INTRODUCTION:
Since the onset of the covid-19 pandemic, preventive behaviors and vaccines have been crucial for mitigation. understanding how vaccination influences risk perception and sustained adherence to non-pharmaceutical interventions is vital for public health strategy.

METHODS:
A systematic review and meta-analysis followed Prisma guidelines. databases were searched from January 2020 to march 2025. studies analyzing risk perception, preventive behaviors, and covid-19 vaccination status were included. methodological quality was assessed using the mixed methods appraisal tool. a meta-analysis using random-effects models compared standardized risk perception scores between vaccinated and unvaccinated subgroups.

RESULTS:
From 1594 screened records, 10 studies met inclusion criteria (six included in meta-analysis, n=9115). most vaccinated individuals maintained protective behaviors like mask-wearing (62%-78%), though declines in handwashing (-15%) and distancing (-22%) were observed. boosted individuals showed higher adherence than partially vaccinated or unvaccinated individuals. unvaccinated individuals intending to vaccinate reported higher risk perception than vaccine refusers. the meta-analysis found no significant difference in pooled risk perception scores between vaccinated (70.3, 95% CI 60.8–79.8) and unvaccinated subgroups (70.8, 95% CI 61.9–79.6; i²=17.5%).

CONCLUSIONS:
Covid-19 vaccination status alone did not yield significant differences in population-level risk perception, potentially due to risk compensation behaviors. sustaining preventive measures requires public health messaging that emphasizes communal responsibility, persistent viral risks, and the complementary role of vaccination alongside other behaviors. future strategies should address these nuanced behavioral determinants to enhance long-term adherence.