Yang Liuqing, Ji Lili, Wang Qiang, Yang Guoping, Xiu Shixin, Cui Tingting, Shi Naiyang, Zhu Lin, Xu Xuepeng, Jin Hui, Zhen Shiqi
Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
JMIR Form Res. 2023 Feb 7;7:e39994. doi: 10.2196/39994.
Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death.
This study aimed to explore the drivers of vaccine hesitancy among older adults based on the "3Cs" (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators.
A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway's coefficients.
A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=-0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=-0.071; P=.02) and lower vaccine hesitancy.
Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.
老年人尤其容易受到传染病的威胁，包括严重并发症、住院和死亡。
本研究旨在基于“3C”（信心、自满和便利）框架探讨老年人疫苗犹豫的驱动因素，其中社会经济地位和疫苗接种史起到调节作用。
2021年6月1日至7月20日在中国江苏省进行了一项横断面问卷调查。采用分层抽样方法招募老年人（年龄≥60岁）。疫苗犹豫在模型中受“3C”影响。通过项目打包法处理的社会经济地位和疫苗接种史用于调节“3C”与犹豫之间的关联。采用分层回归分析和结构方程模型检验新框架的有效性。我们进行了5000次自抽样试验以计算路径系数的95%置信区间。
共有1341名老年人参与。平均年龄为71.3（标准差5.4）岁，44.7%（599/1341）的参与者为男性。信心（b = 0.967；95%置信区间0.759 - 1.201；P = 0.002）、便利（b = 0.458；95%置信区间0.333 - 0.590；P = 0.002）和较少自满（b = 0.301；95%置信区间0.187 - 0.408；P = 0.002）与较低的疫苗犹豫呈正相关。社会经济地位削弱了低自满（b = -0.065；P = 0.03）对低疫苗犹豫的积极影响。新冠病毒疫苗接种史对信心（b = -0.071；P = 0.02）与较低疫苗犹豫之间的正相关起负向调节作用。
我们的研究发现，信心是减少老年人疫苗犹豫中更具影响力的维度。新冠病毒疫苗接种史以及信心与较低的疫苗犹豫呈正相关，且可能削弱信心在疫苗犹豫中的作用。社会经济地位与较少自满存在替代关系，这表明它们在较低疫苗犹豫方面存在竞争性正相关。
