Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey

Background Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. Objective This study aimed to explore the drivers of vaccine hesitancy among older adults based on the “3Cs” (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. Methods A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway’s coefficients. Results A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P =.002), convenience (b=0.458; 95% CI 0.333-0.590; P =.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P =.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=–0.065; P =.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=–0.071; P =.02) and lower vaccine hesitancy. Conclusions Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.