Using the COM-B model to explore factors influencing influenza vaccination among the elderly: Insights from primary healthcare workers in China

The influenza vaccination rate among the elderly in China remains suboptimal. As key figures in effective intervention strategies, the perspectives of primary healthcare workers (PHCWs) on this issue have not been explored yet. This study aims to use the capability, opportunity, motivation-behavior (COM-B) model to identify the factors that influence influenza vaccination among the elderly from the perspective of PHCWs in China, analyze the mechanisms, and formulate targeted intervention strategies. A qualitative study used semi-structured, face-to-face interviews with PHCWs in Yangzhou, Jiangsu Province, China, conducted in September 2023, based on the COM-B model. A purposive sampling method was used, resulting in the participation of 16 PHCWs. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. The study included 16 PHCWs (7 Public health professionals [43.75%], 7 general practitioners [43.75%], and 2 nurses [12.50%]). The main barriers to influenza vaccination identified were the lack of recommendations from PHCWs (Reflective Motivation), limited knowledge of influenza or the influenza vaccine among the elderly (Psychological Capability), and the self-payment policy for the influenza vaccine (Physical Opportunity). Additionally, a clear division of professional boundaries between clinicians and public health professionals was found to discourage the elderly from receiving the influenza vaccine (Reflective Motivation). The components - capability, opportunity, and motivation - of the COM-B model interact with each other to change behavior. Improving elderly influenza vaccination rates in China requires stronger recommendations from PHCWs, better awareness of the elderly, and optimized self-payment policies.