The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China

Objectives: The present study aimed to assess influenza vaccine hesitancy and vaccine literacy levels among youth and adults in China, as well as the association between them. Methods: An online cross-sectional survey was conducted in Mainland China. Participants' total vaccine literacy and three sub-dimension vaccine literacy (knowledge literacy, competence literacy, and decision-making literacy) were assessed by a validated vaccine literacy scale. Having received influenza vaccination in the past three years or intending to accept it in next influenza season indicates less influenza vaccine hesitancy. Results: Among 997 participants, a sub-optimal vaccine literacy was observed, with a mean score of 66.83 +/- 10.27. Regression models 1-4 revealed that participants with middle (aOR: 1.431, P=0.039, 95% CI: 1.018 similar to 2.010) or high (aOR: 1.651, P=0.006, 95% CI: 1.157 similar to 2.354) total vaccine literacy, as well as those with high competence literacy (aOR: 1.533, P=0.017, 95% CI: 1.079 similar to 2.180), or high decision-making literacy (aOR: 1.822, P=0.001, 95% CI: 1.261 similar to 2.632) were more likely to have been vaccinated against influenza at least once in past three years. However, those with a high knowledge literacy were associated with a lower influenza vaccine rate (aOR: 0.676, P=0.046, 95% CI: 0.460 similar to 0.994). Regression models 5-8 revealed that participants with middle (aOR: 1.661, P=0.008, 95% CI: 1.142 similar to 2.414) or high total vaccine literacy (aOR: 2.645, P=0.000, 95% CI: 1.774 similar to 3.942), as well as those with middle (aOR: 1.703, P=0.005, 95% CI: 1.177 similar to 2.464) or high competence literacy (aOR: 2.346, P=0.000, 95% CI: 1.159 similar to 3.461), or high decision-making literacy (aOR: 2.294, P=0.000, 95% CI: 1.531 similar to 3.436) were more likely to express the willingness to receive the influenza vaccine in the next influenza season. Conclusion: The participants' influenza vaccine hesitancy was negatively associated with their total vaccine literacy levels and two of the three sub-dimensions: competence literacy and decision-making literacy. Knowledge literacy suggested a positive or no relationship with influenza vaccine hesitancy.