Restricted accessResearch articleFirst published online 2025
Vaccine hesitancy is anything but homogeneous: The social representations of COVID-19 vaccines among not hesitant and slightly hesitant vaccinated adults
Vaccine hesitancy (VH) among vaccinated individuals remains a relatively under investigated topic. This study contributes to fill this research gap by examining the social representations of COVID-19 vaccines among vaccinated Italian adults. Using a mixed-method approach, we analyzed data from 664 vaccinated Italian adults through hierarchical cluster analysis and similarity analysis. Results revealed distinct representational patterns between non-hesitant and slightly hesitant adopters despite their shared vaccination status. While safety emerged as a core element in both groups’ representations, non-hesitant participants expressed a more positive affective-cognitive orientation anchored in scientific trust whilst slightly hesitant adopters exhibited persistent ambivalence, with emotional elements (particularly fear and anxiety) playing a prominent role. The findings challenged the assumption that VH reflects complete vaccine refusal and suggests the need for tailored public health communication strategies. The results indicate that interventions should consider VH levels and variability beyond the mere dichotomy hesitant-not hesitant. Recommendations are discussed.
AbricJC (2001) A structural approach to social representations. In: DeauxKPhilogèneG (eds) Representations of the Social: Bridging Theoretical Traditions. Blackwell Publishing, pp.42–47. Available at: https://psycnet.apa.org/record/2001-18604-002 (accessed 18 December 2024).
3.
AbricJCTafaniE (2009) Lo sviluppo strutturale della teoria [The structural development of the theory]. In: PalmonariAEmilianiF (eds) Paradigmi Delle Rappresentazioni Sociali. Il Mulino, pp.141–176.
4.
ApostolidisTDanyL (2012) Social thought and risks in the health field: The social representations perspective. Psychologie Française57(2): 67–81.
5.
BardinL (2013) L’analyse de contenu. L’analyse de contenu. Presses Universitaires de France.
6.
BavelJJVBaickerKBoggioPS, et al. (2020) Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour4(5): 460–471.
7.
BendauAPlagJPetzoldMB, et al. (2021) COVID-19 vaccine hesitancy and related fears and anxiety. International Immunopharmacology97: 107724.
8.
BianchiFPStefanizziPCusciannaE, et al. (2023) COVID-19 vaccination hesitancy among Italian parents: A systematic review and meta-analysis. Human Vaccines & Immunotherapeutics19(1): 1–9.
9.
BreakwellGM (2020) Mistrust, uncertainty and health risks. Contemporary Social Science15(5): 504–516.
10.
BruderMHaffkePNeaveN, et al. (2014) Conspiracy Mentality Questionnaire. PsycTESTS Dataset. Epub ahead of print 7 July 2014. DOI: 10.1037/T31566-000.
11.
CENSIS (2021) 55° Rapporto sulla situazione sociale del Paese/2021. 3December.
12.
DanyLUrdapilletaILo MonacoG (2015) Free associations and social representations: Some reflections on rank-frequency and importance-frequency methods. Quality & Quantity49(2): 489–507.
13.
Di StefanoUED’AgostinoA (2022) The impacts of the introduction of the green-pass obligation (Covid-19 green certification) on the workplace in Italy. International In-house Counsel Journal Epub ahead of print 2022.
14.
DubéELabergeCGuayM, et al. (2013) Vaccine hesitancy. Human Vaccines & Immunotherapeutics9(8): 1763–1773.
15.
EnkelSLAttwellKSnellingTL, et al. (2018) ‘Hesitant compliers’: Qualitative analysis of concerned fully-vaccinating parents. Vaccine36(44): 6459–6463.
16.
European Social Survey (2020) European Social Survey Round 10. European Social Survey.
17.
FarrRMoscoviciS (1984) Social Representations. Cambridge University Press.
18.
FasanelliRGalliIRiversoR, et al. (2020a) Social representations of insects as food: An explorative-comparative study among millennials and X-generation consumers. Insects11(10): 1–32.
19.
FasanelliRPiscitelliAGalliI (2020b) Social representations of covid-19 in the framework of risk psychology. Papers on Social Representations29(2).
20.
FaulFErdfelderEBuchnerA, et al. (2009) Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods41(4): 1149–1160.
FridmanAGershonRGneezyA (2021) COVID-19 and vaccine hesitancy: A longitudinal study. PLoS One16(4): e0250123.
23.
GalliIFasanelliR (2020) Public understanding of science and common sense: Social representations of the human microbiome among the expert and non-expert public. Health Psychology Open7(1).
24.
GalliIFasanelliRSchemberE (2018) The construction of icons as a means of access to the social representation of culture. Culture & Psychology24(2): 212–232.
25.
GilanDBirkenbachMWossidloM, et al. (2023) Fear of COVID-19 disease and vaccination as predictors of vaccination status. Scientific Reports13(1): 1–8.
26.
HerzlichCPierretJ (1985) The social construction of the patient: Patients and illnesses in other ages. Social Science & Medicine20(2): 145–151.
Italian Ministry of Health (2025) Campagna vaccinale Autunno-Inverno 2024/2025. Italian Ministry of Health.
30.
JaspalRBreakwellGM (2023) The significance of ethnicity in vaccination uptake: Social psychological aspects. In: RyanJM (ed.) COVID-19: Surviving a Pandemic. Routledge, pp.134–154.
31.
JodeletD (1984) Representations Sociales Phenomenes, concept et theorie. In: MoscoviciS (ed.) Psychology Sociale. Presses Universitaires de France, pp. 357–378.
32.
KarlssonLCSoveriALewandowskyS, et al. (2021) Fearing the disease or the vaccine: The case of COVID-19. Personality and Individual Differences172: 110590.
33.
LedfordCJWCaffertyLAMooreJX, et al. (2022) The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry. Journal of Health Communication27(1): 17–26.
MartinelliMVeltriGA (2021) Do cognitive styles affect vaccine hesitancy? A dual-process cognitive framework for vaccine hesitancy and the role of risk perceptions. Social Science & Medicine289: 114403.
36.
MelottiGBonomoMHakoköngäsE, et al. (2022) Social representations of coronavirus/COVID-19 in Italy: Psychosocial anchoring to conspiracy beliefs, vaccine hesitancy, and the psychological dimension. Journal of Pacific Rim Psychology16.
37.
MooreRPurvisRSWillisDE, et al. (2022) The vaccine hesitancy continuum among hesitant adopters of the COVID-19 vaccine. Clinical and Translational Science15(12): 2844–2857.
38.
MoralesGILeeSBradfordA, et al. (2022) Exploring vaccine hesitancy determinants during the COVID-19 pandemic: An in-depth interview study. SSM - Qualitative Research in Health2: 100045.
39.
MoscoviciS (2001) Why a theory of social representations in. In: DeauxKPhilogeneG (eds) Representations of the Social Bridging Theoretical Traditions. Blackwell, pp.8–35. Available at: https://www.scirp.org/reference/referencespapers?referenceid=79904 (accessed 18 December 2024).
40.
NerlichBJaspalR (2021) Social representations of ‘social distancing’ in response to COVID-19 in the UK media. Current Sociology69(4): 566–583.
41.
PalamenghiLBarelloSBocciaS, et al. (2020) Mistrust in biomedical research and vaccine hesitancy: The forefront challenge in the battle against COVID-19 in Italy. European Journal of Epidemiology35(8): 785–788.
42.
PratiGTzankovaIBarbieriI, et al. (2021) People’s understanding of the COVID-19 pandemic: Social representations of SARS-CoV-2 virus in Italy. Health, Risk & Society23(7–8): 304–320.
43.
PullanSDeyM (2021) Vaccine hesitancy and anti-vaccination in the time of COVID-19: A Google Trends analysis. Vaccine39(14): 1877–1881.
44.
RenoCMaiettiEFantiniMP, et al. (2021) Enhancing COVID-19 vaccines acceptance: Results from a survey on vaccine hesitancy in Northern Italy. Vaccines9(4): 378.
45.
RobertoAJZhouX (2023) Predicting college students’ COVID-19 vaccination behavior: An application of the extended parallel process model. Journal of Behavioral Medicine46(1-2): 76–87.
46.
RoseDEfraimDGervaisMC, et al. (1995) Questioning consensus in social representations theory. Papers on social representations4(2): 150–176.
47.
SantosKCODJunqueira-MarinhoMDFReisAT, et al. (2023) Social representations of hesitant Brazilians about vaccination against COVID-19. International Journal of Environmental Research and Public Health20(13): 6204.
48.
SavareseGCarpinelliLDe ChiaraA, et al. (2022) Anti-SARS-CoV-2 vaccination campaign: Risk perception, emotional states, and vaccine hesitancy in a sample of adolescents’ vaccinated parents in Southern Italy. Vaccines10(6): 958.
49.
SoveriAKarlssonLCAntfolkJ, et al. (2021) Unwillingness to engage in behaviors that protect against COVID-19: The role of conspiracy beliefs, trust, and endorsement of complementary and alternative medicine. BMC Public Health21(1): 1–12.
50.
StefanizziPProvenzanoSSantangeloOE, et al. (2023) Past and future influenza vaccine uptake motivation: A cross-sectional analysis among Italian health sciences students. Vaccines11: 717.
51.
WagnerWHayesN (2005) Everyday Discourse and Common Sense: The Theory of Social Representations. Palgrave Macmillan.
52.
Walker-JonesSMoloneyGHutchinsonM (2023) Juggling risks: A social representations investigation of women, pregnancy and COVID-19 vaccination. Journal of Community & Applied Social Psychology33(6): 1440–1454.
53.
WillisDESeligJPAndersenJA, et al. (2023) Hesitant but vaccinated: Assessing COVID-19 vaccine hesitancy among the recently vaccinated. Journal of Behavioral Medicine46(1–2): 15–24.
54.
WitteK (1992) Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs59(4): 329–349.
55.
World Health Organization (2022) Understanding the behavioral and social drivers of vaccine uptake. Weekly Epidemiological Record97: 209–224.
56.
ZarboCCandiniVFerrariC, et al. (2022) COVID-19 vaccine hesitancy in Italy: Predictors of acceptance, fence sitting and refusal of the COVID-19 vaccination. Frontiers in Public Health10: 873098.
