Shared understandings of vaccine hesitancy: How perceived risk and trust in vaccination frame individuals' vaccine acceptance.

Extensive research has framed vaccine hesitancy as a property of a heterogeneous group of individuals, ranging from total acceptance to complete refusal. Nevertheless, not much research has explored this heterogeneity, mainly focusing on central tendencies of single belief-related items. Using data from an original survey on a sample of Italian citizens, this paper examines this heterogeneity, exploiting individuals' cognitive variation to map clusters of individuals who share similar cognitive schemas on vaccine uptake. The results showed the existence three groups, characterized by a different articulation of predictors of vaccine hesitancy, revealing different understandings of vaccine uptake. We then analyzed within-cluster characteristics and showed that cognitive segmentation was connected to different levels of perceived risk, confidence, and support for vaccination. We further showed that cognitive clustering also entailed a mean of social stratification that was correlated with individuals' educational levels, and that the predictors of vaccine hesitancy were articulated differently in each group. This study, adopting a recent perspective in the analysis of systems of beliefs, moves one step further in disentangling the complexity of vaccine acceptance. Results suggested the usefulness of including individuals' cognitive characteristics in vaccine hesitancy research and in the development of interventions addressed at increasing vaccine acceptance.