Hesitant Minds in Vulnerable Times: COVID-19 Vaccine Hesitancy Among University Students in Ukraine

Round 1

Reviewer 1 Report

The article requires significant changes related to the review of the literature, the formulation of research hypotheses, a more detailed description of the research tool and its validation. It is also necessary to reconsider the description of the sample. The limitations of the study need to be expanded, related to the research technique, sample, etc. It is essential to work on the conclusions of the study.

no

 

Author Response

 

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The paper addresses COVID-19 vaccine hesitancy in Ukraine, a country deeply affected by political instability and war. Focusing on university students—a typically underexamined but important group—adds value to global health communication discourse. There are some major strengths. For example, the application of the validated 5Cs framework (Confidence, Complacency, Constraints, Calculation, Collective Responsibility) provides a strong psychological basis and aligns with current best practices in vaccine hesitancy research. The use of multinomial logistic regression and multivariate analysis adds empirical rigor. 

But there are some major issues to be addressed.

1. More discussions on the specific Ukraine situation and its contribution to the results is beneficial for theoretical contribution. What might be the unique pattern of Ukraine and what was the impacts from the ongoing war (and perhaps the Russian information war) ?

2. Complacency findings lack clarity. The finding that greater complacency reduced the likelihood of resistance (contrary to expectations) is not adequately explained. The authors suggest that this reflects indecision or ambivalence, but this interpretation is speculative and underdeveloped. Suggestion: Provide theoretical or empirical support (e.g., dual-process models of decision-making or indecisive vaccine attitudes) to strengthen this interpretation.

3. Calculation construct was weakly explained. Calculation showed low explanatory power (R² = 3%) and did not significantly predict vaccination behavior, yet is not critically discussed in the manuscript. Suggestion: Either justify the limited value of this construct in the Ukrainian context or re-evaluate its measurement.

3. Sociodemographic Insights were underexplored. While gender was found to influence confidence and calculation, the broader implications (e.g., cultural expectations, risk perceptions among male students) are not thoroughly explored. Suggestion: Expand discussion of gender effects and possible implications for targeted messaging strategies.

4. Limitations need expansion. The limitations section is rather brief. For example, the impact of online survey bias, potential selection bias due to non-response, and cross-sectional design implications for causality deserve further elaboration. Suggestion: Add discussion of how digital-only data collection may have excluded certain student populations or influenced self-selection effects.

5. Conspiracy mentality could be better and more accurately discussed. The term "conspiracy mentality" is broadly used, but different conspiracies may have different psychological profiles and impacts. 

• The manuscript would benefit from light copyediting for grammar and stylistic clarity.

• Please clarify if the 5Cs scale was adapted linguistically or culturally for Ukraine.

• Ensure all URLs in the references (e.g., OSF links) are properly formatted and accessible.

• Abstract line numbers (e.g., “line 2, 3, 4…”) should be removed in the final typeset version.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I would suggest adding some more literature regarding conspiracy theories on vaccination and its negative impact on health.

An analysis of the relationship between the chosen field of study (especially those studing medical related program care versus others) and attitudes towards vaccination would have been useful.
Overall, the balance between the description of the results of the study and the discussion of the results is somewhat skewed. Perhaps some of the material needs to be moved.  
In the head of Table 1, Covid-19 status needs to be replaced by Covid-19 attitude to vaccination
Are the means in the three separate groups in this table statistically significantly different (there is no information on this)

 

In the head of Table 1, Covid-19 status needs to be replaced by Covid-19 attitude to vaccination
Are the means in the three separate groups in this table statistically significantly different (there is no information on this)?

 

Reviewer 2 Report

I think the authors have largely solved my concerns in the first round of review. I recommend the publication of this paper. 

Basically, I am okay with the paper.