Vaccine hesitancy remains a significant public health challenge, particularly in rural populations where geographic and socioeconomic barriers exacerbate the issue. This study aimed to examine the factors influencing vaccine hesitancy, focusing on influenza vaccinations in rural and urban communities in Romania. The study was conducted between October 4 and October 30, 2024, across 16 family medicine practices, including seven in rural and nine in urban areas from Romania. A 13-item vaccine hesitancy questionnaire, assessing factors such as fear of adverse effects, distrust in vaccines, and perceived necessity included 272 responses. Latent Class Analysis (LCA) was used to identify distinct subgroups of hesitancy, while Chi-square and odds ratio analyses assessed geographic differences. We performed logistic regression for the most observed root attitudes on influenza vaccination refusal. Rural residents were significantly more likely to refuse influenza vaccination compared to urban residents. The LCA revealed three distinct latent classes, characterized by varying levels of agreement with key hesitancy items. Class 1 demonstrated low hesitancy, Class 2 exhibited high hesitancy driven by beliefs in natural immunity and perceived lack of necessity, and Class 3 showed intermediate hesitancy, influenced by distrust in vaccines and past negative experiences. Among the key significant triggers underlying vaccine refusal were fear of adverse effects, parental status, chronic diseases, and previous vaccination experiences, while factors such as age and gender showed limited impact. Vaccine hesitancy persists as a complex, multidimensional issue, with rural populations disproportionately affected. Targeted, context-specific interventions addressing key drivers such as distorted risk perception, fear of adverse effects and distrust in vaccines are critical for improving vaccination rates These findings underscore the importance of tailored public health strategies to promote equitable vaccine uptake.

Background: Social prescribing initiatives are tailored coaching programs created to assist participants in improving their personal circumstances and might constitute a creative way to enhance public and preventive health as we work toward providing universal financially sustainable healthcare. Methods: We conducted a scoping review with the aim of summarizing the main global trends on social prescribing and to identify the existing resources and potential targets of social prescribing in Romania. Results: One of the main concerns that arose from this review is the lack of defined pathways to access social programs and the lack of link workers, recognized as a valuable form of support in directing people toward the most appropriate intervention, necessary to increase long-term sustainability. We also acknowledge the importance of primary care in social prescribing, especially in prevention. The level of awareness and the capacity of primary care providers to identify the need for social prescription to increase the awareness of resources and encourage teamwork should be increased. Conclusions: By focusing on these areas, we can enhance the health and well-being of the population and fully realize the benefits of social prescribing in Romania. Further research and collaboration on social prescribing are crucial for optimizing its impact in Romania.

Background: The underutilization of primary care services is a possible factor influencing inappropriate emergency service presentations. The objective of this study was to evaluate the proportion and characteristics of patients inappropriately accessing emergency room services from the perspective of primary care underutilization. Methods: This cross-sectional study included patients who visited the emergency room of a County Hospital, initially triaged with green, blue, or white codes, during a 2-week period in May 2017. Two primary care physicians performed a structured analysis to correlate the initial diagnosis in the emergency room with the final diagnosis to establish whether the patient’s medical complaints could have been resolved in primary care. Results: A total of 1269 adult patients were included in this study. In total, the medical problems of 71.7% of patients could have been resolved by a primary care physician using clinical skills, extended resources, or other ambulatory care and out-of-hours services. Conclusions: Low awareness of out-of-hours centers and a lack of resources for delivering more complex services in primary care can lead to inappropriate presentations to the emergency services. Future research on this topic needs to be conducted at the national level.

Human papilloma virus (HPV) vaccination is a key strategy for preventing HPV-related cancers, yet vaccine hesitancy remains a challenge due to persistent myths and misconceptions. This study aimed to identify the most frequently encountered HPV vaccine-related myths in clinical practice from the perspective of family doctors and to assess differences in their prevalence between urban and rural populations. A cross-sectional study was conducted among family doctors in Romania who reported common myths encountered when discussing HPV vaccination with parents and women eligible for catch-up vaccination. The analysis focused on identifying the most prevalent perceived myths and assessing differences between urban and rural settings, age groups and genders, using Kruskal-Wallis test, followed by post-hoc Dunn’s tests with Holm correction to account for multiple comparisons, as well as Chi-square tests. The most frequently reported myths overall were “The HPV vaccine is only for girls” (mean score±SD, 2.91±1.27), “The HPV vaccine has severe and long-term side effects” (mean score±SD, 2.83±1.27), and “There are too many new vaccines” (mean score±SD, 2.77±1.3). Rural respondents reported significantly higher belief in concerns related to vaccine safety, effectiveness, increasing number of vaccines, necessity in monogamous individuals, fear of injections, and concerns about promiscuity, particularly in their perception of parents of adolescent girls. Family doctors consider that persistent myths continue to fuel vaccine hesitancy, especially in rural areas. Strengthening family doctors' communication skills through motivational interviewing and evidence-based counseling is essential. Public health efforts should focus on targeted educational interventions and social prescription tools to improve vaccine acceptance and reduce the burden of HPV-related diseases.

Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects.

Background and Objectives: Family physicians are central to HPV vaccination delivery in Romania, yet little is known about how they perceive recent changes in parental attitudes and the barriers encountered in routine practice. We described these perceptions and examined factors associated with reporting a perceived change. Materials and Methods: A cross-sectional online survey of a non-probability convenience sample of 525 primary-care physicians was conducted in February 2025. Closed responses were summarised descriptively, free-text responses underwent structured thematic content analysis, and robust Poisson regression estimated adjusted prevalence ratios (aPRs), with nominal inference. Results: Amongst respondents, 82.9% reported perceiving a change in parental attitudes; 67.4% provided content meeting a conservative favourable-coding definition and 76.8% a broader definition. Safety concerns and fear (51.9%) and distrust or resistance (46.8%) were the most frequent barriers. Digital sources were perceived as the principal origins of myths (95.6%). Urban respondents reported perceived change more often than rural respondents (88.2% versus 69.9%; aPR 1.265, 95% CI 1.133–1.413; p < 0.001), with similar estimates across sensitivity analyses. Conclusions: In this convenience sample, most physicians reported perceiving changes in parental attitudes and many descriptions were coded as favourable. These reports generate hypotheses for studies using direct parental measures and documented vaccination outcomes.