Heterogeneity in the psychological antecedents of influenza vaccination among Chinese older adults: A 5C model approach

Seasonal influenza remains a significant public health concern among older adults, who face an increased risk of hospitalization and mortality. Despite the availability of free vaccination programs in many regions of China, influenza vaccination coverage among older adults remains low. Psychological antecedents play a crucial role in shaping vaccination decisions, yet few studies have explored how these factors interact with sociodemographic characteristics. A cross-sectional survey was conducted among 13,363 community-dwelling adults aged ≥60 y in six major Chinese cities between December 2024 and January 2025. The 5C scale - Confidence, Collective Responsibility, Complacency, Constraints, and Calculation - was used to assess psychological determinants of influenza vaccination. Logistic regression models, likelihood ratio tests (LRTs), and stratified analyses were performed to examine the main and interaction effects between psychological and sociodemographic factors. Overall, 34.05% of participants reported receiving an influenza vaccine within the past year. Calculation was positively associated with vaccination uptake (OR = 1.075, 95% CI: 1.057-1.093), while Complacency (OR = 0.658, 95% CI: 0.643-0.673) and Constraints (OR = 0.849, 95% CI: 0.831-0.867) were negatively associated. Significant interaction effects were observed between 5C subscales and education, income, and self-care ability, indicating that the influence of psychological factors varied across subpopulations. The psychological drivers of influenza vaccination among Chinese older adults are heterogeneous across sociodemographic groups. Precision public health strategies are essential: while high-SES individuals may benefit from data-driven information, low-income and low-literacy groups require simplified, emotionally resonant communication focused on personal protection rather than broad altruism. Furthermore, interventions should aim to reduce perceived constraints by streamlining vaccination processes and offering personalized risk-benefit assessments for older adults with chronic conditions.