Application of the 5C model in understanding adult vaccine hesitancy among medical students: a cross-sectional study

Abhirami M. V.; Rajini Senthil

doi:10.18203/2394-6040.ijcmph20263596

Authors

Abhirami M. V. Department of Community Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
Rajini Senthil Department of Community Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263596

Keywords:

Vaccine hesitancy, Prevalence, Medical student, 5C questionnaire, Immunization, Adult vaccination

Abstract

Background: Adult vaccination is an important component of preventive health care, but vaccine hesitancy can limit uptake even when vaccines are available. Medical students represent future health professionals and may influence vaccination decisions in the community. The 5C model provides a multidimensional framework encompassing confidence, complacency, constraints, calculation, and collective responsibility.

Methods: A cross-sectional study was conducted among undergraduate medical students in a tertiary-care teaching institution, Puducherry. A total of 386 medical students from first year through internship were included. Data were collected using a self-administered, pre-tested structured questionnaire containing sociodemographic variables and assessment of adult vaccine hesitancy and the five dimensions of the 5C model. Data were analyzed using IBM SPSS. Categorical variables were expressed as frequency and percentage, and associations were assessed using Pearson's chi-square test. Pearson's correlation coefficient was used to assess correlations between the five 5C dimensions.

Results: Among 386 participants, 216 (56.0%) were classified as vaccine hesitant and 170 (44.0%) as non-hesitant. Age and religion were not significantly associated with vaccine hesitancy (p=0.851 and p=0.495, respectively). Significant associations were observed with gender (p<0.001) and year of study (p<0.001). The five 5C dimensions demonstrated statistically significant positive correlations with one another. Correlation coefficients ranged from 0.581 between calculation and collective responsibility to 0.699 between confidence and calculation (all p<0.001).

Conclusions: Adult vaccine hesitancy was prevalent among the medical students studied. Gender and year of study were significantly associated with hesitancy, while the five psychological antecedents measured by the 5C model demonstrated significant interrelationships.

References

World Health Organization. Immunization Agenda 2030: a global strategy to leave no one behind. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/m/item/immunization-agenda-2030-a-global-strategy-to-leave-no-one-behind. Accessed on 10 September 2026.

MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161-4.

Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine. 2014;32(19):2150-9.

Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9(8):1763-73.

Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines. 2015;14(1):99-117.

Bedford H, Attwell K, Danchin M, Marshall H, Corben P, Leask J. Vaccine hesitancy, refusal and access barriers: the need for clarity in terminology. Vaccine. 2018;36(44):6556-8.

Thomson A, Robinson K, Vallée-Tourangeau G. The 5As: a practical taxonomy for the determinants of vaccine uptake. Vaccine. 2016;34(8):1015-8.

Larson HJ, de Figueiredo A, Xiahong Z, Schulz WS, Verger P, Johnston IG, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. EBioMedicine. 2016;12:295-301.

de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396(10255):898-908.

Dubé E, Gagnon D, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine. 2015;33(34):4191-203.

Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34(52):6700-6.

Jain J, Saurabh S, Kumar P, Verma MK, Goel AD, Gupta MK, et al. COVID-19 vaccine hesitancy among medical students in India. Epidemiol Infect. 2021;149:e132.

Lucia VC, Kelekar A, Afonso NM. COVID-19 vaccine hesitancy among medical students. J Public Health (Oxf). 2021;43(3):445-9.

Saied SM, Saied EM, Kabbash IA, Abdo SAE. Vaccine hesitancy: beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J Med Virol. 2021;93(7):4280-91.

Tavolacci MP, Dechelotte P, Ladner J. COVID-19 vaccine acceptance among medical students: a systematic review and meta-analysis. Vaccines (Basel). 2021;9(11):1337.

Al-Qerem W, Jarab AS. COVID-19 vaccination acceptance and its associated factors among medical students in the Middle East. Int J Environ Res Public Health. 2021;18(12):6167.

Mant M, Aslemand A, Prine A, Jaagumägi Holland A. University students’ perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: a multi-methods study. PLoS One. 2021;16(8):e0255447.

Mahmud S, Mohsin M, Khan IA, Mian AU, Zaman MA. Knowledge, beliefs, attitudes and perceived risk about COVID-19 vaccine and determinants of COVID-19 vaccine acceptance in Bangladesh. PLoS One. 2021;16(9).

Venkatesan K, Menon S, Haroon NN. COVID-19 vaccine hesitancy among medical students: a systematic review. J Educ Health Promot. 2022;11:218.

Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PLoS One. 2018;13(12):e0208601.

Betsch C, Bach Habersaat K, Deshevoi S, Heinemeier D, Briko N, Kostenko N, et al. Sample study protocol for adapting and translating the 5C scale to assess the psychological antecedents of vaccination. BMJ Open. 2020;10(3):e034869.

Geoghegan S, O'Callaghan KP, Offit PA. Vaccine safety: myths and misinformation. Front Microbiol. 2020;11:372.

Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, et al. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2021;10(10).

Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022;52(14):3127-41.

Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-51.

Gandhi AP, Kiran T, Thakur JS, Sharma D, Junaid KP, Gupta R, et al. Validation of the 5C questionnaire to assess the hesitancy towards adult vaccination among the Hindi speaking population of Northern India. Discov Soc Sci Health. 2024;4:2.

Kalra N, Kalra T, Mishra S, Basu S, Bhatnagar N. Hesitancy for adult vaccines among healthcare providers and their family members in Delhi, India: a cross-sectional study. Dialogues Health. 2022;1:100044.

MacDonald NE, Dubé E. Unpacking vaccine hesitancy among healthcare providers. EBioMedicine. 2015;2(8):792-3.

Verger P, Dubé E. Restoring confidence in vaccines in the COVID-19 era. Expert Rev Vaccines. 2020;19(10):991-3.

Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: implications for public health communications. Lancet Reg Health Eur. 2021;1:100012.

AlShurman BA, Khan AF, Mac C, Majeed M, Butt ZA. What demographic, social, and contextual factors influence the intention to use the COVID-19 vaccine: a scoping review. Int J Environ Res Public Health. 2021;18(17):9342.

Opel DJ, Heritage J, Taylor JA, Mangione-Smith R, Salas HS, DeVere V, et al. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics. 2013;132(6):1037-46.

Gagneur A. Motivational interviewing: a powerful tool to address vaccine hesitancy. Can Commun Dis Rep. 2020;46(4):93-7.

Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine. 2013;31(40):4293-304.

Jarrett C, Wilson R, O'Leary M, Eckersberger E, Larson HJ; SAGE Working Group on Vaccine Hesitancy. Strategies for addressing vaccine hesitancy: a systematic review. Vaccine. 2015;33(34):4180-90.

Wilson SL, Wiysonge C. Social media and vaccine hesitancy. BMJ Glob Health. 2020;5(10).

Puri N, Coomes EA, Haghbayan H, Gunaratne K. Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases. Hum Vaccin Immunother. 2020;16(11):2586-93.