Understanding drivers of influenza vaccine hesitancy among pregnant women in China: evidence from an extended theory of planned behavior

ABSTRACT

Background

Pregnant women’s influenza vaccination uptake was low, although being recommended as a priority.

Research design and methods

We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect vaccine hesitancy; response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played as a moderator.

Results

Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [β_indirect = 0.142 (95% confidence interval (CI): 0.084, 0.206), P < 0.001], subjective norms [β_indirect = 0.568 (95%CI: 0.424, 0.754), P < 0.001], perceived behavioral control [β_indirect = 0.070 (95%CI: 0.025, 0.118), P = 0.004] and vaccine hesitancy. Further, indirect effect differences between the two dimensions of attitude (P < 0.001), perceived behavioral control (P < 0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P = 0.679), subjective norms (P = 0.645), and hesitancy.

Conclusions

The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history was limited to reduce hesitancy.

KEYWORDS:

• Influenza vaccination
• pregnant women
• theory of planned behavior (TPB)
• vaccine hesitancy
• drivers

Acknowledgments

We would like to thank Wujin, Liyang, Yandu, and Dongtai Center for Disease Prevention and Control; all pregnant women who participated in this survey for their contributions to this study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

HJ, LQY and LLJ designed the study. QW, LQY, GPY, and TTC conducted the literature review and designed the questionnaire. GPY, LLJ, LZ and NYS assisted with the online investigation. LQY, QW and SXX analyzed the data. HJ, QW, GPY and XPX interpreted the results. All authors critically revised the manuscript for important intellectual content. And that all authors agree to be accountable for all aspects of the work and approve the version for publication.

Ethical approval and patient consent

This study was ethically reviewed and approved by the Ethics Committee of the Wuxi Center for Disease Prevention and Control (2020No10). Oral informed consent was obtained from individual participants.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14760584.2022.2117695

Additional information

Funding

This manuscript was funded by The Wuxi City Technology Development Fund (N20191007); Postgraduate Research & Practice Innovation Program of Jiangsu Province (Grant Number: KYCX21_0160); Public Health Research Center of Jiangnan University (JUPH201845).