Chuxuan Zhang, Beyond Risk Awareness: Confidence, Trust, and Behavioral Access in Influenza Vaccination Decisions Among Chinese Parents, Journal of Public Health International, Volume 8, Issue 1, 2026, Pages 1-14, ISSN 2641-4538, https://doi.org/10.14302/issn.2641-4538.jphi-26-6405.
(https://oap-onlinejournals.org/public-health-international/article/beyond-risk-awareness-confidence-trust-and-behavioral-access-in-influenza-vaccination-decisions-among-chinese-parents-2401)
Abstract: Despite the availability of influenza vaccines and recommendations, vaccination rates among the Chinese population have remained low and below desired public health targets. This student-led study examined how Chinese parents understand and make decisions about influenza vaccination. Using perception, trust, and behavioral access as an organizing framework for the analysis, the authors analyzed closed-ended survey items and optional open-ended responses involving 165 eligible parents of school-age children in selected regions of China. The brief contextual comparison with Australia was made with evidence from policy documents and published literature, which helped interpret the findings within a broader public health system context. The results show that in this sample, risk awareness was less important than confidence, trust, and behavioral access with respect to vaccination behavior. Parents of children who had been vaccinated, and those whose children had not, experienced similar levels of perceived risk. By contrast, parents of vaccinated children were found to have increased belief in the effectiveness of the vaccination, greater perceived necessity of annual vaccination, greater trust in the doctor, greater confidence in medical recommendations, greater convenience of the vaccination, and more social influence supporting vaccination. Some of the most reported barriers were concerns about side effects, uncertainty about whether the vaccines would be effective, and a lack of physician recommendation among unvaccinated respondents. Looking to Australia suggested that system design may make vaccination more visible, routine, and easy to do. This study finds that providing information or vaccines alone may not enhance influenza vaccination uptake. Public health strategies may need to work on increasing confidence in vaccine effectiveness, enhancing trust and encouraging action by giving clear provider recommendations, and making vaccination easier, more visible, and better socially supported.
Keywords: Influenza vaccination; vaccine hesitancy; parental decision-making; China; public health; trust; behavioral access