Frustrated, hopeless and hesitant: Understanding doctors’ learned attitudes and emotions toward vaccine hesitancy through socialisation theory

: Rationale Healthcare professionals (HCPs) play an important role in addressing vaccine hesitancy (VH), yet current interventions often rely on skills-based training (e.g., Motivational Interviewing) while overlooking HCPs’ internal value conflicts. Understanding these conflicts (such as attitudes or emotions of VH, frustration, hopelessness and discomfort with persuasion) may help training HCPs in this area. Method Drawing on Socialisation Theory, this study examines the acculturation mechanisms that shape doctor attitudes toward vaccination. A survey (n=174) supported ten focus groups with medical students and doctor educators (n=46) to explore their knowledge, attitudes and professional norms around vaccines and VH. Results Our findings reveal that professional socialisation may function as a regulatory mechanism. As doctors acculturate, they internalize a biomedical value system, where pro-vaccination advocacy is not merely a clinical task but a core component of professional legitimacy. Consequently, doctors may consciously or sub-consciously align with these values, actively distancing themselves from positions—such as hesitancy—that are inconsistent with this identity. This alignment may suppress personal VH and reduce empathy that doctors have for hesitant patients. Conclusion This study offers a novel theoretical contribution by reframing doctor vaccine advocacy as a performance of professional identity rather than solely a communication competency. Educational interventions focused exclusively on "skills" may be insufficient if they ignore the pressures of socialisation. To sustain the workforce and improve uptake, training interventions should support HCPs in addressing attitudes and emotions towards vaccines and hesitant patients, in the context of potential pressures they may feel professionally.