Factors influencing healthcare workers’ vaccine recommendations: A cross-sectional study in Zhejiang Province, China

To investigate factors influencing vaccine recommendations by healthcare workers (HCWs) in Zhejiang Province, China. A cross-sectional survey was conducted among 569 HCWs to assess their beliefs and attitudes toward vaccines, vaccine recommendations and barriers to recommending vaccinations. Logistic regression was utilized to analyze influencing factors. Most participants (89.4%) believed that vaccines can effectively protect children's health. Higher professional titles (aOR = 1.24, 95% CI: 1.03-1.50) and increased vaccine confidence (aOR = 1.10, 95% CI: 1.05-1.16) were positively associated with vaccine recommendation behaviors, while increased vaccine risk perception significantly reduced recommendations (aOR = 0.84, 95% CI: 0.78-0.90). Moreover, vaccine hesitancy among HCWs was primarily driven by two main factors: safety concerns regarding immunization (60.8%) and cognitive biases related to vaccine necessity and efficacy (25.8%). This study elucidates professional title advancement and vaccine confidence as critical determinants of vaccine recommendation behaviors among HCWs in Zhejiang Province, China. To improve vaccine acceptance and achieve higher immunization coverage, targeted vaccine education and confidence-building programs should be integrated into HCWs' professional training.