Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study

BackgroundChildhood vaccination is a cost-effective intervention for preventing vaccine-preventable diseases. However, the specific mechanisms by which parental education level influences willingness to vaccinate (WTV) for self-paid child vaccines remain unexplored.ObjectivesThis study investigates the mediating roles of family income, vaccine awareness, and trust in self-paid child vaccines in the relationship between parental education and WTV for self-paid child vaccines, including pentavalent, EV71, varicella, and flu vaccines in China.MethodsA survey of 2,212 households with children under five in Hangzhou, Zhejiang Province, was conducted. Mediation analysis was used to assess the effects of family income, vaccine awareness, and trust on WTV.ResultsOur findings indicate that family income was an important pathway linking parental education to WTV, particularly for flu and varicella vaccines. After family income was introduced, the association between parental education and WTV was attenuated, suggesting that income may play an important mediating role. For the pentavalent vaccine, vaccine awareness and trust in self-paid vaccines also attenuated this association. These findings suggest that, although economic factors are important, non-economic factors such as vaccine awareness and trust in self-paid vaccines should also be considered.ConclusionAddressing financial barriers is crucial for increasing vaccine uptake for self-paid child vaccines in developing countries. Public health strategies should prioritize financial assistance programs and targeted communication efforts to build trust and ensure equitable access to essential vaccinations.