Factors Influencing COVID-19 Booster Vaccine Attitudes Among University Students: A Cross-Sectional Study

<ns3:p>Background University students represent a highly mobile and socially active population, making their attitudes toward COVID-19 booster vaccination particularly relevant for campus health promotion. Despite widespread vaccination campaigns, booster uptake among young adults remains inconsistent. This study aimed to examine the psychosocial and behavioural factors associated with attitudes toward COVID-19 booster vaccines among students at a Malaysian public university. Methods A cross-sectional online survey was conducted among undergraduate and postgraduate students (n = 627). Data were analysed using partial least squares structural equation modelling (PLS-SEM) to examine the relationships between perceived benefits, perceived risks, information-seeking behaviour, religiosity, trust in key stakeholders, and attitudes toward booster vaccination. Results The findings indicate that perceived benefits, information-seeking behaviour, religiosity, and perceived risks were significant predictors of students’ attitudes toward COVID-19 booster vaccination. Perceived benefits emerged as the strongest positive predictor, while higher perceived risks were associated with less favourable attitudes. Trust in key stakeholders and perceived government support were indirectly and non-significantly related to attitudes. Conclusion Although the findings are specific to a single university, they provide important insights into the behavioural factors shaping attitudes toward booster vaccines within a campus context. The results highlight the need for targeted university-based health promotion strategies that emphasise vaccine benefits, address safety concerns, and leverage trusted information sources, including religious and institutional actors, to improve booster uptake among students.</ns3:p>