# Psychosocial Determinants of Vaccine Hesitancy and Vaccination Behavior Among Older Adults in China: A Large Cross-Sectional Study

## TL;DR

This study explores why older adults in China are hesitant about vaccines and what influences their vaccination behavior during the pandemic.

## Contribution

The study integrates the Health Belief Model and Theory of Planned Behavior to identify psychosocial determinants of vaccine hesitancy and behavior in older adults.

## Key findings

- Vaccine hesitancy is linked to perceived benefits, barriers, safety concerns, and social influences.
- Actual vaccination behavior is influenced by hesitancy, perceived severity, and positive incentives.
- Age and medical contraindications significantly affect both hesitancy and vaccination behavior.

## Abstract

To identify psychosocial determinants of vaccine hesitancy and vaccination behavior among older adults in China, using an integrated framework of the Health Belief Model and Theory of Planned Behavior.

We conducted a cross-sectional survey targeting individuals aged 60+ years during the pandemic vaccine rollout. The analysis included Probit regression models based on the Health Belief Model (HBM), Theory of Planned Behaviour (TPB), risk perception, vaccine confidence and behavioral intervention, with demographic and health status as control variables.

Among older adults, vaccine hesitancy was significantly associated with perceived benefits, perceived barriers, attitude, self-efficacy, concerns about vaccine safety, perceived vaccine necessity, positive incentives, negative social pressure, information prompts, and vaccination reminders. Actual vaccination behavior was significantly influenced by vaccine hesitancy, perceived severity, perceived benefits, perceived barriers, attitude, self-efficacy, and positive incentives, etc. Age and medical contraindications significantly affected both hesitancy and vaccine behavior.

The integrated theoretical framework reveals age-specific behavioral pathways that are critical to vaccine acceptance among older Chinese adults. These findings underscore the importance of age-tailored interventions that address psychosocial barriers and leverage timely behavioral nudges to improve immunization outcomes in aging populations.