Characteristics,Potential Influencing Factors And Preference Of Influenza Vaccine Hesitancy Among Traditional Chinese Medicine Clinicians

Objective Seasonal influenza,which causes a huge health and economic burden on the population annually,is an important public health challenge.Vaccination is the most effective way to prevent influenza,but the overall vaccination rate of clinicians,especially traditional Chinese medicine(TCM)clinicians,is not high in our country.Due to the emphasis on the role of self-immunity in disease prevention in traditional Chinese medicine theory,and the lack of vaccinology in modern TCM education system,TCM physicians may be more hesitant to receive vaccines.This study aims to reveal the characteristics of influenza vaccine hesitancy among clinicians in our country,especially TCM clinicians.We,therefore,to reveal its potential influencing factors,to explore and quantify effective intervention measures,and to provide evidence for formulating health policies that can comprehensively improve the status of influenza vaccination among clinicians in our country.Methods Using a multi-stage stratified cluster sampling method,51 medical institutions were selected from 31 provincial-level administrative regions in China from January to May 2022,and a web-based questionnaire survey was distributed to all clinical physicians in these institutions.Based on international research and the team’s former research result,the "4Cs" model was proposed,and a Chinese clinician Influenza Vaccine Hesitancy Scale was established.Propensity score matching was used to ensure the comparability of two samples,and all potential risk factors were included in the multiple logistic regression analysis after collinearity testing and univariate analysis.The choice preferences of clinicians were converted into panel data,and the Mixed Logit model was used to analyze and quantify the coefficients(utility values)of various attributes and levels,and to calculate the expected vaccination rates under different scenarios.Results 1,013 TCM clinicians and 2,072 WM clinicians were included into final analysis.534(52.7%)TCM clinicians and 1,495(72.2%)WM clinicians reported having received influenza vaccination before(p<0.001).783(77.3%)TCM clinicians and 1,848(89.2%)WM clinicians were willing to receive influenza vaccination during the 2022/2023 influenza season(p<0.001).Based on the questionnaire evaluation,591(58.3%)TCM clinicians and 1,083(52.3%)WM clinicians were categorized as vaccine hesitancy(p<0.001).TCM clinicians were less likely than WM clinicians to recommend influenza vaccination for those aged 60 years and above(TCM 78.3%versus WM 83.6%),children aged 6-59 months(TCM 68.4%versus WM 80.0%),and pregnant or preparing for pregnancy women(TCM 28.2%versus WM 38.4%).TCM clinicians scored higher than WM clinicians in the dimensions of "confidence"(TCM 6.08±2.39 versus WM 5.72±2.63,p<0.001)and "connection"(TCM 10.76±3.74 versus WM 10.21±4.27,p<0.001).Compared to WM clinicians,TCM clinicians overall have a higher level of agreement with the statement that "people with strong immunity do not need to be vaccinated"(TCM 2.75±1.26 versus WM 2.49±1.34,p<0.001).Price(p<0.001),efficacy(p<0.001),risk of adverse events(p<0.001),vaccination mode(p<0.001)，and recommendations from their workplace(p<0.001)all significantly influence the preference of clinicians for receiving influenza vaccine.Compared with Western medicine clinicians,the utility values of influenza vaccine efficacy(TCM:0.50,95%CI 0.47-0.53;WM:0.43,95%CI 0.41-0.45;p<0.001)and risk of adverse events(TCM:0.14,95%CI0.10-0.17;WM:0.07,95%CI0.04-0.09;p<0.001)are significantly higher for traditional Chinese medicine clinicians.When the other attributes and levels remain unchanged,the price decreased from "100 yuan" to "0 yuan",the vaccination mode Change from "self-arranged" to "workplace arrangement collectively",and the recommendation from workplace changing from "no recommendation" to"recommendation for vaccination" can increase the expected vaccination rate of clinical physicians by 70%,31%,and 65%,respectively.Conclusion In China,clinicians.especially TCM clinicians,exhibit a relatively high level of influenza vaccine hesitancy.The following measures are recommended to medical institutions:(1)provide free influenza vaccine to clinicians annually;(2)provide convenient vaccination services;(3)issue annual notices recommending and encouraging clinicians to receive influenza vaccine annually.In addition,we call for modern TCM to update their knowledge system,establish modern TCM vaccinology theory,and carry out targeted promotion for TCM clinicians to improve the influenza vaccine hesitancy of this group.