Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland

Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland Caoimhe Shields, Emma Berry, Laura J. Sahm, Aoife Fleming, Chikondi C. Kandulu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7658516/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Antimicrobial resistance (AMR) is a global health threat. Vaccines are a powerful tool to address AMR by preventing infections and reducing antimicrobial use. The World Health Organization (WHO) describe vaccine hesitancy as a growing challenge influenced by confidence. Research has highlighted belief and sociodemographic factors as predictors of hesitancy and confidence. However, little research has focused on AMR-related beliefs in this context across the island of Ireland. This study aimed to explore the sociodemographic and AMR-related belief determinants of vaccine hesitancy and confidence across the island of Ireland. Methods A cross-sectional, nationally representative online survey with adults in Northern Ireland (NI) and Ireland (IRL) assessed public knowledge, awareness, behaviours and beliefs related to antibiotics, AMR and vaccines. Bivariate analyses and hierarchical multiple linear regression tested eight sociodemographic and fourteen AMR-related belief predictors for vaccine hesitancy and confidence. Qualitative responses were analysed using inductive content analysis. Results Among 811 respondents (415 (51.2%) in NI, 396 (48.8%) in IRL), regression models showed consistency across jurisdictions for hesitancy ( F (43,729) = 11.19, p = 0.16) and confidence ( F (43,729) = 12.89, p = 0.54). AMR-related beliefs were the strongest predictors, accounting for 37.5% of the variance in hesitancy and 41.6% in confidence. Agreement with the importance of childhood vaccination was the strongest predictor of both lower vaccine hesitancy (B = -3.64, p < 0.001) and higher vaccine confidence; (B = 1.61, p < 0.001). Sociodemographic factors accounted for 6.2% of the variance in both outcomes. Being female (B=-1.58, p = 0.01) and having lower education (B=-1.24, p = 0.05) significantly predicted higher hesitancy, while higher education predicted higher confidence (B = 0.93, p < 0.001). Qualitative findings highlighted concerns around vaccine side effects and new vaccines. Conclusions Vaccine hesitancy and confidence scores across the two jurisdictions were promising, but can be improved, and support an all-island approach for addressors. This all-island comparison provides a unique perspective into AMR-related predictors and can be used to inform the tailoring of public health interventions which aim to promote vaccine uptake across the island of Ireland. Antimicrobial resistance vaccine uptake vaccine hesitancy vaccine confidence antimicrobial stewardship Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7658516","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549346722,"identity":"6a65c5b0-6b4d-4c62-9479-7a5778dbef5d","order_by":0,"name":"Caoimhe Shields","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYFACHoYDDAXMDGzMzAcYGBvAQsxEaDFgZuBjZ0sgXgsDSIscP48BcVr4+88ePPDBwNqejZnn423eHQzy/A08xgb4tEjcyEs4OMMgPbGNmXezNe8ZBsMZB3iME/BpMZDgMTgMRAlszLzbpHnbGBg3MPAYH8Crhf+MweE/BodBDnsG0mJPWAtDjsFhBoPDjG3MPGwgLYkgLXgdJnEjx+BgD9gvbMaWc89IJM84zFaM1/v8/WeMP/yosLaX7z/88MbbHTa2/e3NmyXwaUG1EowIRSS6llEwCkbBKBgFmAAAPbc+yJOkyQ8AAAAASUVORK5CYII=","orcid":"","institution":"Queen's University Belfast","correspondingAuthor":true,"prefix":"","firstName":"Caoimhe","middleName":"","lastName":"Shields","suffix":""},{"id":549346723,"identity":"c485e3f2-afad-46bf-b76b-b272640ef1a7","order_by":1,"name":"Emma Berry","email":"","orcid":"","institution":"Queen's University Belfast","correspondingAuthor":false,"prefix":"","firstName":"Emma","middleName":"","lastName":"Berry","suffix":""},{"id":549346724,"identity":"94acd221-b5f6-4c6d-8d07-a5275de8c328","order_by":2,"name":"Laura J. Sahm","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"J.","lastName":"Sahm","suffix":""},{"id":549346725,"identity":"c0c2d8c7-da95-47f6-b1d6-34438352ff09","order_by":3,"name":"Aoife Fleming","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Aoife","middleName":"","lastName":"Fleming","suffix":""},{"id":549346726,"identity":"7b84cbb7-286a-459a-ab9e-46853e9ddc30","order_by":4,"name":"Chikondi C. Kandulu","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Chikondi","middleName":"C.","lastName":"Kandulu","suffix":""},{"id":549346727,"identity":"cd779c2c-8881-4d6a-93f1-f2e5e64447d1","order_by":5,"name":"Anne C. Moore","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"C.","lastName":"Moore","suffix":""},{"id":549346728,"identity":"d366ff16-a829-4595-b4f6-e86fa302246f","order_by":6,"name":"Gillian W. Shorter","email":"","orcid":"","institution":"Queen's University Belfast","correspondingAuthor":false,"prefix":"","firstName":"Gillian","middleName":"W.","lastName":"Shorter","suffix":""}],"badges":[],"createdAt":"2025-09-19 12:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7658516/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7658516/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96710125,"identity":"5de6520a-86fb-427c-9731-ed73c158688f","added_by":"auto","created_at":"2025-11-25 10:10:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2194004,"visible":true,"origin":"","legend":"","description":"","filename":"FINALVHVCPredictorsManuscript19Sept25.docx","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/23d0ce3b34479aae70658365.docx"},{"id":96669395,"identity":"4fe612a4-4318-40ed-b6ed-aa616403f6f4","added_by":"auto","created_at":"2025-11-24 22:14:54","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9511,"visible":true,"origin":"","legend":"","description":"","filename":"04e49ad6d6464810b9b7ce2076fea476.json","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/36cd65b89d347b6620d7a06b.json"},{"id":96669394,"identity":"abb661e0-4998-4d55-ae88-7fd3c39cf6e9","added_by":"auto","created_at":"2025-11-24 22:14:54","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33192,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/3a005cd887f11490888d0b0d.docx"},{"id":96669397,"identity":"6dd3d98e-effa-4746-875e-0c52565f6abd","added_by":"auto","created_at":"2025-11-24 22:14:54","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":269245,"visible":true,"origin":"","legend":"","description":"","filename":"04e49ad6d6464810b9b7ce2076fea4761enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/b5ff70b43add94a43060b8c6.xml"},{"id":96711215,"identity":"402954ca-e086-4edd-bb55-028220da054c","added_by":"auto","created_at":"2025-11-25 10:11:46","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":268319,"visible":true,"origin":"","legend":"","description":"","filename":"04e49ad6d6464810b9b7ce2076fea4761structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/d3752f46389f315b5c509406.xml"},{"id":96669400,"identity":"231af632-8242-4932-8dc1-586a490bfcdb","added_by":"auto","created_at":"2025-11-24 22:14:54","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":296662,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/4604b6795755dfb3a9756ea8.html"},{"id":110059180,"identity":"0f5ca0aa-cd75-472f-a802-95d2f7023c78","added_by":"auto","created_at":"2026-05-27 06:26:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":484845,"visible":true,"origin":"","legend":"","description":"","filename":"FINALVHVCPredictorsManuscript19Sept25.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1_covered_ecf6eb6e-d78a-4deb-ace6-c96eda974416.pdf"},{"id":96710304,"identity":"2d815af2-8d6f-4134-a000-6d726121f61b","added_by":"auto","created_at":"2025-11-25 10:10:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33192,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7658516/v1/1b0c4a0815f5fa23f2369acb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial resistance, vaccine uptake, vaccine hesitancy, vaccine confidence, antimicrobial stewardship","lastPublishedDoi":"10.21203/rs.3.rs-7658516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7658516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAntimicrobial resistance (AMR) is a global health threat. Vaccines are a powerful tool to address AMR by preventing infections and reducing antimicrobial use. The World Health Organization (WHO) describe vaccine hesitancy as a growing challenge influenced by confidence. Research has highlighted belief and sociodemographic factors as predictors of hesitancy and confidence. However, little research has focused on AMR-related beliefs in this context across the island of Ireland. This study aimed to explore the sociodemographic and AMR-related belief determinants of vaccine hesitancy and confidence across the island of Ireland.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional, nationally representative online survey with adults in Northern Ireland (NI) and Ireland (IRL) assessed public knowledge, awareness, behaviours and beliefs related to antibiotics, AMR and vaccines. Bivariate analyses and hierarchical multiple linear regression tested eight sociodemographic and fourteen AMR-related belief predictors for vaccine hesitancy and confidence. Qualitative responses were analysed using inductive content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 811 respondents (415 (51.2%) in NI, 396 (48.8%) in IRL), regression models showed consistency across jurisdictions for hesitancy (\u003cem\u003eF\u003c/em\u003e(43,729)\u0026thinsp;=\u0026thinsp;11.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.16) and confidence (\u003cem\u003eF\u003c/em\u003e(43,729)\u0026thinsp;=\u0026thinsp;12.89, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.54). AMR-related beliefs were the strongest predictors, accounting for 37.5% of the variance in hesitancy and 41.6% in confidence. Agreement with the importance of childhood vaccination was the strongest predictor of both lower vaccine hesitancy (B = -3.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and higher vaccine confidence; (B\u0026thinsp;=\u0026thinsp;1.61, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Sociodemographic factors accounted for 6.2% of the variance in both outcomes. Being female (B=-1.58, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.01) and having lower education (B=-1.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05) significantly predicted higher hesitancy, while higher education predicted higher confidence (B\u0026thinsp;=\u0026thinsp;0.93, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Qualitative findings highlighted concerns around vaccine side effects and new vaccines.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eVaccine hesitancy and confidence scores across the two jurisdictions were promising, but can be improved, and support an all-island approach for addressors. This all-island comparison provides a unique perspective into AMR-related predictors and can be used to inform the tailoring of public health interventions which aim to promote vaccine uptake across the island of Ireland.\u003c/p\u003e","manuscriptTitle":"Sociodemographic and Antimicrobial Resistance-related Belief Determinants of Vaccine Hesitancy and Confidence across the island of Ireland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 22:14:49","doi":"10.21203/rs.3.rs-7658516/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b06b19ff-2db1-458d-a313-d400ce17aaa9","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-27T06:14:20+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-27T06:25:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-24 22:14:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7658516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7658516","identity":"rs-7658516","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}