Exploring the Impact of Social Networks on Maternal Attitudes Towards Child Non-NIP Vaccine Uptake: A Mixed-Method Study in Chongqing, China

Abstract

Background: In China, childhood vaccination is essential for preventing communicable diseases, yet significant disparities exist between National Immunization Program (NIP) and non-NIP (self-paid) vaccine uptake. While NIP vaccines have high coverage due to government support, non-NIP vaccine uptake remains lower, particularly in economically disadvantaged areas. Social networks play a crucial role in shaping maternal attitudes toward vaccination, but their impact remains underexplored, especially in the context of urban-rural differences.Methods: This study employs a mixed-methods approach, combining quantitative surveys (N=570) and longitudinal qualitative interviews (N=30) conducted in Yuzhong (high-income, urban) and Dazu (low-income, rural) districts of Chongqing. The quantitative analysis examines the relationship between maternal social networks and non-NIP vaccine uptake, while the qualitative component explores dynamic changes in mothers’ decision-making processes across three interview rounds. Results: Quantitative findings indicate that discussions with spouses, family, and media significantly influence non-NIP vaccine uptake, while social network breadth alone has no direct effect. Peer vaccination rates and maternal education levels also play a key role in decision-making. Qualitative analysis reveals that healthcare professionals, social circles, and online information evolve as primary sources over time, with mothers becoming more independent in decision-making. Trust in healthcare professionals remains high, but mothers increasingly integrate peer experiences and online information. Regional disparities persist, with Yuzhong mothers demonstrating higher vaccine acceptance over time compared to Dazu mothers. Conclusions: Social networks are pivotal in shaping maternal vaccine decisions, with trust and information quality outweighing the sheer number of information sources. Spouses and peer influence reinforce vaccine confidence, while online misinformation presents challenges. Public health efforts should leverage trusted social networks, enhance healthcare communication, and provide targeted interventions to bridge regional disparities in vaccine uptake.