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Household and Community Clustering of Concurrent Vaccine Hesitancy in China: Multicenter Survey.

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Title: Household and Community Clustering of Concurrent Vaccine Hesitancy in China: Multicenter Survey.
Authors: Zhang Y; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Bhuyan SS; School of Public and International Affairs, Princeton University, Princeton, NJ, United States.; Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States., Wang S; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Guo X; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Cao T; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Zhu D; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Miao Y; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Hu J; Henan Medical Communication and Project Forward Center, Zhengzhou, Henan, China., Wang W; Henan Medical Communication and Project Forward Center, Zhengzhou, Henan, China., Li Q; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815., Wu J; Department of Health Policy and Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815.
Source: JMIR public health and surveillance [JMIR Public Health Surveill] 2026 Oct 07; Vol. 12, pp. e104263. Date of Electronic Publication: 2026 Oct 07.
Publication Type: Journal Article; Multicenter Study
Language: English
Journal Info: Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101669345 Publication Model: Electronic Cited Medium: Internet ISSN: 2369-2960 (Electronic) Linking ISSN: 23692960 NLM ISO Abbreviation: JMIR Public Health Surveill Subsets: MEDLINE
Imprint Name(s): Original Publication: Toronto : JMIR Publications, [2015]-
MeSH Terms: Vaccination Hesitancy*/statistics & numerical data , Vaccination Hesitancy*/psychology , COVID-19*/prevention & control , COVID-19*/epidemiology , COVID-19 Vaccines*/administration & dosage , Family Characteristics*, China/epidemiology ; Humans ; Cross-Sectional Studies ; Female ; Male ; Adult ; Surveys and Questionnaires ; Middle Aged ; Cluster Analysis
Abstract: Background: Vaccine hesitancy remains a persistent global challenge, especially in the context of major public health emergencies. While individual-level factors have been widely studied, whether and how household and community contexts shape hesitancy clustering has received little attention.
Objective: This study aimed to assess household- and community-level clustering of COVID-19 booster vaccine hesitancy (CBVH), identify key associated factors, and explore potential intervention targets.
Methods: In March 2023, a household-based cross-sectional survey was conducted among Chinese adults across 4 provinces. Concurrent CBVH was defined as hesitancy reported for both current and future booster intentions within the same survey. The analytical samples included 5462 participants for current CBVH, 5437 for future CBVH, and 5407 for concurrent CBVH. Three-level logistic regression models were used to quantify variance attributable to individual, household, and community levels and to identify associated factors. Network analysis was also used to examine interrelationships among key factors and identify central intervention targets.
Results: Among 5407 participants, 1461 (27.0%) exhibited concurrent CBVH. The unweighted prevalence of current and future CBVH was 28.4% (1553/5462) and 30.1% (1636/5437), respectively. The corresponding poststratified prevalence estimates were 30.88% and 32.55%, respectively. In the null model, the combined household- and community-level intraclass correlation coefficients were 77.73% (95% CI 72.40%-82.29%) and 78.84% (95% CI 73.57%-83.30%), respectively. Prior COVID-19 vaccination, self-efficacy, perceived benefits, trust in vaccine developers, and knowledge of the vaccine were associated with lower CBVH, while perceived barriers, perceived severity, household income, chronic disease, history of allergies, and living in the eastern region were associated with higher hesitancy. Network analysis revealed that self-efficacy and prior COVID-19 vaccination had the strongest associations with CBVH. Perceived barriers and trust in vaccine developers formed the strongest association among nodes. The current and future CBVH networks showed similar configurations.
Conclusions: The substantial household and community clustering highlights the need for group interventions. Household-centered vaccine education, community-based vaccine counseling services, and transparent vaccine communication may help reduce vaccine hesitancy and strengthen preparedness for future infectious disease outbreaks.
(© Yijing Zhang, Soumitra S Bhuyan, Saiyi Wang, Xinghong Guo, Tingting Cao, Dongfang Zhu, Yudong Miao, Jianping Hu, Wei Wang, Quanman Li, Jian Wu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)
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Contributed Indexing: Keywords: community clustering; household clustering; multilevel analysis; network analysis; vaccine hesitancy
Substance Nomenclature: 0 (COVID-19 Vaccines)
Entry Date(s): Date Created: 20261007 Date Completed: 20261007 Latest Revision: 20261009
Update Code: 20261009
PubMed Central ID: PMC13645339
DOI: 10.2196/104263
PMID: 42842944
Database: MEDLINE
Description
ISSN:2369-2960
DOI:10.2196/104263