Online Information as a Double-Edged Sword: A Multilevel Analysis of Vaccination Skepticism Based on ISSP 2021

This study examines the relationship between internet use and vaccine scepticism, focusing on the ambivalent role of digital information environments and digital health literacy (DHL). While the internet provides easy access to vaccination-related information, frequent internet use may also increase exposure to misinformation and disinformation. Accordingly, both positive and negative effects of internet-based information seeking are hypothesized. In contrast, higher levels of DHL are expected to reduce vaccine scepticism. The study also investigates the influence of healthcare system quality, measured through both subjective satisfaction with the healthcare system and an objective indicator of healthcare quality. The hypotheses are tested using data from the International Social Survey Programme (ISSP) 2021, employing multilevel logistic regression models based on N = 48,538 respondents. The results reveal a non-linear relationship between internet use and vaccine scepticism. Individuals without internet access as well as those who search very frequently for vaccination-related information online exhibit higher levels of scepticism. In addition, low DHL is consistently associated with greater vaccine scepticism, suggesting that the ability to critically evaluate online health information is as important as access itself. Furthermore, dissatisfaction with the healthcare system and lower national healthcare quality are linked to more sceptical attitudes toward vaccination. These findings highlight the internet as both an opportunity for health education and a potential source of misinformation. Public health strategies should therefore ensure equitable access to reliable vaccination information while strengthening digital health literacy and individuals' critical evaluation skills.