Abstract
Background: Vaccine hesitancy is a global challenge affecting workplaces and academic
institutions. Despite efforts, low vaccination rates persist in South Africa, increasing the
risks associated with pathogen exposure. This study assessed the knowledge, attitudes,
and perceptions (KAPs) of healthcare workers (HCWs) and students at a Nursing College
regarding voluntary and mandatory COVID-19 vaccination. Methods: A quantitative
cross-sectional study was conducted using a structured, self-administered electronic questionnaire.
All eligible nursing students and staff at the participating Nursing College were
Int. J. Environ. Res. Public Health 2026, 23, 1042 https://doi.org/10.3390/ijerph23081042
Int. J. Environ. Res. Public Health 2026, 23, 1042 2 of 20
invited to participate. Of the 504 eligible individuals, 372 completed the questionnaire,
corresponding to a response rate of 73.8%. Data were analyzed using IBM SPSS Statistics
version 30.0. Logistic regression and Mann–Whitney U tests were used to assess associations
and differences between groups, with statistical significance set at p < 0.05. Results:
Most respondents were female (302, 81.0%) and single (252, 67.9%). The age group 26
to 40 was most prominent (144, 38.8%). Only 42.2% of respondents (n = 157) were fully
immunized with no boosters. Student nurses dominated (344, 92.5%), with 226 (60.9%)
having no COVID-19 infections and 198 (72.0%) voluntarily receiving the vaccine. Occupation
(p = 0.030) and age group (p = 0.027) were independently associated with reporting
voluntary COVID-19 vaccination. Age was also associated with respondents’ attitudes
and perceptions of the COVID-19 vaccine (p < 0.001) as well as their understanding of the
vaccine (p = 0.002). Conclusions: Occupation and age group were independently associated
with the reported basis on which COVID-19 vaccination was received (voluntary versus
mandatory). Targeted communication and educational strategies addressing these factors
may improve vaccine acceptance and preparedness for future outbreaks.