Influenza vaccine hesitancy and influencing factors among university students in China: a multicenter cross-sectional survey

Figures & data

Table 1. Questions used to measure influencing factors in survey instrument.

Dimension	Questions	Question design
Contextual influences	Gender	1 = male; 2 = female
	Age	1 = Less than or equal to 21 years; 2 = Older than 21 years
	City	1 = Shanghai; 2 = Wuhan; 3 = Guangzhou; 4 = Nanning
	Major	1 = Science and technology or agriculture; 2 = Social Sciences; 3 = Medicine
	Education level	1 = Junior college; 2 = Undergraduate; 3 = Postgraduate
	Residence	1 = Rural; 2 = Urban
	Are you insured for basic medical insurance?	1 = Yes; 2 = No
	What are your monthly living expenses (CNY)?	1 = Less than 1000; 2 = 1001–2000; 3 = More than 2000
	Do you have a family history of cancer?	1 = Yes; 2 = No
	Have you ever had influenza?	1 = Yes; 2 = No
	Have you heard the negative information about vaccines?	1 = Yes; 2 = NO
Individual and group influences	How much do you know about the influenza vaccine?	0–4 (add up the scores of the correct options)
	What do you think of the severity of being infected by influenza?	0–10 (‘very low’ to ‘very high’)
	What do you think of the probability of being infected by influenza?	0–10 (‘very low’ to ‘very high’)
	How do you fear of being infected by influenza?	0–10 (‘very low’ to ‘very high’)
	What do you think of the necessity of influenza vaccination?	1 = Yes; 2 = No
	Do you trust the vaccine-related advice given by medical professionals?	1 = Yes; 2 = No
	Have you been recommended by your family, classmates or friends to the influenza vaccine?	1 = Yes; 2 = No
vaccine/vaccination-specific issues	Do you believe the efficacy of vaccines?	1 = Yes; 2 = No
	Do you believe the safety of domestic vaccines?	1 = Yes; 2 = No
	Do you believe the safety of vaccines abroad?	1 = Yes; 2 = No
	Have you been recommended by your doctor to the influenza vaccine?	1 = Yes; 2 = No
	Have you been vaccinated against COVID-19?	1 = Yes; 2 = No
	Have you ever had an influenza vaccination/appointment?	1 = vaccination; 2 = appointment; 3 = neither

Table 2. Participants’ characteristics and attitudes toward influenza vaccines.

Factors		Total, n (%)	Attitude to vaccination, n (%)		p value
			No hesitancy	Hesitancy
Gender	male	823 (36.4)	422 (51.3)	401 (48.7)	.004
	female	1438 (63.6)	828 (57.6)	610 (42.4)
Age (years)	≤21	1583 (70.0)	923 (58.3)	660 (41.7)	<.001
	>21	678 (30.0)	327 (48.2)	351 (51.8)
City	Shanghai	687 (30.4)	413 (60.1)	274 (39.9)	<.001
	Wuhan	548 (24.2)	290 (52.9)	258 (47.1)
	Guangzhou	488 (21.6)	220 (45.1)	268 (54.9)
	Nanning	538 (23.8)	327 (60.8)	211 (39.2)
Education level	Junior college	452 (20.0)	302 (66.8)	150 (33.2)	<.001
	Undergraduate	1499 (66.3)	819 (54.6)	680 (45.4)
	Postgraduate	310 (13.7)	129 (41.6)	181 (58.4)
Major	Science and technology/ Agriculture	368 (16.3)	210 (57.1)	158 (42.9)	.010
	Social sciences	932 (41.2)	544 (58.4)	388 (41.6)
	Medicine	961 (42.5)	496 (51.6)	465 (48.4)
Residence	Rural	1214 (53.7)	697 (57.4)	517 (42.6)	.028
	Urban	1047 (46.3)	553 (52.8)	494 (47.2)
Medical insurance	Yes	2102 (93.0)	1156 (55.0)	946 (45.0)	.313
	No	159 (7.0)	94 (59.1)	65 (40.9)
Living expense (CNY)	<1000	294 (13.0)	177 (60.2)	117 (39.8)	.154
	1001–2000	1440 (63.7)	792 (55.0)	648 (45.0)
	>2000	527 (23.3)	281 (53.3)	246 (46.7)
Family history of cancer	Yes	196 (8.7)	83 (42.3)	113 (57.7)	<.001
	No	2065 (91.3)	1167 (56.5)	898 (43.5)

Table 3. Influencing factors associated with influenza vaccine hesitation.

Matrix	Factors		Total, n (%)/Average, $\overline{\mathrm{X}}$	Attitude to vaccination		p
				No hesitancy	Hesitancy
Contextual influences	Have ever got influenza	Yes	181 (8.0)	92 (50.8)	89 (49.2)	.209
		No	2080 (92.0)	1158 (55.7)	922 (44.3)
	The negative information about vaccines	Yes	783 (34.6)	483 (61.7)	300 (38.3)	<.001
		No	1478 (65.4)	767 (51.9)	711 (48.1)
Individual and group influences	Vaccine knowledge	low	867 (38.3)	426 (49.1)	441 (50.9)	<.001
		moderate	990 (43.8)	583 (58.9)	407 (41.1)
		high	404 (17.9)	241 (59.7)	163 (40.3)
	The severity of being infected by influenza	0–10	5.67	6.09	5.14	<.001
	The probability of being infected by influenza	0–10	4.48	4.80	4.09	<.001
	The fear of being infected by influenza	0–10	4.17	4.57	3.68	<.001
	The necessity of influenza vaccination	Yes	1513 (66.9)	1065 (70.4)	448 (29.6)	<.001
		No	748 (33.1)	185 (24.7)	563 (75.3)
	Vaccines recommended by people around	Yes	749 (33.1)	562 (75.0)	187 (25.0)	<.001
		No	1512 (66.9)	688 (45.5)	824 (54.5)
	Trust vaccine-related advice provided by medical staffs	Yes	1632 (72.2)	1050 (64.3)	582 (35.7)	<.001
		No	629 (27.8)	200 (31.8)	429 (68.2)
Vaccine/vaccination-specific issues	The efficacy of vaccines	Yes	1720 (76.1)	1064 (61.9)	656 (38.1)	<.001
		No	541 (23.9)	186 (34.4)	355 (65.6)
	The safety of domestic vaccines	Yes	1446 (64.0)	(62.0)	550 (38.0)	<.001
		No	815 (36.0)	354 (43.4)	461 (56.6)
	The safety of vaccines abroad	Yes	1334 (59.0)	829 (62.1)	505 (37.9)	<.001
		No	927 (41.0)	421 (45.4)	506 (54.6)
	Influenza vaccines recommended by doctor	Yes	697 (30.8)	505 (72.5)	192 (27.5)	<.001
		No	1564 (69.2)	745 (47.6)	819 (52.4)
	Have been vaccinated against COVID-19	Yes	2238 (99.0)	1243 (55.5)	995 (44.5)	.016
		No	23 (1.0)	7 (30.4)	16 (69.6)
	Have an influenza vaccination/appointment	Vaccination	765 (33.8)	599 (78.3)	166 (21.7)	<.001
		Appointment	84 (3.7)	40 (47.6)	44 (52.4)
		Neither	1412 (62.5)	611 (43.3)	801 (56.7)

Table 4. Binary logistic regression to identify factors associated with influenza vaccine hesitancy.

Matrix	Factors		Hesitancy vs. No hesitancy
			OR	p	95% CI
Contextual influences	Gender	(Rf: male)
		Female	0.662	<.001	0.535	0.820
	Education Level	(Rf: Junior college)
		Undergraduate	1.672	.005	1.170	2.390
		Postgraduate	2.387	.001	1.460	3.902
	Family history of cancer	(Ref: Yes)
		No	0.691	.039	0.486	0.982
Individual and group influences	The severity of being infected by influenza		0.946	.025	0.901	0.993
	The probability of being infected by influenza		0.942	.026	0.894	0.993
	The necessity of influenza vaccination	(Rf: Yes)
		No	4.040	<.001	3.124	5.225
	vaccines recommended by people around	(Rf: Yes)
		No	1.476	.012	1.088	2.002
	Trust vaccine-related advice provided by medical staffs	(Rf: No)
		Yes	0.495	<.001	0.380	0.644
vaccine/vaccination-specific issues	Have a influenza vaccination /appointment	(Rf: vaccination)
		Appointment	3.604	<.001	2.158	6.019
		Neither	2.685	<.001	2.097	3.439

Data availability statement

Not applicable.