# Analysis of influenza vaccination status and health information sources among middle-aged and older adults with multiple chronic diseases in Zhejiang, China: a cross-sectional study

## TL;DR

This study examines influenza vaccination rates and information sources among older adults with chronic diseases in Zhejiang, China, finding that coverage is low and influenced by age, health perception, and doctor recommendations.

## Contribution

The study provides province-level data on influenza vaccination behavior and information sources among multi-morbid older adults in China.

## Key findings

- The influenza vaccination coverage rate among participants was 54.92%.
- Age, occupation, self-rated health, and doctor recommendations were significantly associated with vaccination.
- Television, doctors, and family were the main sources of vaccine-related information.

## Abstract

The growing proportion of middle-aged and older adults with multiple chronic diseases, this group faces a high risk of severe complications and death following influenza infection. However, province-level data on influenza vaccine uptake in this vulnerable group are lacking. This study assessed influenza vaccination coverage and identified factors associated with vaccination intention and behavior among multi-morbid patients in Zhejiang Province, China.

A convenience sampling method was utilized to select the sample. A face-to-face questionnaire survey was conducted among multi-morbid patients aged 50 and above in Zhejiang Province. Chi-square testing and multivariate logistic regression were used to analyze factors that may be associated with influenza.

Among 2,531 respondents, 1,390 individuals received influenza vaccination, yielding a coverage rate of 54.92%. Multivariate analysis showed age [odds ratio (OR) = 18.239, 95% confidence interval (CI): 11.718, 28.388], occupation [OR = 5.648, 95% CI: 2.935, 10.867], self-rated health status [OR = 3.070, 95% CI: 1.152, 8.179], doctor recommendation [OR = 2.586, 95% CI: 2.099, 3.186] were associated with flu vaccination. The most frequently reported reasons for vaccination were awareness of free-vaccine policies (69.85%), community campaigns highlighting vaccine benefits (54.17%), and medical advice to vaccinate (43.95%). Key reasons for non-vaccination included perceiving oneself as not at risk or vaccination as unnecessary (46.01%), doubts about vaccine effectiveness (23.14%), lack of awareness of the vaccine (22.17%), and concerns about safety or side effects (18.76%). The main sources of vaccine-related information were television (64.24%), doctors (62.62%), and family members (53.30%). Participants aged ≥80 years were more likely to obtain health knowledge from family members (χ2 = 8.949, p = 0.030). In contrast, participants aged 50–59 years were more likely to rely on WeChat (χ2 = 208.764, p < 0.001) and TikTok (χ2 = 191.295, p < 0.001) as sources of health information.

The influenza vaccination rate among middle-aged and older adults with multiple chronic diseases in Zhejiang Province remains notably low. To enhance the willingness of this group to receive the influenza vaccine, it is essential to consider both factors that promote or hinder vaccination, along with the implementation of targeted communication strategies to effectively enhancing their willingness to receive the influenza vaccine.