Anti-vaccination attitudes and behavioral intentions towards three recommended vaccinations among Chinese older adults with chronic diseases: A multicenter cross-sectional study.

The increasing burden of chronic diseases, along with rapid population aging, has posed significant challenges to public health globally. Older adults with chronic diseases are vulnerable to vaccine-preventable infections. In China, influenza, pneumococcal, and herpes zoster vaccines are recommended for this population, but the uptake is suboptimal. This study aimed to investigate anti-vaccination attitudes among older adults with chronic diseases and examine their behavioral intentions of receiving influenza, pneumococcal, and herpes zoster vaccinations. A nationwide multicenter cross-sectional survey was conducted, enrolling 772 older adults with chronic diseases (mean age = 67.97 ± 6.67 years). Anti-vaccination attitudes were assessed using the Vaccination Attitudes Examination (VAX) Scale. Intention was measured through self-reported assessments. Results demonstrated that participants hold anti-vaccination attitudes (mean VAX score = 27.65 ± 7.62), with "worries about unforeseen future effects" as the strongest dimension (mean score = 9.37 ± 2.69). Overall, 61.4 % of participants intended to receive the influenza vaccination. Only 26.8 % (pneumococcal) and 26.7 % (herpes zoster) of unvaccinated participants intended future uptake. Less anti-vaccination attitudes were associated with not living alone (ba = -2.168, 95 % CI: -4.088 to -0.247) and having a history of receiving the recommended vaccinations (ba ranging from -4.657 to -3.532); stronger anti-vaccination attitudes were associated with having medical insurance (ba = 1.538, 95 % CI: 0.005 to 3.071) and having two or more chronic diseases (ba = 1.512, 95 % CI: 0.448 to 2.575). Anti-vaccination attitudes were negatively associated with vaccination intentions (AOR ranging from 0.905 to 0.932). The study findings illustrated that older adults with chronic diseases exhibited anti-vaccination attitudes and insufficient vaccination intentions. Targeted interventions are needed to enhance perceptions of vaccine efficacy among older adults with chronic diseases, particularly for individuals living alone, lacking a vaccination history, and those with multiple chronic conditions.