Understanding the practices and perceptions of Chinese older adults towards vaccination in the context of COVID-19: A qualitative study in Anhui Province

This study examines vaccination perceptions and practices among rural older adults in China during the COVID-19 pandemic to inform strategies for promoting vaccination among older adults. Qualitative research was employed, involving 13 rural older adults aged 60 and above in Anhui Province. Two rounds of in-depth interviews were conducted in May 2022 (during the severe pandemic period) and May 2024 (post-pandemic era), with data analyzed using grounded theory. Rural older adults exhibited dual perceptions of COVID-19 characterized by "seriousness" and "relative reassurance," maintaining trust, understanding, and acknowledgment of government prevention policies. They generally recognized the necessity of COVID-19 vaccination as a key means to alleviate infection fears and reduce risk exposure. However, they exhibited self-marginalization, believing vaccine resources should be prioritized for younger individuals and those deemed more deserving. And, collectivist values motivated active compliance with epidemic control policies but also led to attention bias, causing them to overlook routine vaccines such as influenza and pneumonia vaccines that received less government promotion. As the pandemic progressed, individual awareness gradually awakened. Professional authority and family opinions emerged as new drivers for vaccination, though health belief biases also surfaced, with some seniors refusing shots citing "good physical constitution." The government should intensify vaccination outreach, optimize community services, guide seniors toward accurate self-perception, and leverage the roles of family members and medical professionals in vaccination efforts. These measures will enhance vaccination rates among rural seniors and safeguard the health of the population.