Theories-based determinants analysis of Hib-combined vaccine hesitancy in China: A multi-group structural equation modeling.

Objectives: To explore determinants of Hib-combined vaccine hesitancy in Chinese parents, and to provide scientific intervention measures to tackle vaccine hesitancy.

Methods: 2,531 parents were recruited from local healthcare centers in Zhejiang Province by accidental sampling, and completed the self-developed online questionnaire with voluntary participation. Health Belief Model and Model of Determinants of Vaccine Hesitancy were applied to construct the framework of research. Multi-group Structural Equation Modeling was performed to explore the effects of determinants of vaccine hesitancy across various socio-economic status (SES).

Results: Hib-combined vaccine hesitancy for total sample was 2.184 ± 0.777 (95%CI: 2.153-2.214), and most of them were in low (n = 1436, 56.7%) level. Low SES group (2.335 ± 0.763, 95%CI: 2.271-2.400) had significantly highest vaccine hesitancy. For total sample, Self-Efficacy and Cues to Action presented -0.517 and -0.437 of standard total effect on Vaccine Hesitancy, respectively. The Multi-group Structural Equation Model with satisfying goodness of fit in SES groups ( = 1616.074, df = 314, /df = 5.147, CFI = 0.973, TLI = 0.966, SRMR = 0.027, RMSEA = 0.041) showed that Cues to Action imposed -0.621 (95%CI: -0.867-0.389,  < .001) of major standard total effect on Vaccine Hesitancy in low SES group, while Self-Efficacy imposed -0.560 (95%CI: -0.668-0.444,  < .001) and -0.685 (95%CI: -0.841-0.454,  < .001) of principal standard total effect on Vaccine Hesitancy in middle and high SES groups, respectively.

Conclusions: Hib-combined vaccine hesitancy in Chinese parents was low, and the lower the SES, the higher the vaccine hesitancy. Cues to Action and Self-Efficacy played primary role in declining vaccine hesitancy for parents at low SES, and at middle and high SES, respectively.