Vaccine Unawareness: Analysis of the Mediating Effect Between Health Literacy and Vaccination Attitudes

Background: This study aims to explore the relationship between Health literacy (HL), vaccination behaviors and Vaccination unawareness (VU) by trying to understand how HL influences vaccination attitudes and the potential mediation of VU. Methods: Data were collected using HLS-EU-Q16, Vaccination Attitude Scale and Vaccine Unawareness Scale. Results: The results show that 17.3% of the variance in total VAX-I is explained by predictors. Among the significant predictors, low VU and age positively predicts VAX-I, while adequate HL negatively predicts the VAX-I. Analyses for specific dimensions of VAX-I reveal that low VU and age positively predict distrust of benefits, concerns about future effects, concerns about profit, and preference for natural immunity, while adequate HL negatively predicts these dimensions. Mediation analysis showed that low VU significantly mediates the relationship between adequate HL and VAX-I, contributing 44% of total effect in VAX-I and percentages between 35% and 54% in specific dimensions. Conclusions: Results show that lower levels of VU, combined with higher HL, are associated with more positive attitudes toward vaccines. The results suggest that increasing HL levels alone may be necessary but not sufficient to improve vaccination attitudes; therefore, interventions should focus not only on increasing HL levels but also on decreasing VU.