Psychological determinants of vaccine hesitancy among Syrian refugees in Türkiye: a cross-sectional study

Vaccine hesitancy has emerged as a significant global public health concern, posing challenges to the success of immunization programs and the control of vaccine-preventable diseases. This study aimed to examine the psychological determinants of vaccine hesitancy and associated sociodemographic factors among Syrian refugees in Türkiye.

A cross-sectional survey was conducted between May and June 2022 among Syrian adults at the Extended Migrant Health Center in Sultanbeyli, Istanbul. The structured questionnaire consists of sociodemographics, COVID-19-related experiences, vaccination attitudes, and the 5 C scale, which identifies five determinants of vaccine behavior: confidence, complacency, constraints, calculation, and collective responsibility. Of 609 participants, those with more than 20% missing data or younger than 18 years were excluded. 472 participants were included in the final analysis. Nonparametric tests and Spearman correlation analyses were performed via R v4.3.2.

Among the 5 C subscales, confidence yielded the highest average score. Confidence levels were significantly lower among participants with chronic conditions, those who were pregnant, and those who reported delaying their children's vaccinations. Higher education was positively associated with greater confidence, calculation, and collective responsibility, while higher income was associated with increased calculation and collective responsibility and fewer constraints.

Syrian refugees in Türkiye demonstrated relatively high levels of trust in vaccines but continued to face psychological and practical barriers to vaccination. Tailored interventions that enhance confidence, address constraints, and support informed decision-making are essential for improving vaccine uptake in displaced populations.