Change in Knowledge and Vaccine Hesitancy Following Immunization Training Among Family Health Workers: The Role of Experience and Cognitive Flexibility.

RATIONALE: Vaccine hesitancy is one of the principal barriers to immunization programs, and health workers are central to this process both in countering hesitancy and through their own attitudes. Although educational interventions targeting health workers are widespread, how the effect of such training differs according to individual characteristics-and which factors determine this variation-remains insufficiently understood.

AIMS AND

OBJECTIVES

This study aimed to evaluate the effect of a 4 h immunization training program delivered to family health workers on vaccine knowledge and vaccine hesitancy, and to determine whether professional experience and cognitive flexibility predict knowledge gain and attitude change.

METHODS

A single-group pre-test-post-test design was used in Trabzon in February 2026. Vaccine knowledge was measured with a 10-item test, vaccine hesitancy with the short form of the Vaccine Hesitancy Scale, and cognitive flexibility with the Cognitive Flexibility Inventory. Change scores were examined with baseline-adjusted multiple linear regression, and the experience × cognitive flexibility interaction with an exploratory moderated regression.

RESULTS

A total of 272 participants, representing 95% of the source population, were analyzed. Immediate post-training knowledge recall increased substantially (from 6.77 to 8.76 out of 10; dz = 1.34; p < 0.001); 84.9% of participants improved their score, and the proportion answering at least 8 of the 10 items correctly rose from 32.4% to 87.9%. The reduction in vaccine hesitancy was statistically significant but negligible in magnitude (Δ = -0.90; p = 0.033; dz = -0.13); this corresponds to 1.9% of the 48-point usable range of the scale, with 51.4% of participants scoring lower, 12.4% unchanged and 36.3% higher after the training. The only individual characteristic that predicted attitude change was the Control dimension of cognitive flexibility (β = -0.116; p = 0.026), whereas professional experience predicted neither knowledge gain nor attitude change. The exploratory experience × cognitive flexibility interaction did not survive heteroscedasticity-consistent estimation and is reported as hypothesis-generating only.

CONCLUSION

A brief, lecture-based training program substantially increased knowledge but produced no meaningful change in vaccine hesitancy in practice. This dissociation suggests that attitude change may require more than the transfer of information, and that cognitive flexibility-given the small and only partly robust associations observed here-is an individual factor whose role should be tested directly. Because of the uncontrolled design and the administration of the post-test immediately after the training, the findings describe short-term recall and immediate attitude reporting; any claim about causality or durability would require a controlled design with delayed follow-up.