Assessing Vaccine Hesitancy Among Nurses in Quebec, Canada Using the Professionals’ Vaccine Confidence and Behaviors Questionnaire

Background Vaccine hesitancy remains a major global health challenge, further intensified by the COVID-19 pandemic through widespread misinformation and declining trust in institutions. Healthcare providers, particularly nurses in Quebec (Canada), play a pivotal role in promoting vaccine uptake, yet hesitancy within this group may undermine public confidence and vaccination coverage. Objective This study aimed to assess nurses’ vaccination attitudes and behaviours in Québec and examine the influence of working conditions on these outcomes . Design, setting and participants A cross-sectional online survey was conducted among 1,428 nurses using the short French version of the Professionals’ Vaccine Confidence and Behaviors Questionnaire (Pro-VC-Be) questionnaire, a validated tool that measures vaccine confidence, trust in authorities, proactive efficacy (i.e., healthcare professionals’ sense of competence and active commitment to promoting vaccination among their patients) and vaccination-related behaviours (i.e., recommendations of specific vaccines to patients and self-vaccination). Additional items assessed perceived working conditions and perceived work degradation since the COVID-19 pandemic. Method Descriptive analyses, regression models and structural equation modeling (SEM) were performed. Results A total of 1,320 questionnaires were analyzed. Nurses showed high levels of vaccine confidence (mean = 81.5/100) and trust in authorities (80.7/100), but lower proactive efficacy (48.9/100) and vaccination-related behaviours, including vaccine recommendations (40.9/100 and 41.1/100). Simple linear regression models show positive “immunization resources” (i.e., vaccine confidence, trust in authorities, proactive efficacy together in a same scale) were strongly associated with increased vaccine-related behaviours and self-vaccination (p < 0.0001). Structural equations model shows that proactive efficacy emerged as a significant direct predictor of vaccine recommendation (path coefficient = 0.7) while trust in authorities was a significant predictor of vaccine confidence (path coefficient = 0.99). Structural equation modeling (SEM) analyses further highlighted significant indirect pathways linking working conditions to vaccine recommendation behaviours. Multiple linear regression models show that trust in authorities and proactive efficacy were positively associated with perceived working conditions. Trust and efficacy were negatively associated with perceived deterioration of work conditions during the pandemic while reluctant confidence was positively associated with perceived deterioration of work conditions. Conclusion Despite generally favorable attitudes toward vaccination, gaps persist in vaccination practices among nurses. Findings suggest that beyond individual beliefs, structural and organizational factors, particularly working conditions, play a critical role in shaping vaccine behaviours. Improving workplace environments and reinforcing institutional trust may represent key levers to strengthen vaccine advocacy among nurses and ultimately enhance population-level vaccination uptake.