Predictors of parental acceptance to live attenuated influenza vaccine for children.

To determine the influencing factors of Chinese parents' intention and behavior for children to receive live attenuated influenza vaccine during the 2022-2023 influenza season. A theoretical model was developed and included seven constructs, and structural equation modeling was used to test 11 hypotheses. From October 2022 to December 2023, a survey was conducted across 38 medical institutions in four Chinese cities and their subordinate districts, counties, and rural areas. Parents who accompanied their children for vaccinations were selected through a randomization process based on their child's medical card numbers. Measures were taken to minimize method bias, including a diverse geographical representation and random sampling. The survey resulted in the collection of 936 valid responses, exceeding the recommended sample size for structural equation model analysis and providing robust statistical inferences. During the study period, 936 respondents were included in the study. Perceived ease of use was verified to be a predictor of perceived usefulness and perceived value. Perceived usefulness was verified as a predictor of perceived value and behavioral intention. Knowledge was a significant antecedent of perceived value and risk perception of influenza disease. Risk perception of influenza disease was proved to be a significant predictor of perceived value and self-reported vaccination behavior. Perceived value significantly affected behavioral intention, and behavioral intention significantly affected self-reported vaccination behavior. Six demographic variables significantly moderate the theoretical models. The low vaccination coverage of live attenuated influenza vaccine (LAIV) among children in China suggests a need for a deeper understanding of the factors that influence vaccination rates. Particularly, effective strategies are necessary from policymakers and practitioners to elevate childhood LAIV coverage.

Determinants of parental self-reported uptake of influenza vaccination in preschool children during the COVID-19 pandemic.

In China, the coverage rate of influenza vaccination among the general population is significantly lower than that of high-income countries, with only 2.46% of the population vaccinated. Preschool-aged children are particularly susceptible to influenza viruses, yet the factors that influence parents' willingness to vaccinate their children are not well understood. To address this research gap, we developed a theoretical model grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT), which explores six key factors influencing parental self-reported uptake of influenza vaccination in preschool children: performance expectancy, effort expectancy, social influence, facilitating conditions, knowledge, and behavioral intention. We collected data from 872 parents of children in five major cities in China and employed structural equation modeling to examine the significance of the theoretical model and explore the potential moderating effects of demographic variables on path relationships. Our analysis revealed that several positive factors influenced parents' intention of influenza vaccination for preschool children, including effort expectancy (ß = 0.38), social influence (ß = 0.17), and knowledge (ß = 0.52). Facilitating conditions (ß = 0.34), knowledge (ß = 0.40), and behavioral intention (ß = 0.34) were found to be associated with self-reported uptake. Furthermore, we observed significant moderating effects of the child's gender and age, as well as the guardian's category and income, on the theoretical models. Parents' willingness to vaccinate preschool children against influenza is influenced by both psychological and demographic variables. Further studies are needed to determine if these relationships persist over time and across different regions.

Factors influencing user acceptance of weight management apps among Chinese obese individuals during the COVID-19 pandemic.

Background: During the COVID-19 epidemic, the number of obesities increased rapidly in China. Weight management apps have potential value in controlling obesity. Objective: Explore the mechanisms behind the adoption of weight management applications by overweight and obese individuals, including psychological factors and demographic variables. Methods: The theoretical model was extended from the technology acceptance model (TAM), and the structural equation model was used for hypothesis testing. From January 2020 to December 2021, we conducted a cross-sectional survey in six megacities in mainland China during the COVID-19 pandemic by an online questionnaire. Results: 1364 participants completed the questionnaire, and the proposed theoretical model explained 55.7% of the variance in behavioral intention. Perceived usefulness was predicted by perceived ease of use (ß = 0. 290), attitude was jointly predicted by perceived usefulness (ß = 0.118) and perceived ease of use (ß = 0.159). Behavioral intention was predicted by perceived usefulness (ß = 0. 256), perceived ease of use (ß = 0. 463), attitude (ß = 0. 293), and perceived risk (ß = -0.136). Health awareness (ß=0.016) did not significantly affect behavioral intention. Four demographic variables gender, age, education, and residence exerted significant moderating effects in theoretical model. Conclusions: During the COVID-19 epidemic, the health awareness and behavior patterns of obese people have changed significantly. Psychological factors and demographic characteristics dynamically interact to generate user behavioral intentions of weight management applications. Weight management application developers and marketers should focus on perceived usefulness, safety, ease of use, and health awareness.

Factors associated with intention to uptake pneumococcal vaccines among Chinese elderly aged 60 years and older during the early stage of COVID-19 pandemic.

Innoculation of pneumococcal vaccines among the elderly is an effective public health policy to prevent pneumococcal diseases and it is widely promoted by many developed countries. The pneumococcal vaccination rate among the elderly in China was only 3.7% in 2019, it grew rapidly during the early stage of the COVID-19 pandemic. The purpose of this cross-sectional study was to investigate the psychological and demographic-economic factors related to the uptake behavior of pneumococcal vaccination among the Chinese elderly by using an integrated model based on the unified theory of acceptance and use of technology (UTAUT), and knowledge, attitudes and practices (KAP). The theoretical model was tested via structural equation modeling (SEM) with data collected from 516 Chinese older adults aged 60 years and older. Our results suggested that knowledge, performance expectancy, effort expectancy, attitude, and trust had a significant correlation with behavioral intention; behavioral intention and trust had a positive correlation with the uptake behavior, gender, and and education level and chronic obstructive pulmonary disease exerted significant moderating effects. To increase the coverage of pneumococcal vaccination among the elderly, it is necessary to provide effective health education by authoritative experts, thereby enhancing their knowledge and positive attitude towardthe vaccination.

Characterizing Wuhan residents' mask-wearing intention at early stages of the COVID-19 pandemic.

OBJECTIVE: As an effective measure to prevent the COVID-19 pandemic, wearing mask is widely recommended in countries around the world. This study aims to identify factors that explain the behavioral intention of Wuhan City urban residents to wear masks. METHODS: A theoretical model was extended on UTAUT by incorporating the feature on residents having relevant knowledge and sufficient awareness on the pandemic. During early stages of the COVID-19 outbreak, an online survey was conducted in Wuhan City and 728 valid samples were collected from 35 communities. Structural equations modeling and bootstrapping were applied. RESULTS: Sample data present acceptable reliability and validity. Performance expectancy, effort expectancy, social influence, and knowledge about COVID-19 have positive effects on behavioral intention. Facilitating condition, knowledge, and behavioral intention have significant effects on use behavior. Gender, age, education, income, and current marital status are significant moderators in the theoretical model. CONCLUSION: Having relevant knowledge on the pandemic, together with performance expectancy, effort expectancy, social influence, and facilitating condition, affects behavioral intention and usage behavior of Wuhan residents to wear masks at early stages of the COVID-19 pandemic. Subgroups have different psychological mechanisms based on their demographic characteristics. PRACTICE IMPLICATIONS: Health policy makers should focus on enhancing residents' knowledge on infectious disease and their awareness of the risk mitigation, and develop personalized measures for different subgroups.

Factors associated with parental acceptance of influenza vaccination for their children: the evidence from four cities of China.

BACKGROUND: It is necessary and urgent to vaccinate 245 million Chinese children against influenza pandemics. The main purpose of this study was to evaluate different psychological and demographic factors that influence parental willingness to vaccinate their children against influenza. METHODS: A hybrid theoretical framework was expanded and verified with 462 sample data collected from four cities in China. Structural equation models were used to test nine theoretical hypotheses, and the non-standardized coefficient method was used to discuss the moderating effects among demographic variables. RESULTS: Knowledge is considered to be the significant factor of performance expectancy (ß = 0.228), effort expectancy (ß = 0.227) and perceived risk (ß = -0.138), and social influence also has the significant impacts on the above three variables, with ß values of 0.437, 0.386, and -0.172. Performance expectancy (ß = 0.402), effort expectancy (ß = 0.343), and perceived risk (ß = -0.244) thus significantly affect parental behavioral intention regarding children's influenza vaccination. Gender, education, and kids' gender are demographic variables with significant moderating effects, while age, income, number of kids are not significant. CONCLUSION: To improve the acceptability of influenza vaccination among Chinese children, the promoting policies should emphasize on public knowledge and social influence, as well as effectiveness, affordability, and safety of vaccination.

Trust collapse caused by the Changsheng vaccine crisis in China.

BACKGROUND: The public acceptance and implementation of vaccination programs is essential to prevent infectious diseases. However, vaccine adverse events may cause public panic and eventually lead to an increasing number of populations who were hesitant or refuse to participate in these vaccination programs. In 2018, the Changsheng vaccine crisis broke out in mainland China, and 252,600 unqualified DTP vaccines were reported to be used for child vaccination. In this study, we observed media and public reactions toward the vaccine crisis. METHODS: This study conducted Internet surveillance by four mainstream indicators from July 15th to August 7th, including social media (WeChat, Sina Weibo), online news and Baidu search index. We also analyzed the emotional perceptions of people in crisis through an online questionnaire survey. RESULTS: During the crisis, huge number of articles emerged on Internet, 125,882,894 articles (including forwarding) on WeChat friends circle, 1,877,660 Sina Weibo posts, 648,265 online news and 4,986,521 Baidu search indexes. Most of these articles were negative and expressed the public's weak confidence to the China-made vaccines. Public confidence in vaccines was undermined by the actions of the manufacturer and the government. CONCLUSIONS: The DTP vaccine crisis led to panic about immunization and eroded trust in the immunization program and in the government. Restoring public confidence in Chinese-made vaccines will take a long time, and meticulous management in vaccine production, and strict government regulation will help to alleviate public anxiety about vaccine safety and ultimately restore confidence.

Factors influencing behavior intentions to telehealth by Chinese elderly: An extended TAM model.

BACKGROUND AND PURPOSE: Telehealth bring significant benefits including improved quality of healthcare, efficiency and cost containment, especially for chronic patients and the elderly. China is the second largest country of investment in telemedicine systems, but the acceptance and behavioral intentions of the technology are still low in the elderly. The objective of this study is to explain the micro-mechanism that determines the behavioral intentions to use telemedicine systems from the perspective of elderly patients based on an extended Technology Acceptance Model. METHODS: A sample consisting of 436 elderlies selected through multistage cluster sampling from four cities in mainland China. The empirical study was conducted to examine the proposed model by two aspects: measurement model and structural model. RESULTS: The study determined that medical service satisfaction (t = 6.770, ß = 0.332), ease of use (t = 5.200, ß = 0.179), information quality (t = 12.540, ß = 0.639) had a significant impact on the elderly patients' acceptance to telehealth, and the acceptance had a significant impact (t = 14.356, ß = 0.697) on the elderly patients' behavior intentions of telehealth. The results also show that the variable of acceptance has significant mediating effects among the theoretical model. CONCLUSIONS: This study confirms the applicability of the extended Technology Acceptance Model in the behavioral intentions among elderly people in China using telehealth systems. The results indicate that relationship between telehealth systems and physical medical services are mutually reinforcing rather than alternative. The study will help technology developers better understand the behavioral characteristics of the elderly and encourage healthcare providers to better understand the true need of telehealth systems. These findings provide valuable information to telehealth system developers, governments, investors, and hospitals to promote the use of this technology by elderly patients.

Parental perceptions of human papillomavirus vaccination in central China: the moderating role of socioeconomic factors.

Background: The huge gap in adolescent human papillomavirus (HPV) uptake between China (< 2%) and developed countries (> 60%) indicates the necessity of comprehensive examination on the modifiable factors for parents' decision-making. The present study investigated parental perceptions of HPV vaccination for children in China from a socio-economic perspective. Methods: Parents of 9-to-14-year-old adolescents who understood the HPV vaccination (n = 925) completed our questionnaire survey in Fall 2017. Based on the structural equation modeling, we examined the relationship among knowledge, awareness, and intentions of 20 items by 7-point Likert scale, the moderating effects also were tested among 5 socioeconomic variables. Results: Parents of female students have more positive intention about the HPV vaccination than male students' parents (3.74 vs 2.80, p < 0.001). Parents of 12-14-years old students have higher average scores in knowledge (p = 0.006) and intention (p < 0.001) than that of 9-11-years old students' parents. The average score of mothers on knowledge (p = 0.018) and awareness (p < 0.001) was lower than that of fathers. The elder parents (≥ 50 years) performed significantly better on knowledge (p < 0.001) and awareness (p < 0.001) than the other two subgroups. Annual household income is an important factor in determining the knowledge (p = 0.0017), awareness (p < 0.001), and intention (p < 0.001). Knowledge and awareness were considered as the positive determinant of intention, and awareness was partial mediator. Child gender (P = 0.046), child age (P = 0.004), parent gender (P = 0.043) and parental age (P = 0.021) were significant moderators. Conclusion: To improve the acceptability of HPV vaccination among Chinese adolescents, policymakers should develop positive strategies for their parents.

Predicting behavioral intentions to children vaccination among Chinese parents: an extended TPB model.

Parental behavioral intentions play a key role in children vaccination. The present study looks at how parental expectations for the vaccination influence their attitudes and behavioral intentions toward children's immunization. The theoretical model is developed on TPB model and empirically tested with sample data from 380 children aged 0-7 years in mainland China. The structural equation modeling and multi-group analysis were used in the model to demonstrate the impact of the vaccination services quality, vaccination promotions and public opinions on attitudes and vaccination behavioral intention. Results support the study's hypotheses and indicate that Vaccination Services Quality (VSQ), Vaccination Promotions (VAP) and Public Opinions (PUO) have positive effects on Attitudes (ATT) and Vaccination Behavioral Intention (VAI), VSQ has the strongest standardized path (.594) while PUO has the least influence (.131), and Attitude is complete mediation in all paths. Attitude is key factor that determine the parental behavioral intentions, and the internal perception comes from the vaccination services quality and the external influence comes from the social environment affect the parental attitude. Governments should implement effective policies and improve vaccination services quantity to eliminate parental misunderstandings.