India has a long-standing history of implementing extensive immunization programs aimed at reducing the burden of vaccine-preventable diseases. The backbone of these efforts was established through the launch of the Expanded Programme on Immunization (EPI) in 1978, which was later renamed the Universal Immunization Programme (UIP) in 1985.(Madhavi, 2005) The UIP remains one of the world’s largest public health programs, targeting millions of infants and pregnant women annually and delivering vaccines free of cost through public health facilities.(Mathew et al., 2022) With the advent of the COVID-19 pandemic, India leveraged its existing public health infrastructure and experience in mass immunization to roll out an unprecedented COVID-19 vaccination campaign, beginning on January 16, 2021.(Kashte et al., 2021) This marked a historic moment in public health, involving a phased approach starting with frontline workers, followed by senior citizens and individuals with comorbidities, and eventually expanding to the general adult population.(Chandani et al., 2021) In India, the scale of the COVID-19 vaccination program has been unprecedented, with more than 2 billion vaccine doses administered since the launch of the national COVID-19 vaccination campaign in January 2021.(Lahariya, 2014) However, despite the availability of vaccines and concerted government efforts, achieving universal coverage has been hindered by varying degrees of vaccine hesitancy, misinformation, and sociocultural resistance.(K. Sharma et al., 2023) Vaccination not only protects individuals but also confers herd immunity, which is vital for shielding vulnerable populations who may not be eligible for vaccination.(Krishnamurthy et al., 2023) The World Health Organization has underscored the importance of community-level awareness and trust in the health system to ensure the success of mass vaccination campaigns.(Patil et al., 2022) In light of the ongoing global discourse surrounding vaccine hesitancy, particularly during the COVID-19 pandemic, this study aimed to explore how exposure to various forms of media and trust in healthcare providers influenced vaccination behavior within the state of Haryana. Given the proliferation of both credible information and misinformation through digital, print, and interpersonal channels, along with varying degrees of public trust in medical professionals, it became essential to examine how these informational and trust-based determinants shaped individual decisions regarding vaccine acceptance or refusal. The primary objective of this research was to assess the relationship between levels of media exposure (social media, news outlets, health campaigns) and trust in healthcare providers with the actual COVID-19 vaccination behavior among adults in Haryana. The findings are expected to offer valuable insights for public health communication strategies and help design interventions that enhance trust and optimize the use of media to support vaccine uptake. Conducting this study in Haryana also aligns with national priorities aimed at identifying local-level barriers and facilitators of vaccine uptake to better inform targeted interventions.(Dinesh et al., 2023) The findings will provide actionable insights to public health authorities and help bridge the existing gap between vaccine availability and uptake.(Pundhir et al., 2023)

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%). Most participants were married, comprising 712 (84.3%) of the total, followed by 115 who were unmarried or single (13.6%), and 18 who were divorced or separated (2.1%). With regard to education level, 106 participants (12.5%) were graduates. (Table 1) Table 1: Sociodemographic profile of the participants Subject Category N=845 % Gender Female 361 42.7% Male 484 57.3% Marital Status Divorced/Separated 18 2.1% Married 712 84.3% Unmarried/Single 115 13.6% Education Level Graduate 106 12.5% Higher Secondary 97 11.5% Not Educated 153 18.1% Post Graduate/ Professional 189 22.4% Primary 107 12.7% Secondary 193 22.8% Residence Rural 549 65.0% Semi-Urban 92 10.9% Urban 204 24.1% Total household monthly income Above 33000 INR 211 25.0% Between 13000 to 33000 INR 269 31.8% Less than 13000 INR 365 43.2% Availability of BPL card No 467 55.3% Yes 378 44.7% In terms of mobile phone usage, a majority of participants (n=662, 78.3%) reported using their phones daily. A smaller proportion used them weekly (n=59, 7.0%) or monthly (n=51, 6.0%), while 45 (5.3%) reported less frequent use and 28 (3.3%) stated they never used a mobile phone. Television viewing was also fairly common, with 456 participants (54.0%) watching TV daily. Weekly viewers accounted for 175 (20.7%), while 147 (17.4%) reported never watching TV. Monthly viewers were few (n=19, 2.2%), and 48 (5.7%) watched less frequently than weekly. Radio listening was much less prevalent. More than half of the participants (n=474, 56.1%) reported never listening to the radio. Daily listeners were 138 (16.3%), followed by those who listened weekly (n=77, 9.1%) or less than weekly (n=102, 12.1%). Monthly listeners were 54 (6.4%). Reading newspapers or magazines was a daily habit for 348 participants (41.2%). Weekly reading was reported by 149 (17.6%), while 206 (24.4%) never engaged in this activity. A smaller proportion read less than weekly (n=115, 13.6%) or monthly (n=27, 3.2%). Regarding internet use, 494 participants (58.5%) reported daily use of Google. Weekly users comprised 90 (10.7%), while 206 (24.4%) never used it. Monthly (n=30, 3.6%) and less frequent (n=25, 3.0%) users were fewer. Facebook was used daily by 497 participants (58.8%). One-fourth of the sample (n=218, 25.8%) never used the platform. Weekly users were 73 (8.6%), and those using it less than weekly (n=37, 4.4%) or monthly (n=20, 2.4%) were even fewer. Instagram had slightly lower usage compared to Facebook. Daily usage was reported by 460 participants (54.4%), while 274 (32.5%) never used it. Weekly users were 89 (10.5%), and monthly or less frequent users were few (n=8, 0.9% and n=14, 1.7%, respectively). WhatsApp was among the most widely used platforms, with 617 participants (73.0%) reporting daily use. Only 165 (19.6%) said they never used WhatsApp, while weekly (n=26, 3.1%), monthly (n=21, 2.5%), and less frequent users (n=16, 1.9%) were comparatively fewer. YouTube was also a highly used platform, with 562 participants (66.5%) accessing it daily. Non-users comprised 154 (18.2%), while 72 (8.5%) used it weekly. Monthly (n=23, 2.7%) and less frequent users (n=34, 4.0%) were in the minority. (Table 2) Table 2: Description of use of social media among the participants N=845 % How often do you use mobile phone? Daily 662 78.3% Less than that 45 5.3% Monthly 51 6.0% Never 28 3.3% Weekly 59 7.0% How often do you watch Television (TV)? Daily 456 54.0% Less than that 48 5.7% Monthly 19 2.2% Never 147 17.4% Weekly 175 20.7% How often do you listen to Radio? Daily 138 16.3% Less than that 102 12.1% Monthly 54 6.4% Never 474 56.1% Weekly 77 9.1% How often do you read Newspaper / Magazine? Daily 348 41.2% Less than that 115 13.6% Monthly 27 3.2% Never 206 24.4% Weekly 149 17.6% How often do you surf Google? Daily 494 58.5% Less than that 25 3.0% Monthly 30 3.6% Never 206 24.4% Weekly 90 10.7% How often do you use Facebook? Daily 497 58.8% Less than that 37 4.4% Monthly 20 2.4% Never 218 25.8% Weekly 73 8.6% How often do you use Instagram? Daily 460 54.4% Less than that 14 1.7% Monthly 8 .9% Never 274 32.5% Weekly 89 10.5% How often do you use WhatsApp? Daily 617 73.0% Less than that 16 1.9% Monthly 21 2.5% Never 165 19.6% Weekly 26 3.1% How often do you use YouTube? Daily 562 66.5% Less than that 34 4.0% Monthly 23 2.7% Never 154 18.2% Weekly 72 8.5% Among the traditional media platforms, newspapers were used for sharing COVID-19 vaccine-related information by 543 participants (64.3%), while 300 (35.5%) did not use newspapers for this purpose. Only 2 participants (0.2%) explicitly marked “Never.” Television emerged as another key medium, with 579 participants (68.5%) reporting that they shared vaccine-related information via TV, while 266 (31.5%) did not. Radio was a less commonly used platform, with only 166 participants (19.6%) utilizing it, while a large majority (n=679, 80.4%) did not. Among digital platforms, mobile phones were the most widely used, with 503 participants (59.5%) reporting information sharing via mobile, and 342 (40.5%) not doing so. In terms of social media: • Facebook was used by 225 participants (26.6%) for sharing vaccine-related information, while 620 (73.4%) did not. • Twitter was the least used platform, with only 62 participants (7.3%) sharing information through it, and 783 (92.7%) not using it. • Instagram had similar patterns, with only 59 users (7.0%) reporting sharing behavior. • YouTube was used by 87 participants (10.3%), while 758 (89.7%) did not use it for this purpose. • WhatsApp, despite being widely used for communication, was reported as a medium for sharing vaccine information by only 80 participants (9.5%), whereas 765 (90.5%) did not. Finally, interpersonal communication through friends was a medium for 220 participants (26.0%), while the majority—625 participants (74.0%)—did not report sharing such information via friends. (Table 3) Table 3: Description of sources for sharing of information about COVID-19 vaccines among participants Through which platform, have you shared Information about COVID-19 vaccines? N=845 % Newspaper Yes 543 64.3% Television Yes 579 68.5% Radio Yes 166 19.6% Mobile Yes 503 59.5% Facebook Yes 225 26.6% Twitter Yes 62 7.3% Instagram Yes 59 7.0% YouTube Yes 87 10.3% WhatsApp Yes 80 9.5% Friends Yes 220 26.0% Among the mainstream media, television emerged as the most frequently cited source of information, with 539 participants (63.8%) reporting it as a major source. Newspapers were a close second, identified by 494 participants (58.5%). Mobile phones also played a significant role, with 486 respondents (57.5%) selecting them as a primary source. Other platforms had lower usage rates. Radio was cited by only 112 participants (13.3%), while Facebook was mentioned by 182 (21.5%). WhatsApp (n=130, 15.4%) and Instagram (n=80, 9.5%) also featured among the lower tiers. Twitter (n=73, 8.6%) and YouTube (n=68, 8.0%) were minimally reported as major sources. Interpersonal and community-based channels were even less influential. Only 163 participants (19.3%) cited friends as a major source, and just 80 (9.5%) received information from health workers. Family members (n=24, 2.8%) and medical faculty (n=33, 3.9%) were rarely mentioned. Sources such as online forums (n=6, 0.7%), online discussion boards (n=4, 0.5%), word of mouth (n=17, 2.0%), community channels (n=12, 1.4%), medical websites (n=6, 0.7%), and posters/hoardings (n=14, 1.7%) were reported by less than 3% of participants, indicating limited reach. Overall, the data indicates that traditional media (television, newspapers) and mobile devices continue to be the dominant sources of vaccine information, while digital and interpersonal channels play a relatively smaller role in public health communication. (Table 4) Table 4: Description of major source of information regarding COVID-19 vaccines Which was your major source of information regarding COVID-19 vaccines? N=845 % Newspaper Yes 494 58.5% Television Yes 539 63.8% Radio Yes 112 13.3% Mobile Yes 486 57.5% Facebook Yes 182 21.5% Twitter Yes 73 8.6% Instagram Yes 80 9.5% YouTube Yes 68 8.0% WhatsApp Yes 130 15.4% Friends Yes 163 19.3% Health workers Yes 80 9.5% Online discussion boards Yes 4 .5% Online forums Yes 6 .7% Word of Mouth Yes 17 2.0% Community Yes 12 1.4% Medical Faculty Yes 33 3.9% Medical Websites Yes 6 .7% Family members Yes 24 2.8% Poster / Hoardings Yes 14 1.7% Among all sources, word of mouth was most frequently reported as a source of misinformation, with 346 participants (40.9%) acknowledging it. This was closely followed by community sources, cited by 334 participants (39.5%), and mobile phones, reported by 247 participants (29.2%). Among digital and social media platforms, Facebook was the most commonly identified source of misinformation (n=214, 25.3%), followed by YouTube (n=164, 19.4%), WhatsApp (n=158, 18.7%), Instagram (n=117, 13.8%), and Twitter (n=81, 9.6%). In contrast, traditional media like television (n=156, 18.5%) and newspapers (n=95, 11.2%) were reported less often as sources of false or misleading information. Radio had a very low proportion of participants reporting misinformation (n=44, 5.2%). Fewer participants cited online forums (n=34, 4.0%) and online discussion boards (n=30, 3.6%) as sources of misinformation. A very small number attributed misinformation to health workers (n=20, 2.4%). An additional 240 participants (28.4%) selected the category “Other” as a source of misinformation, indicating that alternative or unspecified channels also contributed significantly to the spread of false or misleading vaccine information. (Table 5) Table 5: Description of sources of misinformation regarding COVID-19 vaccines among the participants Through which media do you think you have you come across the most false or misleading information specifically about COVID-19 vaccines? N=845 % Newspaper Yes 95 11.2% Television Yes 156 18.5% Radio Yes 44 5.2% Mobile Yes 247 29.2% Facebook Yes 214 25.3% Twitter YES 81 9.6% Instagram Yes 117 13.8% YouTube Yes 164 19.4% WhatsApp Yes 158 18.7% Friends Yes 96 11.4% Health workers Yes 20 2.4% Online discussion boards YES 30 3.6% Online forums YES 34 4.0% Word of Mouth Yes 346 40.9% Community Yes 334 39.5% Other YES 240 28.4% Mobile Phone Type showed significant variation across districts (p < 0.001). Smartphone usage was most prominent in Panchkula (n=203, 40.6%), followed by Nuh (n=113, 22.6%). In contrast, basic phones were more commonly used in Karnal (n=101, 36.7%) and Hisar (n=91, 33.1%). Feature phones were least common, with negligible use in Panchkula (n=0). Regarding mobile phone usage frequency, daily use was highest in Panchkula (n=210, 31.7%) and Nuh (n=178, 26.9%), while lower proportions were seen in Hisar (n=151, 22.8%) and Karnal (n=123, 18.6%) (p < 0.001). Less frequent usage (weekly, monthly, or never) was more evident in Karnal and Hisar. Television watching habits also differed significantly across districts (p < 0.001). Daily TV viewing was highest in Panchkula (n=139, 30.5%), followed by Hisar (n=121, 26.5%). A substantial number of participants from Nuh (n=90, 62.9%) reported never watching TV, far exceeding other districts. Radio listening was less common overall, with daily listeners most common in Hisar (n=49, 35.5%) and least in Panchkula (n=25, 18.1%) (p < 0.001). Nuh showed high non-listening rates (n=171, 36.5%). Newspaper and magazine reading was highest daily in Nuh (n=102, 29.3%), followed by Hisar (n=95, 27.3%) and Panchkula (n=84, 24.1%) (p < 0.001). Karnal had a higher percentage of participants who never read newspapers (n=72, 35.6%). Google usage on a daily basis was most common in Panchkula (n=183, 37.0%) and least in Nuh (n=89, 18.0%) (p < 0.001). Participants from Nuh and Karnal also had the highest proportions of those who never used Google. Regarding Facebook usage, daily use was highest in Panchkula (n=159, 32.0%), with a significant number of non-users in Karnal (n=77, 36.0%) and Nuh (n=73, 34.1%) (p < 0.001). Instagram usage patterns also revealed significant differences (p < 0.001). Panchkula had the highest daily users (n=152, 33.0%) and the lowest proportion of non-users (n=28, 10.4%). In contrast, non-use was highest in Nuh (n=97, 35.9%). WhatsApp usage was highest in Panchkula, with all daily users (n=210, 34.0%) and no non-users, showing a stark contrast with other districts, especially Karnal (n=66, 41.0% non-users) (p < 0.001). YouTube was used daily most in Panchkula (n=178, 31.7%) and Nuh (n=142, 25.3%) (p < 0.001). In contrast, Karnal had the highest non-users (n=66, 46.2%). (Table 6) Table 6: District-wise description of the use of social media Variable Category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % What type mobile phone do you use? Basic Phone 91 33.1% 101 36.7% 76 27.6% 7 2.5% <0.001 Feature Phone 21 32.3% 24 36.9% 20 30.8% 0 0.0% Smart Phone 98 19.6% 86 17.2% 113 22.6% 203 40.6% NA 1 20.0% 2 40.0% 2 40.0% 0 0.0% How often do you use mobile phone? Daily 151 22.8% 123 18.6% 178 26.9% 210 31.7% <0.001 Less than that 11 24.4% 24 53.3% 10 22.2% 0 0.0% Monthly 14 27.5% 19 37.3% 18 35.3% 0 0.0% Never 10 41.7% 14 58.3% 0 0.0% 0 0.0% Weekly 24 40.7% 32 54.2% 3 5.1% 0 0.0% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you watch Television (TV)? Daily 121 26.5% 111 24.3% 85 18.6% 139 30.5% <0.001 Less than that 8 16.7% 15 31.3% 11 22.9% 14 29.2% Monthly 7 36.8% 6 31.6% 6 31.6% 0 0.0% Never 14 9.8% 19 13.3% 90 62.9% 20 14.0% Weekly 60 34.3% 61 34.9% 17 9.7% 37 21.1% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you listen to Radio? Daily 49 35.5% 37 26.8% 27 19.6% 25 18.1% <0.001 Less than that 26 25.5% 33 32.4% 9 8.8% 34 33.3% Monthly 20 37.0% 13 24.1% 0 0.0% 21 38.9% Never 89 19.0% 103 22.0% 171 36.5% 105 22.4% Weekly 25 32.5% 25 32.5% 2 2.6% 25 32.5% NA 2 33.3% 2 33.3% 2 33.3% 0 0.0% How often do you read Newspaper / Magazine? Daily 95 27.3% 67 19.3% 102 29.3% 84 24.1% <0.001 Less than that 21 18.3% 32 27.8% 28 24.3% 34 29.6% Monthly 9 33.3% 10 37.0% 2 7.4% 6 22.2% Never 45 22.3% 72 35.6% 46 22.8% 39 19.3% Weekly 40 26.8% 31 20.8% 31 20.8% 47 31.5% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you surf Google? Daily 124 25.1% 98 19.8% 89 18.0% 183 37.0% <0.001 Less than that 4 16.0% 8 32.0% 13 52.0% 0 0.0% Monthly 9 30.0% 14 46.7% 0 0.0% 7 23.3% Never 52 26.7% 71 36.4% 72 36.9% 0 0.0% Weekly 21 23.3% 21 23.3% 35 38.9% 13 14.4% NA 1 9.1% 1 9.1% 2 18.2% 7 63.6% How often do you use Facebook? Daily 128 25.8% 104 20.9% 106 21.3% 159 32.0% <0.001 Less than that 3 8.1% 7 18.9% 22 59.5% 5 13.5% Monthly 7 35.0% 8 40.0% 0 0.0% 5 25.0% Never 57 26.6% 77 36.0% 73 34.1% 7 3.3% Weekly 15 20.5% 16 21.9% 8 11.0% 34 46.6% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you use Instagram? Daily 122 26.5% 108 23.5% 78 17.0% 152 33.0% <0.001 Less than that 2 14.3% 3 21.4% 4 28.6% 5 35.7% Monthly 1 12.5% 1 12.5% 0 0.0% 6 75.0% Never 63 23.3% 82 30.4% 97 35.9% 28 10.4% Weekly 22 24.7% 18 20.2% 30 33.7% 19 21.3% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you use WhatsApp? Daily 135 21.9% 113 18.3% 159 25.8% 210 34.0% <0.001 Less than that 3 18.8% 9 56.3% 4 25.0% 0 0.0% Monthly 9 42.9% 12 57.1% 0 0.0% 0 0.0% Never 49 30.4% 66 41.0% 46 28.6% 0 0.0% Weekly 14 53.8% 12 46.2% 0 0.0% 0 0.0% NA 1 25.0% 1 25.0% 2 50.0% 0 0.0% How often do you use YouTube? Daily 132 23.5% 110 19.6% 142 25.3% 178 31.7% <0.001 Less than that 6 17.6% 7 20.6% 15 44.1% 6 17.6% Monthly 9 39.1% 14 60.9% 0 0.0% 0 0.0% Never 45 31.5% 66 46.2% 32 22.4% 0 0.0% Weekly 17 23.6% 14 19.4% 20 27.8% 21 29.2% NA 2 18.2% 2 18.2% 2 18.2% 5 45.5% Used Chi Square Test** Newspaper sharing did not show a statistically significant difference between districts (p = 0.065), although the highest proportion was seen in Nuh (27.4%), followed by Karnal (25.8%), Panchkula (25.0%), and Hisar (21.7%). Television was a significantly used source of vaccine-related information across districts (p < 0.001). Hisar (29.7%) and Karnal (30.6%) had the highest proportions, while Nuh (18.3%) and Panchkula (21.4%) showed lower reliance on television. Conversely, a higher proportion in Nuh (39.5%) and Panchkula (32.3%) reported not using television for this purpose. Radio showed significant differences (p < 0.001) with Panchkula (39.8%) having the highest proportion using radio, while the lowest usage was in Nuh (14.5%). Mobile phones as a medium showed notable variation (p < 0.001), with the highest proportion from Nuh (33.2%) using mobiles to share vaccine information, followed by Hisar (26.8%) and Karnal (25.2%). Panchkula had the lowest proportion (14.7%) using mobiles, despite having the highest proportion not using them (39.8%). Facebook usage for information sharing was also significantly different (p < 0.001), with Nuh (35.6%) showing the highest engagement, followed by Panchkula (24.9%). Karnal had the lowest Facebook use (16.4%). Twitter usage was significantly different across districts (p = 0.002), with the highest from Nuh (43.5%), followed by Hisar (25.8%). Panchkula had the lowest use (11.3%). Instagram showed a marked district-wise variation (p < 0.001) — no respondents from Panchkula reported using Instagram for sharing, while Hisar had the highest proportion (44.1%), followed by Karnal (30.5%) and Nuh (25.4%). YouTube usage showed no statistically significant difference across districts (p = 0.61), with comparable proportions in all districts (ranging from 21.8% to 29.9%). WhatsApp usage was significantly different (p < 0.001), with Nuh (42.5%) leading, followed by Panchkula (26.3%). Hisar (18.8%) and Karnal (12.5%) had lower usage. Friends as a source of information showed significant differences (p = 0.02). Karnal (31.4%) and Nuh (27.3%) had higher proportions of participants citing friends, while Panchkula (15.9%) had the lowest. (Table 7) Table 7: District-wise description of the sharing of information regarding COVID-19 vaccines Variable category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Newspaper Yes 118 21.70% 140 25.80% 149 27.40% 136 25.00% 0.065 No 92 30.7% 72 24.0% 62 20.7% 74 24.7% Never 1 50.0% 1 50.0% 0 0.0% 0 0.0% Television No 39 14.7% 36 13.5% 105 39.5% 86 32.3% <0.001 Yes 172 29.7% 177 30.6% 106 18.3% 124 21.4% Radio No 178 26.2% 170 25.0% 187 27.5% 144 21.2% <0.001 Yes 33 19.9% 43 25.9% 24 14.5% 66 39.8% Mobile No 76 22.2% 86 25.1% 44 12.9% 136 39.8% <0.001 Yes 135 26.8% 127 25.2% 167 33.2% 74 14.7% Facebook No 159 25.6% 176 28.4% 131 21.1% 154 24.8% <0.001 Yes 52 23.1% 37 16.4% 80 35.6% 56 24.9% Twitter No 195 24.9% 201 25.7% 184 23.5% 203 25.9% 0.002 Yes 16 25.8% 12 19.4% 27 43.5% 7 11.3% Instagram No 185 23.5% 195 24.8% 196 24.9% 210 26.7% <0.001 Yes 26 44.1% 18 30.5% 15 25.4% 0 0.0% YouTube No 185 24.4% 194 25.6% 188 24.8% 191 25.2% 0.61 Yes 26 29.9% 19 21.8% 23 26.4% 19 21.8% WhatsApp No 196 25.6% 203 26.5% 177 23.1% 189 24.7% <0.001 Yes 15 18.8% 10 12.5% 34 42.5% 21 26.3% Friends No 155 24.8% 144 23.0% 151 24.2% 175 28.0% 0.02 Yes 56 25.5% 69 31.4% 60 27.3% 35 15.9% Used Chi Square Test** Newspaper as a major source of vaccine-related information showed significant district-wise differences (p < 0.001). Nuh (32.2%) and Karnal (26.1%) reported the highest proportions of individuals relying on newspapers, while Panchkula (19.6%) had the lowest. Television was also significantly different across districts (p < 0.001). Hisar (29.3%) and Karnal (30.6%) reported higher usage of television as an information source compared to Panchkula (18.9%) and Nuh (21.2%). Radio did not show a statistically significant difference between districts (p = 0.74), with approximately a quarter of respondents across all districts reporting radio as a source of information. Mobile phones were significantly more utilized in Nuh (32.5%) compared to other districts (p < 0.001), while Hisar and Karnal had lower usage proportions (22.2% and 21.8%, respectively). Facebook showed considerable variation (p < 0.001). Nuh had the highest proportion (42.3%) citing it as a major source, compared to 25.8% in Panchkula, 18.7% in Hisar, and 13.2% in Karnal. Twitter was significantly more frequently reported in Nuh (54.8%) as a source of information than in other districts, especially Panchkula (9.6%) and Karnal (15.1%) (p < 0.001). Instagram also showed significant variation (p < 0.001), with the highest reliance reported in Hisar (41.3%) and Karnal (30.0%), and the lowest in Panchkula (8.8%). YouTube exhibited district-level differences (p = 0.002), with Nuh having the highest use (42.6%) and Panchkula the lowest (10.3%). WhatsApp was significantly more relied upon in Panchkula (36.2%) than in Hisar (29.2%) or Nuh (15.4%) (p = 0.001). Friends as a source did not vary significantly between districts (p = 0.41), with usage hovering around 20–28%. Health workers were significantly more cited in Hisar (37.5%) compared to Nuh (13.8%) and Panchkula (23.8%) (p = 0.018). Online discussion boards showed no significant differences across districts (p = 0.57), with negligible reporting across all. Online forums also showed no significant variation (p = 0.11), with low usage across districts. Word of Mouth was significantly more reported in Hisar (70.6%) than in any other district, where it was nearly absent (p < 0.001). Community sources did not show statistically significant differences (p = 0.19), with minimal reliance across districts. Medical Faculty showed marked variation (p < 0.001), with the highest usage in Panchkula (57.6%) and none in Nuh. Medical websites had low overall usage and no significant district-level difference (p = 0.11). Family members were a significant source in Hisar (45.8%) and Karnal (54.2%), but not in Nuh or Panchkula (p < 0.001). Posters/Hoardings also showed significant variation (p = 0.021), being reported only in Hisar and Karnal. (Table 8) Table 8:District-wise description of major source of information regarding COVID-19 vaccines Variable Category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Newspaper No 102 29.1% 84 23.9% 52 14.8% 113 32.2% <0.001 Yes 109 22.1% 129 26.1% 159 32.2% 97 19.6% Television No 53 17.3% 48 15.7% 97 31.7% 108 35.3% <0.001 Yes 158 29.3% 165 30.6% 114 21.2% 102 18.9% Radio No 184 25.1% 183 25.0% 187 25.5% 179 24.4% 0.74 Yes 27 24.1% 30 26.8% 24 21.4% 31 27.7% Mobile No 103 28.7% 107 29.8% 53 14.8% 96 26.7% <0.001 Yes 108 22.2% 106 21.8% 158 32.5% 114 23.5% Facebook No 177 26.7% 189 28.5% 134 20.2% 163 24.6% <0.001 Yes 34 18.7% 24 13.2% 77 42.3% 47 25.8% Twitter No 196 25.4% 202 26.2% 171 22.2% 203 26.3% <0.001 Yes 15 20.5% 11 15.1% 40 54.8% 7 9.6% Instagram No 178 23.3% 189 24.7% 195 25.5% 203 26.5% <0.001 Yes 33 41.3% 24 30.0% 16 20.0% 7 8.8% YouTube No 192 24.7% 200 25.7% 182 23.4% 203 26.1% 0.002 Yes 19 27.9% 13 19.1% 29 42.6% 7 10.3% WhatsApp No 173 24.2% 188 26.3% 191 26.7% 163 22.8% 0.001 Yes 38 29.2% 25 19.2% 20 15.4% 47 36.2% Friends No 169 24.8% 166 24.3% 170 24.9% 177 26.0% 0.41 Yes 42 25.8% 47 28.8% 41 25.2% 33 20.2% Health workers No 181 23.7% 193 25.2% 200 26.1% 191 25.0% 0.018 Yes 30 37.5% 20 25.0% 11 13.8% 19 23.8% Online discussion boards No 210 25.0% 212 25.2% 209 24.9% 210 25.0% 0.57 Yes 1 25.0% 1 25.0% 2 50.0% 0 0.0% Online forums No 208 24.8% 210 25.0% 211 25.1% 210 25.0% 0.11 Yes 3 50.0% 3 50.0% 0 0.0% 0 0.0% Word of Mouth No 199 24.0% 208 25.1% 211 25.5% 210 25.4% <0.001 Yes 12 70.6% 5 29.4% 0 0.0% 0 0.0% Community No 207 24.8% 208 25.0% 208 25.0% 210 25.2% 0.19 Yes 4 33.3% 5 41.7% 3 25.0% 0 0.0% Medical Faculty No 202 24.9% 208 25.6% 211 26.0% 191 23.5% <0.001 Yes 9 27.3% 5 15.2% 0 0.0% 19 57.6% Medical Websites No 208 24.8% 210 25.0% 211 25.1% 210 25.0% 0.11 Yes 3 50.0% 3 50.0% 0 0.0% 0 0.0% Family members No 200 24.4% 200 24.4% 211 25.7% 210 25.6% <0.001 Yes 11 45.8% 13 54.2% 0 0.0% 0 0.0% Poster / Hoardings No 203 24.4% 207 24.9% 211 25.4% 210 25.3% 0.021 Yes 8 57.1% 6 42.9% 0 0.0% 0 0.0% Used Chi Square Test** There were significant differences across districts in the perception of various media sources as conduits of misinformation regarding COVID-19 vaccines (p < 0.001 for most variables). Newspapers were reported as a source of misleading information by a higher proportion of respondents in Panchkula (40.0%) and Karnal (37.9%), while none in Nuh reported them as misleading. Television was seen as a misleading source most commonly in Panchkula (59.0%), followed by Karnal (23.7%) and Hisar (17.3%), while again, none in Nuh marked it as misleading. Radio was notably reported as misleading by a high proportion of participants in Panchkula (88.6%), with minimal percentages in Karnal (9.1%) and Hisar (2.3%), and none in Nuh. Regarding mobile phones, a relatively high proportion in Hisar (33.6%), Panchkula (27.5%), and Karnal (26.3%) considered them misleading, whereas fewer participants in Nuh (12.6%) did so. Facebook was flagged by 37.4% in Hisar and 25.2% in Karnal, compared to 19.6% in Panchkula and 17.8% in Nuh. For Twitter, 44.4% of respondents from Nuh considered it misleading, while none from Panchkula reported the same. Hisar also reported a relatively high percentage (35.8%), followed by Karnal (19.8%). In the case of Instagram, Hisar (34.2%) and Karnal (26.5%) had the highest proportions, while Panchkula had the lowest (12.0%). For YouTube, 32.3% of respondents in both Hisar and Panchkula flagged it, followed by Karnal (24.4%) and Nuh (11.0%). WhatsApp was similarly reported by more respondents in Hisar (35.4%) and Panchkula (27.8%), with fewer in Karnal (27.2%) and Nuh (9.5%). The perception of friends and health workers as sources of misinformation did not vary significantly across districts (p = 0.23 and p = 0.29, respectively), with percentages ranging from around 15.0% to 40.0%. However, online discussion boards and online forums did show significant differences (p < 0.001), with Nuh having the highest percentages (50.0%) and Panchkula reporting none. Interestingly, word of mouth was most often cited in Nuh (40.8%), while Panchkula reported the least (13.6%). Similarly, community sources were cited most in Nuh (43.1%) and least in Panchkula (2.1%). Lastly, the category ‘Other’ was marked by 53.3% in Nuh and 30.4% in Karnal, while none in Panchkula reported it as misleading. (Table 9) Table 9: District-wise description of source of misinformation about COVID-19 vaccines Variable category District P-value Hisar Karnal Nuh Panchkula N=211 % N=213 % N=211 % N=210 % Newspaper No 190 25.3% 177 23.6% 211 28.1% 172 22.9% <0.001 Yes 21 22.1% 36 37.9% 0 0.0% 38 40.0% Television No 184 26.7% 176 25.5% 211 30.6% 118 17.1% <0.001 Yes 27 17.3% 37 23.7% 0 0.0% 92 59.0% Radio No 210 26.2% 209 26.1% 211 26.3% 171 21.3% <0.001 Yes 1 2.3% 4 9.1% 0 0.0% 39 88.6% Mobile No 128 21.4% 148 24.7% 180 30.1% 142 23.7% <0.001 Yes 83 33.6% 65 26.3% 31 12.6% 68 27.5% Facebook No 131 20.8% 159 25.2% 173 27.4% 168 26.6% <0.001 Yes 80 37.4% 54 25.2% 38 17.8% 42 19.6% Twitter No 182 23.8% 197 25.8% 175 22.9% 210 27.5% <0.001 YES 29 35.8% 16 19.8% 36 44.4% 0 0.0% Instagram No 171 23.5% 182 25.0% 179 24.6% 196 26.9% <0.001 Yes 40 34.2% 31 26.5% 32 27.4% 14 12.0% YouTube No 158 23.2% 173 25.4% 193 28.3% 157 23.1% <0.001 Yes 53 32.3% 40 24.4% 18 11.0% 53 32.3% WhatsApp No 155 22.6% 170 24.7% 196 28.5% 166 24.2% <0.001 Yes 56 35.4% 43 27.2% 15 9.5% 44 27.8% Friends No 181 24.2% 190 25.4% 194 25.9% 184 24.6% 0.23 Yes 30 31.3% 23 24.0% 17 17.7% 26 27.1% Health workers No 208 25.2% 210 25.5% 203 24.6% 204 24.7% 0.29 Yes 3 15.0% 3 15.0% 8 40.0% 6 30.0% Online discussion boards No 203 24.9% 206 25.3% 196 24.0% 210 25.8% <0.001 Yes 8 26.7% 7 23.3% 15 50.0% 0 0.0% Online forums No 203 25.0% 204 25.2% 194 23.9% 210 25.9% <0.001 Yes 8 23.5% 9 26.5% 17 50.0% 0 0.0% Word of Mouth No 140 28.1% 126 25.3% 70 14.0% 163 32.7% <0.001 Yes 71 20.5% 87 25.1% 141 40.8% 47 13.6% Community No 128 25.0% 113 22.1% 67 13.1% 203 39.7% <0.001 Yes 83 24.9% 100 29.9% 144 43.1% 7 2.1% Other No 172 28.4% 140 23.1% 83 13.7% 210 34.7% <0.001 Yes 39 16.3% 73 30.4% 128 53.3% 0 0.0% Used Chi Square Test**

The media—both traditional and digital—has played a pivotal role in shaping public perceptions, disseminating information, and influencing behavioral responses during the COVID-19 pandemic. While credible media platforms have significantly contributed to awareness and vaccination uptake, the parallel spread of misinformation, particularly through social media, has also fueled fear, confusion, and vaccine hesitancy. The present study provides important insights into the influence of various communication channels in shaping the community’s understanding and behavior regarding COVID-19 vaccination.(Awijen et al., 2022; Thorakkattil et al., 2022; Vishwakarma & Chugh, 2023) Media Platforms as Sources of Information and Influence In the current study, participants were asked to report the platforms through which they had shared or received information about COVID-19 vaccines. The most utilized traditional medium was television (n=579, 68.5%), followed by newspapers (n=543, 64.3%), while radio was less frequently used (n=166, 19.6%). Among digital and interpersonal sources, mobile phones (n=503, 59.5%) and Facebook (n=225, 26.6%) emerged as the dominant channels. Other platforms such as Twitter (7.3%), Instagram (7.0%), and YouTube (10.3%) had comparatively lower engagement. Notably, WhatsApp (9.5%), despite its ubiquitous use in India, was reported by relatively fewer respondents as a channel for sharing vaccine-related information. These findings highlight that while traditional mass media remains a significant channel for information dissemination, digital platforms—particularly Facebook and mobile-based communication—are also being actively used by the population. The district-wise analysis showed significant differences in platform preference, reflecting regional digital literacy, access, and trust levels. These patterns are consistent with the findings of Shibal Bhartiya et al. (2021), who observed that television and social media were the most common sources of COVID-19-related information among urban Indian populations. Their study emphasized that although television provided largely credible content, social media platforms were a double-edged sword—simultaneously facilitating awareness and propagating misinformation.(Bhartiya et al., 2021) The Misinformation Epidemic: An Infodemic With in a Pandemic One of the most concerning by-products of increased social media usage during the pandemic has been the spread of misinformation—a phenomenon WHO termed an “infodemic.” In the present study, lack of or incomplete information (n=33, 3.9%) and fear of side effects (n=29, 3.4%) were among the leading reasons for vaccine hesitancy. These concerns are often rooted in exposure to misleading content, conspiracy theories, and unverified health claims shared through unregulated digital channels. Mitali Sengupta et al. (2021) documented that misinformation regarding fertility concerns, the safety of mRNA vaccines, and exaggerated side-effect narratives had a measurable impact on vaccine confidence, especially among young women and rural populations.(Sengupta et al., 2022) Similarly, Vanathy et al. (2022) found that exposure to WhatsApp forwards and viral videos with anecdotal claims about vaccine deaths or deformities significantly reduced the intention to vaccinate.(Vanathy et al., 2022) Aggarwal et al. (2024), in their study on media literacy and vaccine perceptions, highlighted that individuals with low critical appraisal skills were more susceptible to believing false narratives. Their findings indicated that trust in social media as a primary source of information correlated negatively with vaccine acceptance, especially in groups that lacked direct access to health professionals.(Aggarwal et al., 2024) Impact of Positive Media Messaging Despite the risks posed by misinformation, media also holds transformative potential when used responsibly. In the current study, health professionals (n=109, 12.9%), social workers (n=129, 15.3%), and teachers (n=15, 1.8%) were cited as primary motivators for vaccination. This indicates that trusted intermediaries—whose messages are often amplified through media—can effectively combat fear and drive vaccine acceptance. This observation is supported by Anju D. Ade et al. (2024), who showed that audio-visual campaigns featuring local health workers or community leaders had significantly higher trust and engagement levels. When factual messaging is framed within culturally relevant narratives and delivered by familiar faces, it often overrides the impact of negative digital content.(Anju D. Ade et al., 2024) Moreover, Nazir et al. (2021) advocated for a hybrid model of communication, combining community outreach with carefully curated media campaigns to counterbalance online misinformation. Their study found that simple, repetitive, and positive messaging helped reinforce vaccine confidence, even among initially hesitant populations.(Nazir et al., 2021) In the present study, district-wise patterns revealed significant variability in media consumption. For instance, use of Facebook as a platform for sharing vaccine information was highest in Nuh (35.6%), while mobile-based communication was most common in Hisar and Karnal. Interestingly, Twitter and Instagram had minimal penetration across all districts, yet Nuh reported the highest engagement with Twitter (43.5%) and Instagram (25.4%) among those who used it. These variations underscore the importance of tailoring communication strategies based on regional media habits.(M. Dey et al., 2023) As suggested by Banerjee et al. (2024), a uniform media campaign cannot cater to a demographically and geographically diverse country like India.(S. Banerjee et al., 2024) Instead, public health authorities must adopt a decentralized communication model, guided by district-level media mapping and audience segmentation.(Khan et al., 2022)   Media Exposure and Its Influence on Vaccine Perception The role of media in shaping public health perceptions cannot be overstated, especially in the context of a global pandemic like COVID-19. Media exposure has both direct and indirect influences on how individuals perceive the necessity, safety, and efficacy of vaccines. As a powerful source of information, media can both positively educate the public and amplify misconceptions that fuel vaccine hesitancy.(Basu & Sharma, 2023; Sengupta et al., 2022; Thorakkattil et al., 2022) This section delves into the complex relationship between media exposure and vaccine perceptions, based on the findings of the present study and comparisons with global literature. In the present study, media exposure, particularly through television, mobile phones, and social media, was found to play a substantial role in shaping participants’ views on the COVID-19 vaccine. Notably, television (68.5%), mobile phones (59.5%), and newspapers (64.3%) were identified as the top sources of vaccine-related information. Social media platforms such as Facebook (26.6%) and WhatsApp (9.5%) were also significant sources, reflecting the increasing importance of digital spaces in health information dissemination. Despite the widespread use of mass media, the study revealed significant variability in how media exposure influenced vaccine perceptions. For instance, a large proportion of participants (52%) believed that COVID-19 vaccines prevent transmission, while 23.9% disagreed, and 24.1% were unsure. This discrepancy can largely be attributed to contradictory messages circulating on media platforms—especially digital ones. Misinformation regarding the transmissibility of the virus post-vaccination and the belief in vaccine-induced immunity may have arisen from exposure to unverified content on social media or news outlets, as misleading narratives often overshadow credible science. Further analysis indicated that distorted or exaggerated information, such as stories about adverse events following vaccination or unsubstantiated claims about vaccine ingredients, was most likely encountered on platforms like WhatsApp and Facebook. 39.1% of participants (n=330) reported knowing someone who had experienced side effects post-vaccination, a statistic that highlights how anecdotal information shared via personal networks on social media can disproportionately influence attitudes, even in the face of scientific evidence to the contrary. This is consistent with findings from Mangla et al. (2021), who noted that misleading health claims spread on WhatsApp were the most common reason for vaccine hesitancy in rural India. The platform’s lack of gatekeeping and the speed with which misinformation spreads makes it particularly dangerous for public health.(Mangla et al., 2021) Media’s Role in Vaccine Hesitancy The study highlighted significant gaps in public understanding despite the high volume of media consumption. While media exposure was widespread, many participants still reported misconceptions about vaccine efficacy and side effects. For instance, although 83.2% of participants agreed that vaccines help sustain economic activities, only 52% believed that vaccinated individuals could avoid spreading COVID-19 to others, a crucial piece of information. Such knowledge gaps, exacerbated by misinformation, emphasize the double-edged sword that media represents in the context of vaccination campaigns. Social media platforms, especially Facebook (26.6%) and WhatsApp (9.5%), were also cited as sources of both information and misinformation. The pseudoscientific narratives circulating on these platforms, especially about the safety of the vaccine for certain populations (e.g., pregnant women), were prevalent among hesitant individuals. In fact, studies like Shibal Bhartiya et al. (2021) and Afsharinia et al. (2023) have pointed out that social media is a major driver of vaccine skepticism, primarily due to the ease with which unverified content spreads.(Afsharinia & Gurtoo, 2023; Bhartiya et al., 2021) This was corroborated by our study, where respondents who reported frequent exposure to unregulated online content were more likely to express doubts about the vaccine’s safety and efficacy. Furthermore, fear of side effects (reported by 29%) and lack of adequate information (reported by 33%) were strongly linked to media portrayals of adverse reactions. The misrepresentation of vaccine side effects in the media, particularly in sensationalized stories or viral social media posts, creates fear and reluctance, even among individuals who might otherwise be willing to vaccinate. Vanathy et al. (2022) highlighted similar concerns, where even healthcare workers were found to be influenced by misleading media portrayals of vaccine-related side effects.(Vanathy et al., 2022) The study of Afsharinia et al. (2023) further examined the impact of negative media portrayals on vaccine acceptance and found that individuals exposed to sensational headlines about vaccine deaths or injuries were more likely to reject vaccination, even when presented with scientific evidence proving the safety of vaccines. This underscores the profound impact of media framing on public health decisions.(Afsharinia & Gurtoo, 2023) Media and Its Influence on Vaccine Perception Not all media exposure has negative effects. Positive media narratives, especially those that feature trusted sources like health professionals, have the power to change attitudes towards vaccination.(I. Kumar et al., 2024; Mondal et al., 2022; N. Sharma et al., 2023) In the present study, respondents who cited health professionals as the primary source of vaccine information were more likely to show confidence in the vaccine’s effectiveness and safety. This highlights the importance of trusted, credible health communication in promoting vaccine uptake. Aggarwal et al. (2024) demonstrated that when frontline workers and medical professionals were the ones disseminating information about vaccine benefits, the acceptance rate increased significantly. The study also noted that local news stations, featuring expert interviews or health bulletins, helped to clarify misconceptions and build trust in vaccine safety.(Aggarwal et al., 2024) Moreover, television, a traditionally trusted source in India, was one of the most common platforms for participants in the present study. While television viewership has declined with the rise of digital platforms, it remains a powerful tool for broad-reaching health communication. Television programs focusing on vaccine success stories, the importance of booster doses, and addressing vaccine safety concerns were found to boost confidence in the vaccine.(Bansal et al., 2022; I. Kumar et al., 2024; Patwary, Bardhan, et al., 2022) The effectiveness of TV health campaigns was confirmed by Meghna Gupta et al. (2021), who found that public health announcements by trusted local leaders and credible media outlets significantly improved vaccine acceptance rates in regions with low vaccine uptake.(M. Gupta et al., 2021) The influence of media on vaccine perceptions can be seen as a two-sided coin. On one hand, media can enhance understanding, spread knowledge, and normalize positive health behaviors. On the other hand, it can amplify misinformation, create unnecessary fear, and delay or prevent vaccination, particularly in underserved communities where digital literacy and critical thinking are low.

This study underscores the pivotal role that both media exposure and trust in healthcare providers play in influencing COVID-19 vaccination behavior within the community. The findings suggest that individuals with greater access to reliable media content and stronger trust in the healthcare system were more likely to exhibit positive vaccination practices. These elements acted not only as enablers of vaccine acceptance but also mitigated misinformation and hesitancy to a considerable extent. The interplay between media consumption patterns and healthcare trust demonstrated a meaningful impact on health-seeking behavior, especially during a public health crisis. Therefore, building robust and transparent communication strategies, strengthening public trust in the healthcare delivery system, and curbing the spread of misinformation should be central to any future vaccination campaigns or outbreak response efforts. The insights from this community-based study have important implications for designing targeted public health interventions that are culturally appropriate and media-sensitive in low- and middle-income settings.

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