Trust in Information Sources as a Predictor of Parents’ Knowledge, Attitudes, and Practices (KAP) Regarding PCV13 Vaccination for Children in China: A Mixed Methods Study

Abstract

Background: Pneumococcal vaccines could protect children from being infected by some of the deadly Streptococcus pneumonia bacteria. However, since the pneumococcal vaccines have not yet been listed in China’s National Immunization Program (NIP), their coverage remains low due to the non-mandate and self-paid features. Parents are usually the key decision makers regarding their children’s PCV13 vaccine taking. Their exposure to vaccine information from trusted sources might influence this decision-making process. This study aims to explore the association between trust in information sources and parents’ knowledge, attitudes, and practices regarding PCV13 vaccination for children in the Yangtze River Delta region, China.Methods: This study applied an explanatory sequential mixed-method design, combining a web-based quantitative survey (N = 1,871) and qualitative interviews (N =19). Adult parents who had at least one child aged less than 24 months (including 24 months) and lived in the Yangtze River Delta region were recruited. A Five-Point Likert scale measured the level of trust in different sources. Adjusted Ordinary Least Square (OLS) regression model was applied to estimate the association between participants’ level of trust in different information sources and the primary outcomes. Semi-structured individual interviews were conducted. A thematic analytic approach was adopted to analyze the transcripts. Results: CDC received the highest trust score (4.48/5). High levels of uncertainty were identified in parents’ PCV13 knowledge. Age, gender, education, and annual household income were related to varied trust levels in specific sources. After controlling the effect of covariates, trust in healthcare institution sources was significantly associated with better PCV13 knowledge, less vaccine hesitancy, and a higher likelihood of vaccine uptake. Trust in official media was negatively associated with vaccine uptake. Trust in online community sources was positively associated with vaccine uptake. The qualitative study also identified parents’ trust in healthcare-related sources. Parents would consult multiple sources for vaccine information. Insufficient information provision during the vaccination process was one of the key drivers of vaccine information seeking. Parents had varied informed levels about PCV13 when making vaccination decisions. Conclusion: Healthcare institution sources were highly trusted and crucial in enhancing parents’ vaccine knowledge and acceptance of PCV13. The influence of online community sources on vaccine uptake is worth more attention. Public health policymakers could utilize media platforms with high engagement among parents for future optional vaccine promotion. Public health workers could consider embedding vaccine information provision into the pediatric vaccination process to inform parents’ decision-making better.