JMIR Form Res. 2023 Jan 18. doi: 10.2196/39994. Online ahead of print.
BACKGROUND: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death.
OBJECTIVE: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the 3Cs framework, where socioeconomic status and vaccination history played as roles of moderators.
METHODS: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China between June 1, 2021, and July 20, 2021. Older adults (above 60 years) were recruited using a stratified sampling method. Vaccine hesitancy was setting influenced by confidence, complacency, and convenience in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% confidence interval (CI) of the pathway’s coefficients.
RESULTS: A total of 1341 older adults (response rate: 87%) participated. The age was 71.3 ± 5.4 years old and 44.7% of participants were men. Confidence [b = 0.967, 95% CI: 0.759, 1.201, P = .002], convenience (b = 0.458, 95% CI: 0.333, 0.590, P = .002), and less complacency (b = 0.301, 95% CI: 0.187, 0.408, P = .002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b = -0.065, P = .03) on low vaccine hesitancy. Coronavirus disease 2019 (COVID-19) vaccination history negatively moderated the positive association between confidence (b = -0.071, P = .02) and lower vaccine hesitancy.
CONCLUSIONS: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, have a positive association with less vaccine hesitancy, and it could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.