Association of Health Literacy and Information Sources With COVID-19 Booster Vaccine Hesitancy in Japan: A Cohort Study

This study investigated the association of COVID-19 booster vaccine hesitancy with health literacy (HL) and the number of information sources used in Japan. Using data from a longitudinal survey of 6601 vaccinated participants, multivariable logistic regression was used to estimate adjusted odds ratios (AORs). Of the participants, 6.6% were hesitant toward the booster. Higher HL was associated with lower odds of hesitancy (AOR = 0.85, 95% CI = 0.77-0.94). Of its subscales, communicative (AOR = 0.86, 95% CI = 0.79-0.95) and critical (AOR = 0.90, 95% CI = 0.83-0.99) literacy were significantly associated with lower hesitancy, but functional literacy was not. Using more diverse information sources (>3 vs. ≤3) was also associated with lower hesitancy (AOR = 0.70, 95% CI = 0.57-0.87). Higher communicative and critical HL and the use of diverse information sources were associated with lower booster hesitancy. Enhancing these capabilities may be a key strategy for increasing vaccination rates.