ArticleJournal of community health2026
Online Information as a Double-Edged Sword: A Multilevel Analysis of Vaccination Skepticism Based on ISSP 2021.
Article in Journal of community health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This study examines the relationship between internet use and vaccine scepticism, focusing on the ambivalent role of digital information environments and digital health literacy (DHL). While the internet provides easy access to vaccination-related information, frequent internet use may also increase exposure to misinformation and disinformation. Accordingly, both positive and negative effects of internet-based information seeking are hypothesized. In contrast, higher levels of DHL are expected to reduce vaccine scepticism. The study also investigates the influence of healthcare system quality, measured through both subjective satisfaction with the healthcare system and an objective indicator of healthcare quality. The hypotheses are tested using data from the International Social Survey Programme (ISSP) 2021, employing multilevel logistic regression models based on N = 48,538 respondents. The results reveal a non-linear relationship between internet use and vaccine scepticism. Individuals without internet access as well as those who search very frequently for vaccination-related information online exhibit higher levels of scepticism. In addition, low DHL is consistently associated with greater vaccine scepticism, suggesting that the ability to critically evaluate online health information is as important as access itself. Furthermore, dissatisfaction with the healthcare system and lower national healthcare quality are linked to more sceptical attitudes toward vaccination. These findings highlight the internet as both an opportunity for health education and a potential source of misinformation. Public health strategies should therefore ensure equitable access to reliable vaccination information while strengthening digital health literacy and individuals' critical evaluation skills.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.