Abstract

Purpose: The purpose of this study was to examine how vaccine hesitancy and e-health literacy influence intention to vaccinate, and to investigate the mediating role of vaccine confidence in these relationships. The study aimed to integrate psychological attitudes, digital information skills and trust-based mechanisms into a unified model of vaccination decision making. Method: A quantitative cross-sectional design was adopted, and data were collected from 290 adult participants using standardized scales adapted from previous research. Smart-PLS was used to assess both the measurement and structural models, evaluating direct relationships and mediation effects. Findings: The results revealed that vaccine hesitancy significantly reduced intention to vaccinate, while e-health literacy significantly enhanced it. Vaccine confidence showed a strong positive effect on intention and was found to mediate the relationship between hesitancy and intention as well as between e-health literacy and intention. The findings highlight confidence as a central psychological pathway through which attitudes and digital competencies influence vaccination decisions. Originality or Implications: This study extends current understanding by integrating hesitancy, confidence and e-health literacy within a single behavioral framework. The findings offer valuable implications for designing targeted communication strategies that strengthen digital literacy, reduce hesitant attitudes and build trust in vaccination systems.