Background: Vaccine hesitancy is a major public health challenge, particularly in rural populations, where limited access to healthcare, misinformation, and low health literacy may influence vaccination decisions. Understanding the factors contributing to hesitancy is essential to improve vaccine coverage and prevent outbreaks of vaccine-preventable diseases.

Aim: To assess and describe the key factors influencing vaccine hesitancy among a rural population in North India.

Methods: A descriptive cross-sectional study was conducted among 150 adults aged 18 years and above in rural villages of North India from June to August 2025. Participants were selected using a systematic random sampling method. Data were collected through face-to-face interviews using a structured questionnaire based on the WHO SAGE vaccine hesitancy framework. Information on socio-demographics, knowledge, attitudes, trust in healthcare providers, and exposure to misinformation was recorded. Data were analyzed using SPSS v26. Descriptive statistics summarized participant characteristics, and Chi-square tests and multivariate logistic regression were applied to identify determinants of vaccine hesitancy.

Results: Vaccine hesitancy was observed in 43.3% of participants. Key factors associated with hesitancy included lower education, limited trust in healthcare providers, belief in misinformation, and low perceived susceptibility to disease. Gender and occupation were not significantly associated. Logistic regression analysis revealed that participants with no formal education (OR 2.45, 95% CI 1.40–4.30), limited trust in healthcare providers (OR 3.10, 95% CI 1.75–5.50), belief in misinformation (OR 2.90, 95% CI 1.60–5.20), and low perceived disease risk (OR 2.65, 95% CI 1.50–4.70) were significantly more likely to be vaccine-hesitant.

Conclusion: Vaccine hesitancy is prevalent among rural populations and is influenced by education, trust, misinformation, and risk perception. Public health interventions targeting health literacy, community engagement, and trusted communication channels are essential to enhance vaccine acceptance in rural areas.

Keywords: Vaccine hesitancy, Rural population, Education, Trust, Misinformation, Vaccine uptake