Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China

  • Yaofeng Han
  • Jiahui Yin
  • Yanbing Zeng
  • Cheng-I Chu
  • Yi-Chen Chiang
  • Ya FangEmail author
Original Paper


Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents’ acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents’ intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between “cues to action” and “perceived susceptibility” and/or “perceived severity.” A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents’ intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents’ perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.


Parental intent Health belief model (HBM) Kindergarten Influenza vaccination China 



We offer our gratitude to the support and assistance from Xiamen Immunization Information System of the Xiamen Centers for Disease Control and Prevention (CDC) and Education Bureau of Xiamen City Government. We thank the experts who assisted in the development of the questionnaire and provided research suggestions. We especially thank all parents in the study for their time and willingness to participate.

Compliance With Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


This study was supported by the National Natural Science Foundation of China (Grant Nos.: 71874147, 81573257) and the project of Natural Science Fund of Fujian Province (Grant No. 2017J01133).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yaofeng Han
    • 1
    • 2
  • Jiahui Yin
    • 1
    • 2
  • Yanbing Zeng
    • 1
    • 2
  • Cheng-I Chu
    • 3
  • Yi-Chen Chiang
    • 1
    • 2
  • Ya Fang
    • 1
    • 2
    Email author
  1. 1.State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public HealthXiamen UniversityXiamenChina
  2. 2.Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public HealthXiamen UniversityXiamenChina
  3. 3.Department of Public HealthTzu Chi UniversityHualienTaiwan

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