Cent Eur J Public Health 2026, 34(1):9-15 | DOI: 10.21101/cejph.a8477

Factors influencing attitudes toward vaccination in general and against COVID-19 among family medicine patients with and without chronic disease in Croatia

Vedrana Tudor Špalj^{1, 2}, Branislava Popović^{1, 3}, Nives Radošević Quadranti^{1, 2}, Gordana Mičetić Balog^{1, 2}, Zoran Adžić^{1, 2}

¹ Department of Family Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

² Comunity Health Centre of Primorsko-Goranska County, Rijeka, Croatia

³ Specialized Family Practice Branislava Popović, Rijeka, Croatia

Objectives: The aim of the study was to analyse the attitudes and decisions regarding vaccination in general and against COVID-19 among general practitioner (GP) patients in Croatia, and to identify influencing factors, with particular attention to chronic conditions and anxiety.

Methods: A total of 184 patients (stratified by sex and presence of chronic disease) from a GP's offices, aged 18-87 years (average 50.3 ± 1.3 years, 49.5% women) were included. Data were collected using a questionnaire.

Results: Attitudes toward vaccination in general did not differ between patients with and without chronic diseases and were not influenced by anxiety. Chronically ill patients were more likely than those without chronic disease to believe in the efficacy of the COVID-19 vaccine and to express fear of contracting SARS-CoV-2 (p ≤ 0.003). Anxiety was associated with fear of infection (p < 0.001), but not with confidence in vaccine safety or efficacy. After controlling for sex, age, education, chronic illness, anxiety, and knowing someone infected and hospitalized with SARS-CoV-2, factors associated with the decision to be vaccinated against COVID-19 were absence of prior infection (OR = 3.9, 95% CI: 1.6-9.5, p = 0.003), history of influenza vaccination (OR = 3.8, 95% CI: 1.4-10.4, p = 0.009), and knowing someone who had died from COVID-19 (OR = 3.2, 95% CI: 1.1-9.7, p = 0.037).

Conclusion: The decision to vaccinate against COVID-19 was associated with absence of prior infection, knowing someone who died from the disease, and prior influenza vaccination, but not with chronic illness, anxiety, or socio-demographic factors.

Keywords: COVID disease, vaccination, chronic diseases, anxiety, family medicine

Received: December 2, 2024; Revised: August 17, 2025; Accepted: August 17, 2025; Published: March 31, 2026  Show citation