Physician recommendation and vaccine hesitancy as key drivers of pneumococcal vaccination among older adults in China: a cross-sectional study using policy-stratified structural equation modeling

BACKGROUND: Pneumococcal disease causes severe illness in older adults. This study examined the impacts of physician recommendation, vaccine hesitancy, and regional policy differences on pneumococcal vaccination uptake in China. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted among 13,363 adults aged ≥ 60 years in six Chinese cities using structural equation modeling, stratified by free and self-financed vaccination areas. RESULTS: = -0.093). CONCLUSIONS: Vaccine attitudes often reflect generalized psychological constructs. Strategies must be tailored to policy contexts: enhancing information quality in self-financed areas and addressing complacency in free-vaccine settings. Multidimensional interventions should expand healthcare worker roles and optimize organizational logistics. Key limitations include the cross-sectional design and reliance on self-reported data.