Influenza vaccination hesitancy and decision between parental and grandparental caregivers of preschoolers: a comparative study.

BACKGROUND

Grandparents are increasingly involved in childcare, yet their role in childhood vaccination remains understudied. Generational differences shaped by historical and social experiences may influence vaccine attitudes, highlighting the need to compare parents and grandparents in addressing vaccine hesitancy.

METHODS

This study conducted a field survey in five Chinese cities in 2024, collecting data from childhood caregivers. Propensity score matching (1:3) was applied to compare influenza vaccine hesitancy (IVH) between 225 grandparents and 675 parents. The IVH scale was developed, and the matrix of vaccine hesitancy determinants was used to examine factors influencing vaccine attitudes and decisions.

RESULTS

Among 225 grandparents and 675 parents included, the parents had higher IVH scores (32 [IQR: 28-36]) than grandparents (30 [IQR: 25-33]), indicating that grandparents held more positive attitudes toward influenza vaccination (p < 0.001). Mandatory vaccination policies positively influenced both parents' (β = -1.60, p = 0.016) and grandparents' (β = -1.79, p = 0.044) attitudes toward influenza vaccination. Adequate influenza vaccine supply was a common promoting factor for both groups among vaccination-specific issues (Parents: β = -3.28, p < 0.001; Grandparents: β = -2.60, p = 0.014). Furthermore, interaction analyses revealed that the effect of mandatory policies was stronger among parents (interaction β = 2.18, p < 0.001), while prior vaccination experiences (interaction β = -2.03, p = 0.024) and perceived vaccine benefits (interaction β = -1.15, p = 0.034) had greater influence on grandparents. Grandparental caregivers of children aged ≤3 years exhibited greater hesitancy due to social media influence (β = 6.14, p = 0.019) and perceived influenza risk (β = 4.52, p = 0.009). Despite grandparents' generally more positive attitudes, Sankey diagram analysis revealed that IVH levels didn't fully align with vaccination decisions, suggesting additional influencing factors.

CONCLUSION

Grandparents exhibit more positive attitudes and decisions regarding influenza vaccination for both themselves and children. Enhancing grandparents' involvement in children's vaccination decisions could effectively reduce inequities in childhood vaccine access.