Search Results (155)

Background: C scales are important measures that can support the vaccination process by analysing the possible reasons for vaccination hesitancy. In some studies, it is not possible to utilise typical models based on the traditional 3C–7C scales, but it is possible to adjust them by using modified proxy measures and converting individual determinants into variables of similar significance in the logistic regression analysis of a vaccination behavioural model. Objective: The aim of this study was to compare the relationship between determinants defining a vaccination behaviour model based on the classic 3C, 5C, and 7C scales with modified proxy measures and two variables (low vaccine-related fear instead of complacency and exposure to misinformation-prone digital sources instead of conspiracy) and the dependent variable, namely, the vaccination status of patients of primary care centres in Poland from 2024 to 2025. Methods: A cross-sectional study was conducted using a survey and questionnaire data linked with patient records from three Polish health centres (N = 1206, 46.9% rural residents and 53.1% city residents). Demographic data and determinants of three vaccination behaviour models were compared between vaccinated and non-vaccinated patients using Pearson’s χ² test, while behavioural models based on the 3C, 5C, and 7C scales describing the relationship between independent variables and vaccination status (dependent variable) were prepared using logistic regression. Two of seven determinants were changed. Results: All determinants used in the three logistic regression behavioural models differed significantly between vaccinated and non-vaccinated patients (p < 0.001). Furthermore, independent variables in each behavioural model were significantly related to the dependent variable (p < 0.001). With an increasing number of model determinants, Nagelkerke’s R² increased from 0.303 to 0.435 and the ROC-AUC from 0.828 to 0.882. However, the VIF value indicated very low multicollinearity of determinants. The Wald test did not reveal a significant relationship between confidence in public health and the dependent variable (p > 0.05, OR 1.17–0.92 for Models 1 and 3, respectively). Conclusions: In the vaccination behavioural models prepared based on empirical data, all determinants were found to be significantly related to the dependent variable. As the number of independent variables in the behavioural model increased, parameters such as the ROC-AUC and Nagelkerke’s R² also increased, while the Akaike information criterion, which determines the balance between fitting the model to data and its complexity, decreased. No significant individual relationship was found for the determinant “confidence in public health”, but this result confirms observations from other previous studies describing the impact of pandemic fatigue, misinformation, and conflicting expert information on institutional trust. Full article

Background: Vaccine hesitancy is a global challenge affecting workplaces and academic institutions. Despite efforts, low vaccination rates persist in South Africa, increasing the risks associated with pathogen exposure. This study assessed the knowledge, attitudes, and perceptions (KAPs) of healthcare workers (HCWs) and students at a Nursing College regarding voluntary and mandatory COVID-19 vaccination. Methods: A quantitative cross-sectional study was conducted using a structured, self-administered electronic questionnaire. All eligible nursing students and staff at the participating Nursing College were invited to participate. Of the 504 eligible individuals, 372 completed the questionnaire, corresponding to a response rate of 73.8%. Data were analyzed using IBM SPSS Statistics version 30.0. Logistic regression and Mann–Whitney U tests were used to assess associations and differences between groups, with statistical significance set at p < 0.05. Results: Most respondents were female (302, 81.0%) and single (252, 67.9%). The age group 26 to 40 was most prominent (144, 38.8%). Only 42.2% of respondents (n = 157) were fully immunized with no boosters. Student nurses dominated (344, 92.5%), with 226 (60.9%) having no COVID-19 infections and 198 (72.0%) voluntarily receiving the vaccine. Occupation (p = 0.030) and age group (p = 0.027) were independently associated with reporting voluntary COVID-19 vaccination. Age was also associated with respondents’ attitudes and perceptions of the COVID-19 vaccine (p < 0.001) as well as their understanding of the vaccine (p = 0.002). Conclusions: Occupation and age group were independently associated with the reported basis on which COVID-19 vaccination was received (voluntary versus mandatory). Targeted communication and educational strategies addressing these factors may improve vaccine acceptance and preparedness for future outbreaks. Full article

Disaster governance in the Guangdong–Hong Kong–Macao Greater Bay Area (GBA) spans multiple administrative regions, institutions, and platforms, and hazards such as typhoons, storm surges, and urban waterlogging generate strong cross-boundary spillovers that no single city can manage alone. To explain the persistent problems of stakeholder hesitation, underinvestment, and free-riding, this study treats collaborative disaster governance as a multi-actor system and develops a tripartite evolutionary game model linking the regional coordinating regulatory authorities, local emergency management actors, and social participation actors. Static, linear dynamic, and nonlinear dynamic reward–punishment regimes are embedded into the payoff matrix and examined through stability analysis and numerical simulation. The results show that, without incentives, the system settles into an imbalanced “regulatory authorities-driven, weak collaboration” equilibrium; static mechanisms improve targeted behavior but erode the regulatory authorities’ willingness to lead; and linear dynamic mechanisms induce strategy oscillations in cross-regional settings. Under a parameter-adjusted nonlinear dynamic mechanism that combines incremental incentives with progressive constraints, the tested system converges toward “active leadership–proactive collaboration–active participation” under the assumed cost, benefit, and initial-condition settings. These findings provide a basis for designing differentiated subsidies, performance-based rewards, and liability recovery in GBA disaster governance. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Background: Vaccine hesitancy has traditionally been understood as a multifactorial phenomenon shaped by individual beliefs, risk perceptions, and access barriers. However, the COVID-19 pandemic has fundamentally transformed the relationship between citizens, science, and public institutions, raising the question of whether vaccine hesitancy has evolved into a broader form of institutional distrust. Objective: This narrative review synthesizes evidence on vaccine confidence, trust dynamics, misinformation, and post-pandemic attitudes to propose a new conceptual framework, i.e., institutional hesitancy, that reframes vaccine acceptance within the wider context of institutional credibility, transparency, and legitimacy. Methods: We conducted a narrative synthesis of peer-reviewed literature, surveillance reports, and cross-national surveys published between 2015 and 2026, focusing on trust in science, governments, public health agencies, healthcare systems, and regulatory authorities as determinants of vaccination behavior. Results: The evidence consistently demonstrates that institutional trust is among the strongest predictors of vaccine acceptance, often surpassing traditional demographic and knowledge-based variables. The pandemic exposed and amplified pre-existing fractures in the relationship between citizens and institutions, creating a legacy of institutional skepticism that extends beyond COVID-19 vaccines to routine immunization programs, seasonal vaccination campaigns, and future pandemic preparedness. Traditional information-based approaches, which assume that knowledge deficits drive hesitancy, have proven insufficient when trust is compromised. Instead, rebuilding vaccine confidence requires sustained investment in institutional transparency, community engagement, and accountable governance. Conclusions: The post-pandemic era calls for a fundamental reconceptualization of vaccine hesitancy. We propose the institutional hesitancy framework as a complementary lens that shifts the analytical focus from individual knowledge deficits to relational dynamics between citizens and institutions. Addressing this challenge requires moving beyond communication campaigns toward long-term strategies that restore institutional trust and strengthen the resilience of public health systems. Full article

Background/Objectives: Large language models (LLMs) are increasingly used by the public to seek health information, yet their accuracy in addressing common vaccine myths remains unclear. Sycophantic LLM behavior, where models align with rather than correct user-stated beliefs, poses specific risks in health contexts. Methods: We conducted an exploratory multi-vendor evaluation of three LLMs (GPT-5, Gemini 2.5 Flash, Claude Sonnet 4) using officially curated vaccination myths from Germany’s public health institution and two realistic user framings (curious skeptic, convinced believer). All model responses were independently evaluated by two blinded medical experts for misconception addressal (binary criterion applied to the response text), scientific accuracy, and communication clarity (5-point Likert scales). Additionally, blinded marketing experts ranked models for lay communication clarity. Flesch Reading Ease scores were computed for all outputs. Results: Across all myths, framings, and models (66 response items), both medical raters judged that all responses refuted the targeted misconception; no response affirmed or ignored a myth, including under the adversarial convinced believer framing. Scientific accuracy and clarity ratings were high and tightly clustered (median 4.0–4.5), with no combined score below 3 and substantial inter-rater agreement. Marketing experts independently ranked Gemini 2.5 Flash and GPT-5 highest for lay clarity. Readability analysis revealed generally low accessibility, particularly for the convinced believer framing and for Claude Sonnet 4 outputs. Conclusions: Our findings suggest that general-purpose LLMs can produce scientifically accurate, on-topic rebuttals to widely documented vaccine myths under realistic default conditions, although linguistic complexity and framing-sensitive style may limit accessibility. Whether such outputs change beliefs or behavior in hesitant individuals was not tested. With readability optimization, these outputs could serve as building blocks for myth-debunking tools, given prospective evaluation with behavioral endpoints. Full article

Background: Vaccine hesitancy remains a major global public health challenge despite high immunization coverage. While concerns about adverse events following immunization (AEFI) are widely recognized, limited attention has been paid to caregivers’ ability to distinguish vaccine-related adverse reactions from coincidental illnesses, as well as to the associations of compensation awareness and institutional trust with vaccination decisions. Methods: A cross-sectional survey was conducted between January and March 2025 among 3497 caregivers of children aged 0–6 years using multistage random sampling. Data were collected on AEFI knowledge (including understanding of coincidental illnesses), compensation mechanism awareness, institutional trust, and vaccination behaviors. Vaccine hesitancy was assessed using a self-reported measure and the WHO SAGE Vaccine Hesitancy Scale (VHS). Multivariable linear regression models were used to estimate factors associated with hesitancy scores. Results: The prevalence of vaccine hesitancy was 8.6%, with a mean VHS score of 23.2 ± 4.2. Although general awareness of AEFI reached 90.0%, correct understanding of coincidental illnesses was only 25.7%. Higher AEFI knowledge and compensation awareness were associated with lower hesitancy scores, whereas distrust in compensation mechanisms and perceived vaccine unsafety were associated with higher hesitancy. Coverage of national immunization program (NIP) vaccines exceeded 90%, while uptake of self-paid vaccines varied from 46.7% to 89.7%. Conclusions: Vaccine hesitancy among caregivers was associated with cognitive understanding, economic considerations, and institutional trust. Limited understanding of coincidental illnesses may be associated with increased concerns about vaccine safety, while compensation awareness and institutional trust were associated with lower levels of vaccine hesitancy. Strengthening communication on AEFI causality and improving transparency of compensation policies may help reduce vaccine hesitancy and support immunization programs in settings with mixed public–private financing systems. Full article

Introduction: Streptococcus pneumoniae severely affects adults over 65, especially those with comorbidities. Since vaccination coverage among healthcare workers (HCWs) is unknown despite free availability, this study evaluates knowledge, behaviours, hesitancy and accessibility among employees of an Italian hospital. Methods: A prospective cross-sectional survey was administered via “SurveyMonkey.” From February 22 to June 15, 2024, healthcare and administrative staff aged ≥ 18 at the Fondazione Policlinico Universitario Gemelli were recruited by email. Descriptive and inferential analyses used Stata 16.1. Results: Among HCWs, 72% are women, with an average age of 48. Pneumococcal vaccination coverage is 20%, with 82.7% vaccinated in-hospital. Preferred information sources include courses, webinars, and institutional websites. For management staff, vaccine safety and effectiveness were significant determinants. Among administrative employees, 65% are women (average age 51); 19% are vaccinated, 24% are unsure, and 43% prefer in-hospital vaccination. Physicians cited trust in vaccines (25.3%) and self-protection (23.2%) as key motivators, compared with 12.4% among nursing, technical and rehabilitative staff. Recommendation to family members was higher among medical and specialist professionals (90%) than in other groups (77% in nursing/technical/rehabilitative; <50% in assistants and auxiliary staff). About half of the groups rated their knowledge at level 2 (scale 1–4). Multivariable regression analysis showed that medical professionals and specialists exhibited a higher perception of the importance and safety of vaccines compared with other categories. Conclusions: HCWs showed greater knowledge of pneumococcal vaccination, while administrative staff had lower awareness and more hesitancy. Both groups preferred in-hospital vaccination and expressed interest in structured educational initiatives. Full article

Background/Objectives: Healthcare workers play a critical role in vaccination programs, yet vaccine hesitancy has been widely reported even among this group during the Coronavirus disease 2019 (COVID-19) pandemic. Previous studies have primarily focused on identifying factors associated with vaccine acceptance, offering limited insight into the processes underlying decision-making. This study aimed to synthesize qualitative studies on healthcare workers’ COVID-19 vaccination experiences to develop a comprehensive understanding of their decision-making processes. Methods: A qualitative meta-synthesis was conducted using the thematic synthesis approach proposed by Thomas and Harden. Electronic databases including PubMed, Embase, and CINAHL were searched for qualitative studies published up to February 2026. Thirteen studies were included following PRISMA guidelines. Data were analyzed through line-by-line coding, followed by the development of descriptive and analytical themes. Results: Four analytical themes were identified: (1) vaccination as a dynamic risk–benefit negotiation process, (2) trust as a central mechanism shaping information interpretation, (3) socially embedded and relationally negotiated decision-making, and (4) moral identity as a driver of vaccination behavior. Healthcare workers’ vaccination decision-making was not a static choice but an evolving process shaped by continuous appraisal of risks and benefits, filtered through trust in information and institutions, influenced by social interactions, and guided by professional identity and ethical responsibility. Conclusions: Healthcare workers’ vaccination decision-making is a multidimensional process embedded in cognitive, social, and ethical contexts. Interventions should move beyond individual-level approaches and instead focus on building trust, leveraging social networks, and reinforcing professional identity with implications for future public health crises. Full article

This article reexamines Liang Fa’s Riji Yanxing (Record of Words and Deeds, 1830) from the perspective of narrative structure rather than solely as a historical missionary document. Previous scholarship has shown that the diary was produced within the institutional framework of the London Missionary Society and functioned primarily as a record of early Protestant evangelization in China. Building on these studies, this article argues that the diary simultaneously records missionary work and narrates the formation of Christian faith. Through close readings of Liang Fa’s reflections, prayers, and recorded dialogues with potential converts, the study demonstrates how an institutional testimonial text develops a narrative configuration shaped by Christian theology. Within this framework, missionary responsibility, anxiety over divine judgment, and reflections on death and salvation form recurring cycles of crisis, repentance, and renewed commitment. Dialogues with potential converts further dramatize this theological logic by transforming doctrinal arguments into scenes of spiritual confrontation and hesitation. Although Riji Yanxing was not originally composed as a literary work, it reveals the emergence of a new mode of Christian narrative in Chinese writing. The diary thus illustrates how Christian concepts of sin, redemption, and judgment reshaped narrative consciousness in early nineteenth-century China. Full article

This study investigates the effect of green innovation on environmental performance and the moderating role of ownership structure. A generalized method of moments regression approach was applied to a sample of 68 firms operating in the United Arab Emirates (UAE), observed from 2012 to 2024. The results indicate a significant and positive relationship between green innovation and environmental performance. In addition, institutional and state ownership strengthen this relationship. Splitting the sample according to key UAE characteristics (firms listed on the Abu Dhabi Securities Exchange versus the Dubai Financial Market, and the pre-UAE Vision versus post-UAE Vision period) as well as economic conditions (COVID-19) provides further interesting results. Our findings remain robust across alternative estimation methods. The results show significant differences in how ownership structures moderate green innovation effectiveness across the two markets. We also find that green innovation’s effectiveness on environmental performance significantly intensifies after the UAE Vision’s announcement. Our findings also indicate that the positive impact of green innovation on environmental performance becomes more pronounced in the post-COVID period. This paper provides an in-depth assessment of the role of sustainable tools (particularly green innovation) in enhancing environmental performance in the United Arab Emirates. It offers valuable insights for board members, CEOs, regulators, and policymakers who remain undecided or hesitant about implementing sustainability-oriented practices. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic presented significant psychosocial challenges to intensive care unit health care workers (ICU HCW). Prior studies typically used single cross-sectional samples to focus on elements of burnout and psychological stress. We sought to serially assess quality of life and willingness to work before, during, and after the first peak of COVID-19. Methods: Two survey instruments were prospectively administered at regular intervals to multidisciplinary ICU HCWs, initiating at the local onset of COVID-19 and ending 6 months after the first peak ICU census of COVID-19 patients. Results: ICU HCWs reported high levels of compassion satisfaction, burnout, and secondary traumatic stress before, during and after the first peak of COVID-19. Motivation to work declined, and hesitation to work increased from study initiation to the peak ICU census of COVID-19 patients. Hesitation to work was greater in female HCWs and cardiothoracic ICU HCWs. Motivation to work was higher in those working in operating rooms compared to those in the ICU. Concerns about becoming infected, feelings of isolation, and exhaustion were associated with high hesitation to work. Feeling protected by the government and hospital was associated with decreased hesitation and increased motivation to work. Conclusions: ICU HCWs experienced high levels of stress throughout the first year of COVID-19, while satisfaction with work remained high. Willingness to work was associated with gender, work location, ICU subtype, concerns about infection risk, feelings of exhaustion, and feelings of institutional protection. Because the study methodology precludes causal inference and low survey response rates indicate that findings should be interpreted with caution, these results are best viewed as hypothesis-generating for future work aimed at improving stress mitigation in ICU HCWs. Full article

The rapid rise in generative AI (GenAI) in higher education creates a tension between institutional goals for AI literacy and everyday classroom practice: while universities increasingly call for ethical and skills-focused engagement, faculty adoption is uneven and often constrained by uncertainty. To examine this gap, we combined campus-wide attitude surveys, a longitudinal content analysis of 1716 syllabi, and a review of publicly available GenAI assignment collections. Results revealed a persistent implementation gap: although sustained professional development was associated with shifts in faculty perspectives, a majority of course-level policies remained prohibitive or punitive and were not aligned with stated institutional aims. While consistent professional development has helped faculty accept the need for GenAI literacy, most individual faculty policies remain prohibitive, at odds with both the institutional push for transparency in GenAI literacy and the faculty’s stated stance toward the need for teaching GenAI skills. Our analysis of publicly available GenAI-themed assignments demonstrated that engaging students with GenAI can take various shapes depending on instructor and course goals. This work positions AI-themed assignments as a practical solution to faculty reluctance, providing a promising pathway for hesitant educators to integrate AI literacy into their courses and meet the evolving needs of their students. Full article

COVID-19 vaccine hesitancy is well documented, but less is known about booster hesitancy among fully vaccinated adults. A qualitative approach was employed to identify factors affecting COVID-19 booster hesitancy using diffusion of innovation (DoI) theory. The study was conducted in Philadelphia, Pennsylvania. In-depth interviews (n = 30) were done with adults, including those who had (n = 9) and had not (n = 21) been boosted. Participants were categorized into DoI adopter groups or a “refuser” group for those with no intention of getting boosted. Transcripts were analyzed using an iterative coding process with consensus and triangulation to develop thematic categories. Participants had a mean age of 41 and were 63.3% Black; 20% were classified as innovators, 6.7% early adopters, 3.3% early majority, 6.7% late majority, 43.3% laggards and 20% refusers. Three themes varied across groups: level of perceived risk susceptibility of getting COVID-19 in the future, information needs and levels of vaccine literacy, and effects of ongoing institutional mistrust. Those in the laggard and refuser groups generally had lower vaccine literacy, higher levels of institutional mistrust, and were more likely to listen to friends and family for booster advice, all consistent with DoI adopter characteristics. These differences indicate important intervention targets to promote booster uptake, especially in those who have been previously vaccinated. Full article

Background/Objectives: Vaccine hesitancy arises from multiple determinants, including individual beliefs, cognitive style, social norms, political identity and the information environment. In this context, health literacy, e-health literacy, susceptibility to health misinformation, conspiracy beliefs and trust in science may be relevant in mediatized societies. Aim: The aim of the study was to examine how susceptibility to health misinformation relates to vaccine hesitancy in Poland and how this association is influenced by health literacy, e-health literacy, trust in scientists and sociodemographic factors. Methods: Data came from a web-based survey conducted in December 2024 among 2200 adults aged 18–75 years. The questionnaire included validated scales of vaccine hesitancy, health literacy, e-health literacy, vaccine conspiracy beliefs and trust in scientists. The susceptibility to health misinformation was measured with ad hoc instrument based on the statement from fact-checking services. Items assessing digital media use, political sympathies, religious practices and sociodemographics were also applied. Multivariable linear regression was applied with continuous vaccine hesitancy as the dependent variable. Results: The model explained 57.8% of the variance in vaccine hesitancy. Susceptibility to misinformation (B = 0.11, 95% CI: 0.08–0.15) and vaccine conspiracy beliefs (B = 0.44, 95% CI: 0.41–0.46) were positive predictors, whereas trust in scientists (B = −0.20, 95% CI: −0.23–−0.17) and e-health literacy (B = −0.07, 95% CI: −0.11–−0.02) were protective. Older age was associated with lower hesitancy (B = −0.02, 95% CI: −0.03–0.00). Secondary education (B = −0.58) and a master’s degree (B = −0.77) predicted lower hesitancy. Health literacy categories were not significantly related to vaccine hesitancy. Conclusions: Susceptibility to health misinformation and vaccine conspiracy beliefs were key predictors of vaccine hesitancy, outweighing the effects of health literacy and the protective impact of trust in scientists and e-health literacy, and indicating a need for interventions that combine prebunking and literacy-focused strategies with efforts to strengthen confidence in health institutions. Full article