University students’ predictors of vaccine intention toward routine vaccination: a systematic review

INTRODUCTION: Vaccine hesitancy is a major challenge for national immunization programs, especially after the COVID-19 pandemic, which disrupted routine coverage for many vaccinations. Therefore, we systematically examined the determinants of vaccination intention among university students, an age group undergoing training, and for this reason particularly receptive to educational campaigns. METHODS: We searched PubMed, Scopus, and Web of Science. Studies were considered eligible if they analyzed vaccination intention(s) (i.e., sure/willing vs. unsure/unwilling) through multivariable logistic regression analyses in university students. All routine vaccines were considered. Study quality was assessed using the Newcastle-Ottawa scale. Determinants were grouped into three categories: contextual, individual and group, and vaccine/vaccination-specific influences. A narrative synthesis of the results was performed. RESULTS: A total of 14.940 articles were retrieved. Of these, 40 were included, 34 regarded the Human Papillomavirus (HPV) vaccine, and 6 on influenza (flu) vaccine. Out of the 282 factors found, 231 regarded the HPV vaccine. Among the contextual influences, age, gender, and sexual behavior were the most studied, whereas “HPV knowledge” (N = 44) and “awareness” (N = 16) were the most investigated among individual and group influences, showing also higher rates of statistical significance with the outcome. Lastly, among vaccine-specific influences, “healthcare professionals’ recommendation” was the most studied. As for the flu vaccine, 51 factors were found, with ‘Previous flu vaccination’ (N = 5) being the most investigated and always positively associated with vaccine intention. CONCLUSIONS: Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively. These results should be used in planning educational campaigns to increase vaccine uptake in this subgroup. KEY MESSAGES: • Vaccine Hesitancy (VH) is a major public health issue and a challenge for national immunization programs. • Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively.