eMethods 1. Sampling Method
eMethods 2. Survey Instruments
eMethods 3. Statistical Analyses
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Yang H, Ma J. Factors Associated With Chinese Adults’ Vaccine Acceptance. JAMA Health Forum. 2021;2(7):e211466. doi:10.1001/jamahealthforum.2021.1466
Turning COVID-19 vaccines into vaccinations is a critical step to ending the COVID-19 pandemic.1,2 It is thus imperative to understand the disparities in COVID-19 vaccine acceptance and identify approaches to improve vaccination rates. The aim of this study was to add to this understanding.
This survey study received institutional review board clearance from Johns Hopkins University as well as approval by the National School of Development at Peking University where the data collection took place. The data were collected in January 2021, by which time the nationwide distribution of COVID-19 vaccines had just begun in China. A large-scale, nationally representative, random sample of 14 378 Chinese adults were invited to participate in this internet-based survey. The survey was conducted following the guidelines by the American Association for Public Opinion Research (AAPOR). Participants consented before responding to the questionnaire, responded anonymously, and could terminate their participation at any point (eMethods 1 in the Supplement).
Participants indicated whether they had been vaccinated for COVID-19. Those who had not been vaccinated indicated their willingness to receive the vaccine. Participants then rated their knowledge about COVID-19 vaccines on 4 scales (eMethods 2 in the Supplement).
Next, we assessed how information about the vaccination behavior of the general public vs socially proximal others might be associated with vaccination decision-making. Participants who indicated that they were not yet willing to receive the vaccine were randomly assigned to respond to 1 of 2 versions of an additional question: one-half indicated what percentage of the general public had to be vaccinated for COVID-19 before they themselves would be vaccinated; for the other half, the reference group was “people you personally know.” All participants then completed sociodemographic measures.
Responses to the vaccine knowledge items were averaged into a single measure (α = .73). A dummy variable was created to represent whether participants resided in Hubei, the province where COVID-19 was first found in China.3 Ordinary least squares regression and mediation analyses (eMethods 3 in the Supplement) were conducted using SAS, version 9.4 (SAS Institute) to examine the associations between vaccination measures and sociodemographic variables.
A total of 12 651 participants (6145 [48.6%] women; mean age, 36.6 years; 7715 [61.0%] married; from 32 provincial regions) completed the study (88% response rate). Only 2% of participants were already vaccinated for COVID-19. Among the rest, 1.3% indicated that they definitely would not receive the vaccine, 3.5% probably would not, 9.1% were uncertain, 37% probably would, and 47% definitely would (see Table 1 for more details). An ordinary least squares regression revealed that women and individuals with lower incomes or education levels were less likely to indicate that they would receive the vaccine (Table 2). Higher vaccine knowledge ratings were associated with higher willingness to be vaccinated (r = 0.31; P < .001). Mediation analyses showed that knowledge ratings significantly mediated differences in vaccine acceptance across income and education levels but not gender.
Those not yet willing to be vaccinated indicated that they would receive the vaccine when a mean of 64% (SD, 22%) of the general public had been vaccinated. This ratio was significantly lower if the reference group was “people you personally know” (54%; SD, 29.9%; F1,1539 = 67.67; P < .001).
In this survey study of Chinese adults, we found that women and individuals with lower incomes or education levels indicated that they were less willing to be vaccinated. Vaccine knowledge mediated the latter 2 associations. Individuals who were not yet willing to receive the vaccine took account of vaccination behaviors of others, particularly socially proximal others, in deciding when they would receive vaccination.
Adding to a growing stream of research,4,5 these findings highlight the need to address disparities in COVID-19 vaccine acceptance across demographic segments and suggest that health policies for improving vaccination should consider leveraging vaccine knowledge dissemination and social influence. Finally, our research focused on China, the world’s most populous nation. However, the extent to which the results are generalizable to other regions requires further investigation.
Accepted for Publication: May 11, 2021.
Published: July 9, 2021. doi:10.1001/jamahealthforum.2021.1466
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Yang H et al. JAMA Health Forum.
Corresponding Author: Jingjing Ma, PhD, Peking University, 5 Yiheyuan Rd, Beijing, 100871, China (firstname.lastname@example.org).
Author Contributions: Dr Ma had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: All authors.
Obtained funding: Ma.
Administrative, technical, or material support: All authors.
Conflict of Interest Disclosures: None reported.