The COVID-19 pandemic has had a profound and far-reaching impact on public health systems, economies, and social structures globally. With millions of lives lost and healthcare systems stretched beyond their capacities, the urgent development and deployment of vaccines became the cornerstone of pandemic response strategies worldwide.(Afsharinia & Gurtoo, 2023) Mass vaccination has been recognized as the most effective public health measure for curbing transmission, reducing hospitalizations, and preventing deaths associated with COVID-19.(Chandani et al., 2021) Haryana, a state in North India with diverse urban and rural populations, presents a unique case for studying COVID-19 vaccine acceptance. While government records show high coverage rates in many districts, ground-level reports indicate lingering pockets of hesitancy and misinformation—especially in rural and peri-urban areas.(Chinnasamy & Adhimoolam, 2023) In light of the ongoing challenges related to COVID-19 vaccination acceptance and uptake, this study was undertaken to systematically examine the knowledge, attitudes, and practices (KAP) of individuals regarding COVID-19 vaccination in Haryana, India. The primary objective was to assess the level of awareness and understanding about the COVID-19 vaccine among the general population. Additionally, the study aimed to explore prevailing attitudes and perceptions—both supportive and hesitant—towards vaccination, including trust in vaccine safety, efficacy, and sources of information. Finally, the study sought to evaluate actual vaccination practices and uptake within the population, thereby identifying possible gaps between knowledge and behavior. These insights are expected to inform evidence-based public health strategies tailored to local contexts to improve vaccine coverage and address vaccine hesitancy effectively.

A cross-sectional based survey approach was carried out in the districts of Panchkula, Nuh, Hisar, and Karnal, encompassing both urban and rural areas. From each district, seven health centers were selected for data collection, ensuring wide geographic and demographic representation. At each health center, data were collected from 30 individuals. Thus, for each district, the total sample size was 210 participants per district. Actual data collection in the field was conducted through interviewer-administered structured questionnaires among individuals aged 18–60 years who were residents of Haryana. For participants attending the Outpatient Department (O.P.D.) for short durations, exit interviews were conducted. In cases where participants were able and willing, a pen-and-paper-based self-administration method was used. The data collection tool included both closed-ended and Likert-scale items and was informed by previously validated instruments used in national and international studies.(Dhalaria et al., 2022; Dhama et al., 2021). This study employed a convenient sampling technique, a non-probability method wherein participants were selected based on their accessibility and proximity to the investigator. Community hubs such as outpatient departments (OPDs), vaccination centers, community health camps, and local public areas (markets, anganwadis, panchayat premises) served as key locations for recruiting participants. The inclusion criteria were adults aged 18 years and above, residing in Haryana for at least six months, and willing to participate in the study after informed consent. Exclusion criteria included healthcare professionals (to avoid bias), severely ill individuals, or those unable to communicate effectively. The data was analysed using spss version 26. The qualitative data was expressed in frequencies and proportions, whereas the quantitative data was expressed in mean and standard deviation.

A total of 845 participants were recruited for the present study, that included 484 males (57.3%) and 361 females (42.7%). The age distribution varied notably across districts. In the 15–30 year age group, participant proportions were relatively similar across Hisar (n=47; 25.1%), Karnal (n=51; 27.3%), Nuh (n=44; 23.5%), and Panchkula (n=45; 24.1%). The 31–45 year group was also well-represented across districts, with the highest proportion in Panchkula (n=103; 28.1%). Participants aged 46–60 years were more common in Nuh (n=68; 30.9%) and Panchkula (n=62; 28.2%) compared to Hisar (n=42; 19.1%) and Karnal (n=48; 21.8%). Notably, the highest representation of participants aged >75 years was from Hisar (n=6; 60.0%) and Karnal (n=3; 30.0%), while Panchkula had none in this category. Gender distribution showed a higher proportion of males in Nuh (n=138; 28.5%) and Karnal (n=112; 23.1%) compared to females, while the gender distribution in Hisar (114 males; 23.6% and 97 females; 26.9%) and Panchkula (120 males; 24.8% and 90 females; 24.9%) was relatively balanced. Marital status distribution showed that the highest proportion of married participants was from Nuh (n=189; 26.5%) and Panchkula (n=187; 26.3%). Unmarried or single individuals were most prevalent in Hisar (n=41; 35.7%) and Karnal (n=36; 31.3%), while divorced or separated individuals were few across all districts, with a relatively higher proportion in Hisar (n=7; 38.9%). In terms of education, Panchkula had a dominant share of participants with postgraduate or professional qualifications (n=153; 81.0%), whereas this category was absent in Nuh. Participants with no formal education were more prevalent in Karnal (n=57; 37.3%) and Nuh (n=56; 36.6%). Primary and secondary education levels were most common in Hisar and Nuh, while higher secondary education was relatively evenly distributed, with Nuh having the highest proportion (n=34; 35.1%). Household monthly income distribution indicated economic disparity across districts. Panchkula had the highest proportion of participants with income above ₹33,000 (n=137; 64.9%), while Nuh had the lowest (n=2; 0.9%). Conversely, participants earning less than ₹13,000 per month were most prevalent in Nuh (n=153; 41.9%) and Karnal (n=111; 30.4%). Hisar showed a relatively balanced income distribution. Availability of BPL cards further reflected socioeconomic differences. Nuh had the highest proportion of participants possessing a BPL card (n=194; 51.3%), while Panchkula had the lowest (n=15; 4.0%). The majority of participants without a BPL card were from Panchkula (n=195; 41.8%) and Hisar (n=129; 27.6%). (Table 1) Table 1: District-wise sociodemographic profile of the participants Variable Category District Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Age Interval 15-30 Year 47 25.1% 51 27.3% 44 23.5% 45 24.1% 31-45 Year 92 25.1% 88 24.0% 84 22.9% 103 28.1% 46-60 Year 42 19.1% 48 21.8% 68 30.9% 62 28.2% 61-75 Year 24 39.3% 23 37.7% 14 23.0% 0 0.0% >75 Year 6 60.0% 3 30.0% 1 10.0% 0 0.0% Gender Female 97 26.9% 101 28.0% 73 20.2% 90 24.9% Male 114 23.6% 112 23.1% 138 28.5% 120 24.8% Marital Status Divorced/Separated 7 38.9% 4 22.2% 6 33.3% 1 5.6% Married 163 22.9% 173 24.3% 189 26.5% 187 26.3% Unmarried/Single 41 35.7% 36 31.3% 16 13.9% 22 19.1% Education Level Graduate 28 26.4% 30 28.3% 22 20.8% 26 24.5% Higher Secondary 31 32.0% 24 24.7% 34 35.1% 8 8.2% None 39 25.5% 57 37.3% 56 36.6% 1 .7% Post Graduate/ Professional 20 10.6% 16 8.5% 0 0.0% 153 81.0% Primary 40 37.4% 38 35.5% 22 20.6% 7 6.5% Secondary 53 27.5% 48 24.9% 77 39.9% 15 7.8% Total household monthly income Above 33000 INR 38 18.0% 34 16.1% 2 .9% 137 64.9% Between 13000 to 33000 INR 84 31.2% 68 25.3% 56 20.8% 61 22.7% Less than 13000 INR 89 24.4% 111 30.4% 153 41.9% 12 3.3% Availability of BPL card No 129 27.6% 126 27.0% 17 3.6% 195 41.8% Yes 82 21.7% 87 23.0% 194 51.3% 15 4.0% Most participants reported living with their families across all districts, with the highest proportion in Nuh (n=209, 26.9%), followed by Panchkula (n=197, 25.3%), Hisar (n=188, 24.2%), and Karnal (n=184, 23.7%). In contrast, those not living with their families were more commonly from Karnal (n=29, 43.3%) and Hisar (n=23, 34.3%), with fewer from Panchkula (n=13, 19.4%) and Nuh (n=2, 3.0%). In terms of area of residence, rural participants were most prevalent in Nuh (n=209, 38.1%) and Karnal (n=149, 27.1%), followed by Hisar (n=141, 25.7%). Panchkula had the least rural respondents (n=50, 9.1%) but the highest proportion of urban residents (n=155, 76.0%). Semi-urban participants were more common in Hisar (n=44, 47.8%) and Karnal (n=41, 44.6%), with very few in Panchkula (n=5, 5.4%) and Nuh (n=2, 2.2%). Urban residency was negligible in Nuh (n=0), moderate in Hisar (n=26, 12.7%) and Karnal (n=23, 11.3%), and highest in Panchkula. Family size data revealed that participants with 4 to 10 family members were distributed fairly evenly across all districts, highest in Nuh (n=128, 26.9%), followed by Karnal (n=122, 25.7%), Hisar (n=119, 25.1%), and Panchkula (n=106, 22.3%). Those with three or fewer family members were more common in Panchkula (n=95, 37.1%), while the few reporting more than 10 family members were almost entirely from Nuh (n=10, 90.9%). Presence of family members above 60 years was reported more frequently in Panchkula (n=126, 26.9%), Hisar (n=137, 29.3%), and Karnal (n=135, 28.8%), while only 70 participants (n=70, 15.0%) in Nuh reported having elderly family members. Conversely, the absence of such members was most reported in Nuh (n=141, 37.4%). Family history of chronic diseases was reported most often by participants in Panchkula (n=147, 33.9%) and Karnal (n=129, 29.8%), followed by Hisar (n=107, 24.7%). Nuh had the lowest proportion reporting such a history (n=50, 11.5%). On the other hand, the absence of family history of chronic illness was most common in Nuh (n=161, 39.1%), followed by Hisar (n=104, 25.2%), Karnal (n=84, 20.4%), and Panchkula (n=63, 15.3%). (Table 2) Table 2: District wise family history of the participants Variable category District Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Living with family members No 23 34.3% 29 43.3% 2 3.0% 13 19.4% Yes 188 24.2% 184 23.7% 209 26.9% 197 25.3% Residence Rural 141 25.7% 149 27.1% 209 38.1% 50 9.1% Semi-Urban 44 47.8% 41 44.6% 2 2.2% 5 5.4% Urban 26 12.7% 23 11.3% 0 0.0% 155 76.0% No. of family members >=3 56 21.9% 55 21.5% 50 19.5% 95 37.1% 4-10 119 25.1% 122 25.7% 128 26.9% 106 22.3% >10 1 9.1% 0 0.0% 10 90.9% 0 0.0% <3 35 34.0% 36 35.0% 23 22.3% 9 8.7% Family members above the age of 60 years No 74 19.6% 78 20.7% 141 37.4% 84 22.3% Yes 137 29.3% 135 28.8% 70 15.0% 126 26.9% Family History of Chronic Diseases No 104 25.2% 84 20.4% 161 39.1% 63 15.3% Yes 107 24.7% 129 29.8% 50 11.5% 147 33.9% Knowledge A large majority of participants (n=689, 81.5%) were aware that the Government of India had recommended the COVID-19 vaccination program, while 151 (17.9%) believed it was not recommended, and 5 (0.6%) were unsure. Regarding recommendations by healthcare professionals, 691 participants (81.8%) reported that a doctor, either known to them or consulted, had recommended taking the COVID-19 vaccine. However, 149 (17.6%) stated they did not receive such a recommendation, and 5 (0.6%) were unsure. In assessing knowledge about vaccination eligibility for children, 479 participants (56.7%) correctly identified that COVID-19 vaccines were not recommended for children below 11 years of age. On the contrary, 360 (42.6%) incorrectly believed the statement to be true, and 6 (0.7%) were unsure. When asked whether COVID-19 vaccines provide lifelong immunity if taken in the correct dosage and schedule, responses were mixed: 362 (42.8%) incorrectly believed this to be true, 243 (28.8%) correctly responded as false, and 240 (28.4%) were unsure. A total of 409 participants (48.4%) correctly disagreed with the statement that a single dose of COVID-19 vaccine provides complete protection against infection. However, 252 (29.8%) incorrectly believed it to be true, and 184 (21.8%) were uncertain. A strong majority—657 participants (77.8%)—correctly recognized that people who have recovered from COVID-19 infection can still receive vaccination. Conversely, 172 (20.4%) responded incorrectly, and 16 (1.9%) were unsure. Participants overwhelmingly agreed (n=750, 88.8%) that preventive measures like mask-wearing, handwashing, and social distancing should be continued even after vaccination. Only 89 (10.5%) disagreed, and 6 (0.7%) could not say. The correct interval of 12–16 weeks between vaccine doses was known to 716 participants (84.7%), while 123 (14.6%) answered incorrectly, and 6 (0.7%) were unsure. Regarding adverse effects of vaccination, 654 participants (77.4%) believed that adverse effects can occur, while 186 (22.0%) did not, and 5 (0.6%) were unsure. Finally, when asked about personally witnessing serious adverse effects in friends or family after vaccination, 398 (47.1%) answered yes, while a slightly higher number—442 (52.3%)—said no. A small number (n=5, 0.6%) were unsure. (Table 3) Table 3: Knowledge regarding COVID-19 vaccine among the participants N=845 % Did Government of India recommend the Vaccination program for COVID-19? Yes 689 81.5% No 151 17.9% Not sure 5 .6% How many doses of the covid 19 vaccine have been recommended by Government of India? 1 547 64.7% 2 96 11.4% 3 187 22.1% 4 1 0.1% Not sure 14 1.7% Did your family doctor or any doctor known to you or you met recommended that you take Covid-19 vaccine? Yes 691 81.8% No 149 17.6% Can't Say 5 .6% Is the following statement True or False? Currently Covid-19 vaccines in India are recommended for children below 11 years of age. False 479 56.7% True 360 42.6% Can't Say 6 .7% Is the following statement true or false? If taken, in the correct dosage and Proper schedule, then the immunity generated by Covid vaccine will be lifelong. False 243 28.8% True 362 42.8% Can't Say 240 28.4% Is the following statement True or False? A single dose of COVID-19 vaccine gives complete protection against infection. False 409 48.4% True 252 29.8% Can't Say 184 21.8% Is the following statement True or False? A person who has already recovered from COVID- 19 infection can receive COVID vaccination. False 172 20.4% True 657 77.8% Can't Say 16 1.9% Is the following statement True or False? We need to follow preventive measures like social distancing, hand washing, and wearing mask even after covid-19 vaccination. False 89 10.5% True 750 88.8% Can't Say 6 .7% Is the following statement True or False? Recommended interval between two doses of COVID-19 vaccines in India is 12-16 weeks. False 123 14.6% True 716 84.7% Can't Say 6 .7% Do you think that someone can suffer adverse effects after taking Covid-19 vaccination? Yes 654 77.4% No 186 22.0% Can't Say 5 .6% Among your friends or family members, have you seen anyone suffer serious adverse effects after taking Covid vaccination? Yes 398 47.1% No 442 52.3% Can't Say 5 .6% Awareness regarding the Government of India’s recommendation for the COVID-19 vaccination program varied significantly across districts (p < 0.001). The highest awareness was observed in Panchkula (n=207, 30.0%), followed by Nuh (n=195, 28.3%), Hisar (n=155, 22.5%), and Karnal (n=132, 19.2%). However, a higher proportion of respondents from Karnal (n=79, 52.3%) and Hisar (n=56, 37.1%) believed that the government had not recommended vaccination, in contrast to much lower proportions from Nuh (n=14, 9.3%) and Panchkula (n=2, 1.3%). Responses to the number of doses recommended by the government also showed significant variation (p < 0.001). The belief that only one dose was required was most prevalent in Nuh (n=164, 30.0%), followed by Karnal and Panchkula (n=139 each, 25.4%), and Hisar (n=105, 19.2%). Notably, the belief in three doses was most frequent in Hisar (n=80, 42.8%), followed by Karnal (n=40, 21.4%) and Nuh (n=36, 19.3%). Interestingly, the highest proportion believing two doses were recommended came from Panchkula (n=40, 41.7%). Doctor recommendations to take the COVID-19 vaccine also significantly differed by district (p < 0.001), with the highest proportion of affirmative responses in Panchkula (n=187, 27.1%) and Karnal (n=184, 26.6%), followed by Hisar (n=174, 25.2%) and Nuh (n=146, 21.1%). However, nearly half the participants from Nuh (n=63, 42.3%) reported not receiving a doctor’s recommendation. On the question of whether vaccines were recommended for children under 11 years, a significant difference was seen (p < 0.001). Misconceptions were more prevalent in Panchkula (n=111, 30.8%) and Karnal (n=106, 29.4%), while the lowest incorrect responses were in Nuh (n=44, 12.2%). Conversely, the correct response (False) was highest in Nuh (n=164, 34.2%). Belief in lifelong immunity from COVID-19 vaccines if taken in the correct schedule also differed significantly (p = 0.018). The belief was most prevalent in Karnal (n=110, 30.4%), followed by Panchkula (n=89, 24.6%), Nuh (n=87, 24.0%), and Hisar (n=76, 21.0%). The correct response (False) was given most frequently in Hisar (n=75, 30.9%). Regarding the belief that a single dose provides complete protection, significant differences were seen (p < 0.001). Incorrect belief was highest in Karnal (n=100, 39.7%) and Panchkula (n=68, 27.0%). Correct identification of the statement as false was highest in Nuh (n=139, 34.0%) and Hisar (n=118, 28.9%). Awareness that recovered COVID-19 patients can still receive vaccination was significantly different across districts (p < 0.001), with the highest correct responses from Nuh (n=195, 29.7%) and Hisar (n=164, 25.0%). Incorrect beliefs were more prevalent in Karnal (n=63, 36.6%) and Panchkula (n=50, 29.1%). On the continuation of preventive measures post-vaccination, no statistically significant difference was noted across districts (p = 0.053). Most participants in all districts correctly agreed, with proportions ranging from 23.9% to 26.3%. Similarly, understanding of the recommended interval (12–16 weeks) between vaccine doses showed no significant difference across districts (p = 0.067), with correct responses consistently high, led by Nuh (n=187, 26.1%). Perception of adverse effects from vaccination differed significantly (p < 0.001), with the highest affirmative responses in Nuh (n=206, 31.5%) and Hisar (n=182, 27.8%), and lowest in Panchkula (n=119, 18.2%). Conversely, the belief that vaccines cause no adverse effects was most common in Panchkula (n=91, 48.9%) and Karnal (n=65, 34.9%). Finally, reports of observing serious adverse effects among acquaintances showed a significant difference (p = 0.016), with affirmative responses highest in Hisar (n=115, 28.9%) and Nuh (n=104, 26.1%), while the largest number of negative responses came from Panchkula (n=131, 29.6%). (Table 4) Table 4: District-wise knowledge regarding COVID-19 vaccination Variable Category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Did Government of India recommend the Vaccination program for COVID-19? Yes 155 22.5% 132 19.2% 195 28.3% 207 30.0% <0.001 No 56 37.1% 79 52.3% 14 9.3% 2 1.3% Missing 0 0.0% 2 40.0% 2 40.0% 1 20.0% How many doses of the covid 19 vaccine have been recommended by Government of India? 1 105 19.2% 139 25.4% 164 30.0% 139 25.4% <0.001 2 17 17.7% 32 33.3% 7 7.3% 40 41.7% 3 80 42.8% 40 21.4% 36 19.3% 31 16.6% 4 0 0.0% 1 100.0% 0 0.0% 0 0.0% Not sure 9 64.3% 1 7.1% 4 28.6% 0 0.0% Did your family doctor or any doctor known to you or you met recommended that you take Covid-19 vaccine? Yes 174 25.2% 184 26.6% 146 21.1% 187 27.1% <0.001 No 35 23.5% 28 18.8% 63 42.3% 23 15.4% Can't Say 2 40.0% 1 20.0% 2 40.0% 0 0.0% Is the following statement True or False? Currently Covid-19 vaccines in India are recommended for children below 11 years of age. True 99 27.5% 106 29.4% 44 12.2% 111 30.8% <0.001 False 110 23.0% 106 22.1% 164 34.2% 99 20.7% Can't Say 2 33.3% 1 16.7% 3 50.0% 0 0.0% Is the following statement true or false? If taken, in the correct dosage and Proper schedule, then the immunity generated by Covid vaccine will be lifelong. True 76 21.0% 110 30.4% 87 24.0% 89 24.6% 0.018 False 75 30.9% 56 23.0% 57 23.5% 55 22.6% Can't Say 60 25.0% 47 19.6% 67 27.9% 66 27.5% Is the following statement True or False? A single dose of COVID-19 vaccine gives complete protection against infection. True 49 19.4% 100 39.7% 35 13.9% 68 27.0% <0.001 False 118 28.9% 73 17.8% 139 34.0% 79 19.3% Can't Say 44 23.9% 40 21.7% 37 20.1% 63 34.2% Is the following statement True or False? A person who has already recovered from COVID- 19 infection can receive COVID vaccination. True 164 25.0% 142 21.6% 195 29.7% 156 23.7% <0.001 False 45 26.2% 63 36.6% 14 8.1% 50 29.1% Can't Say 2 12.5% 8 50.0% 2 12.5% 4 25.0% Is the following statement True or False? We need to follow preventive measures like social distancing, hand washing, and wearing mask even after covid-19 vaccination. True 197 26.3% 179 23.9% 189 25.2% 185 24.7% 0.053 False 12 13.5% 32 36.0% 20 22.5% 25 28.1% Can't Say 2 33.3% 2 33.3% 2 33.3% 0 0.0% Is the following statement True or False? Recommended interval between two doses of COVID-19 vaccines in India is 12-16 weeks. True 183 25.6% 176 24.6% 187 26.1% 170 23.7% 0.067 False 26 21.1% 36 29.3% 21 17.1% 40 32.5% Can't Say 2 33.3% 1 16.7% 3 50.0% 0 0.0% Do you think that someone can suffer adverse effects after taking Covid-19 vaccination? Yes 182 27.8% 147 22.5% 206 31.5% 119 18.2% <0.001 No 27 14.5% 65 34.9% 3 1.6% 91 48.9% Can't Say 2 40.0% 1 20.0% 2 40.0% 0 0.0% Among your friends or family members, have you seen anyone suffer serious adverse effects after taking Covid vaccination? Yes 115 28.9% 100 25.1% 104 26.1% 79 19.8% 0.016 No 94 21.3% 112 25.3% 105 23.8% 131 29.6% Can't Say 2 40.0% 1 20.0% 2 40.0% 0 0.0% Used Chi Square Test** Attitude A majority of participants (n=615, 72.8%) expressed confidence that the COVID-19 vaccine can protect them from infection. However, 225 (26.6%) disagreed with this belief, 4 (0.5%) were uncertain, and 1 participant (0.1%) did not respond. When asked whether the vaccine can prevent severe COVID-19 disease, 602 participants (71.2%) agreed, while 233 (27.6%) disagreed, and 10 (1.2%) were unsure. Regarding concerns about serious side effects following vaccination in healthy individuals, opinions were divided: 449 participants (53.1%) agreed that serious side effects could occur, while 389 (46.0%) disagreed, and 7 (0.8%) could not say. A strong majority—694 participants (82.1%)—acknowledged the possibility of contracting COVID-19 even after vaccination. Meanwhile, 147 (17.4%) disagreed, and 4 (0.5%) were unsure. Support for requiring a COVID-19 vaccination certificate for international travel remained high, with 630 participants (74.6%) agreeing. However, 212 (25.1%) opposed the idea, and 3 (0.4%) were uncertain. Regarding the interchangeability of vaccine brands, opinions were mixed: 432 participants (51.1%) believed there is no issue in completing the vaccination schedule with different brands, while 401 (47.5%) disagreed, and 12 (1.4%) were unsure. Belief in the inevitability of minor side effects was expressed by 642 participants (76.0%), while 197 (23.3%) disagreed, and 6 (0.7%) could not say. Lastly, when asked whether minor side effects are acceptable, 571 participants (67.6%) affirmed this belief, while 267 (31.6%) did not agree, and 7 (0.8%) were uncertain. (Table 5) Table 5: Description of attitude of participants regarding COVID-19 infection and vaccination N=845 % I have confidence that the Covid vaccine can protect me from Covid-19 infection Agree 615 72.8% Can't Say 4 .5% Disagree 225 26.6% NA 1 .1% Covid vaccination can prevent severe Covid-19 disease Agree 602 71.2% Can't Say 10 1.2% Disagree 233 27.6% After Covid-19 vaccination a healthy person can get serious side effects Agree 449 53.1% Can't say 7 .8% Disagree 389 46.0% It is possible to get COVID infection even after vaccination Agree 694 82.1% Can't Say 4 .5% Disagree 147 17.4% Even today, Covid vaccination certificate should be made mandatory for international travellers. Agree 630 74.6% Can't Say 3 .4% Disagree 212 25.1% There is no problem if a person completes the Covid vaccination schedule by taking different doses of Covid vaccine from vials or products made by different companies Agree 432 51.1% Can't Say 12 1.4% Disagree 401 47.5% Minor side effects of Covid vaccine are inevitable Agree 642 76.0% Can't Say 6 .7% Disagree 197 23.3% I believe that minor side-effects of the vaccine are acceptable Can't Say 7 .8% No 267 31.6% Yes 571 67.6% A majority of respondents (n=531, 62.8%) believed that the benefits of taking the COVID-19 vaccine outweigh its risks, while 114 (13.5%) disagreed, and 200 (23.7%) were unsure. A strong proportion—712 participants (84.3%)—reported that they had recommended all doses, including the booster dose, to their family and friends. In contrast, 130 (15.4%) had not, and only 3 (0.4%) were uncertain. When asked about concerns regarding major long-term side effects, 457 (54.1%) expressed worry, while 385 (45.6%) did not, and 3 (0.4%) were unsure. Most participants (n=652, 77.2%) stated that their religious beliefs did not interfere with vaccination, whereas 190 (22.5%) indicated that religious beliefs were a hindrance, and 3 (0.4%) were unsure. On the perception of post-vaccination safety in crowded places, 489 participants (57.9%) believed it to be safe, 351 (41.5%) disagreed, and 5 (0.6%) were uncertain. Regarding the likelihood of re-infection after vaccination, 503 participants (59.5%) believed vaccination could prevent re-infection, 334 (39.5%) disagreed, and 8 (1.0%) were unsure. When asked if vaccinated individuals can avoid transmitting COVID-19 to others, 439 participants (52.0%) agreed, 202 (23.9%) disagreed, and 203 (24.1%) were unsure. Most participants (n=647, 76.6%) agreed that COVID-19 vaccines help protect public health in the country, while 85 (10.1%) disagreed, and 113 (13.4%) were unsure. Similarly, a significant majority (n=703, 83.2%) agreed that vaccination enables economic activities to continue without disruption. A smaller number disagreed (n=131, 15.1%), and 11 (1.3%) were unsure. Regarding external motivation, 645 participants (76.3%) reported that family members or neighbors had encouraged them to take the vaccine. However, 194 (23.0%) had not received such encouragement, and 6 (0.8%) were uncertain. Finally, 603 participants (71.4%) agreed that vaccination is an important solution in addressing the pandemic, while 96 (11.4%) disagreed, and 146 (17.3%) were unsure. (Table 6) Table 6: Beliefs regarding COVID-19 infection and vaccination among participants N=845 % I believe that benefits of taking covid-19 vaccine outweigh its risks /OR/ The Covid-19 Vaccine has more benefits as compared to its risks Can't say 200 23.7% No 114 13.5% Yes 531 62.8% I have recommended all the doses including booster dose of Covid -19 vaccine to my family and friends Can't Say 3 .4% No 130 15.4% Yes 712 84.3% I worry about major long term side effects of COVID vaccine Can't Say 3 .4% No 385 45.6% Yes 457 54.1% My religious beliefs hinder me from getting Covid-19 vaccine Can't Say 3 .4% No 652 77.2% Yes 190 22.5% After receiving the vaccine, it is safe for me to go to crowded places more frequently Can't say 5 .6% No 351 41.5% Yes 489 57.9% If I am vaccinated with Covid vaccine, I can avoid getting re-infection with Covid-19 Can't say 8 1.0% No 334 39.5% Yes 503 59.5% If I am vaccinated with Covid-19 vaccine, then I won’t be passing Covid-19 infection to others around me Can't say 203 24.1% No 202 23.9% Yes 439 52.0% Covid vaccine can help to protect the health of the people of my country Agree 647 76.6% Can't say 113 13.4% Disagree 85 10.1% Vaccination against Covid-19 can help economic activities to continue without disruption Agree 703 83.2% Can't say 11 1.3% Disagree 131 15.1% Family members and neighbours have asked me to take the Covid-19 vaccine Can't say 6 .8% No 194 23.0% Yes 645 76.3% Vaccination is the important solution in dealing with pandemic situation Agree 603 71.4% Can't say 146 17.3% Disagree 96 11.4% Out of 845 respondents, a large majority (91.5%) stated that they were not hesitant to take the COVID-19 vaccine, while 8.5% reported vaccine hesitancy. Among those who were hesitant, the most commonly cited reason was lack of information or incomplete information (3.9%), followed by fear of side effects (3.4%). Other less common reasons included the presence of other diseases (0.8%), age factors (0.1%), and other reasons (0.2%), while 91.5% marked the question as not applicable. When asked whether they knew anyone who was hesitant to take the COVID-19 vaccine, 58.5% reported knowing such individuals among friends or neighbours, whereas 41.2% denied knowing anyone with hesitancy, and 0.4% chose not to respond. Regarding post-vaccination side effects observed among relatives, friends, or neighbours, 39.1% of participants acknowledged knowing someone who developed side effects after receiving the COVID-19 vaccine, while 60.6% did not, and 0.4% did not respond. (Table 7) Table 7: Description of vaccine hesitancy among the participants N=845 % I am hesitant to take Covid-19 vaccine No 773 91.5% Yes 72 8.5% Reasons for hesitancy Presence of other diseases 7 .8% Lack of Information/ Incomplete information 33 3.9% Fear of Side Effects 29 3.4% Other reasons 2 .2% Age Factor 1 .1% NA 773 91.5% I know people (Friends or neighbours) who are hesitant to take Covid-19 vaccine Yes 494 58.5% No 348 41.2% NA 3 .4% Do you have any of your relatives, friends or neighbours who were given Covid-19 vaccine, and developed side-effects Yes 330 39.1% No 512 60.6% NA 3 .4% Confidence in the protective effect of the COVID-19 vaccine differed significantly across districts (p < 0.001). The highest agreement was seen in Panchkula (n=171, 27.8%) and Karnal (n=163, 26.5%), followed by Hisar (n=154, 25.0%) and Nuh (n=127, 20.7%). Disagreement was most prominent in Nuh (n=81, 36.0%) and least in Panchkula (n=39, 17.3%). A significant variation was also observed in the belief that the vaccine can prevent severe disease (p < 0.001), with the highest agreement in Panchkula (n=168, 27.9%) and Karnal (n=165, 27.4%). Disagreement was highest in Nuh (n=73, 31.3%) and Hisar (n=71, 30.5%). Concerns regarding serious side effects in healthy individuals after vaccination also showed significant differences (p = 0.021). Agreement was highest in Karnal (n=130, 29.0%) and Nuh (n=119, 26.5%). Disagreement was most common in Hisar (n=115, 29.6%) and Panchkula (n=102, 26.2%). The belief that COVID-19 infection is possible even after vaccination was significantly more prevalent in Nuh (n=195, 28.1%) and Karnal (n=176, 25.4%) than in Panchkula (n=166, 23.9%) and Hisar (n=157, 22.6%) (p < 0.001). In contrast, disagreement was notably higher in Hisar (n=53, 36.1%) and Panchkula (n=44, 29.9%). Participants’ support for making vaccination certificates mandatory for international travel showed significant differences (p < 0.001), with highest agreement in Panchkula (n=171, 27.1%) and Karnal (n=169, 26.8%). Disagreement was highest in Nuh (n=80, 37.7%). When asked about completing vaccination schedules with different vaccine brands, district-wise variation was again significant (p < 0.001). Agreement was highest in Karnal (n=144, 33.3%) and Panchkula (n=137, 31.7%), while disagreement was highest in Hisar (n=131, 32.7%) and Nuh (n=129, 32.2%). Perception of minor side effects as inevitable varied significantly across districts (p = 0.001). Agreement was highest in Nuh (n=178, 27.7%) and Karnal (n=171, 26.6%). Disagreement was most frequent in Hisar (n=66, 33.5%) and Panchkula (n=60, 30.5%). On the acceptability of minor side effects, differences across districts were not statistically significant (p = 0.062), though the highest agreement was observed in Nuh (n=159, 27.8%), followed by Karnal (n=146, 25.6%) and Hisar (n=134, 23.5%). Belief that the benefits of vaccination outweigh its risks significantly varied (p < 0.001). Agreement was consistent across Hisar (n=138, 26.0%), Karnal (n=137, 25.8%), and Nuh (n=135, 25.4%). Disagreement was highest in Panchkula (n=42, 36.8%) and Karnal (n=38, 33.3%). Recommendation of all vaccine doses to family and friends showed no significant variation across districts (p = 0.087), with relatively uniform agreement: Panchkula (n=187, 26.3%), Karnal (n=181, 25.4%), Nuh (n=177, 24.9%), and Hisar (n=167, 23.5%). Concerns about long-term side effects showed no significant difference (p = 0.30), though agreement was highest in Hisar (n=124, 27.1%) and Karnal (n=117, 25.6%). Disagreement was slightly higher in Nuh (n=104, 27.0%) and Panchkula (n=99, 25.7%). Religious beliefs as a barrier to vaccination varied significantly (p < 0.001), with the highest proportion of such responses in Karnal (n=73, 38.4%) and Panchkula (n=60, 31.6%), while very few participants from Nuh (n=3, 1.6%) reported this hindrance. Perception of safety in crowded places post-vaccination differed significantly across districts (p < 0.001). Agreement was highest in Panchkula (n=152, 31.1%) and Karnal (n=142, 29.0%), whereas disagreement was more common in Nuh (n=125, 35.6%) and Hisar (n=99, 28.2%). (Table 8) Table 8: District-wise description of attitude regarding COVID-19 vaccination among the participants Variable Category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % I have confidence that the Covid vaccine can protect me from Covid-19 infection Agree 154 25.0% 163 26.5% 127 20.7% 171 27.8% <0.001 Disagree 56 24.9% 49 21.8% 81 36.0% 39 17.3% Can't Say 1 25.0% 0 0.0% 3 75.0% 0 0.0% Missing 0 0.0% 1 100.0% 0 0.0% 0 0.0% Covid vaccination can prevent severe Covid-19 disease Agree 139 23.1% 165 27.4% 130 21.6% 168 27.9% <0.001 Can't Say 1 10.0% 1 10.0% 8 80.0% 0 0.0% Disagree 71 30.5% 47 20.2% 73 31.3% 42 18.0% After Covid-19 vaccination a healthy person can get serious side effects Agree 93 20.7% 130 29.0% 119 26.5% 107 23.8% 0.021 Can't say 3 42.0% 1 14.0% 2 28.0% 1 14.0% Disagree 115 29.6% 82 21.1% 90 23.1% 102 26.2% It is possible to get COVID infection even after vaccination Agree 157 22.6% 176 25.4% 195 28.1% 166 23.9% <0.001 Can't Say 1 25.0% 1 25.0% 2 50.0% 0 0.0% Disagree 53 36.1% 36 24.5% 14 9.5% 44 29.9% Even today, Covid vaccination certificate should be made mandatory for international travellers. Agree 161 25.6% 169 26.8% 129 20.5% 171 27.1% <0.001 Can't Say 1 33.3% 0 0.0% 2 66.7% 0 0.0% Disagree 49 23.1% 44 20.8% 80 37.7% 39 18.4% There is no problem if a person completes the Covid vaccination schedule by taking different doses of Covid vaccine from vials or products made by different companies Agree 77 17.8% 144 33.3% 74 17.1% 137 31.7% <0.001 Can't say 3 25.0% 1 8.0% 8 67.0% 0 0.0% Disagree 131 32.7% 68 17.0% 129 32.2% 73 18.2% Minor side effects of Covid vaccine are inevitable Agree 144 22.4% 171 26.6% 178 27.7% 149 23.2% 0.001 Can't Say 1 16.7% 2 33.3% 2 33.3% 1 16.7% Disagree 66 33.5% 40 20.3% 31 15.7% 60 30.5% I believe that minor side-effects of the vaccine are acceptable Can't Say 1 14.3% 3 42.9% 2 28.6% 1 14.3% 0.062 No 76 28.5% 64 24.0% 50 18.7% 77 28.8% Yes 134 23.5% 146 25.6% 159 27.8% 132 23.1% I believe that benefits of taking covid-19 vaccine outweigh its risks /OR/ The Covid-19 Vaccine has more benefits as compared to its risks Yes 138 26.0% 137 25.8% 135 25.4% 121 22.8% <0.001 Can't say 56 27.9% 38 19.3% 59 28.9% 47 23.9% No 17 14.9% 38 33.3% 17 14.9% 42 36.8% I have recommended all the doses including booster dose of Covid -19 vaccine to my family and friends Yes 167 23.5% 181 25.4% 177 24.9% 187 26.3% 0.087 No 43 33.1% 32 24.6% 32 24.6% 23 17.7% Can't Say 1 33.3% 0 0.0% 2 66.7% 0 0.0% I worry about major long term side effects of COVID vaccine Yes 124 27.1% 117 25.6% 105 23.0% 111 24.3% 0.30 No 86 22.3% 96 24.9% 104 27.0% 99 25.7% Can't Say 1 33.3% 0 0.0% 2 66.7% 0 0.0% My religious beliefs hinder me from getting Covid-19 vaccine Yes 54 28.4% 73 38.4% 3 1.6% 60 31.6% <0.001 No 156 23.9% 140 21.5% 206 31.6% 150 23.0% Can't Say 1 33.3% 0 0.0% 2 66.7% 0 0.0% After receiving the vaccine, it is safe for me to go to crowded places more frequently Yes 111 22.7% 142 29.0% 84 17.2% 152 31.1% <0.001 No 99 28.2% 70 19.9% 125 35.6% 57 16.2% Can't say 1 20.0% 1 20.0% 2 40.0% 1 20.0% Used Chi Square Test** When asked about COVID-19 vaccine hesitancy, the majority of participants across all districts reported no hesitancy, with 209 (27.0%) in Hisar, 186 (24.1%) in Karnal, 195 (25.2%) in Nuh, and 183 (23.7%) in Panchkula stating they were not hesitant. In contrast, vaccine hesitancy was reported by 2 (2.8%) in Hisar, 27 (37.5%) in Karnal, 16 (22.2%) in Nuh, and 27 (37.5%) in Panchkula, with a statistically significant difference across districts (p < 0.001). Among those who expressed hesitancy, the presence of other diseases was cited by 2 (28.6%) in Hisar, 3 (42.9%) in Karnal, 1 (14.3%) in Nuh, and 1 (14.3%) in Panchkula. Lack of or incomplete information was mentioned by 12 (36.4%) in Hisar, 10 (30.3%) in Karnal, 5 (15.2%) in Nuh, and 6 (18.2%) in Panchkula. Fear of side effects was reported by 9 (27.3%) in Hisar, 14 (42.4%) in Karnal, 4 (12.1%) in Nuh, and 6 (18.2%) in Panchkula. Other reasons were mentioned only by 2 (100.0%) in Karnal. The age factor was cited by 1 (100.0%) participant in Panchkula alone. The distribution of reasons for hesitancy showed a statistically significant difference across districts (p < 0.001). (Table 9) Table 9: District wise description of vaccine hesitancy among the participants Variable Category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % I am hesitant to take Covid-19 vaccine No 209 27.0% 186 24.1% 195 25.2% 183 23.7% <0.001 Yes 2 2.8% 27 37.5% 16 22.2% 27 37.5% Reasons for hesitancy Presence of other diseases 2 28.6% 3 42.9% 1 14.3% 1 14.3% <0.001 Lack of Information/ Incomplete information 12 36.4% 10 30.3% 5 15.2% 6 18.2% Fear of Side Effects 9 27.3% 14 42.4% 4 12.1% 6 18.2% Other reasons 0 0.0% 2 100.0% 0 0.0% 0 0.0% Age Factor 0 0.0% 0 0.0% 0 0.0% 1 100% Used Chi Square Test** Practice A large majority of participants (n=764, 90.4%) reported that they followed COVID-19 safety protocols during the pandemic, which included mask-wearing, regular handwashing, and social distancing. A small proportion—67 (7.9%)—admitted to not following these protocols, while 14 (1.7%) were uncertain. Specifically regarding mask usage, 728 participants (86.2%) stated that they consistently wore a mask, especially when outside or in the presence of others. However, 93 (11.1%) did not adhere to this practice, and 24 (2.8%) were unsure. Hand hygiene practices were more strictly followed. A vast majority—790 participants (93.5%)—reported regularly sanitizing or washing hands with soap, particularly after returning from public places or touching potentially contaminated surfaces. Only 27 participants (3.2%) reported not following this practice, and 28 (3.3%) were uncertain. Maintaining physical distance in public spaces was practiced by 650 participants (76.9%), while 73 (8.7%) did not adhere to this guideline. A notable portion—122 participants (14.4%)—were unsure or could not recall their behavior. In terms of mobile phone usage, the majority of participants (n=500, 59.2%) used smartphones. This was followed by 275 participants (32.5%) who used basic phones, and 70 (8.3%) who reported using feature phones. (Table 10) Table 10: Description regarding practices during COVID-19 pandemic N=845 % Were you following Covid-19 protocols such as wearing mask, regular washing hands with soap and social distancing during covid-19 pandemic? Yes 764 90.4% Can't Say 14 1.7% No 67 7.9% Were you wearing mask at all times (especially when outside or in the presence of people or in crowds) during Covid-19 pandemic? Yes 728 86.2% Can't Say 24 2.8% No 93 11.1% Were you sanitizing / or washing your hands with soap regularly during Covid-19 pandemic, especially while coming from outside or touching anything? Yes 790 93.5% Can't Say 28 3.3% No 27 3.2% Were you keeping a distance of two feet from other people while going out in public? Yes 650 76.9% Can't Say 122 14.4% No 73 8.7% Never.1) What type mobile phone do you use? (Ask interviewer to carry photos of these different types of phones to show the respondent) Smart Phone 500 59.2% Basic Phone 275 32.5% Feature Phone 70 8.3%

The present study was undertaken to assess the knowledge, attitudes, and perceptions related to COVID-19 vaccination among the adult population residing in selected districts of Haryana. Amidst a global public health crisis, the rollout of COVID-19 vaccines marked a pivotal moment in combating the pandemic; however, vaccine hesitancy and misinformation presented significant barriers to achieving optimal coverage.(Ennab et al., 2022; Raut et al., 2023; Sanghavi & Neiterman, 2022) This study aimed to investigate the underlying determinants influencing vaccine acceptance and hesitancy, sources of vaccine-related information, motivational factors for uptake, and the perceived side effects of vaccination among the population. The key findings revealed a high overall COVID-19 vaccine acceptance rate, with the majority of participants expressing willingness to receive or having already received the vaccine. Nevertheless, a notable proportion of respondents reported hesitancy, primarily driven by fear of side effects, lack of complete information, and the presence of comorbidities. Social networks such as friends, family, and community health workers emerged as important motivators for vaccine uptake. Digital platforms, especially mobile-based applications and social media, were also identified as common sources of both information and misinformation. A significant number of respondents reported witnessing side effects among acquaintances post-vaccination, and a small but meaningful proportion cited direct experiences of illness or discomfort following their own vaccination. These findings are of considerable significance as they offer context-specific insights into the behavioral and informational landscape surrounding COVID-19 vaccination in Haryana. Understanding the nuances of public perception and misinformation pathways is essential for tailoring public health strategies and communication efforts. The study contributes to the growing body of literature on vaccine behavior during pandemics and provides empirical evidence that can inform future immunization campaigns, not only for COVID-19 but also for other emerging infectious diseases. Knowledge and Misconceptions About COVID-19 Vaccines The knowledge landscape surrounding COVID-19 vaccines has played a pivotal role in shaping public behavior and vaccine uptake across communities.(Kishore et al., 2021) Adequate knowledge serves as a foundation for informed health decisions, while misconceptions can create fertile ground for fear, hesitancy, and refusal.(Ubale et al., 2022) The present study reveals crucial insights into the prevailing awareness levels, patterns of understanding, and the persistence of common myths and misinformation among the population studied. In the present study, a large majority of respondents demonstrated awareness of the public health benefits of COVID-19 vaccination. Specifically, 647 participants (76.6%) agreed that vaccination helps protect public health in the country, while 703 (83.2%) acknowledged that it enables the continuation of economic activities. Furthermore, 439 respondents (52.0%) believed that vaccinated individuals can avoid transmitting the virus to others, though a notable proportion either disagreed (202, 23.9%) or were unsure (203, 24.1%)—highlighting lingering uncertainty and partial misconceptions. While these figures indicate a generally high level of awareness, the gap between positive knowledge and complete understanding becomes evident when one considers the relatively lower agreement on transmission dynamics post-vaccination. This suggests that while people may be aware of the broader benefits, nuances such as breakthrough infections, need for booster doses, and herd immunity thresholds remain misunderstood. Additionally, 330 respondents (39.1%) reported that they had friends or relatives who experienced side effects after vaccination. While not necessarily based on verified clinical data, such shared anecdotes can significantly influence perceptions and perpetuate myths, especially in low-literacy or rural contexts. Similar patterns of partial knowledge and prevalent misconceptions were reported by Danabal et al. (2021), who found that although most urban participants were aware of the COVID-19 vaccine rollout, a substantial proportion held incorrect beliefs—such as vaccines causing infertility, altering DNA, or being unnecessary after recovery from infection. Their study highlighted that education level and exposure to verified sources directly impacted vaccine literacy.(Grace et al., 2021) Afsharinia et al. (2023), in a study conducted in Iran, also documented widespread misinformation, with a significant number of participants believing that the vaccine was rushed without proper testing or that it was developed for profit motives. They noted that even among those who accepted vaccination, underlying doubts persisted, reflecting the complex interplay of knowledge, belief, and trust.(Afsharinia & Gurtoo, 2023) Analysis of the current study’s data reveals that knowledge gaps were often linked to socio-demographic characteristics. District-wise differences in the belief that vaccination prevents transmission suggest that geographic and perhaps linguistic or cultural factors influence understanding. Furthermore, education level, media exposure, and trust in health authorities likely mediated the formation of beliefs, as suggested by studies such as Barman et al. (2024) and Bhattacharyya et al. (2023).(Barman et al., 2024; Bhattacharyya et al., 2023) These studies consistently underscore that misconceptions flourish in information vacuums—when public health messages are inconsistent, absent, or overshadowed by informal sources. For instance, in districts where fewer people accessed reliable media or engaged with health professionals, incorrect beliefs were more persistent and widespread. Attitude Towards Vaccination Attitude and trust are deeply intertwined determinants of health behavior, especially during public health emergencies such as the COVID-19 pandemic. While knowledge and access are critical, it is ultimately an individual’s attitude towards vaccination and their level of trust in the health system that governs vaccine acceptance or hesitancy. The present study, alongside comparative literature, highlights both encouraging trends and persisting challenges in this regard. A large proportion of participants in the present study expressed a positive attitude towards COVID-19 vaccination. Specifically, 91.5% (773 out of 845) respondents reported that they were not hesitant to receive the COVID-19 vaccine. Only 8.5% (n=72) admitted to hesitancy, which reflects a relatively high level of acceptance within the study population. However, this also implies that nearly 1 in 12 individuals still harbored concerns about the vaccine. Among those hesitant, the most frequently cited reasons were lack of information (3.9%), fear of side effects (3.4%), and presence of other diseases (0.8%), while ‘other reasons’ and ‘age factor’ were rarely reported. These findings underline the role of uncertainty and fear in shaping negative attitudes, often in the absence of direct mistrust in the system itself. Importantly, a high level of social awareness was also reflected—58.5% (n=494) participants acknowledged that they personally knew someone who was hesitant to take the vaccine, and 39.1% (n=330) knew individuals who had reportedly developed side effects post-vaccination. These perceptions, even if anecdotal, can influence attitudes by shaping communal narratives around risk and safety. When participants were asked who motivated them most to get vaccinated, the majority mentioned self-motivation (35.9%), followed by parents (20.0%), health professionals (12.9%), and social workers (15.3%). This self-directed and community-driven motivation pattern suggests not only a proactive attitude but also trust in immediate social networks and formal health providers. Meanwhile, only 0.1% mentioned ASHA workers, and a combined 3.2% attributed their decision to national leaders and teachers, indicating an underutilization of top-down public messaging in shaping vaccine attitudes. The levels of vaccine hesitancy observed in this study are considerably lower than in several other Indian and international contexts. For instance, Danabal et al. (2021) reported that around 30% of participants in Tamil Nadu exhibited hesitancy toward COVID-19 vaccines, with higher distrust observed in lower socioeconomic and less-educated strata. They noted that distrust in vaccine safety, fear of adverse effects, and doubts about government motives were central drivers of hesitancy—factors only modestly represented in the present study.(Grace et al., 2021) Similarly, Mathew et al. (2022) found that among healthcare workers in Kerala, a more educated and medically trained group, 16.4% still expressed vaccine hesitancy, citing distrust in pharmaceutical companies and concerns about long-term safety. This suggests that even in well-informed populations, attitudes are influenced not just by facts but by trust in institutions and perceived transparency.(Mathew et al., 2022) Practices In the current study, 69.9% of participants (n=591) reported that they continued to take protective measures such as wearing masks, maintaining social distancing, and carrying their own bags while visiting crowded or public places. In contrast, 29.7% (n=251) admitted to not adhering to these practices, and 0.4% (n=3) were non-respondents. These findings suggest a generally high level of compliance with public health guidelines, though a significant one-third of the population displayed behavioral fatigue or complacency post-vaccination. This level of sustained protective behavior is encouraging and may reflect effective health communication strategies, trust in scientific guidance, and personal risk perception.(Ritschl et al., 2022) However, the considerable minority who have abandoned these practices raises concerns about the misconception of total immunity after vaccination, which could contribute to ongoing transmission, especially with emerging variants and waning immunity.(Dasgupta et al., 2021; Samantaray et al., 2022) Additionally, 43.3% (n=366) of participants reported experiencing illness or side effects after receiving the COVID-19 vaccine, whereas 56.3% (n=476) did not report any side effects. Importantly, despite this high proportion of reported side effects, there was no major decline in adherence to preventive practices, suggesting resilience in public health behavior and possibly a recognition of the expected mild nature of post-vaccination symptoms. Danabal et al. (2021) highlighted similar concerns in Tamil Nadu. Their research indicated that a significant number of individuals relaxed protective behaviors after the first vaccine dose, believing themselves to be safe. They recommended booster awareness campaigns and reminders on the importance of dual-layered protection (vaccine + behavior).(Grace et al., 2021) Mathew et al. (2022), studying healthcare workers in Kerala, reported that 89% continued to follow mask mandates even after full vaccination, underscoring that professional background and scientific literacy have a significant impact on behavior retention. This contrast with the general population highlights the critical role of continuous education and training, especially outside healthcare settings.(Mathew et al., 2022)

The study revealed that overall vaccine acceptance was high, yet pockets of hesitancy persisted, particularly in socioeconomically disadvantaged and rural districts such as Nuh. Sociodemographic factors, including gender, education level, and marital status, significantly influenced vaccine attitudes. While most respondents demonstrated positive practices post-vaccination, such as continued use of masks and social distancing, there remained inconsistencies in risk perception and protective behavior adherence. Trust in healthcare professionals and personal motivation played a substantial role in influencing vaccination decisions, whereas media misinformation—particularly via social platforms and word of mouth—emerged as a critical barrier.

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