Factors influencing vaccination willingness in the context of the COVID-19 pandemic: data from the CoCo-Fakt study

BACKGROUND: During the COVID-19 pandemic, the population's willingness to be vaccinated was a decisive factor in containing infections. International studies have identified that health literacy and sociodemographic characteristics play a significant role in vaccination decisions. This study investigated possible factors influencing vaccination willingness in Germany. METHODS: Data were collected from the CoCo-Fakt study, which used an online questionnaire to survey infected cases and contact persons from the health authorities in Cologne and Augsburg county. Sociodemographic data and information on chronic diseases, vaccination status, willingness to be vaccinated, and subjectively perceived health literacy via a modified HLS19-Q47 questionnaire were collected. A total of 9,705 people was included in the analysis. Factors associated with vaccination willingness were assessed using chi-squared-tests and t-tests, followed by binary logistic regression with backward elimination to identify independent associations. RESULTS: Of those surveyed, 91.6% had already been vaccinated against COVID-19 or were willing to be vaccinated, while 8.4% had refused. A higher willingness to be vaccinated was found among older people (OR = 1.02), infected individuals (OR = 1.98), individuals with chronic diseases (OR = 1.32), individuals with higher socioeconomic status (OR = 1.26), and those with high health literacy (OR = 1.28). By contrast, individuals with a migration background (OR = 0.39) and those with moderate health literacy (OR = 0.76) showed greater reluctance to be vaccinated. CONCLUSION: The results underscore the importance of individual and social factors for vaccination acceptance. Particularly vulnerable groups included younger adults, individuals with a migration background, and those with moderate health literacy. This highlights the need to tailor future vaccination campaigns to target specific groups, possibly through low-threshold, multilingual information services and targeted health literacy promotion.