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Chen C, Chen T, Huang M, Huang Y, Zhang L, Li P. Factors associated with HPV vaccine hesitancy among college students: A cross-sectional survey based on 3Cs and structural equation model in China. Hum Vaccin Immunother 2024; 20:2309731. [PMID: 38314749 PMCID: PMC10854271 DOI: 10.1080/21645515.2024.2309731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
Despite the high effectiveness of HPV vaccines in preventing infection, vaccine hesitancy remains a concern, particularly in China. This study aimed to explore college students' attitudes toward HPV vaccination and identify associated factors. Data was collected through a cross-sectional survey using self-administered questionnaires in four cities from May to June 2022. Chi-square tests and logistic regression analyses were conducted to identify factors. Additionally, an integrated structural equation model (SEM) based on the 3Cs (confidence, convenience, complacency) was developed to understand underlying factors contributing to hesitancy. The results from 2261 valid questionnaires were enlightening. A significant 89.47% (59.4% for females) considered HPV vaccination necessary, with 9.82% remaining neutral and only 0.71% deeming it unnecessary. Factors like higher education, being a medical student, residing in urban areas, having medical insurance, more extraordinary living expenses, a family history of tumors, and a solid understanding of HPV played a role in perceiving the vaccine as necessary. Among the 1438 female respondents, 84.36% had no hesitancy toward HPV vaccination, 13.53% expressed hesitancy, and 2.11% refused vaccination. Factors like age, understanding of HPV, medical staff recommendations, living expenses, and family history influenced hesitancy levels. SEM revealed that the 3Cs significantly affected vaccine hesitancy. Factors like price, booking process, vaccination times, trust in vaccines, medical staff recommendations, efficiency, and risk perception collectively influenced hesitancy. In conclusion, this study found high acceptance of HPV vaccination but acknowledged the complexity of hesitancy factors. It recommends medical staff disseminate scientific knowledge, offer recommendations, simplify booking procedures, and expand vaccination sites to address vaccine hesitancy effectively.
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Affiliation(s)
- Cheng Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Chen
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Mingzhao Huang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Occupational Disease Hazard Identification and Control, Wuhan, China
| | - Yan Huang
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, China
| | - Luying Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Pindong Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation, Wuhan, China
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Han K, Hou Z, Tu S, Wang Q, Hu S, Xing Y, Du J, Zang S, Chantler T, Larson H. Caregivers' understanding of childhood influenza vaccination during the epidemic in China. A mixed-methods study. Front Public Health 2023; 11:1196019. [PMID: 37637809 PMCID: PMC10447896 DOI: 10.3389/fpubh.2023.1196019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Influenza vaccination uptake among young children has been poor in China, but it is unclear how it changed during the COVID-19. This study aimed to investigate the uptake status and reasons of childhood influenza vaccination during the pandemic in China. Methods A mixed-methods study combining a questionnaire survey and semi-structured interviews was conducted in Anhui, Shaanxi, and Guangdong provinces between September and November 2021. 2081 caregivers completed the valid questionnaire. 38 caregivers participated in interviews, and data were analyzed thematically, using deductive and inductive coding. Results A total of 2081 caregivers completed the valid questionnaire, and 38 caregivers participated in interviews. Among the caregivers, a total of 1796 were in the age group for high-risk groups in the 2019-2020 flu season, and 46.10% reported that their children received influenza vaccination in the 2019-2020 flu season; 43.63% said that they vaccinated their children against influenza in the 2020-2021 flu season. Many caregivers indicated that the adoption of nonpharmacologic interventions (NPIs) during COVID-19 reduced the risk of influenza infection for children. Most caregivers consider the severity of influenza to be low, and some confused the common cold with influenza. Meanwhile, some caregivers lack confidence in the vaccine's effectiveness and importance. They thought that vaccines are not effective in preventing the constantly mutating virus. Despite clear perceptions about the severity of influenza and the effectiveness of the vaccine, we found that most caregivers did not receive any relevant medical information, and the communication about vaccines between caregivers and professional information sources, such as healthcare workers, is inadequate. Hence, caregivers have no scientific evidence to back up their perceptions. In terms of access to vaccination service, caregivers reported conflicts between time of vaccination service and their schedule, and the need for vaccine prices to be reduced. Discussion Targeted interventions are needed to address caregivers' lack of risk perception on influenza during COVID-19 and promote communication between caregivers and professional information sources. Extending vaccination service hours and increasing the number of vaccine clinics close to residential areas and expansion of financing sources for self-paid vaccination could facilitate the access to influenza vaccination service.
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Affiliation(s)
- Kaiyi Han
- School of Public and Health, Fudan University, Shanghai, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zhiyuan Hou
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shiyi Tu
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Qian Wang
- School of Public and Health, Fudan University, Shanghai, China
| | - Simeng Hu
- School of Public and Health, Fudan University, Shanghai, China
| | - Yuting Xing
- School of Public and Health, Fudan University, Shanghai, China
| | - Jing Du
- School of Public and Health, Fudan University, Shanghai, China
| | - Shujie Zang
- School of Public and Health, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States
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Wang M, Li M, Li X, Chen X, Jiang F, A K, Wang Z, Zhang L, Lu Y, Peng W, Wang W, Fu C, Wang Y. Intention and Attitude to Accept a Pertussis Cocooning Vaccination among Chinese Children's Guardians: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16282. [PMID: 36498351 PMCID: PMC9740915 DOI: 10.3390/ijerph192316282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE to assess Chinese children's guardians' intentions and attitudes toward accepting a pertussis cocooning vaccination and its determinants. METHODS a self-administered questionnaire was designed based on a theoretical framework that originated mainly from the reasoned action approach. Associations between questionnaire variables and outcomes were assessed using univariate and multivariate analyses with odds ratios (OR), regression coefficients (β), and their 95% confidence intervals (CIs). RESULTS among 762 eligible participants, most (80.71%) reported a positive intention to accept a pertussis cocooning vaccination. The guardians' positive intention was related to the children's pertussis vaccination experience (OR = 2.483, 95% CI: 1.340-4.600). Guardians who had a positive attitude towards pertussis vaccination (OR = 1.554, 95% CI: 1.053-2.296), higher subjective norms (OR = 1.960, 95% CI: 1.371-2.802) and better perceived behavioral control (OR = 7.482, 95% CI: 4.829-11.591) stated a higher intention to receive a pertussis cocooning vaccination. The mean attitude score was 3.88 ± 0.863. Greater risk perception about pertussis (β = 0.390, 95% CI: 0.298-0.483), stronger obligation from moral norms (β = 0.355, 95% CI: 0.279-0.430), and good knowledge (β = 0.108, 95% CI: 0.070-0.146) were significantly related to positive attitude toward pertussis cocooning vaccination among guardians. CONCLUSIONS Chinese children's guardians held positive intentions and attitudes toward accepting a pertussis cocooning vaccination. The current findings described the determinants of such intention and attitude and provided knowledge based on improving guardians' intentions for policymakers if cocooning vaccinations or related immunization strategies are implemented in China in the future.
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Affiliation(s)
- Meng Wang
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Mengying Li
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Xinghui Li
- Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Xiaoli Chen
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Feng Jiang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Kezhong A
- Institute of Immunization, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China
| | - Zhiguo Wang
- Department of Expanded Programmed on Immunization, Jiangsu Provincial Centre of Disease Control and Prevention, Nanjing 210009, China
| | - Liping Zhang
- Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai 200032, China
| | - Wenjia Peng
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai 200032, China
| | - Weibing Wang
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai 200032, China
| | - Chaowei Fu
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Ying Wang
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
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Han K, Hou Z, Tu S, Wang Q, Hu S, Xing Y, Du J, Zang S, Chantler T, Larson H. Childhood Influenza Vaccination and Its Determinants during 2020-2021 Flu Seasons in China: A Cross-Sectional Survey. Vaccines (Basel) 2022; 10:vaccines10121994. [PMID: 36560404 PMCID: PMC9783337 DOI: 10.3390/vaccines10121994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Young children aged 6−59 months are recommended as one of the priority groups for seasonal influenza vaccination in China. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among children in three Chinese provinces. In September 2021, 2081 caregivers with children <5 years completed self-administered questionnaires as part of a cross-sectional survey. Logistic regression was used to assess determinants of childhood influenza vaccination. A total of 43.63% of respondents reported vaccinating their children against influenza during the 2020−2021 flu season. Caregivers who lived in Anhui province, had a bachelor degree or above, and an annual household income <20,000 RMB were more likely to vaccinate their children against influenza. Confidence in the importance (OR: 2.50; 95%CI: 1.77−3.54), safety (OR: 1.60; 95%CI: 1.29−1.99), and effectiveness (OR: 1.54; 95%CI: 1.23−1.93) of influenza vaccine was significantly associated with childhood vaccine acceptance. Respondents who saw that other caregivers were vaccinating their children had significantly higher odds of vaccinating their own children. Caregivers’ receiving positive influence from healthcare workers (OR: 1.33; 95%CI: 1.00−1.77), family members, or friends (OR: 1.30; 95%CI: 1.14−1.49) were also significantly associated with childhood influenza vaccination. Poor access, including conflicts between caregivers’ availability and vaccination service schedules and inconvenient transportation to the vaccination site were negatively associated with childhood flu vaccination. To promote childhood influenza vaccination, public health information campaigns need to target wealthier and less educated caregivers to enhance caregivers’ confidence in influenza vaccination. Targeted interventions are also needed to optimize access to vaccination services, including extending vaccination service hours and increasing the number of vaccination sites close to residential areas. Interventions are also needed to encourage primary care providers to play a greater role in promoting vaccination. Finally, the dissemination of related information and the public response need to be monitored for the timely understanding of public perceptions.
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Affiliation(s)
- Kaiyi Han
- School of Public and Health, Fudan University, Shanghai 200032, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Zhiyuan Hou
- School of Public and Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Correspondence:
| | - Shiyi Tu
- School of Public and Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Qian Wang
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Simeng Hu
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Yuting Xing
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Jing Du
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Shujie Zang
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
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Lai X, Li M, Hou Z, Guo J, Zhang H, Wang J, Fang H. Factors associated with caregivers' hesitancy to vaccinate children against influenza: A cross-sectional survey in China. Vaccine 2022; 40:3975-3983. [PMID: 35637066 DOI: 10.1016/j.vaccine.2022.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Seasonal influenza can cause serious harm to children under five years of age, while caregivers are still hesitant to vaccinate children against influenza. This study aimed to investigate caregivers' hesitancy regarding influenza vaccination and assess the associated factors. METHODS From August to October 2019, a cross-sectional survey was conducted in ten provinces in China. The questionnaire collected information about sociodemographic characteristics and caregivers' knowledge, perceptions and attitudes toward influenza vaccination. Caregivers were identified as not hesitating, hesitating or refusing to vaccinate children. Multinomial logistic regression was adopted to determine factors related to vaccine hesitancy based on the 3C model with three dimensions namely complacency, convenience and confidence. RESULTS A total of 6668 valid questionnaires were collected, among which 38.57% did not hesitate to vaccinate children against influenza, 56.03% were hesitant, and 5.40% refused. Multinomial logistic regression showed that caregivers perceiving high importance (AOR = 0.68 for hesitancy; 0.15 for refusal), safety (AOR = 0.42; 0.46) or efficacy (AOR = 0.73; 0.65) of influenza vaccination, knowing children as a priority group (AOR = 0.80; 0.48), and trusting vaccination advice from medical staff (AOR = 0.65; 0.51) had lower odds of hesitancy or refusal. Those considering price as a hindering factor had higher odds of hesitancy (AOR = 1.66) or refusal (AOR = 1.47), and those viewing time or distance as a hindering factor (AOR = 1.45) or having heard of vaccine-related negative information (AOR = 1.78) had higher odds of hesitancy. Sociodemographic characteristics were associated with vaccine hesitancy or refusal, and the associations varied for hesitators and refusers. CONCLUSION A large proportion of caregivers in China reported their hesitancy for influenza vaccination, and the associated factors of such hesitancy were complicated. Health professionals are recommended to spread relevant scientific knowledge and give vaccine-related suggestions to caregivers in doctor visits to promote caregivers' trust in influenza vaccination and therefore expand childhood vaccine coverage.
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Affiliation(s)
- Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100191, China; China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Mengyao Li
- School of Public Health, Peking University, Beijing 100191, China.
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai 200032, China.
| | - Jia Guo
- School of Public Health, Peking University, Beijing 100191, China; China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing 100191, China; China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Jiahao Wang
- School of Public Health, Peking University, Beijing 100191, China; China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100191, China; Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing 100083, China; Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100083, China.
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