVID-19 pandemic emergency. Salud Pública de México, 62(3), 698–701. https://doi.org/10.21149/11408
19. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.
20. Nuwarda, R. F., Ramzan, I., Weekes, L., & Kayser, V. (2022). Vaccine hesitancy: Contemporary issues and historical background. Vaccines, 10(10), 1595. https://doi.org/10.3390/vaccines10101595
21. Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981–1988. https://doi.org/10.1056/NEJMsa0806477
22. Özceylan, G., Toprak, D., & Esen, E. S. (2020). Vaccine rejection and hesitation in Turkey. Human Vaccines & Immunotherapeutics, 16(5), 1034–1039. https://doi.org/10.1080/21645515.2020.1717182
23. Ratzan, S. C. (2011). Vaccine literacy: A new shot for advancing health. Journal of Health Communication, 16(3), 227–229. https://doi.org/10.1080/10810730.2011.561726
24. Salali, G. D., & Uysal, M. S. (2022). COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychological Medicine, 52(15), 3750–3752. https://doi.org/10.1017/S0033291720004067
25. Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9(2), 160. https://doi.org/10.3390/vaccines9020160
26. Salmon, D. A., Dudley, M. Z., Glanz, J. M., & Omer, S. B. (2015). Vaccine hesitancy: Causes, consequences, and a call to action. Vaccine, 33, D66–D71. https://doi.org/10.1016/j.vaccine.2015.09.035
27. Sekaran, U., & Bougie, R. (2016). Research methods for business: A skill-building approach (7th ed.). Wiley.
28. Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23–74.
29. Suarez-Lledo, V., & Alvarez-Galvez, J. (2021). Prevalence of health misinformation on social media: Systematic review. Journal of Medical Internet Research, 23(1), e17187. https://doi.org/10.2196/17187
30. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson.
31. Troiano, G., & Nardi, A. (2021). Vaccine hesitancy in the era of COVID-19. Public Health, 194, 245–251. https://doi.org/10.1016/j.puhe.2021.02.025
32. Wang, X., Zhou, X., Leesa, L., & Mantwill, S. (2018). The effect of vaccine literacy on parental trust and intention to vaccinate after a major vaccine scandal. Journal of Health Communication, 23(5), 413–421. https://doi.org/10.1080/10810730.2018.1455771
33. Wheaton, B., Muthén, B., Alwin, D. F., & Summers, G. F. (1977). Assessing reliability and stability in panel models. Sociological Methodology, 8, 84–136. https://doi.org/10.2307/270754
34. World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
35. World Health Organization. (2020). Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. https://www.who.int/news-room/questions-and-answers/item/herd-immunity-lockdowns-and-covid-19
36. World Health Organization. (2025). Vaccines and immunization. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
37. World Health Organization. (2026). Stronger together - milestones that mattered in 2025. https://www.who.int/news-room/spotlight/stronger-together-milestones-that-mattered-in-2025
38. Wiysonge, C. S., Ndwandwe, D., Ryan, J., Jaca, A., Batouré, O., Anya, B. P. M., & Cooper, S. (2022). Vaccine hesitancy in the era of COVID-19: Could lessons from the past help in divining the future? Human Vaccines & Immunotherapeutics, 18(1), 1–3. https://doi.org/10.1080/21645515.2021.1893062
39. Zhang, E., Dai, Z., Wang, S., Wang, X., Zhang, X., & Fang, Q. (2023). Vaccine literacy and vaccination: A systematic review. International Journal of Public Health, 68, 1605606. https://doi.org/10.3389/ijph.2023.1605606
40. Zhang, F., Or, P. P. L., & Chung, J. W. Y. (2020). The effects of health literacy in influenza vaccination competencies among community-dwelling older adults in Hong Kong. BMC Geriatrics, 20, 1–7. https://doi.org/10.1186/s12877-020-1504-5