The interplay of trust in science, e-health literacy, and misinformation in vaccine hesitancy

Abstract Background Comprehensive models of vaccine hesitancy (VH) determinants indicate complex interactions between many factors. Some studies have demonstrated that VH is strongly associated with conspiracy beliefs (CB). In turn, health literacy (HL) has been proposed as a factor that may ameliorate VH. The main aim of this study was to analyze the role of vaccine-related CB (VCB), susceptibility to misinformation (SUM), trust in science (TRS), HL, and e health literacy (eHL) in determining the level of VH. Methods The computer-assisted web-based interviewing survey was conducted in November 2024 on a sample of 2,200 adult Internet users in Poland. The multivariate linear regression model was developed for VH as a dependent variable. Independent variables included scores reflecting VCB (VCB), SUM, TRS, HL, and e-HL. The role of these predictors was adjusted for age, gender, education level, and Internet and social media use by respondents. Results VCB and SUM were significant positive predictors of VH (B, 95% CI: 0.44, 0.41-0.46, and 0.12, 0.09-0.15, respectively). EHL and TRS were negative predictors (B, 95% CI: -0.06, -0.11 - -0.02, and -0.21, -0.24 - -0.17, respectively). Furthermore, older respondents demonstrated a lower level of VH (B, 95% CI: -0.03, -0.04 - -0.01). The level of achieved education was also a negative predictor of VH (B, 95% CI for comparison between persons with lower than secondary education and those with university education: -0.97, -1.59 - -0.35). Unexpectedly, neither HL nor Internet or social media use was significantly related to VH in this model. Conclusions We have confirmed that variables reflecting the individual vulnerability to misinformation are significant positive predictors of VH. Higher levels of eHL and TRS were associated with lower levels of VH. Unexpectedly, the HL score was not significantly related to VH. Key messages • Vaccine hesitancy depends in a complex framework of interacting factors. • Conspiracy beliefs and susceptibility to misinformation increase vaccine hesitancy, e-health literacy and trust in science may decrease it.