{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:18:28Z","timestamp":1785417508141,"version":"3.56.0"},"reference-count":20,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007937","name":"Peking University","doi-asserted-by":"crossref","award":["10001202415"],"award-info":[{"award-number":["10001202415"]}],"id":[{"id":"10.13039\/501100007937","id-type":"DOI","asserted-by":"crossref"}]},{"award":["10001202415"],"award-info":[{"award-number":["10001202415"]}],"id":[{"id":"https:\/\/ror.org\/02v51f717","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Priority Disease Prevention and Control Project of Henan CDC Science and Technology Research Program","award":["HNCDCZD20250221"],"award-info":[{"award-number":["HNCDCZD20250221"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Objectives: To identify factors influencing influenza vaccination willingness and uptake among adults aged \u226560 years in Henan Province and to evaluate the effect of a brief educational intervention on vaccination willingness and behavior. Methods: In September 2024, a cross-sectional survey based on the Behavioral and Social Drivers (BeSD) framework was conducted among adults aged \u226560 years across five counties in Henan. For participants without baseline willingness, a 3 min one-on-one educational intervention was delivered. In May 2025, following the end of the 2024\u20132025 influenza vaccination season (which runs from 1 October to 31 March in Henan Province), we retrieved vaccination records for all participants from the Henan Provincial Immunization Information System. This system captures all influenza vaccinations administered at designated vaccination clinics across the province. To ensure completeness for doses administered outside the provincial system (e.g., in other provinces or at private healthcare facilities), we conducted telephone follow-up interviews with all participants whose baseline vaccination intention was inconsistent with their actual vaccination behavior (i.e., willing but unvaccinated or unwilling but vaccinated). During these interviews, for those who reported receiving the vaccine outside Henan Province or at private facilities, we inquired about the specific date and location of vaccination to supplement the registry data. We also explored the reasons behind the intention\u2013behavior discrepancy. For these participants, we requested vaccination certificates or other supporting documentation to confirm their vaccination status. Results: Baseline vaccination willingness was 68.20% (1630\/2390), whereas the actual vaccination rate was only 6.95% (166\/2390), yielding a willingness-to-behavior conversion rate of 9.51% (155\/1630) among those with baseline willingness. Of the 760 participants without baseline willingness, 543 (71.45%) completed the 3 min one-on-one instant educational intervention and the follow-up assessment; the remaining 217 were excluded due to refusal or loss to follow-up. Among these 543 completers, 46 (8.47%) became willing to vaccinate, and eight (1.47%) were subsequently vaccinated. Multivariate analysis identified the social processes dimension as the strongest correlate of both willingness (OR = 1.38 per 1-point increase, 95% CI: 1.33\u20131.44) and uptake (OR = 1.12, 95% CI: 1.03\u20131.22). Urban residence was associated with higher willingness (OR = 1.41, 95% CI: 1.12\u20131.78) and higher uptake (OR = 1.64, 95% CI: 1.11\u20132.42). Current smokers had a significantly lower uptake than never smokers (OR = 0.43, 95% CI: 0.22\u20130.85). Among the 11 participants without baseline willingness who were eventually vaccinated (eight from the intervention group and three from the non-intervention group), family\/friend influence (63.64%, 7\/11) and physician recommendation (36.36%, 4\/11) were the primary drivers. For those with willingness but no action (n = 1475), the main barriers were perceived good health (33.29%), high vaccine cost (27.12%), and lack of time (26.31%). Conclusions: Influenza vaccination among older adults in Henan exhibits a \u201chigh willingness, low conversion\u201d pattern, with social processes as the strongest driver bridging the intention\u2013behavior gap. A brief educational intervention improved willingness but failed to translate into meaningful uptake, underscoring that knowledge transfer alone is insufficient. We recommend a multi-component strategy that (1) mobilizes family members and community doctors as trusted vaccine advocates; (2) leverages family and village doctor networks to reduce urban\u2013rural disparities; (3) counters the \u201cperceived good health\u201d barrier with age-specific risk communication; and (4) integrates vaccine recommendations into routine care for high-risk groups, particularly frequent outpatient attendees and smokers.<\/jats:p>","DOI":"10.3390\/vaccines14070605","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:55:32Z","timestamp":1783598132000},"page":"605","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influenza Vaccination Willingness, Uptake, and Behavioral Drivers Among Adults Aged \u226560 Years in Henan Province: A BeSD-Based Survey with Registry Follow-Up"],"prefix":"10.3390","volume":"14","author":[{"given":"Jun","family":"Li","sequence":"first","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyang","family":"Li","sequence":"additional","affiliation":[{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"},{"name":"School of Public Health, Zhengzhou University, Zhengzhou 450001, China"},{"name":"Pharmacy and Medical Equipment Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaichao","family":"Yang","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxia","family":"Yun","sequence":"additional","affiliation":[{"name":"Immunization Planning Section, Puyang Center for Disease Control and Prevention, Puyang 457000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Yang","sequence":"additional","affiliation":[{"name":"Xinyang Center for Disease Control and Prevention, Xinyang 464000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Deng","sequence":"additional","affiliation":[{"name":"Immunization Planning Department, Zhengzhou Center for Disease Control and Prevention, Zhengzhou 450007, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunshui","family":"Li","sequence":"additional","affiliation":[{"name":"Immunization Planning Department, Sanmenxia Center for Disease Control and Prevention, Sanmenxia 472000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubin","family":"Shi","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binghui","family":"Du","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Ji","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghao","family":"Guo","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Immunization Prevention and Planning Department, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China"},{"name":"Henan Preventive Medicine Institute, Zhengzhou 450016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6129-0310","authenticated-orcid":false,"given":"Shuaiyin","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","first-page":"2064","article-title":"Evolution of Supportive Environment for Influenza Vaccination among the Elderly Population in China and Regional 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