Physician recommendation and vaccine hesitancy as key drivers of pneumococcal vaccination among older adults in China: a cross-sectional study using policy-stratified structural equation modeling
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Pneumococcal disease causes severe illness in older adults. This study examined the impacts of physician recommendation, vaccine hesitancy, and regional policy differences on pneumococcal vaccination uptake in China.Research design and methods A cross-sectional study was conducted among 13,363 adults aged ≥ 60 years in six Chinese cities using structural equation modeling, stratified by free and self-financed vaccination areas.Results Mean age was 69.53 years, 54.74% female, with 22.79% vaccination rate. Vaccine hesitancy had a significant negative direct effect on vaccination uptake (β = −0.387, p < 0.001), while physician recommendation exerted the largest total positive effect (β = 0.349). In self-financed policy area, vaccine hesitancy was the strongest negative predictor (β = −0.529, p < 0.001), and diverse information sources mitigated hesitancy but showed a slight negative direct effect on uptake (β = −0.059).In the free-vaccine policy area, physician recommendation had a more pronounced direct effect (β = 0.305, p < 0.001), and better perceived health status was associated with suppressed uptake (β = −0.093).Conclusions Vaccine attitudes often reflect generalized psychological constructs. Strategies must be tailored to policy contexts: enhancing information quality in self-financed areas and addressing complacency in free-vaccine settings. Multidimensional interventions should expand healthcare worker roles and optimize organizational logistics. Key limitations include the cross-sectional design and reliance on self-reported data.
Source: Expert Review of Vaccines
Authors: Yuxing Wang, Shuai Yuan, Yuanruo Xie, Jianing Dai, Ling Zhu, Gang Liu, Zhujiazi Zhang, Lili You
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7155197891