{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T04:29:42Z","timestamp":1786768182892,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["101132545"],"award-info":[{"award-number":["101132545"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"award":["101132545"],"award-info":[{"award-number":["101132545"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Polish Ministry of Science and Higher Education"},{"id":[{"id":"https:\/\/ror.org\/05dwvd537","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: C scales are important measures that can support the vaccination process by analysing the possible reasons for vaccination hesitancy. In some studies, it is not possible to utilise typical models based on the traditional 3C\u20137C scales, but it is possible to adjust them by using modified proxy measures and converting individual determinants into variables of similar significance in the logistic regression analysis of a vaccination behavioural model. Objective: The aim of this study was to compare the relationship between determinants defining a vaccination behaviour model based on the classic 3C, 5C, and 7C scales with modified proxy measures and two variables (low vaccine-related fear instead of complacency and exposure to misinformation-prone digital sources instead of conspiracy) and the dependent variable, namely, the vaccination status of patients of primary care centres in Poland from 2024 to 2025. Methods: A cross-sectional study was conducted using a survey and questionnaire data linked with patient records from three Polish health centres (N = 1206, 46.9% rural residents and 53.1% city residents). Demographic data and determinants of three vaccination behaviour models were compared between vaccinated and non-vaccinated patients using Pearson\u2019s \u03c72 test, while behavioural models based on the 3C, 5C, and 7C scales describing the relationship between independent variables and vaccination status (dependent variable) were prepared using logistic regression. Two of seven determinants were changed. Results: All determinants used in the three logistic regression behavioural models differed significantly between vaccinated and non-vaccinated patients (p &lt; 0.001). Furthermore, independent variables in each behavioural model were significantly related to the dependent variable (p &lt; 0.001). With an increasing number of model determinants, Nagelkerke\u2019s R2 increased from 0.303 to 0.435 and the ROC-AUC from 0.828 to 0.882. However, the VIF value indicated very low multicollinearity of determinants. The Wald test did not reveal a significant relationship between confidence in public health and the dependent variable (p &gt; 0.05, OR 1.17\u20130.92 for Models 1 and 3, respectively). Conclusions: In the vaccination behavioural models prepared based on empirical data, all determinants were found to be significantly related to the dependent variable. As the number of independent variables in the behavioural model increased, parameters such as the ROC-AUC and Nagelkerke\u2019s R2 also increased, while the Akaike information criterion, which determines the balance between fitting the model to data and its complexity, decreased. No significant individual relationship was found for the determinant \u201cconfidence in public health\u201d, but this result confirms observations from other previous studies describing the impact of pandemic fatigue, misinformation, and conflicting expert information on institutional trust.<\/jats:p>","DOI":"10.3390\/vaccines14080700","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:06:16Z","timestamp":1786608376000},"page":"700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of Vaccination Behavioural Models Based on Modified Proxy Measures for C Scales and Characteristics of Their Determinants in Patients Vaccinated Against Infectious Diseases: A Cross-Sectional Survey"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0040-1045","authenticated-orcid":false,"given":"Tomasz","family":"Hikawczuk","sequence":"first","affiliation":[{"name":"Biostatistics Teaching Team, Statistical Analysis Centre, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Stefanicka-Wojtas","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2017-9688","authenticated-orcid":false,"given":"Agnieszka","family":"Rusiecka","sequence":"additional","affiliation":[{"name":"Biostatistics Teaching Team, Statistical Analysis Centre, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kasprzyk-Smardz","sequence":"additional","affiliation":[{"name":"Medra Kasprzyk-Smardz & Partners, 63-600 K\u0119pno, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Zadka","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Center \u201cPrzychodnia Nowy Dw\u00f3r\u201d, 54-438 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Zachara","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Center \u201cReMed\u201d, 32-825 Borz\u0119cin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"Zachara","sequence":"additional","affiliation":[{"name":"Non-Public Healthcare Center \u201cReMed\u201d, 32-825 Borz\u0119cin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4292-161X","authenticated-orcid":false,"given":"Stanis\u0142aw Karol","family":"Manulik","sequence":"additional","affiliation":[{"name":"Division of Healthcare Organization, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6884-5200","authenticated-orcid":false,"given":"Katarzyna","family":"Lomper","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-0210","authenticated-orcid":false,"given":"Izabella","family":"Uchmanowicz","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-8920","authenticated-orcid":false,"given":"Donata","family":"Kurpas","sequence":"additional","affiliation":[{"name":"Division of Scientific Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3927","DOI":"10.1016\/j.vaccine.2022.05.052","article-title":"Have vaccine hesitancy models oversimplified a complex problem to our detriment? The Adapted Royal Society of Canada vaccine uptake framework","volume":"40","author":"MacDonald","year":"2022","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.copsyc.2021.08.010","article-title":"Prosocial vaccination","volume":"43","author":"Betsch","year":"2022","journal-title":"Curr. Opin. Psychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"127134","DOI":"10.1016\/j.vaccine.2025.127134","article-title":"The role of health systems in shaping vaccine decisions: Insights from Italy, Mexico, the United Kingdom, and the United States","volume":"54","author":"Arsenault","year":"2025","journal-title":"Vaccine"},{"key":"ref_4","first-page":"8997","article-title":"Determinants and reasons for coronavirus disease 2019 vaccine hesitancy in Croatia","volume":"63","year":"2022","journal-title":"Croat. Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chan, N.N., Ong, K.W., Siau, C.S., Lee, K.W., Peh, S.C., Yacob, S., Chia, Y.C., Seow, V.K., and Ooi, P.B. (2022). The lived experiences of a COVID-19 immunization programme vaccine hesitancy and vaccine refusal. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-12632-z"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Duplaga, M., Zwierczyk, U., and Kowalska-Duplaga, K. (2022). The assessment of the reliability and validity of the Polish version of the Adult Vaccine Hesitancy Scale (Pl-a VHS) in the context of attitudes toward COVID-19 vaccination. Vaccines, 10.","DOI":"10.3390\/vaccines10101666"},{"key":"ref_7","unstructured":"World Health Organization (2019). Ten Threats to Global Health in 2019, WHO. Available online: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/S0140-6736(20)31558-0","article-title":"Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: A large scale retrospective temporal modelling study","volume":"396","author":"Simas","year":"2020","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Callela, P., Pellulo, C.P., Di Giuseppe, G., Neapolitano, F., Liguori, F., Liguori, G., and Gall\u00e9, F. (2025). Adoption of focus groups in designing interventions to address vaccine hesitancy among adolescents and their parents: A systematic review. Vaccines, 13.","DOI":"10.3390\/vaccines13111108"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: Definition, scope and determinants","volume":"33","author":"MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., and B\u00f6hm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS ONE, 13.","DOI":"10.31234\/osf.io\/ytb7w"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1027\/1015-5759\/a000663","article-title":"Measuring the 7Cs of vaccination readiness","volume":"38","author":"Geiger","year":"2022","journal-title":"Eur. J. Psychol. Assess."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"19895","DOI":"10.1038\/s41598-023-46864-9","article-title":"Psychometric validation of a 7C-model of antecedents of vaccine acceptance among healthcare workers, parents, and adolescents in France","volume":"13","author":"Doglioni","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s44197-025-00485-9","article-title":"The 7C vaccination readiness scale: An empirical country comparison between Germany and Greece","volume":"15","author":"Teichmann","year":"2025","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_15","unstructured":"Strzelecka, H., and Szlubowska, A. (2024, December 20). Health and Healthcare in 2023. Statistics Poland, Warszawa and Krak\u00f3w, 2024, (In Polish)."},{"key":"ref_16","unstructured":"Czarkowski, M.P., and Wielgosz, U. (2024, December 01). Vaccinations in Poland in 2023, (In Polish)."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Albrecht, D. (2022). Vaccination, politics and COVID-19 impacts. BMC Public Health, 22.","DOI":"10.1186\/s12889-021-12432-x"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"18103","DOI":"10.1007\/s12144-025-08418-2","article-title":"Source awareness and vaccine attitudes: Evaluation of a normal technique for combating disinformation","volume":"44","author":"Izydorczak","year":"2025","journal-title":"Curr. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gerretsen, P., Kim, J., Caravaggio, F., Quilty, L., Sanches, M., Wells, S., Brown, E.E., Agic, B., Pollock, B.G., and Graff-Guerrero, A. (2021). Individual determinants of COVID-19 vaccine hesitancy. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258462"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bendetson, J., Swann, M.C., Lozano, A., West, J., Hanlon, A.L., Crandell, I., Jatta, M., Schleupner, C.J., and Baffoe-Bonnie, A. (2023). Deepening our understanding of COVID-19 vaccine decision-making amongst healthcare workers in Southwest Virginia, USA using exploratory and confirmatory factor analysis. Vaccines, 11.","DOI":"10.3390\/vaccines11030556"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Deng, X., Zhao, Y., Wang, S., He, H., Chen, Z., Zhou, Y., Yan, R., Tang, X., Zhu, Y., and Xu, X. (2023). Assessing Covid-19 vaccine booster hesitancy using the modified 5C scale in Zheijiang province, China: A cross-sectional study. Vaccines, 11.","DOI":"10.3390\/vaccines11030706"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhou, L., Wang, J., Cheng, P., Li, Y., Liu, G., and Zhang, X. (2022). HPV vaccine hesitancy among medical students in China: A multicenter study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.774767"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Joshi, A., Kaur, M., Kaur, R., Grover, A., Nash, D., and El-Mohanes, A. (2021). Predictors of Covid-19 vaccine acceptance, intention, and hesitancy: A scoping review. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.698111"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3107","DOI":"10.1016\/j.vaccine.2024.04.030","article-title":"Reliance on sources of immunization and vaccine uptake among older adults in rural state: The mediating role of trust","volume":"42","author":"Fuller","year":"2024","journal-title":"Vaccine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e19318","DOI":"10.7717\/peerj.19318","article-title":"Development and validation of Covid-19 vaccination perception (CoVaP) instrument among healthcare workers in Malysia","volume":"13","author":"Zaid","year":"2025","journal-title":"PeerJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpsychires.2023.02.018","article-title":"Using the 5C model to understand COVID-19 vaccine hesitancy across a National and South Carolina sample","volume":"160","author":"Rancher","year":"2023","journal-title":"J. Psychiatr. Res."},{"key":"ref_27","unstructured":"Figueiredo, A., Eagen, R.L., Hendrickx, G., Karafillakis, E., Van Damme, P., and Larson, H.J. (2022, November 18). State of Vaccine Confidence in the European Union, August 2022. Available online: https:\/\/data.europa.eu\/doi\/10.2875\/188426."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14416","DOI":"10.1038\/s41598-024-65468-5","article-title":"The landscape of the COVID-19 pandemic in Poland emerging from epidemiological and genomic data","volume":"14","author":"Mirska","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Krastev, S., Krajden, O., Vang, Z.M., P\u00e9rez-Gay Ju\u00e1rez, F., Solomonova, E., Goldenberg, M.J., Weinstock, D., Smith, M.J., Dervis, E., and Pilat, D. (2023). Institutional trust is a distinct construct related to vaccine hesitancy and refusal. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-17345-5"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Rzymski, P., Poniedzia\u0142ek, B., and Fal, A. (2021). Willingness to receive the booster COVID-19 vaccine dose in Poland. Vaccines, 9.","DOI":"10.3390\/vaccines9111286"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"127169","DOI":"10.1016\/j.vaccine.2025.127169","article-title":"Vaccination readiness among adults in Norway: A cross-sectional survey using the 7C model","volume":"56","author":"Hansen","year":"2025","journal-title":"Vaccine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1080\/08964289.2022.2071198","article-title":"Profiling hesitancy to COVID-19 vaccinations in six European countries: Behavioral, attitudinal and demographic determinants","volume":"49","author":"Kyprianidou","year":"2022","journal-title":"Behav. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.2147\/RMHP.S519479","article-title":"Vaccine hesitancy and immunization patterns in Central and Eastern Europe: Sociocultural, economic, political and digital influences across seven countries","volume":"18","author":"Kurpas","year":"2025","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ligeti, A.S., Oroszi, B., Luca, C., Bilics, E., \u00c1goston, J., R\u00f6st, G., and Koltai, J. (2024). Socioeconomic determinants and reasons for non-acceptance to vaccination recommendations during the 3rd\u20135th waves of the COVID-19 pandemic in Hungary. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-19267-2"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e1983389","DOI":"10.1080\/21645515.2021.1983389","article-title":"Socio-demographic, psychological, and experiential predictors of COVID-19 vaccine hesitancy in South Korea, October-December 2020","volume":"18","author":"Hwang","year":"2022","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7262","DOI":"10.1016\/j.vaccine.2022.10.061","article-title":"Is vaccine confidence an unexpected victim of the COVID-19 pandemic?","volume":"40","author":"Siani","year":"2022","journal-title":"Vaccine"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Lorini, C., Del Riccio, M., Zanobini, P., Biasio, R.L., Bonanni, P., Giorgetti, D., Allodola Ferro, V., Guazzini, A., Maghrebi, O., and Lastrucci, V. (2023). Vaccination as a social practice: Towards a definition of personal, community, population, and organizational vaccine literacy. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16550-6"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Dziedzic, A., Issa, J., Hussain, S., Tanasiewicz, M., Wojtyczka, R., Kubina, R., Dyszkiewicz-Konwinska, M., and Riad, A. (2022). COVID-19 vaccine booster hesitancy (VBH) of healthcare professionals and students in Poland: Cross sectional survey-based study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.938067"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e2100173","DOI":"10.1080\/21645515.2022.2100173","article-title":"Information systems for vaccine safety surveillance","volume":"18","author":"Buttery","year":"2022","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_40","first-page":"e03736","article-title":"Vaccine fake news: An analysis under the World Health Organization\u2019s 3Cs model","volume":"55","author":"Matozinhos","year":"2021","journal-title":"Rev. Esc. Enferm."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1093\/phe\/phac026","article-title":"How mandatory can we make vaccination?","volume":"15","author":"Saunders","year":"2022","journal-title":"Public Health Ethics"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Taubert, F., Meyer-Hoeven, G., Schmid, P., Gerdes, P., and Betsch, C. (2024). Conspiracy narratives and vaccine hesitancy: A scoping review of prevalence, impact, and interventions. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20797-y"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Pan, S., and Chen, S. (2023). Empirical comparison of imputation methods for multivariate missing data in Public Health. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021524"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21315\/mjms2018.25.4.12","article-title":"Sample size guidelines for logistic regression from observational studies with large population: Emphasis on the accuracy between statistics and parameters based on real life clinical data","volume":"25","author":"Bujang","year":"2018","journal-title":"Malays. J. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10865-022-00310-9","article-title":"College student\u2019s influenza vaccine hesitation: A reasoned action investigation with quantitative and qualitative data","volume":"46","author":"Mongeau","year":"2023","journal-title":"J. Behav. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Eitze, S., Felgendreff, L., Horstk\u00f6tter, N., Seefeld, L., and Betsch, C. (2024). Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: Results from representative surveys in 2016 and 2018. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-18674-9"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/700\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T04:19:28Z","timestamp":1786767568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["vaccines14080700"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14080700","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}