Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
The Effect of Distrust in the Health System on Vaccine Hesitancy and Determination of Factors Affecting Vaccine Hesitancy: A Descriptive Research
Sağlık Sistemine Güvensizliğin Aşı Tereddütlüğü Üzerinde Etkisi ve Aşı Tereddütlüğünü Etkileyen Faktörlerin Belirlenmesi: Tanımlayıcı Araştırma
Duygu DENİZ ÇELİKa , Emre İŞÇİb
aİstanbul Arel University, Vocational School Department of Medical Services and Techniques, İstanbul, Türkiye
bİstanbul Marmara University Faculty of Health Sciences, Department of Health Management, İstanbul, Türkiye
Turkiye Klinikleri J Health Sci. 2025;10(1):198-205
doi: 10.5336/healthsci.2024-104492
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of the study is to investigate how distrust in the health system affects vaccine hesitancy and to explain the relationship between these two variables. The study aims to contribute to the determination of effective strategies in the fight against vaccine hesitancy. Material and Methods: Within the scope of the study, the questionnaires collected from 444 people over the age of 18 living in Istanbul were included in the analysis. In the survey, in addition to demographic information, Distrust in Health Systems, Vaccine Hesitation and Social Media Confirmation/Trust Scales were used. Frequency analysis was used to determine the sociodemographic characteristics of the participants. The participants' vaccine hesitancy and perception of trust in the health system were determined by means of mean and standard deviation. The relationship between the variables was revealed by correlation and multiple regression analyses. Results: The relationship between vaccine hesitancy and distrust in the health system was found to be moderate at r=-0.345 (p=0.00<0.05). In the analysis, a significant negative relationship was found between vaccine hesitancy and distrust in the health system. According to the regression analysis results, 11.7% of the change in vaccine hesitancy levels is explained by distrust in health systems. The total vaccine hesitancy scores of the participants showed significant differences according to age. Conclusion: The study found that as trust in the health system increases, vaccine hesitancy also increases. The importance of reliability and transparency of health systems in combating vaccine hesitancy was emphasized. It was determined that vaccine hesitancy scores showed significant differences according to age. It showed that vaccine hesitancy may be at different levels among different age groups and therefore vaccination campaigns and communication strategies should be adapted according to age.

Keywords: Vaccine hesitancy; health systems; coronavirus disease-2019
ÖZET
 Amaç: Çalışmanın amacı, sağlık sistemine olan güvensizliğin aşı tereddütlüğünü nasıl etkilediğini araştırmak ve bu iki değişken arasındaki ilişkiyi açıklamaktır. Çalışma, aşı tereddütüyle mücadelede etkili stratejilerin belirlenmesine katkıda bulunmayı amaçlamaktadır. Gereç ve Yöntemler: Çalışma kapsamında İstanbul ilinde yaşayan 18 yaş üstü 444 kişiden toplanan anketler analizlere dâhil edilmiştir. Ankette demografik bilgilerin yanı sıra Sağlık Sistemlerine Güvensizlik, Aşı Tereddütü ve Sosyal Medya Teyit/Güven Ölçeklerinden faydalanılmıştır. Katılımcıların sosyodemografik özelliklerini belirlemek için frekans analizinden faydalanılmıştır. Katılımcıların aşı tereddütlüğü ve sağlık sistemine güvensizlik algıları ortalama ve standart sapma ile belirlenmiştir. Değişkenler arasındaki ilişki korelasyon ve çoklu regresyon analizleri ile ortaya konulmuştur. Bulgular: Aşı tereddütlüğü ve sağlık sistemine olan güvensizlik arasındaki ilişki düzeyi orta seviyede çıkmıştır r=-0,345 (p=0,00<0,05). Analiz sonucunda aşı tereddütlüğü ve sağlık sistemine güvensizlik arasında istatistiksel olarak anlamlı negatif bir ilişki bulunmuştur. Regresyon analizi sonuçlarına göre aşı tereddütü düzeyindeki değişim %11,7 oranında sağlık sistemlerine güvensizlik tarafından açıklanmaktadır. Katılımcıların aşı tereddüdü toplam puanları yaşa göre anlamlı farklılık göstermiştir. Sonuç: Çalışmada, sağlık sistemine duyulan güvensizlik arttıkça, aşı tereddütü düzeyinin de arttığı görülmüştür. Çalışma, aşı tereddütlüğü ile mücadelede sağlık sistemlerinin güvenilirliği ve şeffaflığının önemini vurgulamıştır. Aşı tereddütü puanlarının yaşa göre istatistiksel olarak anlamlı farklılık gösterdiği belirlenmiştir. Bu bulgu, farklı yaş grupları arasında aşı tereddütünün farklı düzeylerde olabileceğini ve bu nedenle aşı kampanyaları ve iletişim stratejilerinin yaşa göre özelleştirilmesi gerektiğini göstermiştir.

Anahtar Kelimeler: Aşı tereddütü; sağlık sistemleri; koronavirüs hastalığı-19
REFERENCES:
  1. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9(8):1763-73. [Crossref]  [PubMed]  [PMC] 
  2. 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. [Crossref]  [PubMed] 
  3. World Health Organization [Internet]. Strategic Advisory Group of Experts on Immunization (SAGE). © 2025 WHO. Report of the SAGE working group on vaccine hesitancy. [Cited: April 21, 2024]. Available from: [Link] 
  4. Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-51. [Crossref]  [PubMed]  [PMC] 
  5. Anand P, Stahel VP. Review the safety of Covid-19 mRNA vaccines: a review. Patient Saf Surg. 2021;15(1):20. Erratum in: Patient Saf Surg. 2021;15(1):22. [Crossref]  [PubMed]  [PMC] 
  6. Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. European Journal of Epidemiology. 2020;35(8):775-9. [Crossref]  [PubMed]  [PMC] 
  7. Biasio LR, Bonaccorsi G, Lorini C, Pecorelli S. Assessing COVID-19 vaccine literacy: a preliminary online survey. Hum Vaccin Immunother. 2021;17(5):1304-12. [Crossref]  [PubMed]  [PMC] 
  8. Razai MS, Chaudhry UAR, Doerholt K, Bauld L, Majeed A. Covid-19 vaccination hesitancy. BMJ. 2021;373:n1138. [Crossref]  [PubMed] 
  9. Soares P, Rocha JV, Moniz M, Gama A, Laires PA, Pedro AR, et al. Factors associated with COVID-19 vaccine hesitancy. Vaccines (Basel). 2021;9(3):300. [Crossref]  [PubMed]  [PMC] 
  10. Ozawa S, Paina L, Qiu M. Exploring pathways for building trust in vaccination and strengthening health system resilience. BMC health services research. 2016:16(7);639. [Crossref]  [PubMed]  [PMC] 
  11. Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Soc Sci Med. 2013;91:10-4. [Crossref]  [PubMed] 
  12. Çömlekçi MF, Başol O. Sosyal medya haberlerine güven ve kullanıcı teyit alışkanlıkları üzerine bir inceleme [Research on social media news trust and news verification awareness]. Galatasaray Üniversitesi İletişim Dergisi. 2019;(30):55-77. [Crossref] 
  13. Luyten J, Bruyneel L, van Hoek AJ. Assessing vaccine hesitancy in the UK population using a generalized vaccine hesitancy survey instrument. Vaccine. 2019;37(18):2494-501. [Crossref]  [PubMed] 
  14. Yılmaz N, Öke Karakaya P, Sönmez S. Aşı tereddüdü ölçeğinin Türkçe geçerlik ve güvenirliği [Validity and reliability of the vaccine hesitancy scale in Turkish]. İşletme Bilimi Dergisi. 2021;9(3):499-517. [Crossref] 
  15. Rose A, Peters N, Shea JA, Armstrong K. Development and testing of the health care system distrust scale. J Gen Intern Med. 2004;19(1):57-63. [Crossref]  [PubMed]  [PMC] 
  16. Yeşildal M, Erişen M, Kıraç R. Sağlık sistemlerine güvensizlik: bir geçerlik ve güvenilirlik çalışması [Health care system distrust: a study of validity and reliability]. Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi. 2020;6(2):251-9. [Link] 
  17. Gülmez Y, Bircan H, Yılmaz H. Sağlık Hizmetleri Tüketicilerinin Covid-19'a Yönelik Aşı Tereddütlerini Etkileyen Faktörlerin Belirlenmesi [Determining the factors affecting the vaccination hesitancy to COVID-19 of healthcare consumers]. Kadim Akademi SBD. 2023;7(1):65-88. [Crossref] 
  18. Okubo R, Yoshioka T, Ohfuji S, Matsuo T, Tabuchi T. COVID-19 vaccine hesitancy and its associated factors in Japan. Vaccines (Basel). 2021;9(6):662. [Crossref]  [PubMed]  [PMC] 
  19. Shih SF, Wagner AL, Masters NB, Prosser LA, Lu Y, Zikmund-Fisher BJ. Vaccine hesitancy and rejection of a vaccine for the novel coronavirus in the United States. Front Immunol. 2021;12:558270. [Crossref]  [PubMed]  [PMC] 
  20. Turhan Z, Dilcen HY, Dolu İ. The mediating role of health literacy on the relationship between health care system distrust and vaccine hesitancy during COVID-19 pandemic. Curr Psychol. 2022;41(11):8147-56. [Crossref]  [PubMed]  [PMC] 
  21. Ebrahimi OV, Johnson MS, Ebling S, Amundsen OM, Halsøy Ø, Hoffart A, et al. Risk, trust, and flawed assumptions: vaccine hesitancy during the COVID-19 pandemic. Front Public Health. 2021;9:700213. [Crossref]  [PubMed]  [PMC] 
  22. Nowak SA, Gidengil CA, Parker AM, Matthews LJ. Association among trust in health care providers, friends, and family, and vaccine hesitancy. Vaccine. 2021;39(40):5737-40. [Crossref]  [PubMed]  [PMC] 
  23. Liu PL, Zhao X, Wan B. COVID-19 information exposure and vaccine hesitancy: The influence of trust in government and vaccine confidence. Psychol Health Med. 2023;28(1):27-36. [Crossref]  [PubMed] 
  24. Özer Ö, Budak F, Alp S. Is vaccine hesitancy affected by distrust in the healthcare system? A study in Turkish population. Social Work In Public Health. 2023;38(4):323-33. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com