Frontiers in public health · 2026
Behavioural and service-context correlates of tetanus vaccination intention after trauma exposure in China: a cross-sectional BeSD study.
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Fang Quanjun, Mao Jilai, Gong Xiaoying, Liu Xinyuan, Zheng Canjie, Cao Guoping, Yin Zhiying
Аннотация
INTRODUCTION: Trauma-care encounters provide an opportunity to assess tetanus risk and deliver post-exposure prophylaxis. We primarily examined behavioural, social, and service-context factors associated with tetanus vaccination intention using the Behavioural and Social Drivers of Vaccination (BeSD) framework. We additionally described documented vaccination, guideline-based indications, and exploratory algorithm-classified guideline concordance among trauma-exposed adults.
METHODS: A cross-sectional study was conducted at 12 healthcare sites in Quzhou, China, from March to May 2026. Vaccination intention was assessed via a questionnaire, whereas documented active vaccination was verified from clinical and immunisation records. Guideline-based indications were determined from wound characteristics and previous immunisation history using a prespecified algorithm, and guideline concordance reflected whether documented management matched the algorithm-based recommendation. Logistic regression and structural equation modelling were used to assess factors associated with vaccination intention.
RESULTS: Among 657 participants, 341 (51.9%) reported a willingness to receive tetanus vaccination. Animal-related injury, thinking and feeling, social processes, and practical accessibility were positively associated with willingness, with practical accessibility showing the strongest association with latent intention. Overall, 642 participants had a guideline-based indication for active vaccination, while 126/657 (19.2%) had documented active vaccination within 7 days. Among 333 participants who were both willing and guideline-indicated, 100/333 (30.0%) had documented vaccination. Separately, 119/657 (18.1%) met the exploratory algorithm-classified guideline-concordance definition.
CONCLUSION: BeSD-related perceptions, particularly perceived practical accessibility, were associated with tetanus vaccination intention during the trauma-care episode. However, documented vaccination and guideline-concordant prophylaxis could not be fully interpreted because reliable assessment depended on complete immunisation histories and wound documentation. Because the temporal sequence between questionnaire completion and clinical care could not be verified for all participants, the findings should be interpreted as cross-sectional associations. Algorithm-classified guideline concordance should be viewed as an exploratory, data-dependent classification rather than a direct measure of clinician adherence to prophylaxis guidelines. These findings highlight the potential value of improving immunisation record verification and facilitating accessible vaccination services, while further studies with more complete clinical documentation are needed to evaluate guideline-concordant prophylaxis.
METHODS: A cross-sectional study was conducted at 12 healthcare sites in Quzhou, China, from March to May 2026. Vaccination intention was assessed via a questionnaire, whereas documented active vaccination was verified from clinical and immunisation records. Guideline-based indications were determined from wound characteristics and previous immunisation history using a prespecified algorithm, and guideline concordance reflected whether documented management matched the algorithm-based recommendation. Logistic regression and structural equation modelling were used to assess factors associated with vaccination intention.
RESULTS: Among 657 participants, 341 (51.9%) reported a willingness to receive tetanus vaccination. Animal-related injury, thinking and feeling, social processes, and practical accessibility were positively associated with willingness, with practical accessibility showing the strongest association with latent intention. Overall, 642 participants had a guideline-based indication for active vaccination, while 126/657 (19.2%) had documented active vaccination within 7 days. Among 333 participants who were both willing and guideline-indicated, 100/333 (30.0%) had documented vaccination. Separately, 119/657 (18.1%) met the exploratory algorithm-classified guideline-concordance definition.
CONCLUSION: BeSD-related perceptions, particularly perceived practical accessibility, were associated with tetanus vaccination intention during the trauma-care episode. However, documented vaccination and guideline-concordant prophylaxis could not be fully interpreted because reliable assessment depended on complete immunisation histories and wound documentation. Because the temporal sequence between questionnaire completion and clinical care could not be verified for all participants, the findings should be interpreted as cross-sectional associations. Algorithm-classified guideline concordance should be viewed as an exploratory, data-dependent classification rather than a direct measure of clinician adherence to prophylaxis guidelines. These findings highlight the potential value of improving immunisation record verification and facilitating accessible vaccination services, while further studies with more complete clinical documentation are needed to evaluate guideline-concordant prophylaxis.