Relationship Between Parental Vaccine Hesitancy and Health Locus of Control: A Structural Equation Modeling Study

Parental vaccine hesitancy (pVH) remains a major public health concern. While sociodemographic and trust-related factors are well studied, the role of parental health locus of control (PHLOC) is less known. This study examined the association between PHLOC dimensions and pVH in Italian parents. This secondary analysis of a cross-sectional online survey (Italy, October 2024-February 2025) included 308 parents of children aged 0-18 years, recruited via social media using snowball sampling. Participants were mostly female (79.6%), with a mean age of 43.6 years (SD = 8.5). pVH was assessed with the PACV-5 and PHLOC across six dimensions (Parent, Child, Professionals, Media, Fate, Divine). Bayesian structural equation modeling (SEM) estimated associations between PHLOC and pVH, adjusting for age, sex, education, civil status, living context, and healthcare professional status. pVH prevalence was 12.99%. In the fully adjusted model, greater perceived influence of healthcare professionals was associated with lower pVH (β = -0.28, 95% CrI [-0.47, -0.09]). Higher educational attainment was also inversely associated with pVH (β = -0.28, 95% CrI [-0.39, -0.16]). Other PHLOC dimensions were not credibly associated with pVH. The model explained 27% of the variance in pVH. Beliefs regarding the influence of healthcare professionals, along with educational attainment, appear to play a central role in shaping parental vaccine hesitancy. Strengthening trust in healthcare providers and tailoring communication strategies for parents with lower educational levels may represent key targets for interventions aimed at improving vaccine confidence. The study was registered on the Open Science Framework (10.17605/OSF.IO/6SVQX).