16 | Attitudes, prevention and vaccine choices in the post-pandemic era: results from the BEHAVE-MOD nationwide multiwave survey in Italy

Abstract

Background. The COVID-19 pandemic exposed the vulnerability of health systems and communities to emerging pathogens. Understanding the behavioral determinants of preventive practices and vaccine acceptance is therefore essential for preparedness. The BEHAVE-MOD project aims to build a conceptual framework of the determinants of preventive behaviors, to develop tools for timely behavioral surveillance and to describe attitudes and practices towards influenza and COVID-19.

Materials and Methods. A multiwave cross-sectional survey was conducted by a national network of universities and research institutes on samples representative of the Italian adult population, stratified by gender, age and region of residence. Wave 1 (December 2024-January 2025; about 8,000 respondents) explored health status, preventive behaviors, information sources, psychological and economic impact of the pandemic and health locus of control; wave 2 (April-May 2025; about 4,000 follow-up and 4,000 new respondents) vaccination follow-up, institutional trust, health system evaluation and digital health; wave 3 (August 2025; about 4,000 follow-up and 7,000 new respondents) health literacy, public health communication, behavioral barriers and health decision-making. Predictors of vaccine uptake were assessed by multivariable logistic regression.

Results. Overall, 20,434 subjects were recruited (49.98% women; 30.41% from Southern Italy and Islands). In wave 1 (n=8,067), 33.7% received the 2024-2025 influenza vaccine and 17.8% received or intended to receive the COVID-19 vaccine. Past vaccination was the strongest predictor of both influenza (OR=8.19; 95% CI: 3.98-16.84) and COVID-19 vaccine uptake (OR=21.23; 95% CI: 16.35-27.73). COVID-19 vaccination was associated with a five- to six-fold higher influenza vaccine uptake, while perceived usefulness of masks and willingness to be vaccinated against emerging pathogens emerged as further predictors. Overall, 84.5% declared willingness to be vaccinated against future emerging pathogens.

Conclusions. Vaccine decisions tend to crystallize into stable groups, and preventive habits acquired during the pandemic shape long-term vaccination choices. Generic information campaigns are unlikely to reach hesitant groups and targeted strategies tailored to behavioral profiles, institutional trust and health literacy are needed. Integrating behavioral data into public health surveillance may strengthen pandemic preparedness.

Data Availability Statement

OA