Barriers and Enablers: Exploring Vaccine Uptake Among Middle-Aged and Older Adults in a Multi-Ethnic Region of China

Abstract

Background: Influenza and pneumonia vaccination rates among middle-aged and older adults in China remain low, despite the proven efficacy of these vaccines. Research focusing on multi-ethnic regions is particularly scarce. Understanding the unique challenges is crucial for developing targeted interventions to improve vaccination rates.

Objectives: To explore the factors influencing influenza and pneumonia vaccine uptake among middle-aged and older adults in multi-ethnic regions of China.

Methods: A mixed-methods approach was employed, combining quantitative data from the Western China Health and Aging Trend study and interviews with 48 residents, 7 healthcare providers, and 7 local health officials. Data were collected in 2023 and 2024 from four counties in Sichuan Province: Chongzhou, Kangding, Maoxian, and Mianning. Descriptive and logistic regression analyses were used to examine vaccination rates and determinants. Thematic analysis was applied to qualitative data.

Results: Among 2,039 participants, vaccination rates were low, with significant ethnic and educational disparities. Factors associated with vaccine uptake included healthcare provider recommendations, health literacy, and trust in government and local leaders. Key barriers to vaccination were lack of awareness, concerns about safety and effectiveness, and uncertainty about vaccine locations. Despite concerns about vaccine costs, most older adults prioritized their health needs and trusted government-backed vaccines. Qualitative findings highlighted the importance of family and community support, as well as the need for tailored vaccine education campaigns and improved access to healthcare services, particularly in ethnically diverse communities with limited health literacy.

Conclusions: Vaccine uptake remains low due to systemic, cultural, and individual factors, including lack of awareness, uncertainty about access, and the belief that vaccination is unnecessary for persons in good health. Strengthening health education, improving access to vaccines, and integrating vaccination into routine care are critical steps toward improving vaccine uptake and ensuring equitable healthcare access in multi-ethnic regions.

Note:
Bill and Melinda Gates grant number(s): INV-034554

Data availability statement: PENDING

Keywords: China, Multiethnic region, Health Disparities, Health knowledge, Vaccine Hesitancy