# Public Perceptions and Influencing Factors of Non-National Immunization Program (Non-NIP) Vaccines in Shanghai: A Population-Based Study

## TL;DR

This study examines how Shanghai residents perceive non-NIP vaccines and finds that while acceptance is relatively high, awareness is low and influenced by factors like age and healthcare provider recommendations.

## Contribution

The study identifies key sociodemographic and behavioral factors influencing awareness and acceptance of non-NIP vaccines in Shanghai.

## Key findings

- Only 15.5% of respondents had very high awareness of non-NIP vaccines, while 6.5% were completely unaware.
- Higher awareness and acceptance were linked to younger age, urban residence, medical recommendations, and participation in educational programs.
- A 'high acceptance but low knowledge' pattern was observed, suggesting a need for improved public education and accessibility.

## Abstract

This study aimed to explore the cognitive levels and influencing factors of Shanghai residents regarding non-immunization program vaccines. A population-based study was conducted in Shanghai in 2024. Objective: To examine awareness levels and factors influencing perceptions of non-National Immunization Program (non-NIP) vaccines among residents of Shanghai. Methods: A population cross-sectional survey was conducted in Shanghai from 20 October to 31 December 2024, using stratified random sampling. Five districts were selected, four communities per district were randomly chosen, and 35–40 residents per community were invited to complete a questionnaire. Data collected included sociodemographic characteristics, awareness of non-NIP vaccines, and potential influencing factors. Awareness and acceptance of non-NIP vaccines were measured using five-point Likert scales. On a 0–4 scale, where 0 = completely unaware/unsupportive and 4 = very aware/strongly supportive, respondents rated their level of understanding and endorsement of non-NIP vaccines. Descriptive analysis, the Kruskal–Wallis test, and ordinal logistic regression were used to assess awareness levels and their determinants. Results: Among the 753 respondents, 15.5% of respondents reported very high awareness, 18.7% reported fairly high awareness, 32.1% reported moderate awareness, 27.2% reported somewhat low awareness, and 6.5% reported complete unawareness. Acceptance levels were distributed as follows: 20.3% strongly in favour, 24.7% somewhat in favour, 45.9% neutral, 7.3% somewhat opposed, and 1.9% strongly opposed. Higher awareness was significantly associated with younger age, higher household living standard, receiving a recommendation from medical personnel, and participation in vaccine education programs (all p < 0.05). Acceptance was significantly influenced by age, residence type (urban community, town center, or rural), medical personnel recommendation, educational campaign participation, and perceived affordability of vaccine cost (all p < 0.05). Conclusions: Overall, Shanghai residents exhibited suboptimal awareness and acceptance of non-NIP vaccines, with a clear “high acceptance but low knowledge” phenomenon. To improve awareness, strategies should include strengthening healthcare providers’ recommendations and implementing systematic educational campaigns. To enhance acceptance, efforts should focus on disseminating positive, evidence-based information; reinforcing provider guidance; expanding outreach and education; and optimizing payment mechanisms to improve economic accessibility.