Background: The COVID-19 pandemic continues to challenge global public health, with vaccination playing a key role in mitigating transmission. Despite recognising its importance, Tanzania exhibits considerable regional disparities in vaccine uptake. Understanding the determinants influencing vaccination is essential.

Aim: This study investigated determinants of COVID-19 vaccination rates within Tanzania, employing a socio-ecological framework to comprehensively examine individual, interpersonal, community, and institutional influences.

Setting: Eight regions across Tanzania, purposively selected to represent urban, peri-urban, and rural contexts, reflecting varying socio-cultural and infrastructural conditions.

Methods: A concurrent mixed-method design was utilised, combining quantitative surveys from 3098 participants with qualitative data collected through focus group discussions and key informant interviews.

Results: Although general awareness of COVID-19 was notably high (99.3%), overall vaccine acceptance remained low (37.2%), exhibiting significant regional variations (22.5% in Morogoro to 50.0% in Mtwara). Individual factors such as personal vaccine beliefs, perceived safety, and misinformation significantly impacted uptake. Interpersonal influences from family, friends, and community leaders critically shaped vaccination decisions. Despite high acknowledgment of community leaders' roles (88.3%), governmental campaign awareness was minimal (22.4%). Institutional factors, notably healthcare system trust and vaccine accessibility, also significantly influenced uptake.

Conclusion: Findings advocate for region-specific, multilevel interventions addressing misinformation, engaging trusted community influencers, improving transparency, and enhancing healthcare service delivery to mitigate disparities and enhance vaccine acceptance.

Contribution: The study offers insights foundational for tailored public health strategies, improving vaccine accessibility and resilience against future pandemics in Tanzania and comparable socio-ecological contexts.

Keywords: COVID-19; Tanzania; mixed-method study; socio-ecological determinants; vaccine uptake.

© 2025. The Authors.

背景： 新冠肺炎疫情继续挑战全球公共卫生，疫苗接种在减轻病毒传播方面发挥着关键作用。尽管认识到其重要性，坦桑尼亚各地区的疫苗接种率仍存在显著差异。理解影响疫苗接种的因素至关重要。

目的： 本研究采用社会生态框架调查了坦桑尼亚COVID-19疫苗接种率的影响因素，全面考察个体、人际、社区和机构层面的影响力。

地点： 选取了坦桑尼亚八个地区（包括城市、城郊和农村地区），旨在反映不同的社会文化与基础设施条件。

方法： 采用定性定量结合的研究设计，其中包括对3098名参与者的问卷调查以及通过焦点小组讨论和关键信息人士访谈收集的质性数据。

结果： 尽管总体上对于新冠肺炎的认知度很高（99.3%），但整体疫苗接种接受率仍然较低（37.2%），并且表现出显著的地区差异（莫罗戈罗地区的22.5%至姆特瓦拉地区的50.0%）。个人因素，如对疫苗的看法、认为安全性和错误信息，显著影响了接种决定。家庭成员、朋友和社区领导的人际影响力也极大地塑造了接种决策过程。尽管高度认可社区领导的作用（88.3%），但政府宣传活动的认知度却非常低（22.4%）。此外，机构因素如医疗系统的信任程度及疫苗获取的便利性也显著影响着接种率。

结论： 研究发现表明，需要采取地区特定、多层次干预措施来应对错误信息问题，吸引值得信赖的社区影响力人士参与，并改善透明度和医疗服务供给，以减少不平等并提高疫苗接受度。

贡献： 本研究为制定量身定制的公共卫生策略提供了基础见解，有助于提升坦桑尼亚及其他类似社会生态背景下的疫苗获取能力和应对未来疫情的能力。

关键词： COVID-19；坦桑尼亚；混合方法研究；社会生态决定因素；疫苗接种率