1 Introduction

For a long time, Coronavirus disease (COVID-19) has emerged as a leading health and humanitarian crisis and persisted with resurgent waves with new variants. The pandemic is still ongoing and likely to persist for the foreseeable future. In the meantime, a highly transmittable new variant EG.5 now makes up a plurality of COVID-19 cases in the United States of America [1, 2]. The highly transmittable variant may spread to the rest of the world quickly. A wide variety of public health measures have been put into place  to prevent COVID-19 pandemic transmission across the globe. These non-pharmaceutical measures include travel bans, country lockdowns, social distancing, cancellation of public functions, and most importantly using face masks. Unintended consequences of infection prevention might have been reduced by the implementation of public health measures and protocols [3]. While developing [4, 5] and developed [6, 7] countries implemented these protective measures, they faced significant challenges, particularly when it came to reopening educational institutions during an outbreak [8].

Vaccine-based intervention was the most effective therapeutic approach to limit the diffusion of contagious Coronaviruses [9], however, there still seems to be some significant doubtful attitudes of people in their willingness to be vaccinated  against COVID-19 [10]. Worldwide, numerous multi-dimensional factors influence public response to COVID-19 vaccines, and the response rate varies with the regional and global context [11,12,13,14]. Roy et al., (2022) deduced that the students group had a 30% prevalence of COVID-19 vaccine hesitancy globally [15]. This author also reported that several socio-psychological antecedents such as safety, efficacy, side effects, trust, communication, information source, anti-vaccination sentiments, and non-compliance with injection led to COVID-19 vaccine apprehension among students [14, 15]. In this context, inter-disciplinary educational actions in public health would be the best effective measures for improving communicable disease awareness and COVID-19 vaccination willingness among students and the adult population [16,17,18,19].

Public health education is an intellectual, psychological, and social process that includes activities for an individual to make informed decisions regarding their health, well-being, and the well-being of their families and communities [20]. Since public health education is an important way of measuring changing human beliefs and behaviors over time [21]; hence effective education could be the cornerstone in the prevention and control of infectious diseases. Health education messaging aims to build vaccine confidence by magnifying psychological understandings of vaccine-hesitant individuals [22]. In this context, evaluating students’ behavioral responses to the COVID-19 vaccine and disease consciousness would be useful in designing multidisciplinary educational strategies in the public health domain. The educational material should focus on students’ psychological perspective of vaccine hesitance and the underlying factors [23]. Education in public health, specifically, was significantly related to improving students’ adherence, attitude, and knowledge about the vaccination consequences [24, 25] as well as contributed to enhancing vaccine willingness among the general people [26,27,28,29]. A recent global view noted that education has a potential role in influencing public COVID-19 vaccine willingness [30]. It is likely that public health education would be effective in reducing the unwillingness to receive COVID-19 vaccination among students [31] and other subgroups.

In Bangladesh, numerous studies focused on COVID-19 vaccine willingness among students and reported a substantial reluctance to receive a vaccine [14, 32,33,34,35,36,37,38]. It was unfortunate that the general public in Bangladesh lacked adequate knowledge about COVID-19 vaccinations [39], with a low level of vaccine uptake intent [33, 40]. Tertiary students in Bangladesh adhere to a low level of risk perception, knowledge, and preventive practices regarding COVID-19 as well [4, 41]. In this regard, public health education could act as a social vaccine focusing on COVID-19 preclusion while combining prevention and treatment in a prevention alliance [42].

Despite the fact that public health education plays a crucial role in the advancement of COVID-19 awareness and vaccination decisions, students’ preference for public health education during COVID-19 vaccination was underdeveloped. At the same time, how an educator approaches students to receive health information during the country-wide vaccination campaign was a challenging public health issue. This study was designed to rationalize a research question “how public health education does support tertiary students’ COVID-19 vaccine willingness and which factors should be forecast in designing a study of a unique public health education module?” Therefore, this study aims to assess the preference for public health education of university students during COVID-19 vaccination interventions and compares the predictors of health education preferences between science and non-science students in Bangladesh.

2 Methods

2.1 Study design

This cross-sectional study used an anonymous, multi-item, closed-ended questionnaire to rationalize the study's outlined objectives. Questionnaire was deployed in Google form and data were collected using a digital platform. The convenience sampling technique employed the methods in accordance with the relevant guidelines and regulations for involving human subjects. All experimental protocols were approved by the Institutional Review Committee” (IRC), Faculty of Biological Science and Technology, Jashore University of Science and Technology. Since no clinical experiments were conducted and data was collected and analyzed anonymously, this study was approved by the IRC as exempt. Informed consent (indirect) was obtained from all subjects during data submission. There was no external funding for the study.

2.2 Setting and participants

This analysis involved students from both science and non-science backgrounds in universities across Bangladesh. The University Grants Commission (UGC) of Bangladesh approved a total of 164 universities, including 53 public, 109 privately funded, and 2 international universities, with a combined enrollment of 30,976 students in each year. Participants who completed the survey interview were not given any cash or in-kind incentives. Indirect written consent was obtained during the data collection process. Individuals were not harmed by this study, and they were free to decline participation at any stage of the study.

2.3 Participants’ inclusion and exclusion criteria

The eligibility criteria for the participants were the following: (i) understand and agree to the study objectives, (ii) willing to provide anonymous data on health education preferences based on COVID-19 vaccination decisions, (iii) science students of the government-funded university (iv) non-science students of the government-funded university (v) science students of the privately funded university, and (v) non-science students of the privately funded university in Bangladesh. The exclusion criteria were as follows: (i) not agreeing to give informed consent (ii) health science students of the university (iii) college students.

2.4 Measures and survey instrument development

The potential role of health education in developing people’s bio-safety behaviors and vaccine awareness has been evident to inform research and practices in the recent public health arena [43,44,45,46,47]. Similarly the concept of health education preference during COVID-19 vaccination consequences has been conceptualized from a theoretical analysis of the relevant kinds of literature on the topic [16, 18, 42, 48]. In addition, in-field consultation was performed in selecting a few questionnaire items. Items of the questionnaire were developed in the English language and needed 15 min to complete the interview session.

The survey instrument assessed (1) the socio-demographic profiles of the participants; (2) preference for health education during COVID-19 vaccination interventions, and (3) the predictors of health education preference during the vaccine rollout.

2.5 Validity and reliability of the measurements

To ensure the validity of the study measurements, the relevant literature on the topics was conceptualized and analyzed. A panel of public health experts reviewed the suitability of the questionnaire items and assessed the relevance and intelligibility of the constructs. To confirm the validity of the instrument, pilot testing (n = 20) was conducted, and the piloted data were not included in the final analysis. The reliability of the dichotomous questionnaire in the measurement was confirmed by examining Cronbach’s alpha (α) and Kuder–Richardson (KR-20) values. Cronbach’s alpha and KR-20 were estimated to be 0.79 and 0.77, respectively, which was deemed an appropriate scale for ensuring internal consistency of the measurements.

2.6 Outcome variable

Preference for public health education was the outcome variable. The outcome question was, “Would you prefer public health education for making COVID-19 vaccination decisions?" In this question, participants could reply whether they had a preference, not sure, and not preferred. For the binary regression analysis, the dependent variable was categorized and dichotomized into a binary variable where the acceptance intent was considered yes = 1 while the remaining two responses were transformed into otherwise = 0.

2.7 Predictor variables

Predictor or independent variables were contextualized from recent studies conducted on COVID-19 vaccination consequences in local, regional, and global contexts. Independent variables were categorized as contextual factors (socio-demographic and socio-economic characteristics of the respondents), socio-psychological, and vaccine-related antecedents of health education preferences. The effect of these independent variables on response variables was measured by dichotomizing these values into 1 = yes response and 0 = unsure/no response.

2.8 Data management and analysis

The Statistical Package for the Social Sciences (SPSS) program was used to import the data after they were inputted into Microsoft Excel version 10. Version 25 of IBM SPSS (RRID: SCR_016479). Both dependent and independent variables underwent descriptive analysis, with results given in the form of frequency, mean, percentage, and text. To investigate any potential confounding effects of the chosen variables, binary logistic regression analysis was conducted. Variables with a P-value < 0.05 were considered to be statistically significant. Model fitness was checked by the Hosmer and Lemeshow goodness-of-model fit test. Statistical significance between dependent variables and independent variables was assessed by odds ratios and 95% confidence intervals. No missing data were recorded in this analysis.

3 Results

3.1 Comparative socio-demographic overview of the students

The Table 1 below compares the socio-demographic characteristics of the population of the studied groups. The investigator checked eligibility criteria and confirmed eligible participants. A total of 363 sciencestudents and 395 non-science students, who were potentially eligible, participated in and completed the survey. Most of the students were 21–23 years old (43.6% vs. 41.9%) and were in the third year of their bachelor’s degree program (31.4% vs. 30.7%). The highest 68.1% of science students participated from public universities and 69.9% of non-science students were most prevalent in public universities. Dhaka was the geographical location of the highest number of encounters (26.9% and 26.5% respectively). The COVID-19 infection-positive history was 14% vs. 18.2% while 95.3% vs. 93.4% was the vaccination status of the student respectively. In total, 55.4% and 52.2% of male participants were recruited from science and non-science groups respectively. Most of the participants were Muslims by religion (78.5% vs. 76.3%). Most importantly, 71.3% of science students and 81.5% of non-science students preferred health education during the vaccination drive.

Table 1 Comparative socio-demographic overview of the study participants
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3.2 Description of the variables

The following Table 2 describes the descriptive statistics of the study outlined variables.

Table 2 Description of the variables’ in the study
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3.3 Goodness-of-model fit

Table 3 shows the goodness-of-model fit for performing a binary regression analysis.

Table 3 Omnibus tests of model coefficients and Hosmer and Lemeshow test
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Table 3's Hosmer and Lemeshow test as well as the Omnibus tests of the model coefficients have been used to explain the model's fit quality. After assessing the underlying hypotheses, the results indicated that the omnibus tests of the model coefficients had a substantial level of significance (p < 0.05), however, the Hosmer and Lemeshow test for both models revealed an inconsequential level of significance (p > 0.05). These findings showed that the study’s samples had very good model fitness for binary logistic regression.

3.4 Predictors of health education preferences during COVID-19 vaccination services

Table 4 highlights the comparative binary regression analysis between science and non-science student groups. The pooled preference for public health education was 71.3% (95% CI 67.7–74.3) vs. 81.5% (95% CI 79.3–84.7) among science and non-science university students. Out of twelve predictors of public health education preferences“vaccine agreement”, “bio-safety” behavior, and “disease awareness” were significantly associated (p < 0.01, p < 0.05) with the preference for public health education in both groups. The students who believed that health education would be effective for increasing individual vaccine agreement (AOR 3.659 vs. AOR 2.739), help to adopt bio-safety behavior (AOR 1.030 vs. AOR 1.388), and improve communicable disease awareness (AOR 1.388 vs. AOR 1.09) during COVID-19 pandemic were more likely to prefer public health education during the COVID-19 vaccination (p < 0.01 and p < 0.05). A varied effect was also observed for some predictors: vaccine “safety” (AOR 1.684) and “environmental health”(AOR 1.021) were significantly (p < 0.05) associated with the preference for public health education in science students whereas these were insignificant among the non-science group. Science students who believed that vaccine safety information and knowledge of environmental health was important to enhance COVID-19 vaccine agreement during a pandemic situation were more likely to prefer public health education. Similarly, side effects (AOR: 2.592) had a highly significant and the importance of prevention alliances (AOR: 1.160) had a significant association with health education preference in non-science students group. Non-science students who thought that public health education reduces perceived side effects fear and delineates the significance of prevention alliances during COVID-19 vaccination as well as supports them to address conflict of vaccination decisions (AOR: 1.398) were more likely to prefer public health education (p < 0.01, p < 0.05) during COVID-19 vaccination drive Table 4.

Table 4 Predictors of public health education preferences during COVID-19 vaccination intervention
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4 Discussion

For public preparedness against the outbreak of infectious diseases, public health education has been recognized by the World Health Organization (WHO) as an effective measure to prevent outbreaks of communicable diseases. Disease outbreaks and public health emergencies require education to play a vital role in the active response by providing well-established tools, especially in the absence of specific drugs or vaccines. [48, 49]. In order to slow down and control the spread of COVID-19 infection, public health education and awareness play a critical role in making students adhere to appropriate bio-safety behaviors such as social distance and maintaining the necessary hygiene habits.

The vaccine-based therapies are among the greatest achievements in medical science because they saved millions from emerging infectious diseases within a few decades [50], however, vaccine hesitancy or vaccine reluctance has been recognized as one of the biggest public health challenges [51]. Public resistance to scientific claims about vaccine data was believed to be a result of public ignorance (or misunderstanding) of science [52]. While investigations into the COVID-19 vaccine response were underway, numerous modeling studies were conducted to synthesize the potential factors influencing public vaccination decisions. Global disparities in COVID-19 vaccine acceptance existed in which several socio-psychological antecedents were associated with the COVID-19 vaccine decision across the continents [53]. This study thus examined students’ preference for public health education during the country-wide COVID-19 vaccination intervention and identified the key predictors associated with students' preference for public health education.

This study demonstrated that the comparative pooled preference for public health education of university science and non-science students was 71.3% vs. 81.5%. A study in the USA reported that effective educational messages increased 38.8% of vaccinated people against influenza vaccination services [54] and the Hepatitis B vaccination rate was raised significantly after educational activities in Saudi Arabia [55]. Lack of available data on vaccine safety, efficacy, effectiveness, and side effects fears would lead to long-term hesitancy of a newly promoted vaccine. Nonetheless, safety and efficacy regarding the CIVID-19 vaccine were among the predictors shaping students’ [14, 33, 34, 36] and general people’s [35, 40, 56, 57] attitudes toward COVID-19 vaccination in Bangladesh. Consequently, students were more likely to be fascinated by learning about the safety profile, efficacy information, and consequences of COVID-19 vaccination. During the pandemic, two terms, 'efficacy' and 'effectiveness’ were widely discussed and endorsed across various social networks in the global context, particularly concerning Vero Cell from China. Despite two different formulas being employed to calculate efficacy and effectiveness, from a learner’s viewpoint, most people understand “efficacy” as the vaccine's ability to produce desired positive effects, such as preventing illness or reducing symptom severity. A person who believes in the vaccine’s efficacy means they are convinced it functions as intended. Moreover, most individuals also comprehend vaccine effectiveness as the vaccine's capability to protect against a specific disease under real-world conditions. Consequently, efficacy and effectiveness of COVID-19 vaccine was the most common concern of COVID-19 vaccination willingness among the education sector in many countries [32, 58, 59]

The fear of post-vaccination side effects was a common concern among students considering COVID-19 vaccination in global [60, 61] as well as national vaccination drive among students [32] and general population [57]. To ensure successful vaccination campaigns and public health initiatives in Bangladesh, it is imperative to understand and address concerns about the side effects of vaccines in the context of a global crisis. University students who believed that public health education would be the appropriate tool to disseminate information about side effect facts of vaccines were more likely to prefer public health education and wanted to be familiar with vaccine data including perceived side effects. It has been evident that public health measures and non-pharmaceutical interventions were effective in reducing the transmission of COVID-19 in Bangladesh [62]. A wide variety of public health measures have been utilized to limit COVID-19 transmission worldwide, such as travel bans, country lockdowns, social distancing, and mask use. Other preventive measures includ frequent hand washing, sanitizing surfaces, and practicing good respiratory hygiene by covering mouth and nose when coughing or sneezing. These non-pharmaceutical measures, however, face challenges in Bangladesh [41], a developing country with one of the densest populations in the world. Although Bangladesh has taken multiple steps to slow the COVID-19 epidemic's rapid expansion, such broad population control programs affected life-style, attitudes, behavioral patterns, and perceptions even after vaccine uptake [38]. However, widespread application modes of these measures and long-term compliance with bio-safety behavior were the major challenges in adopting non-pharmaceutical measures. As a result, university education must include a unique topic on public health measures, including their comprehensive application and effective use to contend with the next pandemic. Accordingly, this study found that non-science students were more likely to be interested in learning about the benefits and implications of public health measures during COVID-19 vaccination.

The concept of perceived information inconsistency refers to a person's perception of discrepancies, contradictions, or conflicting information across various sources or channels related to a specific topic, event, or concept [63]. Vaccine inconsistency occurs when the public perceives a conflict or inconsistency among different sources, including the media, health authorities, and public discourse, regarding vaccine effectiveness, safety, side effects, and other relevant factors [64, 65]. Information about the safety or unsafe indicators of COVID-19 vaccines is also accessible, such as, multiple vaccines have demonstrated over 90% effectiveness in preventing severe cases while some COVID-19 vaccines have been linked to rare adverse events such as myocarditis (heart inflammation), blood clotting disorders, or vaccine-induced immune thrombotic thrombocytopenia. However, the occurrence of these events is extremely rare, and for most individuals, the benefits of vaccination far outweigh the risks. It is possible that certain individuals may be concerned about potential long-term effects that may manifest over time after experiencing COVID-19 vaccines. The proliferation of misinformation and disinformation about COVID-19 vaccines has contributed to uncertainties and doubts regarding their safety, causing some individuals to refrain from vaccine willingness in many countries [66,67,68]. Therefore, health information sources were identified as a significant predictor of students’ preferences for public health education during the COVID-19 vaccine rollout.

Since a sizable portion of the public lacks the tools to understand about vaccination, hence, educational campaigns and awareness programs may be a perfect psychological approach to overcome misinformation, rumors, and other negative traits [69, 70]. It was one of the fundamental strategies for infectious disease prevention to educate individuals about vaccine safety, side effects, and efficacy in order to boost trust in vaccines [71]. A sustained level of confidence in the immunization process was developed even among vaccine-hesitant individuals through public health education messaging [72, 73]. It is thus essential that the community becomes aware of the importance of transformative education systems, so that students receive clear, relevant health education that transcends bio-safety and vaccination behaviors.

4.1 Strengths and limitations

Public health education has a significant positive impact on students’ vaccination care and makes them individual critical thinkers who gain new knowledge about health outcomes. This is the first study to examine the preferences for health education of students during the country-wide COVID-19 vaccination programs in a developing country. This study applied a new analytical tool to explore the key predators of health education preferences. A significant strength of our study is that it analyzed data from students in age groups between 18 and 30 years old. The significance of community protective measures was found to be a predictor of health education; hence the prospective community health benefits during communicable disease exposure have been established. The importance of prevention alliances among public health measures and vaccine therapy other than the dependency of vaccine therapy on students was demonstrated. The findings will add new value to the existing field of health education research. The identification of various antecedents of health education preferences such as disease awareness, the importance of public health measures, health psychology, and environmental health, along with vaccine information thus calls for a unique health curriculum mapping in higher educational settings. This study established that health education would be the best-preferred approach to building COVID-19 vaccine confidence among people.

This study has some specific limitations. This study is cross-sectional, so causal associations between the investigated factors cannot be determined. The results may be overstated or understated based on self-reported feedback. Secondly, the study’s sample size was not adequate to represent complete insight into the overall population size. Therefore, generalization of the study results to other parts of the country and overseas should be taken with caution.

5 Conclusions

Refusal attitudes towards COVID-19 vaccines among students are a global public health challenge. An academician should address students’ vaccine-receptive behavior during the COVID-19 pandemic to discover a multi-disciplinary health curriculum. Transformative health education improves students’ knowledge of infectious diseases and promotes the development of appropriate behaviors toward communicable disease prevention and control. Since health education enhances students’ vaccine willingness, hence comprehensive knowledge on several aspects such as infectious disease information, bio-safety awareness, the significance of combined preventive values (vaccination and preventive measures), along with health safety and side effects information should be the fundamental parts of health education modules. This study contributed to innovations and education policy reforms that improve diversity, equity, and inclusion in tertiary education systems in the post-pandemic era. Public health education programs aimed at promoting the COVID-19 vaccine by examining the underlying factors of COVID-19 vaccine willingness have practical implications for global vaccine policy development. Policymakers need to incorporate these multicultural topics of public health education preferences into their strategic plans for transformative health education policy reform. Future research should focus on understanding the impact of incorporating multicultural topics into public health education on health outcomes and health disparities as well as evaluating the effectiveness of different strategies for implementing these topics in educational settings, in order to provide policymakers with evidence-based recommendations for effective policy reform in near real-time.