Analysis Of Influence Mechanism Of Vaccine Hesitancy By Integrating The Theory Of Planned Behavior And The Protective Motivation Theory

Background and objectiveIn 2019,vaccine hesitancy was listed as "one of the top ten threats to global health." With the gradual rise in anti-vaccination attitudes and behaviors,vaccine hesitancy is becoming more common.In the past decade,a series of "vaccine crisis" events have occurred,which has led to a marked decrease in the confidence of Chinese parents in vaccination.This study aimed to formulate a vaccine hesitancy questionnaire for parents based on an integration of the theory of planned behavior(TPB)and the protection motivation theory(PMT),and then evaluate the status of vaccine hesitancy and its influencing factors.The structural equation model(SEM)was used to explore the influence mechanism of vaccine hesitancy to provide a scientific basis for the effective prevention and control of vaccine preventable diseases.Methods(1)To develop a Chinese version of the Vaccine Hesitancy Scale(VHS)and conduct a reliability and validity analysis to evaluate whether it is suitable for measuring vaccine hesitancy among parents in China.(2)Combined with VHS and based on the TPB and PMT,a vaccine hesitancy questionnaire for parents was jointly formulated,and then“Questionnaire star” was used to conduct online surveys.A generalized linear model was used to evaluate the status and influencing factors of vaccine hesitancy among parents,and the SEM was constructed to explore the mechanism of vaccine hesitancy.(3)The above questionnaire was used again to conduct a field survey in a city in Jiangsu Province,and the SEM was used to construct the same model structure to evaluate the interpretation effect and stability of the theoretical model.Results(1)The 10-item Chinese version of the VHS has good reliability and validity(Cronbach’s alpha coefficient was 0.790),and the scale has an obvious two-factor structure(the cumulative variance contribution rate was 70.62%).(2)Online survey found that the average VHS score of 2908 parents was 38.81 points,and 7.36% of them had high vaccine hesitancy.Multivariate analysis found that age,gender,whether engaged in medical-related industries,whether suffering from chronic diseases,the number of contacts in one day,and self-assessed health status had significant effects on the VHS scores of parents(P<0.05).Among them,whether suffering from chronic diseases(β=3.11,P<0.001)had the greatest impact on the VHS scores of parents.Attitude,subjective norm,self-efficacy,and perceived severity had significant positive predictive effects on vaccination intention(P<0.001).The subjective norm had the greatest impact on vaccination intention(β=0.445,P<0.001).The effect of response cost on vaccination intention was not statistically significant(P=0.853).Both selfefficacy and vaccination intention had significant positive predictive effects on vaccination behavior(P<0.001).(3)The online survey data showed that TPB model,PMT model,and the integrated model of TPB and PMT explained 59%,31%,and 60%of the variance of vaccination intention,respectively.The results of field survey data showed that TPB model,PMT model,and the integrated model of TPB and PMT explained 36%,17%,and 36% of the variance of vaccination intention,respectively.Meanwhile,the effects of the social economic status(SES)and the influenza vaccination history on vaccination intention were not statistically significant in all parents,parents of vaccination clinics,and parents of kindergarten(P>0.05).Conclusions(1)The Chinese version of the VHS has good reliability and validity.It can be used to evaluate the vaccine hesitancy of parents in China.(2)Parents who were younger,fathers,engaged in the medical-related industries,suffered from chronic diseases,and self-assessed poor health were more hesitant about vaccines.(3)The more positive the attitude towards vaccination,the stronger the concept of subjective norm,the higher the level of self-efficacy,and the more serious the perceived disease,the stronger the parent’s vaccination intention.The higher the level of self-efficacy and the stronger the intention to vaccinate,the more likely the parents were to adopt vaccination behavior.(4)TPB model has good utility and stability in explaining the decision-making mechanism of vaccination,while PMT model has weak explanatory utility and uncertainty.The integrated model of TPB and PMT did not achieve the expected improvement in explanatory power.