The attitude-behavior gap in vaccine acceptance among medical students: A single‑center study

Objective: This study aimed to determine medical students’ level of knowledge regarding vaccines, assess the prevalence of vaccine hesitancy, and identify key factors influencing both attitudinal and behavioral acceptance. Methods: In this single‑center cross‑sectional study (April-May 2023), 305 medical students at Harran University completed a 37‑item interview‑administered questionnaire. Attitudinal and behavioral acceptance (complete acceptance/hesitancy/rejection) were assessed, and predictors of hesitancy were identified via decision‑tree analyses. Results: Of the participants, 47.2% did not know the infant/childhood vaccination schedule, while 30.5% and 36.7% reported having completed hepatitis B and varicella vaccines, respectively. Attitudinal complete acceptance was 82.0%, whereas behavioral complete acceptance was 9.2% with 69.5% hesitancy, indicating a pronounced attitude–behavior gap. Uptake of recommended vaccines was generally low (25.2-36.7%), highest for varicella (36.7%). Clinical phase students showed higher complete acceptance in both attitude and behavior (p<0.05); formal training on vaccines/immunization and COVID 19 related anxiety were associated with higher attitudinal acceptance (p<0.05 and p<0.01, respectively). Across vaccine types, the most common reason for non vaccination was “never recommended/reminded.” Decision tree models highlighted vaccine related knowledge, personal/family vaccination experiences, and media influences as major drivers of hesitancy. Conclusion: Findings underscore a substantial attitude–behavior gap alongside suboptimal uptake. Targeted strategies to bridge knowledge gaps and translate positive attitudes into actual vaccination behavior-particularly addressing knowledge/awareness, experiential factors, and the communication/media environment are essential for reducing hesitancy among future healthcare providers.