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Background This study aims to evaluate the vaccination and immunization knowledge, attitudes and practices and health literacy levels of adults living in rural area of Eskisehir City in Turkey. Methods The study is a cross-sectional study conducted on individuals aged 18 years and over who live in the rural area of Eskisehir City between November 16 and December 30, 2018. The study group consisted of 955 participants. The survey includes the questions about the evaluation of vaccination and immunization knowledge, attitudes and practices and the questions from the European Health Literacy Scale Short Form (HLS-EU-Q16). The statistical significance value was accepted as p ≤ 0.05. Results 493 participants (51.6%) of the study group was female. Their ages ranged between 18 and 85 years with a mean (SD) 42.6 (15.6) years. In the study, it was found that 325 people (34.0%) had insufficient knowledge of vaccine and immunization. A positive weak correlation was found between the scores obtained from the information questions about vaccination and immunization and the scores obtained from HLS-EU-Q16 (r = 0.252; p = 0.001). It was found that there was a weak positive correlation between the scores obtained from information questions about vaccination and immunization and the scores obtained from questions about their attitudes and practices towards vaccination and immunization services(r = 0.333; p = 0.001). Being 65 years and older, living in the village having not been vaccinated in the last 10 years and lack of previous information about vaccines, were found to be important risk factors for lack of knowledge level on vaccine and immunization. Conclusions In the study, it was observed that one third of the group's vaccine and immunization knowledge levels were insufficient. Determining the factors that affect the level of knowledge about vaccination and immunization may be important in terms of sustaining the effectiveness of vaccination applications and campaigns. Key messages Lack of information about vaccines and insufficient knowledge about vaccine-preventable diseases can feed individuals' indecisiveness to vaccination. Health education and information services can be provided to increase the level of vaccination and immunization knowledge.

Evaluation of Vaccination Knowledge, Attitudes and Practices and Health Literacy Levels of Adults