Vaccine hesitancy among Syrian refugees in Türkiye: Evaluation of psychological antecedents

Abstract Background Understanding vaccine hesitancy in migrant populations is essential due to increased health inequalities and barriers to vaccination access. The psychological model known as ‘5C’ identifies five key factors influencing vaccination behaviors: confidence (trust in vaccines), complacency (perceived necessity), constraints (barriers), calculation (weighing risks and benefits), and collective responsibility (willingness to protect others). This study aimed to assess vaccine hesitancy and associated factors among Syrian refugees accessing primary healthcare services in Türkiye. Methods A cross-sectional study was conducted between May-June 2022 among Syrian adults attending the Extended Migrant Health Center in Sultanbeyli, Istanbul. Participants completed a face-to-face survey including demographics, COVID-19 experiences, vaccination attitudes, and the 5C scale. Individuals with >20% missing data or aged under 18 were excluded. Of the 609 participants, 472 were included. Data were analyzed using nonparametric tests and Spearman correlations (R 4.3.2). Results Mean age was 33.3±10.6 years; 64.8% were female. 87.1% had lower income than expenses, 75.8% had children under 18, and 73.9% had chronic diseases. Influenza vaccination, COVID-19 vaccination, high perceived COVID-19 risk, and prior PCR testing were associated with higher total 5C scores (p < 0.05). Among the 5C domains, confidence scored highest. Chronic disease, pregnancy, and delays in child vaccination were linked to lower confidence. Higher education and better income correlated with greater confidence, calculation, and collective responsibility scores (p < 0.05). Conclusions Findings highlight relatively higher confidence compared to other 5C domains, but significant barriers, including both structural factors and psychological constraints, among Syrian refugees. Targeted interventions should aim to enhance trust, reduce barriers, and support informed vaccination decisions to promote equitable coverage. Key messages • Acceptance of vaccines was associated with higher overall 5C scores among Syrian refugees. • Vaccine confidence was the highest-scoring domain on the 5C scale among Syrian refugees, yet structural and psychological barriers must be addressed to improve equitable vaccine uptake.