Assessing vaccine hesitancy and vaccine literacy in the European prison population: a multicenter repeated cross-sectional study

Abstract The study aimed to quantify vaccine hesitancy and vaccine literacy in prison populations and assess their correlation prior and after the implementation of training and information activities targeting PLP. A repeated cross-sectional observational study was conducted in 13 prisons of 4 European countries prior and after the implementation of a co-developed training package. The study sample included 847 people living in prison in the baseline round. The second round is currently ongoing. Through a structured questionnaire vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal history and socio-demographic characteristics of participants were assessed. Exploratory factor analysis was used to extract three independent components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; multiple linear regression was applied to assess the association between vaccine hesitancy and vaccine literacy and general health literacy. All analyses were adjusted for socio-demographic variables. In the baseline round, we identified three independent components of vaccine hesitancy explaining 49% of the total variance: Mistrust (proportion of the variance explained, 27%), Concern (14%) and Conspiracy (8%). All the components were associated with previous vaccine refusal (p-value <0.001) and presented very good internal consistency. Young participants presented the highest levels of vaccine hesitancy; migrants had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of academic education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were associated with general health literacy (all p-values <0.001).