{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:08:59Z","timestamp":1789711739490,"version":"4.0.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vaccination attitudes and uptake are shaped by sociodemographic context, geography, and health status. How comorbidities and prior infection experiences interact with place of residence to influence vaccine decision-making remains insufficiently characterized in Polish primary care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare vaccination attitudes, self-reported adverse events following immunisation (AEFI), and determinants of vaccination across large-city, small-city, and rural primary care populations in Poland, with particular attention to comorbidities and prior infectious disease experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study using questionnaire data linked to primary care records in three primary healthcare centres representing a large city, a small-to-medium city, and a rural setting. Group differences were assessed with contingency tables and Pearson\u2019s chi-square tests (two-sided alpha 0.05). Multivariable logistic regression modeled uptake of influenza, COVID-19, and pertussis vaccination using comorbid respiratory, circulatory, and metabolic conditions and prior infection history as predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Vaccination coverage differed markedly by setting (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), reaching 100% in the rural centre compared with 73\u201376% in urban centres. Self-reported AEFIs were least frequent among rural participants (7.1%) and most frequent among large-city participants (20.0%) (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). Perceived information availability and quality, as well as trust in the healthcare system, varied across sites (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). In adjusted models, prior infection history and respiratory comorbidity were associated with higher odds of influenza vaccination (OR\u202f=\u202f11.0;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001 and OR=3.9;\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.001, respectively) and COVID-19 vaccination (OR\u202f=\u202f3.6;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001 and OR\u202f=\u202f2.8;\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.010). Circulatory and metabolic conditions were not associated with influenza or COVID-19 vaccination (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt;\u202f0.05) but were inversely associated with pertussis vaccination in this sample (both\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vaccination attitudes, uptake, and self-reported AEFIs differ substantially between urban and rural primary care settings in Poland. Respiratory comorbidity and prior infection experiences consistently predict vaccine uptake, underscoring the need for geographically tailored communication strategies and risk framing that reflects local context and chronic disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1871915","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:38:49Z","timestamp":1789709929000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Urban\u2013rural and comorbidity-related differences in vaccination attitudes and self-reported adverse events following immunisation in Poland: a cross-sectional primary care study"],"prefix":"10.3389","volume":"14","author":[{"given":"Dorota","family":"Stefanicka-Wojtas","sequence":"first","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Rusiecka","sequence":"additional","affiliation":[{"name":"Statistical Analysis Centre, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Hikawczuk","sequence":"additional","affiliation":[{"name":"Statistical Analysis Centre, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneta","family":"Soll-Morka","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kasprzyk-Smardz","sequence":"additional","affiliation":[{"name":"Medra Kasprzyk-Smardz & Partners","place":["K\u0119pno, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Zadka","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Centre \u201cPrzychodnia Nowy Dw\u00f3r\u201d","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Zachara","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Centre \u201cReMed\u201d","place":["Borz\u0119cin, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"Zachara","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Centre \u201cReMed\u201d","place":["Borz\u0119cin, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donata","family":"Kurpas","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.1016\/S0140-6736(18)32608-4","article-title":"The state of vaccine confidence","volume":"392","author":"Larson","year":"2018","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0208601","DOI":"10.1371\/journal.pone.0208601","article-title":"Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination","volume":"13","author":"Betsch","year":"2018","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.4161\/hv.24657","article-title":"Vaccine hesitancy: an overview","volume":"9","author":"Dub\u00e9","year":"2013","journal-title":"Hum Vaccin Immunother"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/21645515.2021.1893062","article-title":"Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future?","volume":"18","author":"Wiysonge","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"ref5","year":"2020"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"861","DOI":"10.3390\/vaccines13080861","article-title":"Rural\u2013urban disparities in COVID-19 vaccine uptake and associated mortality and cardiovascular disease outcomes in the United States","volume":"13","author":"Smith","year":"2025","journal-title":"Vaccines"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"14655","DOI":"10.3390\/ijerph192214655","article-title":"An analysis of factors shaping vaccine attitudes and behaviours in a low-trust society: the case of Poland\u2019s vaccination programme against 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A systematic literature review of perceived risks of vaccines in European populations","volume":"35","author":"Karafillakis","year":"2017","journal-title":"Vaccine"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"101603","DOI":"10.1016\/j.lanepe.2026.101603","article-title":"Prevalence of vaccine hesitancy in Italy: a cross-sectional study","volume":"63","author":"Lo Moro","year":"2026","journal-title":"Lancet Reg Health Eur"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.2147\/RMHP.S519479","article-title":"Vaccine hesitancy and immunization patterns in central and Eastern Europe","volume":"18","author":"Kurpas","year":"2025","journal-title":"Risk Manag Healthc Policy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3390\/vaccines13010031","article-title":"Vaccine hesitancy and acceptance: the present and the future","volume":"13","author":"Sheinfeld Gorin","year":"2025","journal-title":"Vaccines"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s13561-025-00685-w","article-title":"Vaccination for adults and their children: insights from survey and experimental data","volume":"15","author":"Guo","year":"2025","journal-title":"Health Econ Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.3390\/vaccines11061069","article-title":"Impact of the COVID-19 pandemic on attitudes toward vaccination: representative study of polish society","volume":"11","author":"Sobierajski","year":"2023","journal-title":"Vaccines"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"6107","DOI":"10.3390\/su15076107","article-title":"Impact of socioeconomic status, perceived threat and healthism on vaccine hesitancy","volume":"15","author":"Kirbi\u0161","year":"2023","journal-title":"Sustainability"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"401","DOI":"10.17219\/acem\/162349","article-title":"Special roles of rural primary care and family medicine in improving vaccine hesitancy","volume":"32","author":"Piccoliori","year":"2023","journal-title":"Adv Clin Exp Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3390\/vaccines9050503","article-title":"Attitudes toward vaccination against COVID-19 in Poland: a longitudinal study","volume":"9","author":"Babicki","year":"2021","journal-title":"Vaccines"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"320","DOI":"10.3390\/tropicalmed10110320","article-title":"Underreporting of adverse events following COVID-19 vaccination among healthcare professionals in Poland: potential implications for vaccine hesitancy","volume":"10","author":"Grabowski","year":"2025","journal-title":"Trop Med Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"ckaa166","DOI":"10.1093\/eurpub\/ckaa166.1450","article-title":"Determinants of influenza vaccination among polish patients attending primary care clinics","volume":"30","author":"Dubiel","year":"2020","journal-title":"Eur J Pub Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3325\/cmj.2011.52.126","article-title":"Reasons for low influenza vaccination coverage: cross-sectional survey in Poland","volume":"52","author":"Kardas","year":"2011","journal-title":"Croat Med J"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1101\/2021.03.21.21254047","article-title":"Factors influencing COVID-19 vaccination uptake in an elderly sample in Poland","author":"Malesza","year":"2021","journal-title":"medRxiv"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"88","DOI":"10.70058\/cjm.1849064","article-title":"Investigation of influenza and pneumococcal vaccination status and associated factors among older adults: a cross-sectional study","volume":"3","author":"G\u00fcrel K\u00f6ksal","year":"2026","journal-title":"Cerasus J Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"127265","DOI":"10.1016\/j.vaccine.2025.127265","article-title":"What may influence older Europeans' decision about the seasonal influenza vaccine? 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