Health literacy and vaccination attitudes among parents from different ethnic groups: a health belief model approach

INTRODUCTION: Health literacy is a key determinant of health behaviours, including vaccination. Despite the proven benefits of immunization, vaccine hesitancy remains a global challenge, shaped by cultural, social, and individual factors. The aim of this study was to investigate the relationship between parents' health literacy and vaccine attitudes according to the health belief model among different ethnic groups. This study is expected to highlight the role of cultural differences in achieving public health objectives, while also contributing to improved health literacy and the development of more inclusive policies in child health and immunization. METHODS: This descriptive cross-sectional study was conducted with 908 parents (Turkish: 249; Kurdish: 217; Arab: 245; Assyrian: 197) living in Mardin, Turkey, between January and July 2025. Data were collected through face-to-face interviews using a sociodemographic form, the Public Attitude Towards Vaccination Scale-Health Belief Model, and the Turkey Health Literacy Scale-32. Data were analysed using descriptive statistics, chi-square tests, one-way ANOVA, and generalized linear model analyses. RESULTS: Health literacy and vaccination attitudes differed significantly according to ethnic group (p< .001). Arab parents had the lowest general health literacy scores and the most negative vaccination attitudes, including the highest perceived barriers to vaccination (24.04 ± 3.98). In contrast, Assyrian parents had the highest scores for sensitivity and severity, awareness of importance, belief in vaccine benefits, and health responsibility. Higher health literacy was positively associated with more favourable vaccination attitudes among Turkish, Kurdish, and Assyrian parents. However, among Arab parents, higher health literacy was associated with lower awareness of importance, lower belief in vaccine benefits, lower health responsibility, and greater perceived barriers. Significant interaction effects between ethnicity and health literacy were found for awareness of importance, belief in vaccine benefits, and health responsibility. CONCLUSION: Health literacy is an important factor influencing vaccination attitudes, but its effect varies according to ethnic background and cultural context. In some groups, higher health literacy supports more positive vaccination attitudes, whereas in others it may not lead to greater vaccine acceptance. Public health interventions should therefore use culturally sensitive and trust-based approaches to improve vaccination attitudes among diverse populations.