Health Literacy and Vaccine Hesitancy: Insights from a Study on Italian Adolescents
V Cerabona, C Bertola, L Bronzetti, F Paciosi, G Pocetta, E Lorenzini, M Chiavarini, C De WaureAbstract
Introduction
Health Literacy (HL) enables individuals to understand and use health information and may influence health behaviours, including Vaccine Hesitancy (VH). To evaluate HL, VH, and their relationship, a cross-sectional study was conducted in Umbria, a region of Central Italy, through the involvement of lower secondary schools from April 2024 to February 2025.
Methods
Forty-three lower secondary schools participated to the project. A questionnaire was developed and directed to adolescents aged 12-13 via a link on the school electronic register. Two validated tools were used: the VAX (Vaccination Attitudes Examination) scale and the Measurement of Health Literacy Among Adolescents Questionnaire (MOHLAA-Q). The VAX scale assesses four dimensions on a 6-point Likert scale: distrust in vaccine benefits, concerns about unforeseen future effects, concerns about commercial speculation, and preference for natural immunity. The MOHLAA-Q uses a 4- or 5-point Likert scale and a closed question to assess four subdomains: health-related information, communication and interaction skills, attitudes towards health, and health-related knowledge.
Results
We collected 305 responses: 87.2% of adolescents showed moderate/high negative attitudes towards vaccines, 70.16% and 64.26% reported difficulties with health-related information and communication and interaction skills and 91.48% had low health-related knowledge, whereas less than 50% were passive in respect to attitudes towards own health. A significant association emerged between distrust in vaccine benefits and difficulties with health-related information (p = 0.030), lower communication skills (p = 0.016), and a passive approach to health (p = 0.021). Concerns about vaccine-related future effects were associated with lower health-related knowledge (p = 0.038).
Conclusions
HL is associated with VH in adolescents, highlighting the need for interventions to enhance HL also in the aim of reducing VH.