Vaccine hesitancy and attitudes toward newborn heel-prick screening among religious officials: A mixed-methods study, Erzurum, Türkiye

Vaccine hesitancy has risen globally and in Türkiye. Religious officials often act as community opinion leaders; their views may shape acceptance of vaccination and newborn bloodspot screening (NBS). We conducted a cross-sectional study among Muslim religious officials in Erzurum, Türkiye (n = 200). A 47-item questionnaire captured sociodemographics, health-service use/satisfaction, attitudes to childhood/adult vaccines and newborn bloodspot screening, and the 21-item Turkish Vaccine Hesitancy Scale (higher scores = higher hesitancy). Open-ended item elicited qualitative comments. Quantitative comparisons used t-tests/one-way ANOVA (α = 0.05). Qualitative data underwent inductive thematic analysis (Braun-Clarke); two independent coders achieved Cohen's κ = 0.80. Mean vaccine hesitancy score was 62.9 ± 11.4. Scores did not differ by sociodemographics (p > .05). Lower satisfaction with health services was associated with higher hesitancy (overall p = .004). Hesitancy varied by attitudes toward adult vaccination (p = .003), childhood vaccination (p = .002), and NBS support (p = .004) - with lower scores among supporters. Only 19% were aware of the Organization of Islamic Cooperation (OIC) fatwa on vaccination; awareness was not associated with hesitancy (p > .05). Thematic analysis (n = 40 textual responses) yielded five themes: safety/adverse-effect concerns (27.5%); information & service-process experience (22.5%); perceived benefit/effectiveness (bipolar) (20.0%); privacy/biomaterial (NBS) (17.5%); and fertility/genetic-harm beliefs (12.5%).Among religious officials, vaccine hesitancy appeared to cluster around safety and institutional trust, reinforced by privacy/biomaterial, fertility/genetic, and effectiveness narratives. Interventions should prioritize content transparency (including halal and safety information), process transparency for NBS (storage/secondary use/disposal policies), co-delivery of messages by physicians and religious officials, proactive risk communication, and brief, targeted training modules.