{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T02:57:19Z","timestamp":1781665039381,"version":"3.54.5"},"reference-count":32,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["reference EPIDZL9012"],"award-info":[{"award-number":["reference EPIDZL9012"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71974035"],"award-info":[{"award-number":["71974035"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Ministry of Education of Humanities and Social Science project","award":["19YJCZH143"],"award-info":[{"award-number":["19YJCZH143"]}]},{"name":"Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2020\u20132022)","award":["GWV-10.1-XK23"],"award-info":[{"award-number":["GWV-10.1-XK23"]}]},{"name":"National University of Singapore Saw Swee Hock School of Public Health","award":["\/"],"award-info":[{"award-number":["\/"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Recommendations by health professionals are important for vaccines that are not included in national schedules. This study explored health professionals\u2019 perspectives on recommending non-scheduled (user-fee) childhood vaccinations in China, identifying key influences on professionals\u2019 interactions with caregivers. We conducted individual semi-structured interviews with 20 health professionals from three provinces in China and analyzed data thematically using deductive and inductive coding. Health professionals from all three provinces were uncomfortable about being perceived to encourage parents to accept vaccines that incurred a fee. They provided information about non-scheduled vaccines but emphasized parental autonomy in decision-making. Rural parents were less aware of unscheduled vaccines and health professionals were more likely to encourage parents living in more affluent areas to consider these vaccines; varicella vaccine was preferred by parents as a way of preventing school absence. Economic incentives for unscheduled vaccines were given to staff at most study sites, although the amount given varied widely. These variations meant that staff receiving lower incentives were not motivated to promote non-scheduled vaccines if their workload was high; on the contrary, those receiving higher incentives were more likely to promote these vaccines. Health professionals need more guidance on how to recommend unscheduled vaccines in an informative, positive and appropriate manner. It is evident that parents\u2019 awareness of these vaccines, and their economic circumstances, influence vaccinators recommendation practice. Economic incentives prompted health professionals to recommend non-scheduled vaccines; however, the application of such staff incentives varied widely in China. To adopt appropriate economic incentives, professional organizations should develop protocols for the use of incentives that account for their influence on recommendation practices. Suitable recommendation policy needs to balance basic salaries with performance-based incentives, consider overall workload, and include monitoring and evaluation of economic incentives.<\/jats:p>","DOI":"10.3390\/vaccines9121433","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T03:21:05Z","timestamp":1638847265000},"page":"1433","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["What Influences Health Professionals\u2019 Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals\u2019 Perspectives in Three Provinces of China"],"prefix":"10.3390","volume":"9","author":[{"given":"Jiejie","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoqi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-7349","authenticated-orcid":false,"given":"Natasha","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiatong","family":"Zou","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Department of Organization and Personnel, 1380 West Zhongshan Road, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona Yueqian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-5977","authenticated-orcid":false,"given":"Mei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7776-7339","authenticated-orcid":false,"given":"Tracey","family":"Chantler","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/14760584.2019.1552141","article-title":"Vaccination of healthcare workers: Is mandatory vaccination needed?","volume":"18","author":"Maltezou","year":"2019","journal-title":"Expert Rev. 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