Impact of Education on Vaccination Knowledge and the COVID-19 Vaccine Uptake Intention in Slovenia: Does Trust in the Healthcare System Moderate the Effects?

Monika Lamot, Marija Javornik Krečič and Andrej Kirbiš

Summary:  Although education is an important determinant of scientific knowledge and trust in science, research shows that better educated individuals are not ‘immune’ to anti-scientific views. In some studies, for example, education was neither a significant determinant of vaccination knowledge nor consistently linked with the intention to get vaccinated against vaccine-preventable diseases. Trust in the healthcare system is also known to be a determinant of health-related attitudes and behaviours. However, it remains unclear whether trust in the healthcare system moderates the effect of education on vaccination knowledge and vaccine uptake intention. In our study, we examined whether in Slovenia education is linked to higher levels of knowledge about vaccination, whether education is linked with a greater intention to get vaccinated against Covid-19, and whether trust in the healthcare system moderates the effect of education. We analysed two non-representative samples obtained through online surveys in November 2019 (Study 1; N = 661; 76% women) and in March/April 2020 (Study 2; N = 851; 84% women). We compared three educational groups (1 = secondary school or lower; 2 = up to the first-cycle Bologna degree; 3 = second-cycle Bologna degree or higher). Multivariate analyses showed that, when controlling for other determinants (gender, age, employment/activity status, self-rated health and political orientation), the mid-level education group showed the lowest level of vaccination knowledge (Study 1) and the lowest Covid-19 vaccine uptake intention (Study 2). Additionally, we found that trust in the healthcare system moderated the effects of education. Among high-trust groups, higher education had a significant positive impact only on Covid-19 vaccine uptake intention (Study 2) but had no significant impact on vaccine knowledge (Study 1). Among low-trust groups, the educational impact was similar for both outcomes; the mid-level educational groups had significantly lower Covid-19 vaccine uptake intention and vaccine knowledge, while the highest and the lowest educational group had the most vaccine knowledge and uptake intention. The implications of the results are discussed.