The impact of health literacy on vaccine opposition: The Mediational effect of distrust in the healthcare system

This study is carried out to determine whether distrust in the health system has a mediating role in the effect of anti-vaccination of health literacy. The population of the research consists of people over the age of 18 who applied to the outpatient clinics of Yozgat Akdağmadeni Şehit Sinan Babacan State Hospital. At the time of the research was conducted, an average of 400 daily and 9000 monthly patients received outpatient clinic services from this hospital. In this case, the sample size of the study was calculated as 369 with a 95% confidence level and 5% error. The number of people in this research reached 450, and it can be said that the determined sample number has been reached. In the study, a questionnaire consisting of four sections was used as the data collection tool. The first section includes personal and demographic information, while the other sections use three Likert-type scales. These scales are the health literacy scale, the vaccine opposition scale, and the healthcare system distrust scale. The data collection tool was applied between June 1st and August 1st 2023. In the analysis of variables, Pearson correlation analysis, mediation analysis with Process Macro (Model 4) based on the bootstrap confidence interval, and structural equation modeling with SPSS AMOS based on the bootstrap confidence interval were used. The bootstrap technique is based on 5000 resamplings and a 95% confidence interval. According to the analysis result of Process Macro, the total effect (c= -.115, p<.01) and direct effect (c'= -.073, p<.01) of health literacy on anti-vaccination are negative and statistically significant. It was determined that health literacy affected distrust in the health system negatively and significantly (a= -.098, p<.01), and distrust in the health system affected anti-vaccination positively and significantly (b= .432, p<.01). As a result of the analysis, it was determined that distrust in the health system statistically and significantly mediated the effect of health literacy on anti-vaccination [= -.042 95% CI (-.076; -.012)]. The full standardized effect value of the mediation effect is -.053 [95% CI (-.093; -.016)], and it is sayable that this value is a medium effect size. Although similar results were found in the structural equation modeling, higher standardized and non-standardized loads and explained variance were obtained according to the Process Macro analysis result. In terms of the results of the research, individuals' distrust of the health system and opposition to vaccination can be reduced by increasing their health literacy.