Vaccine literacy among healthcare workers in a metropolis of China

Abstract Background Suboptimal vaccine uptake remains a public health concern in China. This study aimed to assess vaccine literacy and its associated factors among healthcare workers (HCWs) in an urban district of Shanghai, China. Methods A cross-sectional survey was conducted among HCWs in Shanghai during August–September 2025 using an online questionnaire. The questionnaire collected information on demographic characteristics and five dimensions of vaccine literacy: knowledge, ability, decision-making, specific vaccine, and recommendation literacy. Overall and dimension-specific vaccine literacy scores were calculated. Correlation analysis, multivariable linear regression, and cluster analysis were used to examine relationships among dimensions, identify factors associated with overall vaccine literacy, and characterize vaccine literacy profiles among HCWs, respectively. Results A total of 911 HCWs were included in the analysis. The mean standardized overall vaccine literacy score was 75.22 ± 11.72. Among the five dimensions, knowledge literacy scored highest, followed by ability literacy ( P < 0.001). In the fully adjusted model, higher overall vaccine literacy scores were associated with younger age, higher monthly income, working in public health positions, and child caregivers (all P < 0.05). Cluster analysis identified a higher-literacy cluster ( n = 550) and a lower-literacy cluster ( n = 361), with the lower-literacy cluster scoring significantly lower across all five dimensions (all P < 0.001). Positive correlations were observed among the five dimensions, with the strongest correlation between ability and recommendation literacy; however, the correlation between decision-making and recommendation literacy was weak. Conclusions The overall vaccine literacy among HCWs was favorable, while scores varied across different dimensions. Overall vaccine literacy was associated with age, position category, monthly income, and child caregiver status. Vaccine literacy appears to be a multidimensional construct with interrelated components. Interventions may prioritize HCWs with lower vaccine literacy and focus on decision-making and specific vaccine literacy. Potential strategies include targeted training in vaccine decision-making and risk communication, standardized information and decision-support tools, clear recommendation responsibilities, and rapid referral, appointment, and vaccination feedback.