Vaccine hesitancy and its correlates among religious personnel in Malatya, Türkiye: a cross-sectional study

Abstract Background Religious personnel may shape community perceptions of vaccination. We assessed vaccine hesitancy and its attitudinal, information-source, and behavioral correlates among religious personnel in Malatya, Türkiye. Methods In February 2026, we conducted a cross-sectional survey of religious personnel in Battalgazi and Yeşilyurt, Malatya. Of 755 eligible personnel, 533 were included in the analysis. Vaccine hesitancy was assessed using the 10-item Vaccine Hesitancy Scale (VHS), with VHS-7 Lack of Confidence as the primary outcome. Adjusted associations were estimated using linear and modified Poisson regression; restricted cubic splines assessed nonlinearity, and Firth-penalized logistic regression evaluated the parent-reported childhood-vaccination outcome. Results Participants had a median VHS-7 score of 20 (IQR: 16–24). Overall, 81.8% reported vaccine-related concerns, 59.7% perceived traditional and complementary medicine (T&CM) as more reliable than vaccines, 65.7% did not support vaccination information in religious talks, 72.6% did not provide vaccine-related advice, and 36.0% reported COVID-19 nonvaccination. In adjusted models, VHS-7 scores were higher among participants reporting vaccine-related concerns (B = 4.77; 95% CI 3.37–6.16) and perceiving T&CM as more reliable than vaccines (B = 3.07; 95% CI 2.05–4.09). Each 5-point increase in VHS-7 was associated with higher prevalences of non-support for vaccination information in religious talks (aPR = 1.14; 95% CI 1.09–1.19) and COVID-19 nonvaccination (aPR = 1.24; 95% CI 1.14–1.34). In exploratory spline models, overall associations were observed for non-support (p < 0.001), non-provision of advice (p = 0.013), and COVID-19 nonvaccination (p < 0.001); only non-provision showed evidence of nonlinearity (nonlinearity p = 0.004; FDR q = 0.012). In an exploratory analysis of 464 participants with children, each 5-point higher VHS-7 score was associated with greater odds of parent-reported nonreceipt of ≥ 1 childhood vaccination (34/464 [7.3%]; aOR = 2.18; 95% CI 1.57–3.12). Conclusions Lower vaccine confidence was more consistently associated with vaccine-related attitudes and behaviors than with sociodemographic characteristics. These findings may inform tailored engagement with religious personnel.