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The study aimed to investigate the range of experiences and attitudes of Croatian medical doctors (MDs) related to vaccination and vaccine hesitancy. In January 2021 three asynchronous online focus groups were held using MRQual, a web-based platform, which included 46 MDs from all three levels of the healthcare system in Croatia. NVivo, a qualitative data analysis software package, was used for the thematic analysis of collected data. The participants expressed a high level of support for the Croatian immunization program and vaccines in general. However, some skepticism was expressed regarding new vaccines and the regulatory processes of their approval. A significant number of participants raised concerns over the approval of COVID-19 vaccines, especially given their rapid development. The results also revealed that the process of communication with patients is often based on the very elaborate categorizations of patients based on previous experience, which leads to prioritizing and a communication breakup when dealing with “problematic patients”. MDs find themselves in a delicate situation where a fine balance between time-consuming communication with patients and the demands for maintaining satisfying vaccination uptake is needed. The situation arises from a social roles conflict that is embedded in wider social values and expectations, since communication problems do not arise in the doctor’s office, and therefore cannot be solved without addressing the social forces that cause trust deficiencies. To achieve better immunization results public health leaders need to better understand the social contexts and constraints of MDs vaccine-related behaviors.

Abstract The primary focus of this paper is to investigate the influence of science literacy, particularly health literacy, on vaccine-specific conspiracy beliefs, within the broader context of vaccine hesitancy. The authors tested deficit (scientific literacy shapes science attitudes) and contextual models (contextual variables exert direct influence and influence the connection between literacy and science attitudes) in a survey research study (N = 729) in Croatia. The analytical approach included structural equation modeling with vaccination conspiracy beliefs as the outcome variable and health literacy, religiosity, and political identification as predictors. The results showed that lower health literacy and higher religiosity were related to higher vaccination conspiracy beliefs, which was not the case for political identification. In addition, the moderating effect of religiosity on the relationship between health literacy and conspiracy beliefs was confirmed. In contrast, the moderating effect of political identification was not confirmed, thus partially confirming the stronger version of the contextual model. The authors comparatively discuss the results by evoking specific socio-political characteristics of Croatian society as well as the reactions of political and religious organizations to the COVID-19 pandemic.

The prevalence of vaccine hesitancy underscores the fact that the general public does not uniformly embrace scientific recommendations. Vaccine hesitancy represents a spectrum, encompassing both those who accept all vaccines and those who outright reject them. This paper aims to explore the relationship between science literacy, contextual factors, and vaccine hesitancy while accounting for specific mediation mechanisms. The authors applied a theoretical framework derived from the deficit model and the contextual model of public understanding of science. Hypotheses regarding the relationship between scientific literacy, religiosity, political identification, and vaccine hesitancy were tested. The authors also tested several hypotheses based on the assumption that the perception of scientific credibility and institutional trust are significant mediators of the above-mentioned relationships. The data from an online survey with a nationally representative quota sample of the Croatian population (with an average age of 42.6 years.) were used ( N = 1,500), while the data were analyzed using structural equation modeling. The results indicated that the perception of scientific credibility plays a significant role as a mechanism that translates the impacts of literacy, religiosity, and political identification. Institutional trust proved to be a significant mediator but in a way opposite to the hypotheses, which points to the need to contextualize the aforementioned relationships. The authors also determined that younger age, right-wing political orientation, higher religiosity, and lower scientific literacy were the determinants of hesitancy in both vaccine types (COVID-19 and vaccines in general), thus indicating that they might be connected to deeply rooted value dispositions.