Emotions, preventive measures, and risk perception in post-emergency COVID-19: a cross-sectional study in Italian university staff during the seasonal vaccination campaign

Background: Despite the end of the global health emergency, COVID-19 is expected to persist and continue to pose a threat to public health, due to the emergence of new virus variants and the risks of long-term effects. Therefore, seasonal vaccinations for vulnerable populations (i.e., older adults and individuals with underlying medical conditions) and extensive testing to detect infection remain crucial strategies for protecting public health. This study aimed to investigate attitudes, intentions, behaviors, and emotions related to COVID-19, vaccination, and the use of antigen tests among university staff during the 2023–2024 COVID-19 vaccination campaign in Italy. Method: An ad hoc anonymous survey was administered to 267 university staff members, aged 18–70 years, between February 15 and March 20, 2024. Logistic regression models were estimated to evaluate the determinants of vaccination adherence, risk perception, and test-taking intention. Results: Adherence to the vaccination campaign was low (13.1% overall; 30.6% among individuals aged ≥ 60) and was positively associated with older age (OR = 1.84, CI [1.01, 3.33]) and with a greater number of previous vaccine doses (OR = 22.65, CI [7.00, 73.28]). Trust/hope toward vaccination increased the likelihood of adherence (OR = 1.76, CI [1.10, 2.82]), whereas higher early-pandemic anxiety/worry reduced it (OR = 0.46, CI [0.27, 0.77]). Individuals who had never contracted COVID-19 were less likely to perceive high infection risk (OR = 0.31, CI [0.17, 0.58]), and higher early-pandemic anxiety/worry was associated with greater perceived risk (OR = 1.31, CI [1.06, 1.62]); however, risk perception did not predict COVID-19 vaccination adherence or test-taking intentions. The intention to take an antigen test was greater among individuals who adopted more preventive measures, such as mask use, distancing, and hygiene behaviors (OR = 1.56, CI [1.19, 2.05]), who had received more vaccine doses (OR = 2.24, CI [1.22, 4.11]), and who reported greater trust/hope toward testing (OR = 2.18, CI [1.46, 3.27]). Conclusions: Overall, the findings underscore the central role of emotional responses and past preventive behaviors, rather than risk perception, in shaping both COVID-19 vaccination adherence and test-taking intentions during the post-emergency phase. Supplementary information: The online version contains supplementary material available at 10.1186/s12889-026-26782-x.