Factors affecting parental intention to vaccinate kindergarten children against influenza: A cross-sectional survey in China

Background: The impact of influenza in children under 5 can be severe and fatal. However, the influenza vaccination uptake in China remains suboptimal. The objectives of this study were to investigate parents' perceptions on influenza vaccination and to assess vaccination promotional factors.

Methods: A cross-sectional survey among 1506 parents with children in kindergarten was conducted in two areas with different policies: self-paid vaccination and free vaccination. The questionnaire was based on the structure of the Health Belief Model (HBM). Multiple logistic regression was used to analyze the determinants of parental vaccination intention. Odds ratios (OR) and respective 95% confidence intervals (95% CI) are reported.

Results: Within the free policy group versus the non-free group, vaccination intention rates were 76.3% versus 83.4%, and vaccination rates were 34.2% versus 3.1%. Results from multivariate analysis showed that parents with high scores for perceived susceptibility (OR = 1.44; 95% CI: 1.09-1.91), perceived benefits (OR = 1.80; 95% CI: 1.30-2.50) and cues to action (OR = 3.32; 95% CI: 2.47-4.46) were more likely to get their children vaccinated, while those perceived more barriers (OR = 0.50; 95% CI: 0.37-0.68) had lower vaccination intention. More knowledge (OR = 1.74; 95% CI: 1.18-2.56) and preferable attitudes (higher perceived necessity: OR = 1.84; 95% CI: 1.53-2.22; less safety worry: OR = 1.35; 95% CI: 1.10-1.66) were associated with significantly higher vaccination intention. Adjusted for parents' gender, age, education, income and children's age, the same significant factors were found. Parental intention was found to be influenced by different vaccination policies. Under a free policy, past influenza vaccination uptake (OR = 4.52; 95% CI: 1.07-19.02) greatly promoted parents' willingness to vaccinate their children.

Conclusion: Parents had high intention to get their kindergarten children vaccinated with the influenza vaccine in spite of the low uptake rate. Our results indicate that offering free influenza vaccines and parental education over the next years may increase the influenza vaccination rate.