Maternal influenza vaccination intention and associated factors among pregnant women in Guizhou Province, China

Despite global recommendations, maternal influenza vaccination coverage in China remains critically low. This hospital-based cross-sectional study (January-February 2022) applied the Health Belief Model (HBM) to examine determinants among 564 pregnant women in Guizhou Province. Mann-Whitney U tests and modified Poisson regression were employed to compare inter-group distributions and estimate prevalence ratios (PRs). Analysis revealed only 11.9% (67 of 564) of respondents received pre-pregnancy vaccination, and 36.7% (207 of 564) intended to be vaccinated during pregnancy. Key HBM-based predictors of vaccination intention included: (i) perceived barriers, primarily fetal/maternal safety concerns and familial opposition; (ii) cues to action and perceived benefits; and (iii) perceived susceptibility and severity. PRs and 95% CIs across quantiles indicated statistical significance in influenza vaccination intention by levels of perceived barriers (contrast = -0.34; 95% CI: -0.51, -0.17; <i>P</i>_<i>trend</i> < 0.001), cues to action, and perceived benefits (contrast = 0.34; 95% CI: 0.13, 0.55; <i>P</i>_<i>trend</i> = 0.002). These context-specific determinants provide the basis for our intervention strategies and measures. Integrated interventions, such as prenatal counseling, mobile health education, financial incentives, peer networks, and reminders, may enhance maternal influenza vaccination coverage, warranting broader implementation.