Trust in science, knowledge and risk perception as predictors of COVID-19 vaccination: application of an extended Theory of Planned Behavior model in Hungary.

BACKGROUND: Although a number of studies have shown that some form of trust plays an important role in vaccination decisions, few studies have explicitly examined trust in science. This study aims to explore the determinants of COVID-19 vaccine acceptance, with special regard to trust in science. For our empirical analysis, we focus on Hungary, a case characterized by high infection and mortality rates during the pandemic, as well as relatively low levels of trust in science. The study’s contribution to the literature is that, first, in contrast to most previous studies, it builds on an established theoretical framework, and second, within this framework, it analyses the impact of trust in science in relation to knowledge and perceived risk of COVID-19. We use the Theory of Planned Behavior (TBP) to better understand predictors of COVID-19 vaccine acceptance. The key components of TBP (i.e. attitudes, subjective norms, and perceived behavioral control) are extended with further predictors of attitudes toward COVID-19 vaccination: trust in science, knowledge about COVID-19, and perceived risk of COVID-19. To our knowledge, ours is the first study using TPB to examine the impact of these three factors on attitudes towards vaccination in a single model. METHODS: To test our extended TPB model, we use a sample of 761 Hungarian adults from a cross-sectional survey conducted in late 2022. We apply structural equation modeling (SEM) with COVID-19 vaccine acceptance as the main endogenous variable. RESULTS: Our findings show that of the key components of TPB, attitude toward COVID-19 vaccination is the strongest predictor of vaccine acceptance. Perceived COVID-19 risk, COVID-19-related knowledge, and trust in science are all important predictors of attitude toward COVID-19 vaccination. Importantly, perceived risk and knowledge are also related to trust in science in a meaningful way. CONCLUSIONS: Our findings suggest that since COVID-19-related knowledge and trust in science are interrelated, vaccination campaigns cannot focus on only one or the other: knowledge without trust and vice versa are not enough to increase vaccine acceptance. However, for those with low levels of education, trust in science does not influence attitudes toward vaccination, so increasing COVID-19-related knowledge is key to fostering pro-vaccine attitudes.