Factors associated with adherence to COVID-19 vaccination in young adults: a systematic review
e202510057
Keywords:
Coronavirus infections, COVID-19 vaccine, Compliance and adherence to treatment, Mistrust in vaccinationAbstract
BACKGROUND // Young adults may be more likely to spread COVID-19 as they have low adherence to public health guidelines and are more reluctant to get vaccinated.
The purpose of this review was to provide the most current evidence regarding the assessment of adherence to COVID-19 vaccination in young adults.
METHODS // The bibliographic search was carried out in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: “Treatment Adherence and Compliance”, “COVID-19
Vaccines”, “Young Adult”. Ten selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2021 and 2024.
RESULTS // The main study tool represents the adherence of COVID-19 vaccines. The most important discussion topics extracted in the analyzed articles refer to concern about side effects, mistrust, beliefs or low income level.
CONCLUSIONS // The findings of this study indicate the need to carry out vaccination promotion programs to provide accessible, transparent and age-appropriate information. Thus, it could be considered a useful tool to improve adherence and confidence in the COVID-19 vaccine.
Downloads
References
World Health Organization. WHO health emergency dashboard. 2020. [Acceso 25/03/2024]. Disponible en: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Tran VD, Pak TV, Gribkova EI, Galkina GA, Loskutova EE, Dorofeeva V et al. Determinants of COVID-19 vaccine acceptance in a high infection-rate country: a cross-sectional study in Russia. Pharm Pract (Granada). 2021;19:2276. DOI: https://doi.org/10.18549/PharmPract.2021.1.2276
WHO. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. 2020 [acceso 25/03/2024]. Disponible en: https://www.who.int/director-general/speeches/detail/whodirector- general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020
Our World in Data. Coronavirus pandemic (COVID-19); 2022 Feb 22 [acceso 25/03/2024]. Disponible en: https://ourworldindata.org/coronavirus
Bergman J, Ballin M, Nordstrom A, Nordstrom P. Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study. Eur J Epidemiol. 2021;36(3):287-298. DOI: https://doi.org/10.1007/s10654-021-00732
Ling Y, Zhong J, Luo J. Safety and effectiveness of SARS-CoV-2vaccines: A systematic reviewandmeta-analysis. JMedVirol2021;93(12):6486-6495. DOI: https://doi.org/10.1002/jmv.27203
Thomas SJ, Moreira ED, Kitchin N, Absalon J, Gurtman A, Lockhart S et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine through 6 months. N Engl J Med 2021;385(19):1761-1773. DOI: https://doi.org/10.1056/ NEJMoa2110345
Kaplan RM, Milstein A. Influence of a COVID-19 vaccine’s effectiveness and safety profile on vaccination acceptance. ProcNatlAcadSci2021;118(10). DOI: https://doi.org/10.1073/pnas.2021726118 e2021726118
Afifi TO, Salmon S, Taillieu T, Stewart-Tufescu A, Fortier J, Driedger SM. Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies. Vaccine. 2021 Jun 11;39(26):3473-3479. DOI: https://doi.org/10.1016/j.vaccine.2021.05.026
MacDonald NE. Vaccine hesitancy: Definition, scope and determinant Vaccine. 2015;33:4161-4164. DOI: https://doi.org/10.1016/j.vaccine.2015.04.036
World Health Organization. Ten threats to global health in 2019. 2019 [acceso 25/03/2024]. Disponible en: https://www.who.int/newsroom/spotlight/ten-threats-to-global-health-in-2019
Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: Causes, consequences, and a call to action. Vaccine. 2015 Nov 27;33 Suppl4:D66-71. DOI: https://doi.org/10.1016/j.vaccine.2015.09.035
Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications. Lancet Reg Health Eur. 2021 Feb;1:100012. DOI: https://doi.org/ 10.1016/j.lanepe.2020.100012
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, RabinK et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med2021;27 (2):225-228. DOI: https://doi.org/10.1038/s41591-020-1124-9
Andrews JL, Foulkes L, Blakemore SJ. Peer Influence in Adolescence: Public-Health Implications for COVID-19. Trends Cogn Sci. 2020 Aug;24(8):585-587. DOI: https://doi.org/10.1016/j.tics.2020.05.001
Nivette A, Ribeaud D, Murray A, Steinhoff A, Bechtiger L, Hepp U et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Soc Sci Med. 2021 Jan;268:113370. DOI: https://doi.org/10.1016/j.socscimed.2020.113370
Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022 Oct;52(14):3127-3141. DOI: https://doi.org/10.1017/S0033291720005188
Adams SH, Schaub JP, Nagata JM, Park MJ, Brindis CD, Irwin CE. Young Adult Perspectives on COVID-19 Vaccinations. J Adol Health. 2021;69(3):511-514. DOI: https://doi.org/10.1016/j.jadohealth.2021.06.003
Brandt EJ, Rosenberg J, Waselewski ME, Amaro X, Wasag J, Chang T. National Study of Youth Opinions on Vaccination for COVID-19 in the US. JAdolesc Health 2021;68(5):869-872. DOI: https://doi.org/10.1016/j.jadohealth.2021.02.013
Zhu P, Tatar O, Griffin-Mathieu G, Perez S, Haward B, Zimet G et al. The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial. JMIR Public Health Surveill. 2022 May 30;8(5):e37328. DOI: https://doi.org/10.2196/37328
Walsh JC, Comar M, Folan J, Williams S, Kola-Palmer S. The psychological and behavioural correlates of COVID-19 vaccine hesitancy and resistance in Ireland and the UK. Acta Psychol (Amst). 2022 May;225:103550. DOI: https://doi.org/10.1016/j.actpsy.2022.103550
Urrútia G, Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis [PRISMA declaration: a proposaltoimprovethepublicationofsystematicreviews and meta-analyses]. Med Clin (Barc). 2010;135(11):507-511. DOI: https://doi.org/10.1016/j.medcli.2010.01.015
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467-473. DOI: https://doi.org/10.7326/M18-0850
Higgins JP, Altman DG, Gotzsche PC et al. Herramienta para evaluar el riesgo de sesgo en los ensayos aleatorios. BMJ. 2011 [consultado 25 de marzo 2024]. Disponible en: https://es.cochrane.org/sites/es.cochrane.org/files/uploads/Manual_Cochrane_510_reduit.pdf
Kim S, Willis E, Wehlage S, Scheffer-Wentz H, Dulitz M. COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach. BMC Public Health. 2022 Nov 7;22(1):2030. DOI: https://doi.org/10.1186/s12889-022-14448-3
Hossain MS, Islam MS, Pardhan S, Banik R, Ahmed A, Islam MZ et al. Beliefs, barriers and hesitancy towards the COVID-19 vaccine among Bangladeshi residents: Findings from a cross-sectional study. PLoS One. 2022 Aug 23;17(8):e0269944. DOI: https://doi.org/ 10.1371/journal.pone.0269944
Noh Y, Kim JH, Yoon D, Choe YJ, Choe SA, Jung J et al. Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey. Epidemiol Health. 2022;44:e2022061. DOI: https://doi.org/10.4178/epih.e2022061
Dai H, Barrington-Trimis JL, Unger JB, Baezconde-Garbanati L, Leventhal AM. Patterns and mediators of racial and ethnic disparities in COVID-19 vaccine hesitancy among young adults. Prev Med. 2022 Jun;159:107077. DOI: https://doi.org/10.1016/j.ypmed.2022.107077
Moscardino U, Musso P, Inguglia C, Ceccon C, Miconi D, Rousseau C. Sociodemographic and psychological correlates of COVID-19 vaccine hesitancy and resistance in the young adult population in Italy. Vaccine. 2022 Apr 6;40(16):2379-2387. DOI: https://doi.org/10.1016/j.vaccine.2022.03.018
Moccia G, Carpinelli L, Savarese G, De Caro F. Vaccine Hesitancy and the Green Digital Pass: A Study on Adherence to the Italian COVID-19 Vaccination Campaign. Int J Environ Res Public Health. 2022 Mar 3;19(5):2970. DOI: https://doi.org/10.3390/ijerph19052970
Zhang P, Li Y, Wang H, Luo L, Wang P, Wang H et al. COVID-19 Vaccine Hesitancy Among Older Adolescents and Young Adults: A National Cross-Sectional Study in China. Front Public Health. 2022 May 12;10:877668. DOI: https://doi.org/10.3389/fpubh.2022.877668
Su Y, Li S, Huang F, Xue J, Zhu T. Exploring the Influencing Factors of COVID-19 Vaccination Willingness among Young Adults in China. Int J Environ Res Public Health. 2023 Feb 23;20(5):3960. DOI: https://doi.org/10.3390/ijerph20053960
Yang F, Li X, Su X, Xiao T, Wang Y, Hu P et al. A study on willingness and influencing factors to receive COVID-19 vaccination among Qingdao residents. Hum Vaccin Immunother. 2021 Feb 1;17(2):408-413. DOI: https://doi.org/10.1080/21645515.2020.1817712
El-Elimat T, AbuAlSamen MM, Almomani BA, Al-Sawalha NA, Alali FQ. Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan. PLoS One. 2021 Apr 23;16(4):e0250555. DOI: https://doi.org/10.1371/journal.pone.0250555
Zarbo C, Candini V, Ferrari C, d’Addazio M, Calamandrei G, Starace F et al. COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination. Front Public Health. 2022 Apr 29;10:873098. DOI: https://doi.org/10.3389/fpubh.2022.873098
Machida M, Nakamura I, Kojima T, Saito R, Nakaya T, Hanibuchi T et al. Trends in COVID-19 vaccination intent from pre- to post-COVID-19 vaccine distribution and their associations with the 5C psychological antecedents of vaccination by sex and age in Japan. Hum VaccinImmunother. 2021 Nov 2;17(11):3954-3962. DOI: https://doi.org/10.1080/21645515.2021.1968217
Qiao S, Friedman DB, Tam CC, Zeng C, Li X. Vaccine acceptance among college students in South Carolina: Do information sources and trust in information make a difference? medRxiv: the preprint server for health sciences. 2020. DOI: https://doi.org/10.1101/2020.12.02.20242982
Cellule d’Analyseen Sciences Sociales (CASS). Humanitarian Programme Recommendations for COVID-19 Based on Social Sciences Evidence from the DRC Ebola Outbreak Response. 2020 [acceso 25/03/2024]. Disponible en: https://www.socialscienceinaction.org/resources/humanitarian-programmerecommendations-covid-19-based-social-sciences-evidence-drc-ebola-outbreak-response/
Schwartz JL. Evaluating and Deploying Covid-19 Vaccines-The Importance of Transparency, Scientific Integrity, and Public Trust. N Engl J Med. 2020; 383: 1703–1705. DOI: https://doi.org/10.1056/ NEJMp2026393
Lucia VC, Kelekar A, Afonso NM. COVID-19 vaccine hesitancy among medical students. J Public Health (Oxf). 2020; 43: 445-449. DOI: https://doi.org/10.1093/pubmed/fdaa230
Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications. Lancet Reg Health Eur. 2021 Feb;1:100012. DOI: https://doi.org/10.1016/j.lanepe.2020.100012
Sønderskov KM, Vistisen HT, Dinesen PT, Østergaard SD. COVID-19 booster vaccine willingness. Dan Med J 2021;69:A10210765
Truong J, Bakshi S, Wasim A, Ahmad M, Majid U. What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis. Health Promot Int. 2022 Feb 17;37(1):daab105. DOI: https://doi.org/10.1093/heapro/daab105
Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine. 2021 Oct;40:101113. DOI: https://doi.org/10.1016/j.eclinm.2021.101113
Callaghan T, Moghtaderi A, Lueck JA, Hotez P, Strych U, Dor A et al. Correlates and disparities of intention to vaccinate against COVID-19. Soc Sci Med. 2021 Mar;272:113638. DOI: https://doi.org/10.1016/j.socscimed.2020.113638
Gold JAW, Rossen LM, Ahmad FB, Sutton P, Li Z, Salvatore PP et al. Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 - United States, May-August 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct 23;69(42):1517-1521. DOI: https://doi.org/10.15585/mmwr.mm6942e1
The Centers for Disease Control and Prevention, 2021a. CDC COVID Data Tracker: Demographic Trends of COVID-19 Cases and Deaths in the US Reported to CDC. [Acceso 25/03/2024]. Disponible en: https://stacks.cdc.gov/view/cdc/99332
Lopez L 3rd, Hart LH 3rd, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021 Feb 23;325(8):719-720. DOI: https://doi.org/10.1001/jama.2020.26443
Robinson E, Jones A, Lesser I, Daly M. International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative esamples. Vaccine2021;39 (15):2024-2034. DOI: https://doi.org/10.1016/j.vaccine.2021.02.005
Brandt EJ, Rosenberg J , Waselewski ME, Amaro X, Wasag J, Chang T. National Study of Youth Opinions on Vaccination for COVID-19 in the US. J Adolesc Health 2021;68(5):86-872. DOI: https://doi.org/10.1016/j.jadohealth.2021.02.013
Rozek LS, Jones P, Menon A, Hicken A, Apsley S, King EJ. Understanding Vaccine Hesitancy in the Context of COVID-19: The Role of Trust and Confidence in a Seventeen-Country Survey. Int J Public Health. 2021 May 14;66:636255. DOI: https://doi.org/10.3389/ijph.2021.636255
Zhu FC, Guan XH, Li YH, Huang JY, Jiang T, Hou LH et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet. (2020) 396:479-488. DOI: https://doi.org/10.1016/S0140-6736(20)31605-6
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. (2020) 383:2603-2615. DOI: https://doi.org/10.1056/NEJMoa2034577
Wake AD. The Willingness to Receive COVID-19 Vaccine and Its Associated Factors: “Vaccination Refusal Could Prolong the War of This Pandemic” - A Systematic Review. Risk Manag Healthc Policy. 2021 Jun 21;14:2609-2623. DOI: https://doi.org/10.2147/RMHP.S311074
Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R. High contagiousness and rapid spread of severe acute respiratory syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(7). DOI: https://doi.org/10.3201/eid2607.200282
Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. E Clinical Medicine. 2020; 26:100495. DOI: https://doi.org/10.1016/j.eclinm.2020
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2020:1-4. DOI: https://doi.org/10.1038/s41591-020-1124-9
Downloads
Additional Files
- FIGURA 1 (Español (España))
- TABLA 1 (Español (España))
- TABLA 2 (a) (Español (España))
- TABLA 2 (b) (Español (España))
- TABLA 2 (c) (Español (España))
- TABLA 2 (d) (Español (España))
- TABLA 2 (e) (Español (España))
- TABLA 2 (f) (Español (España))
- TABLA 2 (g) (Español (España))
- TABLA 2 (h) (Español (España))
Published
Versions
- 2025-10-07 (3)
- 2025-10-07 (2)
- 2025-10-02 (1)
How to Cite
License
Copyright (c) 2025 Francisco Miguel Escandell Rico, Lucía Pérez Fernández

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.








![¿Cómo evaluar para la RESP? [PARA REVISORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-revisores-0eaa113abcbc4fc554c7c6c7840ca4c6.jpg)
![¿Cómo recibir avisos sobre nuevos artículos de la RESP? [PARA LECTORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-lectores-aa689338e95aab07df45b4b0d583188f.jpg)

