Analysis Of Vaccination Acceptance And Willingness To Pay And Its Influencing Factors For Hand Foot And Mouth Disease Vaccination Among Parents In Bijie City

Objective:Research on Vaccination Acceptance(in short VA)and Willingness to Pay(in short WTP)of the hand,foot and mouth disease(in short HFMD)vaccine for parents of children aged 5 years and younger in child care-institutions in Bijie City,by introducing and applying The Parent Attitudes about Childhood Vaccines(in short PACV)questionnaire among the parents for the first time,analyzing the important influencing factors of the VA and WTP,to provide a scientific reference for the development of vaccination strategies for HFMD vaccination.Methods:According to average disposable income level of the parents,stratify cluster sample methods were used from 533 parents in 6 kindergartens in three counties in Bijie.Based on the two-class decision-making theory of consumer behavior,the VA and WTP of HFMD vaccination were evaluated.The Chinese version PACV Questionnaire was developed to measure the degree of vaccine-hesitancy of parents,the Infectious Diseases Health Literacy Questionnaire(in short IDHLQ)was used to measure the infectious health literacy level of the parents,the Extended Linear Expenditure System(in short ELES)method was used to study on the payment ability of health-care services for the parents.The unconditional two-class logistic regression model was used to analyze the influencing factors of VA.The multiple linear regression model and structural equation model was used to analyze the influencing factors of the WTP.Results:The Cronbach?coefficient of the Chinese version PACV questionnaire is 0.8740,and the Cronbach?coefficients of the three factors are 0.7960,0.8200,0.7330 respectively,the questionnaire has 3-factors with the same original version structure(CFI=0.942,TLI=0.902,RMSEA=0.060,90%CI:0.050-0.070).Among the 533 children's parents,453 parents are willingness to vaccinate the HFMD vaccine(detecting VA),the VA detection rate is(84.99%),and 80 parents are unwillingness to vaccinate(15.01%).The top three reasons why parents are unwillingness to vaccinate are"Vaccination is the responsibility of the government and should not be borne by me."(47.50%),"I cannot afford fees of the vaccine"(16.25%),"I worried about quality of the vaccine"(11.25%).The one-way analysis results of VA shows that the vaccine-hesitancy among parents has significant different(?~2=66.568,P<0.01),"low vaccine-hesitancy"parents constitute the highest level of those who have VA,"high vaccine-hesitancy"parents constitute the lowest ones,"medium vaccine-hesitancy"parents constitute the highest level of those who have VA and"low of vaccine-hesitancy"parents constitute the lowest ones.In ability to pay for health care services(?~2=8.413,P<0.05),willingness parents and unwillingness ones have the highest"medium payment ability",and both have the lowest"weak ability".The infectious health literacy score of willingness parents are higher than unwillingness ones(t=3.070,P<0.05).In age groups(?~2=8.387,P<0.05),willingness parents are the highest in 30 years old group,unwillingness ones are the highest in 29 years old and younger group,and the lowest in both age groups are 35 years and older.In education groups(?~2=18.767,P<0.05),university degree and above parents are the highest in willingness parents,high school parents are the highest in unwillingness parents,primary school ones and below are in the both.The results of the unconditional two-class logistic regression analysis showed that the model was statistically significant(G=68.761,P<0.01),after adjusting the influence of university degree and above,the probability of VA parents with medium and low vaccine-hesitancy is 14.500 times(OR=14.500,95%CI:3.367~57.810)and 47.407 times(OR=47.407,95%CI:11.566~194.322)over the ones with high vaccine-hesitancy,respectively.The probability of vaccination was 3.271 times higher than that of parents with medium vaccine-hesitancy(OR=3.271,95%CI:1.862~5.741),after adjusting the influence of vaccine-hesitancy,the probability of VA parents with university and above is 2.879 times than that of parents with primary school and below(OR=2.879,95%CI:1.172~7.701).The average WTP is(199.60±110.84)yuan.The one-way analysis results showed that only the WTP of low vaccine-hesitancy group is higher than the medium and high-level groups(P<0.01),only the"strong payment ability"group is higher than the low and medium payment ability group in the payment ability of different health care services(P<0.01),parents had infectious health literacy group is higher than ones who had not(t=17.180,P<0.01),the WTP of sequence in education is primary school<middle school<high school<university degree and above(P<0.01),medium and high disposal income groups are all higher than low ones(P<0.01).The multiple linear regression analysis of WTP results show that the model has statistical significant(F=26.48,P<0.01),WTP decreases 1.193 yuan for every 1 point increase of vaccine-hesitancy score after adjusting the education and income level of parents(t=-2.590,P<0.05),WTP increases 10.060 yuan for every 10000 yuan of income after adjusting the education and vaccine-hesitancy(t=6.081,P<0.01),the structural equation model of WTP results shows that model fitting indexes are CFI=0.856,TLI=0.832,RMSEA=0.063(95%CI:0.055~0.071),vaccine safety and effective factor has an effect loading on WTP(?=-0.128,P<0.05),general attitude factor has an effect loading on WTP(?=0.469,P<0.01),vaccination behavior factor has an effect loading on WTP(?=-0.140,P<0.05),income level of parents has an effect loading on WTP(?=0.211,P<0.05),education has an effect loading on WTP(?=0.250,P<0.01).Conclusion:(1)The Chinese version of the PACV Questionnaire can be used to measure the degree of vaccine-hesitancy of parents.(2)The vaccination-hesitancy and education of parents aged 5 years and younger are important factors influencing the HFMD vaccination acceptance in Bijie City's child care institutions.(3)The vaccine safety and effective,vaccination related knowledge,vaccination experience,education and income are important factors influencing the HFMD willingness to pay in parents aged 5 years and younger of Bijie City's child care institutions.Following policy recommendations are suggested basing on study results:(1)To improve the HFMD vaccination level,knowledge related to vaccination,prevention and control of infectious diseases should be emphasized,and the vaccine-hesitancy of parents should be reduced.(2)By strengthening the regulation and management of information dissemination channels related to vaccination,establishing a media environment for vaccination information dissemination,reducing vaccination-hesitancy to improve the HFMD vaccination level.(3)Establishing a reasonable vaccine pricing mechanism,incorporating HFMD vaccine into the medical insurance catalogue or implementing free vaccination to controlling HFMD.