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Article(id=1241102814668189807, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401374, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1705939200000, receivedDateStr=2024-01-23, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831569592, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831569592, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831569592, creator=13701087609, updateTime=1773831569592, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3042, endPage=3047, ext={EN=ArticleExt(id=1241102814986956912, articleId=1241102814668189807, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Investigation of non-immunization vaccines hesitancy and associated factors among parents in Karamay, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the non-immunization vaccines hesitancy and associated factors among parents of 0-18 years old children in Karamay.

Methods

Based on the theory of planned behavior (TPB), we used a stratified sampling method to select parents of 0-18 years old children in 12 schools of Karamay for a questionnaire-based survey．The structural equation model was used to determine relationships between variables.

Results

Of 1 258 parents included in the analysis, the incidence of vaccine hesitancy among those was 38.95%. Logistic regression analysis showed that parents with younger children, higher educated, higher income, and longer local residence were less likely to be hesitant. The indicators of model fit are in line with the theoretical requirements. The model explains 56% of the variance of parental hesitancy to vaccinate. Attitudes (βstandard=-0.36, P<0.01), subjective norms (βstandard=-0.23, P<0.01), perceived behavioral control (βstandard=-0.21, P<0.01), and perceived risk (βstandard=-0.12, P<0.01) were associated with non-immunization vaccines hesitancy.

Conclusion

The TPB model can better explain parents’ hesitancy to receive non-immunization vaccines. To increase parental willingness about vaccinate, it is essential to strengthen parents’ trust in vaccine quality and knowledge of vaccines. Furthermore, utilizing physicians and social media for health education is crucial.

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目的

了解克拉玛依市0~18岁儿童家长非免疫规划疫苗犹豫现状及影响因素。

方法

基于计划行为理论框架自行编制问卷，采用分层抽样方法在克拉玛依市12所托幼机构、中小学抽取0~18岁儿童家长开展调查，运用结构方程模型分析儿童家长非免疫规划疫苗接种犹豫影响因素。

结果

克拉玛依市儿童家长非免疫规划疫苗犹豫比例为38.95%。Logistic回归显示子女年龄小、文化程度高、家庭年收入高、本地居住时间长的家长发生疫苗犹豫风险低。结构方程模型适配度良好，能够解释56%的接种犹豫。态度（β标准=-0.36，P<0.01）、主观规范（β标准=-0.23，P<0.01）、知觉行为控制（β标准=-0.21，P <0.01）、感知风险（β标准=-0.12，P<0.01）均与家长非免疫规划疫苗接种犹豫有关。

结论

应用计划行为理论模型可以在一定程度上解释家长对儿童非免疫规划疫苗接种犹豫，提升家长疫苗信心及认知水平，加强医务人员、社交媒体宣传科普，有助于提高家长接种意愿。

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王峰，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=q3yTDJwVzAu3LhtPYMHlnw==, magXml=XSaO2/+Rtc66rbPVvAn8Ag==, pdfUrl=null, pdf=Rq3ELXIbTXTFUjnw+Od/MA==, pdfFileSize=759054, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=4PPgFl1MYIROsygVutapZQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=UpUIeCS0BL6eexHsgyO2Wg==, mapNumber=null, authorCompany=null, fund=null, authors=

左羚（1997—），女，本科，医师，研究方向：免疫规划和疫苗针对传染病监测

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左羚（1997—），女，本科，医师，研究方向：免疫规划和疫苗针对传染病监测

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左羚（1997—），女，本科，医师，研究方向：免疫规划和疫苗针对传染病监测

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Chinese Journal of Public Health, 2022, 38(2): 209-212., articleTitle=Recommendation practice on childhood vaccine and its determinants among pediatricians in China, refAbstract=null), Reference(id=1241102825854398861, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=7, pageStart=879, pageEnd=883, url=null, language=null, rfNumber=[18], rfOrder=28, authorNames=王茜, 韩开益, 涂诗意, journalName=中国公共卫生, refType=null, unstructuredReference=王茜，韩开益，涂诗意，等．接种医生疫苗信息获取与二类疫苗推荐行为分析[J]．中国公共卫生，2022，38（7）：879-883., articleTitle=接种医生疫苗信息获取与二类疫苗推荐行为分析, refAbstract=null), Reference(id=1241102827355959703, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=7, pageStart=879, pageEnd=883, url=null, language=null, rfNumber=[18], rfOrder=29, authorNames=Wang Q, Han KY, Tu SY, journalName=Chinese Journal of Public Health, refType=null, unstructuredReference=Wang Q, Han KY, Tu SY, et al. 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Chinese Journal of Public Health, 2022, 38(7): 879-883., articleTitle=Access to vaccine information and recommendation practiceof non-EPI vaccines among vaccination service providers in China, refAbstract=null), Reference(id=1241102827485983134, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2021, volume=27, issue=3, pageStart=297, pageEnd=301, url=null, language=null, rfNumber=[19], rfOrder=30, authorNames=曹曼, 叶丽红, 张娟, journalName=中国疫苗和免疫, refType=null, unstructuredReference=曹曼，叶丽红，张娟，等．社交媒体对儿童家长预防接种相关知识、态度和行为的影响[J]．中国疫苗和免疫，2021，27（3）：297-301., articleTitle=社交媒体对儿童家长预防接种相关知识、态度和行为的影响, refAbstract=null), Reference(id=1241102827628589482, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2021, volume=27, issue=3, pageStart=297, pageEnd=301, url=null, language=null, rfNumber=[19], rfOrder=31, authorNames=Cao M, Ye LH, Zhang J, journalName=Chinese Journal of Vaccines and Immunization, refType=null, unstructuredReference=Cao M, Ye LH, Zhang J, et al. Impact of social media on vaccination knowledge, attitudes and behaviors of parents[J]. Chinese Journal of Vaccines and Immunization, 2021, 27(3): 297-301., articleTitle=Impact of social media on vaccination knowledge, attitudes and behaviors of parents, refAbstract=null), Reference(id=1241102827767001523, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2021, volume=9, issue=3, pageStart=201, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=32, authorNames=Du FX, Chantler T, Francis MR, journalName=Vaccines, refType=null, unstructuredReference=Du FX, Chantler T, Francis MR, et al. Access to vaccination information and confidence/hesitancy towards childhood vaccination: a cross-sectional survey in China[J]. Vaccines, 2021, 9(3): 201., articleTitle=Access to vaccination information and confidence/hesitancy towards childhood vaccination: a cross-sectional survey in China, refAbstract=null), Reference(id=1241102827855081916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2020, volume=26, issue=6, pageStart=639, pageEnd=642, url=null, language=null, rfNumber=[21], rfOrder=33, authorNames=沈灵智, 骆淑英, 潘雪娇, journalName=中国疫苗和免疫, refType=null, unstructuredReference=沈灵智，骆淑英，潘雪娇，等．浙江省义乌市孕前妇女风疹知识知晓率和含风疹成分疫苗接种意愿调查[J]．中国疫苗和免疫，2020，26（6）：639-642., articleTitle=浙江省义乌市孕前妇女风疹知识知晓率和含风疹成分疫苗接种意愿调查, refAbstract=null), Reference(id=1241102827997688262, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2020, volume=26, issue=6, pageStart=639, pageEnd=642, url=null, language=null, rfNumber=[21], rfOrder=34, authorNames=Shen LZ, Luo SY, Pan XJ, journalName=Chinese Journal of Vaccines and Immunization, refType=null, unstructuredReference=Shen LZ, Luo SY, Pan XJ, et al. Awareness and knowledge about rubella and willingness to receive rubellacontaining vaccine among women receiving pre-conception evaluation in Yiwu city of Zhejiang province[J]. Chinese Journal of Vaccines and Immunization, 2020, 26(6): 639-642., articleTitle=Awareness and knowledge about rubella and willingness to receive rubellacontaining vaccine among women receiving pre-conception evaluation in Yiwu city of Zhejiang province, refAbstract=null), Reference(id=1241102828115128783, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, doi=null, pmid=null, pmcid=null, year=2022, volume=22, issue=1, pageStart=385, pageEnd=null, url=null, language=null, rfNumber=[22], rfOrder=35, authorNames=Du M, Tao LY, Liu J, journalName=BMC Public Health, refType=null, unstructuredReference=Du M, Tao LY, Liu J. Association between risk perception and influenza vaccine hesitancy for children among reproductive women in China during the COVID-19 pandemic: a National online survey[J]. BMC Public Health, 2022, 22(1): 385., articleTitle=Association between risk perception and influenza vaccine hesitancy for children among reproductive women in China during the COVID-19 pandemic: a National online survey, refAbstract=null)], funds=[Fund(id=1241102821400047872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, awardId=20232023hjrkx0041, language=CN, fundingSource=克拉玛依市创新环境建设计划（软科学）项目(20232023hjrkx0041), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102816207499391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, xref=1., ext=[AuthorCompanyExt(id=1241102816232665216, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, companyId=1241102816207499391, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Institute of Immunization and Prevention, Karamay Center for Disease Control and Prevention, Karamay, Xinjiang 834000, China), AuthorCompanyExt(id=1241102816262025345, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, companyId=1241102816207499391, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.克拉玛依市疾病预防控制中心免疫规划科，新疆 克拉玛依 834000)]), AuthorCompany(id=1241102816324939908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, xref=2., ext=[AuthorCompanyExt(id=1241102816333328516, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, companyId=1241102816324939908, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.江苏省现场流行病学培训项目)])], figs=[ArticleFig(id=1241102820489883884, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=EN, label=Fig.1, caption=Structural equation model of vaccination hesitancy, figureFileSmall=pKBjx7NqGHjUy5sjyvW8aQ==, figureFileBig=4PPgFl1MYIROsygVutapZQ==, tableContent=null), ArticleFig(id=1241102820582158574, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=CN, label=图1, caption=家长对儿童接种非免疫规划疫苗犹豫的TPB模型标准路径图

** P<0.01。

, figureFileSmall=pKBjx7NqGHjUy5sjyvW8aQ==, figureFileBig=4PPgFl1MYIROsygVutapZQ==, tableContent=null), ArticleFig(id=1241102820779290865, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=EN, label=Table 1, caption=

Results of non-immunization vaccines hesitancy and associated factors among parents

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数犹豫不犹豫单因素分析多因素分析
χ2POR值（95%CI）P
性别0.050.829
男289111178
女969379590
年龄8.970.011
<30岁5917421.000
31~45岁1 0103836271.433(0.788-2.605)0.238
>45岁18990991.854(0.956-3.593)0.090
与儿童关系0.570.750
父亲289116173
母亲949365584
其他20911
本地居住时间13.810.001
<1年7042281.000
≥1年1 1884487400.462(0.280-0.765)0.003
家庭年收入19.640.001
<10万3862161701.000
10~20万7232464770.756(0.577-0.992)0.044
>20万149411080.587(0.387-0.890)0.012
家庭成员中是否有医务人员1.040.309
是1084761
否1 150443707
受教育程度25.600.001
初中及以下2611341271.000
高中、专科3821522300.682(0.493-0.944)0.022
本科及以上6152044110.610(0.443-0.840)0.002
儿童年龄22.730.001
≤6岁229601691.000
7~12岁6682654031.300(0.952-1.775)0.070
13~18岁3611651961.677(1.190-2.364)0.003
儿童兄弟、姐妹数量2.220.330
0519211308
1484176308
2个以上255103152
健康状况5.830.120
较差261115
一般21296116
较好662257405
非常好358126232
), ArticleFig(id=1241102820863176948, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=CN, label=表1, caption=

儿童家长非免疫规划疫苗接种犹豫影响因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数犹豫不犹豫单因素分析多因素分析
χ2POR值（95%CI）P
性别0.050.829
男289111178
女969379590
年龄8.970.011
<30岁5917421.000
31~45岁1 0103836271.433(0.788-2.605)0.238
>45岁18990991.854(0.956-3.593)0.090
与儿童关系0.570.750
父亲289116173
母亲949365584
其他20911
本地居住时间13.810.001
<1年7042281.000
≥1年1 1884487400.462(0.280-0.765)0.003
家庭年收入19.640.001
<10万3862161701.000
10~20万7232464770.756(0.577-0.992)0.044
>20万149411080.587(0.387-0.890)0.012
家庭成员中是否有医务人员1.040.309
是1084761
否1 150443707
受教育程度25.600.001
初中及以下2611341271.000
高中、专科3821522300.682(0.493-0.944)0.022
本科及以上6152044110.610(0.443-0.840)0.002
儿童年龄22.730.001
≤6岁229601691.000
7~12岁6682654031.300(0.952-1.775)0.070
13~18岁3611651961.677(1.190-2.364)0.003
儿童兄弟、姐妹数量2.220.330
0519211308
1484176308
2个以上255103152
健康状况5.830.120
较差261115
一般21296116
较好662257405
非常好358126232
), ArticleFig(id=1241102820963840247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=EN, label=Table 2, caption=

Reliability and validity analysis of the theory of planned behavior model

, figureFileSmall=null, figureFileBig=null, tableContent=
潜变量得分（）因子载荷Cronbach α系数CRAVEAVE平方根
态度0.8910.8700.6370.798
态度13.65±0.920.621
态度23.62±0.890.606
态度33.73±0.800.952
态度43.75±0.780.943
主观规范0.8470.8540.6630.814
主观规范13.92±1.040.796
主观规范23.82±1.000.891
主观规范33.70±0.990.749
知觉行为控制0.8590.8820.6070.779
行为控制13.39±1.080.523
行为控制23.73±0.820.712
行为控制33.84±0.770.886
行为控制43.78±0.810.837
行为控制53.83±0.770.876
感知风险0.7350.7630.6160.785
感知风险13.41±0.860.776
感知风险23.30±0.850.750
接种犹豫0.8410.8470.6490.806
接种犹豫13.77±0.970.847
接种犹豫23.71±0.960.741
接种犹豫34.02±0.900.823
), ArticleFig(id=1241102821077086457, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=CN, label=表2, caption=

计划行为理论模型信效度分析

, figureFileSmall=null, figureFileBig=null, tableContent=
潜变量得分（）因子载荷Cronbach α系数CRAVEAVE平方根
态度0.8910.8700.6370.798
态度13.65±0.920.621
态度23.62±0.890.606
态度33.73±0.800.952
态度43.75±0.780.943
主观规范0.8470.8540.6630.814
主观规范13.92±1.040.796
主观规范23.82±1.000.891
主观规范33.70±0.990.749
知觉行为控制0.8590.8820.6070.779
行为控制13.39±1.080.523
行为控制23.73±0.820.712
行为控制33.84±0.770.886
行为控制43.78±0.810.837
行为控制53.83±0.770.876
感知风险0.7350.7630.6160.785
感知风险13.41±0.860.776
感知风险23.30±0.850.750
接种犹豫0.8410.8470.6490.806
接种犹豫13.77±0.970.847
接种犹豫23.71±0.960.741
接种犹豫34.02±0.900.823
), ArticleFig(id=1241102821173555453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=EN, label=Table 3, caption=

Analysis of correlation between variables

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变量行为意愿感知风险知觉行为控制主观规范态度
接种犹豫0.806
感知风险0.535a0.785
知觉行为控制0.576a0.538a0.779
主观规范0.583a0.542a0.453a0.814
态度0.655a0.485a0.539a0.528a0.798
), ArticleFig(id=1241102821257441533, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102814668189807, language=CN, label=表3, caption=

各变量间相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量行为意愿感知风险知觉行为控制主观规范态度
接种犹豫0.806
感知风险0.535a0.785
知觉行为控制0.576a0.538a0.779
主观规范0.583a0.542a0.453a0.814
态度0.655a0.485a0.539a0.528a0.798
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克拉玛依市儿童家长对非免疫规划疫苗的接种犹豫现状及其影响因素研究
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左羚 1, 2 , 李霞 1 , 鲜军 1 , 荣利萍 1 , 玛伊沙·达肯 1 , 王峰 1
现代预防医学 | 疾病预防控制 2024,51(16): 3042-3047
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现代预防医学 | 疾病预防控制 2024, 51(16): 3042-3047
克拉玛依市儿童家长对非免疫规划疫苗的接种犹豫现状及其影响因素研究
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左羚1, 2, 李霞1, 鲜军1, 荣利萍1, 玛伊沙·达肯1, 王峰1
作者信息
  • 1.克拉玛依市疾病预防控制中心免疫规划科，新疆 克拉玛依 834000
  • 2.江苏省现场流行病学培训项目

    • 左羚（1997—），女，本科，医师，研究方向：免疫规划和疫苗针对传染病监测

通讯作者:

王峰，E-mail：
Investigation of non-immunization vaccines hesitancy and associated factors among parents in Karamay
Ling ZUO1, 2, Xia LI1, Jun XIAN1, Li-ping RONG1, Mayisha Daken1, Feng WANG1
Affiliations
  • Institute of Immunization and Prevention, Karamay Center for Disease Control and Prevention, Karamay, Xinjiang 834000, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202401374
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摘要
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目的

了解克拉玛依市0~18岁儿童家长非免疫规划疫苗犹豫现状及影响因素。

方法

基于计划行为理论框架自行编制问卷，采用分层抽样方法在克拉玛依市12所托幼机构、中小学抽取0~18岁儿童家长开展调查，运用结构方程模型分析儿童家长非免疫规划疫苗接种犹豫影响因素。

结果

克拉玛依市儿童家长非免疫规划疫苗犹豫比例为38.95%。Logistic回归显示子女年龄小、文化程度高、家庭年收入高、本地居住时间长的家长发生疫苗犹豫风险低。结构方程模型适配度良好，能够解释56%的接种犹豫。态度（β标准=-0.36，P<0.01）、主观规范（β标准=-0.23，P<0.01）、知觉行为控制（β标准=-0.21，P <0.01）、感知风险（β标准=-0.12，P<0.01）均与家长非免疫规划疫苗接种犹豫有关。

结论

应用计划行为理论模型可以在一定程度上解释家长对儿童非免疫规划疫苗接种犹豫，提升家长疫苗信心及认知水平，加强医务人员、社交媒体宣传科普，有助于提高家长接种意愿。

非免疫规划疫苗  /  儿童家长  /  预防接种  /  计划行为理论
Objective

To explore the non-immunization vaccines hesitancy and associated factors among parents of 0-18 years old children in Karamay.

Methods

Based on the theory of planned behavior (TPB), we used a stratified sampling method to select parents of 0-18 years old children in 12 schools of Karamay for a questionnaire-based survey．The structural equation model was used to determine relationships between variables.

Results

Of 1 258 parents included in the analysis, the incidence of vaccine hesitancy among those was 38.95%. Logistic regression analysis showed that parents with younger children, higher educated, higher income, and longer local residence were less likely to be hesitant. The indicators of model fit are in line with the theoretical requirements. The model explains 56% of the variance of parental hesitancy to vaccinate. Attitudes (βstandard=-0.36, P<0.01), subjective norms (βstandard=-0.23, P<0.01), perceived behavioral control (βstandard=-0.21, P<0.01), and perceived risk (βstandard=-0.12, P<0.01) were associated with non-immunization vaccines hesitancy.

Conclusion

The TPB model can better explain parents’ hesitancy to receive non-immunization vaccines. To increase parental willingness about vaccinate, it is essential to strengthen parents’ trust in vaccine quality and knowledge of vaccines. Furthermore, utilizing physicians and social media for health education is crucial.

Non-immunization vaccines  /  Parents of children  /  Vaccination  /  Theory of planned behavior
左羚, 李霞, 鲜军, 荣利萍, 玛伊沙·达肯, 王峰. 克拉玛依市儿童家长对非免疫规划疫苗的接种犹豫现状及其影响因素研究. 现代预防医学, 2024 , 51 (16) : 3042 -3047 . DOI: 10.20043/j.cnki.MPM.202401374
Ling ZUO, Xia LI, Jun XIAN, Li-ping RONG, Mayisha Daken, Feng WANG. Investigation of non-immunization vaccines hesitancy and associated factors among parents in Karamay[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3042 -3047 . DOI: 10.20043/j.cnki.MPM.202401374
正文
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非免疫规划疫苗是指未纳入我国免疫规划，由公民自愿、自费接种的疫苗。与免疫规划疫苗相比，非免疫规划疫苗接种存在地区性差异，青少年、老年人等高风险群体接种覆盖不足[1-2]。相关研究认为，疫苗犹豫是影响我国非免疫规划疫苗接种的重要原因[3]，且未引起足够重视。在疫苗服务可及的情况下，延迟或拒绝接种疫苗可能造成严重的个人疾病负担及公共卫生问题[4]。
家长是儿童接种疫苗的主要决策者，其对非免疫规划疫苗的看法是影响接种的重要因素。既往研究显示疫苗的安全性、有效性、接种益处等均与家长疫苗犹豫有关[5-6]，但相关研究多关注单一行为或因素与接种意向的关联，较少进行系统分析和解释。作为社会心理学领域研究态度与意向关系的综合性方法，计划行为理论（theory of planned behavior, TPB）认为意图由对特定行为的态度、对他人的认可(主观规范)和对行为的控制能力(知觉行为控制)共同决定，能够较好解释多个维度之间的关系，且已在控烟、慢病患者管理等领域得到有效运用[7-8]。因此，本研究于2023年8-9月对克拉玛依市0~18岁儿童家长开展调查，旨在运用拓展计划行为理论探讨家长对儿童非免疫规划疫苗接种犹豫的影响因素，为制定针对性策略，优化非免疫规划疫苗接种服务提供依据。
1　资料与方法
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1.1　研究对象
采用分层抽样方法，于克拉玛依市4个辖区内随机抽取1所托幼机构、1所小学、1所中学作为调查点位，2023年8月25日至9月15日间在各抽样学校班级群内投放问卷开展调查。纳入标准：（1）年龄≤18岁儿童的家长；（2）在知情同意前提下自愿参与本研究。排除标准：本地居住时间<3个月。本研究经克拉玛依市疾控中心伦理委员会审查通过（伦理审批号：202305）。
样本量的确定 采用以下公式计算样本量，结合既往研究，预计非免疫规划疫苗犹豫比例为40%[9-10]，显著性水平α=0.05，设计效应deff=2[11]，最大容许误差d=0.1P，估算所需样本量为1 153人。本次调查共发放问卷1 335份，剔除不合格数据后纳入有效问卷1 258份，有效问卷回收率94.23%。
1.2　研究方法
1.2.1　调查方法
利用网络调查工具“问卷星”制作电子问卷，组织各学校在QQ、微信等班级群内发放问卷链接，邀请儿童家长参与调查。问卷采用无记名方式，每个用户仅可提交1次，受访者须阅读知情同意后方可开始填写，用时约为3~4分钟。质控人员每日监测在线调查进展，在完成全部问卷回收后，剔除填写时间小于60秒、存在逻辑错误及项目不完整问卷。
1.2.2　调查工具
调查问卷由两部分组成。第一部分为社会人口学信息，包括参与者性别、年龄、受教育程度、居住时间、家庭年收入、家庭医学背景、儿童健康状况等。第二部分为拓展计划行为理论量表，由团队结合理论框架[12]、既往研究[13-14]及专家函询建议自行编制。主要包括家长对儿童接种非免疫规划疫苗的态度（安全性、有效性、必要性、有益性）、主观规范（家人、医务人员、社交媒体）、知觉行为控制（疫苗成本、时间成本、服务可及性、疫苗知晓度、接种便捷性）、感知风险（感知易感性、感知严重性）、行为意向（自评犹豫程度及为儿童接种流感、水痘等非免疫规划疫苗可能性）5个维度，所有问题均使用Likert 5级量表（1=非常不同意，2=不同意，3=不确定，4=同意，5=非常同意）进行评估。非免疫规划疫苗犹豫主要通过行为意向维度中的3个问题测量，平均得分≥4分为“不犹豫”，<4分为“犹豫”。将问卷中的“非免疫规划疫苗”改为“自费疫苗”，以便于受访者理解。调查前选取30人开展预调查，按照反馈意见对相关问题进行删除、修改，问卷Cronbach α系数为0.645~0.856，KMO值为0.747，信效度良好。
1.3　统计学方法
采用Excel 2021整理数据并建立数据库，使用SPSS 27.0进行描述性统计、χ2检验、多因素logistic回归；使用AMOS 28.0构建结构方程模型，进行信、效度检验评估模型适配性，并分析态度、主观规范、知觉行为控制、感知风险与儿童家长非免疫规划疫苗犹豫之间的关系。检验水准α=0.05。
2　结果
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2.1　人口学特征
本次共调查1 258人，受访者多为儿童父母，其中男性289人（22.97%）、女性969人（77.03%），年龄以31~45岁为主（80.27%）；初中及以下、高中/专科、本科及以上学历占比分别为20.75%、30.36%、48.89%；家庭年收入分为3个等级，<10万、10~20万、20万以上占比分别为30.68%、57.47%、11.84%；8.59%的受访者家庭具有一定医学背景。受访者家庭中儿童为独生子女的占41.26%，子女年龄≤6岁、7~12岁、13~18岁占比依次为18.20%、53.10%、28.70%，多数家长（81.08%）认为儿童健康状态达较好及以上水平。
2.2　家长非免疫规划疫苗犹豫影响因素分析
本次调查发现490名（38.95%）儿童家长存在非免疫规划疫苗犹豫。将人口学特征纳入单因素分析显示，在家长年龄、儿童年龄、居住时间、家庭收入、受教育程度等方面，家长对接种非免疫规划疫苗的犹豫比例差异有统计学意义（P<0.01）。以家长非免疫规划疫苗接种意向为因变量（不犹豫=0，犹豫=1）进行多因素logistic回归，家中儿童年龄小、文化程度高、家庭年收入高、本地居住时间长的家长发生疫苗犹豫风险低。见表1。
2.3　结构方程模型的信度和效度检验
根据计划行为理论，以态度、主观规范、知觉行为控制、感知风险为潜在变量，接种犹豫为因变量构建结构方程模型，采用Cronbach α系数、验证性因子分析评价模型信度和效度。结果显示，量表中各潜在变量Cronbach α系数在0.735~0.891之间，总Cronbach α系数为0.922，组合信度CR>0.7，AVE>0.6，满足各指标推荐参考标准，内部一致性高。各潜在变量AVE的平方根均高于其相关系数，具有足够的区分效度。拟合指标NFI=0.937>0.9，IFI=0.944>0.9，RFI=0.920>0.9，TLI=0.929>0.9，CFI=0.943>0.9，GFI=0.918>0.9，AGFI=0.885>0.85，RMSEA=0.077<0.1，均符合理论要求，结构效度较好。见表2、表3。
2.4　儿童家长非免疫规划疫苗犹豫结构方程模型
构建结构方程模型及标准化结果如图1所示，模型总体方差解释率为56%（r2=0.56），对疫苗犹豫的解释能力较好，4个维度均为疫苗犹豫的影响因素，其中态度（β=-0.35，β标准=-0.36，SE=0.032，P <0.01）对家长接种意向影响最强，其次为主观规范（β=-0.22，β标准=-0.23，SE=0.033，P <0.01）、知觉行为控制（β=-0.23，β标准=-0.21，SE=0.037，P <0.01）和感知风险（β=-0.14，β标准=-0.12，SE=0.045，P <0.01）。见图1。
3　讨论
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本研究基于TPB框架设计，采用结构方程模型检验态度、主观规范、知觉行为控制、感知风险与非免疫规划疫苗犹豫间的关系，探究儿童家长疫苗犹豫的影响因素。调查显示，克拉玛依市38.95%的儿童家长存在非免疫规划疫苗接种犹豫，与2021年全国调查结果相近[10]。态度、主观规范、知觉行为控制、感知风险均为儿童家长非免疫规划疫苗犹豫的预测因子，能够解释56%的接种犹豫。
各维度中态度对疫苗犹豫影响最强，儿童家长对疫苗的风险、效益、必要性认知越全面，越不易出现疫苗犹豫。本研究中安全性、有效性评分较低，说明家长对非免疫规划疫苗信心不足；但在有益性及接种必要性方面可观察到家长寻求疫苗健康效益的积极倾向，这与既往研究结果一致[15-16]。一方面，通过加强疫苗的安全监管体系，向家长传播正确的疫苗知识，可以增强家长对疫苗的信任度；另一方面，提升家长对疫苗风险及效益的全面认知，充分权衡接种非免疫规划疫苗的利与弊，有利于提高家长为儿童接种的意愿。
主观规范对家长疫苗犹豫的影响作用仅次于态度，其得分越高，家长感受到的社会支持越大，出现疫苗犹豫可能性越低。在各决策支撑主体中，医务人员发挥的促进作用大于家人及社交媒体。然而，既往调查显示，因对疫苗了解有限且工作负荷较重，仅有25.4%~51.53%的医务人员经常推荐儿童接种非免疫规划疫苗[17-18]。此外，当前社交媒体已成为家长获取疫苗信息的主要渠道[19]，疫苗相关事件的负面报道及失实信息的传播可能是限制社交媒体在家长决策过程中发挥积极作用的重要因素[20]。为此，有必要针对医务人员开展疫苗知识培训，藉由官方媒体规范发布、澄清疫苗信息，以减少家长疫苗犹豫。
知觉行为控制可以在一定程度上解释儿童家长的接种犹豫。观测变量中，接种经济、时间成本得分较低、影响较弱，提示价格及时间成本并非疫苗接种的首要障碍，但部分家长仍不能接受其带来的经济、时间负担。此外，接种便捷性、服务可及性、疫苗知晓率对知觉行为控制的影响较强，提供便利的服务、扩大服务资源及宣传对提高家长意愿有重要意义。多因素分析结果侧面印证了上述结论，家庭内儿童年龄小、文化程度高、收入高、本地居住时间长的家长出现疫苗犹豫可能性较低，原因可能是此类人群子女正处于接种免疫规划疫苗时间段，对疫苗了解较多；高文化、高收入人群更易获取疫苗相关知识及资源，承担相应成本的能力更强[1]；久居本地居民对辖区接种服务、政策更了解。提升公众疫苗素养，通过政府统筹优化非免疫规划疫苗筹资、采购策略，改善服务可及性、接种公平性，对促进非免疫规划疫苗接种具有积极作用。
分析结果显示，感知风险同样对疫苗犹豫存在影响。本研究观察到家长对流感、水痘等疾病的感知易感性、感知严重性均处较低水平，和接种犹豫的关联较弱。首先，对疾病认知有限可能是儿童家长感知风险不足的主要原因[21]，针对相关疾病的科普宣传有待进一步提高。其次，感知风险水平与开展调查的时间有关，疾病高位流行时人群感知风险往往更高[22]，后续有必要结合不同时期探讨感知风险对接种犹豫的影响，采取针对性措施提升家长接种意愿。
研究存在以下局限性：首先，本研究属于横断面调查，结果仅代表家长在某一时刻的疫苗犹豫状况，随着接种政策、人群认知以及疾病流行水平变化，家长对儿童接种非免疫规划疫苗的态度也会随之改变。其次，研究缺乏“儿童是否接种非免疫规划疫苗”这一行为结果，未来使用纵向队列研究可以更好地探究接种犹豫对实际行动的影响作用。最后，由于调查数据通过自填式问卷收集，尽管采取了质量控制措施，但仍可能存在一定偏倚及社会期望偏差。
基金
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  • 克拉玛依市创新环境建设计划（软科学）项目(20232023hjrkx0041)
文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202401374
  • 接收时间：2024-01-23
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-01-23
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克拉玛依市创新环境建设计划（软科学）项目(20232023hjrkx0041)
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    1.克拉玛依市疾病预防控制中心免疫规划科，新疆 克拉玛依 834000
    2.江苏省现场流行病学培训项目

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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