Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

Figures & data

Figure 1. Questionnaire instruments, COM-B model, TDF and definitions.

Table 1. Sociodemographic characteristics.

Sociodemographic category	Total (N = 1006)	C-UK students (N = 404)	C-M students (N = 602)	X^2 or t^a	p-value
Age, years (Mean, ± SD)	22.7 (±2.8)	23.2 (±2.2)	22.4 (±3.2)	−4.416	< .001
Gender, N (%)				0.009	.925
Female	718 (71.4)	289 (71.5)	429 (71.3)
Male	288 (28.6)	115 (28.5)	173 (28.7)
Degree, N (%)				359.050	< .001
Bachelor	598 (59.4)	98 (24.3)	500 (83.1)
Master	382 (38.0)	295 (73)	87 (13.4)
Doctoral	26 (2.6)	11 (2.7)	15 (2.5)
Major, N (%)				173.390	< .001
Health-related	271 (26.9)	18 (4.5)	253 (42.0)
Others	735 (73.1)	386 (95.5)	349 (58.0)
City (Top 3), N (%)				-	-
UK-London	221 (22.0)	221 (54.7)	-
UK-Coventry	46 (4.6)	46 (11.3)	-
UK-Edinburgh	25 (2.5)	25 (6.2)	-
China-Nanjing	246 (24.5)	-	246 (40.1)
China-Suzhou	99 (9.8)	-	99 (16.1)
China-Guiyang	56 (5.6)	-	56 (9.1)
Frequency of having cold-like symptoms within last 3 months, N (%)				13.235	.004
0	644 (64.0)	233 (57.7)	411 (68.3)
1–2	341 (33.9)	160 (39.6)	181 (30.1)
3–4	20 (2.0)	11 (2.7)	9 (1.5)
>5	1 (0.1)	0 (0)	1 (0.1)
Chronic disease, N (%)				4.004	.135
Yes	29 (2.9)	8 (2)	21 (3.5)
No	949 (94.3)	381 (94.3)	568 (94.4)
Unknown	28 (2.8)	15 (3.7)	13 (2.1)
Self-rated health condition, N (%)				230.4	< .001
Very bad	1 (0.1)	1 (0.20)	0 (0)
Not good	132 (13.1)	12 (3.0)	120 (19.9)
Normal	424 (42.1)	99 (24.5)	325 (54.0)
Good	366 (36.4)	225 (55.7)	141 (23.4)
Very good	83 (8.3)	67 (16.6)	16 (2.7)

^aT-test was performed for continuous variables (age only); Chi-square tests were performed for categorical variables.

^bCold-like symptoms – such as a blocked or runny nose, sneezing, and a sore throat – caused by all kinds of diseases, including lab-confirmed and non-lab-confirmed influenza.

Table 2. Influenza vaccine history and intention by groups.

Category	C-UK students, N (%) (N = 404)	C-M students, N (%) (N = 602)			X^2	P-value
Vaccine acceptance (history)					19.8	<.001
Never	101 (25)	186 (30.1)
A year ago	114 (28.2)	218 (36.2)
Within a year	189 (46.8)	198 (32.9)
Vaccine intention (Beginning)					22.597	<.001
Impossible	29 (7.2)	23 (3.8)
Less likely	109 (27.0)	130 (21.6)
Not sure	82 (20.3)	197 (32.7)
Likely	112 (27.7)	158 (26.2)
Very likely	72 (17.8)	94 (15.6)
(Ending)					14.322	.006
Impossible	11 (2.7)	6 (1.0)
Less likely	65 (16.1)	101 (16.8)
Not sure	127 (31.4)	228 (37.9)
Likely	119 (29.5)	186 (30.1)
Very likely	82 (20.3)	81 (13.5)
Planned time					33.8	<.001
Within 3 months	50 (12.4)	35 (5.8)
3–6 months	32 (7.9)	34 (5.6)
6–12 months	28 (6.9)	17 (2.8)
A year after	1 (0.3)	7 (1.2)
No plan	220 (54.5)	350 (58.1)
Not sure	73 (18.1)	159 (26.4)
	C-UK students (N = 404)		C-M students (N = 602)		Total sample (N = 1006)
Planned behavior^a	V	P	V	P	V	p
(Before vs after)	6474	<.001	19014	.009	47844	<.001

^aMann-Whitney tests were performed to compare the beginning and ending intention scores; Intention scores used the five-point Likert scale (1 = Impossible, 2 = Less likely, 3 = Not sure, 4 = Likely, 5 = Very likely).

Figure 2. Likert chart displaying questionnaire responses on factors influencing influenza vaccine decisions with group differences.

Table 3. Factors associated with the influenza vaccination behavior of the study population.

	Vaccination acceptance (history)^b						Vaccination intention (within one year)^c
	Total participants (N = 1006)		UK students (N = 404)		Mainland students (N = 602)		Total participants (N = 1006)		UK students (N = 404)		Mainland students (N = 602)
Factor categories^a	aOR(95%CI)	P	aOR(95%CI)	P	aOR(95%CI)	P	aOR(95%CI)	P	aOR(95%CI)	P	aOR(95%CI)	P
Age, years	0.97(0.95–0.99)	.015	0.89(0.77–1.02)	.097	0.86(0.77–0.96)	.005	1.01(0.99–1.04)	.300	1.04(0.90–1.20)	.578	0.96(0.88–1.05)	.430
Gender
Female	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/
Male	1.50(1.06–2.11)	.021	1.89(1.05–3.41)	.035	1.46(0.94–2.27)	.088	0.90(0.64–1.25)	.515	1.14(0.67–1.95)	.628	0.79(0.51–1.22)	.286
Degree
Bachelor	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/
Master	0.67(0.48–0.95)	.023	1.08(0.53–2.19)	.838	1.09(0.58–2.05)	.777	0.90(0.64–1.26)	.539	0.66(0.33–1.34)	.252	1.69(0.87–3.29)	.123
Doctoral	0.89(0.36–2.18)	.792	1.77(0.29–10.99)	.539	2.04(0.53–7.90)	.300	0.66(0.27–1.58)	.349	2.26(0.23–22.62)	.487	0.48(0.13–1.70)	.253
Major
Health-related	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/	Reference	/
Others	2.30(1.57–3.39)	<.001	2.32(0.76–7.07)	.138	2.01(1.29–3.14)	.002	1.34(0.89–2.00)	.161	0.94(0.28–3.22)	.924	1.32(0.83–2.10)	.235
TDF domains
Knowledge	1.64(1.33–2.03)	<.001	1.72(1.25–2.37)	.001	1.57(1.18–2.10)	.002	1.28(1.04–1.58)	.023	1.43(1.05–1.95)	.022	1.15(0.85–1.55)	.355
Environmental context	1.13(0.88–1.47)	.341	1.07(0.71–1.63)	.737	1.13(0.80–1.59)	.489	1.36(1.05–1.77)	.022	1.2(0.80–1.80)	.384	1.44(1.00–20.07)	.049
Social influence	1.04(0.77–1.40)	.785	0.89(0.58–1.37)	.600	1.17(0.74–1.83)	.505	1.51(1.12–2.03)	.007	1.3(0.86–1.96)	.221	1.79(1.11–2.88)	.017
Belief about consequence	0.59(0.41–0.84)	.004	0.68(0.40–1.13)	.139	0.54(0.32–0.90)	.019	0.36(0.25–0.53)	<.001	0.43(0.25–0.72)	.001	0.29(0.16–0.52)	<.001
Intention	0.86(0.62–1.19)	.356	0.94(0.57–1.53)	.794	0.80(0.51–1.26)	.343	0.97(0.70–1.35)	.848	0.97(0.60–1.56)	.892	0.99(0.61–1.62)	.974
Emotions	1.19(0.87–1.64)	.277	1.25(0.76–2.05)	.382	1.23(0.80–1.88)	.342	1.51(1.09–2.07)	.012	1.66(1.04–2.66)	.035	1.43(0.91–2.26)	.122
Reinforcement	1.82(1.44–2.29)	<.001	1.89(1.36–2.64)	<.001	1.71(1.23–2.37)	.001	1.66(1.32–2.08)	<.001	1.80(1.31–2.47)	<.001	1.53(1.08–2.17)	.018
Group
Mainland students	Reference	/					Reference	/
UK students	1.34(1.01–1.78)	.043					0.92(0.73–1.16)	.480

^aFrequency of having cold-like symptoms and health condition, were dropped out due to insufficient sample size in partial groups.

^bVaccination acceptance (history) measured by the influenza vaccine history (0 = No, 1 = Yes); binary logistic regression was performed to test its associations with the factors.

^cVaccination intention measured two willingness questions (beginning and end) by five Likert-scale options from impossible to very likely, valued 1 to 5 respectively; the average scores were counted and coded to binary (very low to medium willingness: 0 = “≤2.5;” high to very high willingness: 1 = “>2.5”); binary logistic regression was performed subsequently.

Data availability statement

The survey data is available on request provided ethics committee approval for sharing the anonymized data is granted. To request access conditional on approval, please contact [email protected].