Investigation of parents' knowledge, attitudes, and practices regarding childhood influenza vaccination in Jiangsu showed moderate knowledge and positive attitudes but low actual vaccination rates, suggesting targeted interventions are needed to reduce the cognition-practice gap and improve childhood influenza vaccination coverage.
Abstract
Background
Influenza presents a severe health threat to children, and influenza vaccination represents the most cost-effective preventive measure. This study was conducted to investigate parents' knowledge, attitudes, and practices (KAP) regarding childhood influenza vaccination and identify key factors affecting vaccination behavior.
RESEARCH
Design
AND
Methods
A cross-sectional survey was performed among parents of children aged 6 months to 18 years in Jiangsu Province, China, in January 2026. Data were collected using a structured KAP questionnaire. Univariate analyses and multivariate binary logistic regression were used to examine associated factors and independent predictors.
Results
A total of 718 valid questionnaires were analyzed. KAP scores differed significantly by demographic variables. Major barriers to vaccination included safety/side-effect concerns (23.40%), time shortage (14.48%), lack of recommendation (11.84%) and unawareness(10.72%). Regression showed child age, specific vaccine knowledge, perceived necessity, and side-effect worries were independent influencing factors.(all P < 0.05).
Conclusions
Parents in Jiangsu showed moderate knowledge and positive attitudes but low actual vaccination rates. Targeted interventions such as government subsidies, health education, and safety promotion are needed to reduce the cognition-practice gap and improve childhood influenza vaccination coverage.
Parental knowledge and attitudes towards vaccination impact vaccine uptake, which is essential in maintaining population immunity. We assessed the psychometric validity of a questionnaire assessing parental knowledge, attitudes, and practices regarding polio immunization.
A questionnaire assessing polio disease knowledge and attitudes was designed and administered to parents of children receiving care at a hospital-based metropolitan primary care pediatric clinic. Psychometric analysis using RStudio (Version 2025.05) was performed to validate domains of disease knowledge and vaccine attitudes, including exploratory factor analysis (EFA) to identify underlying constructs and group questions by construct for cumulative scoring. Relationships between demographic characteristics, questionnaire constructs, and vaccination status, were evaluated using mean comparison tests. Delayed polio immunization status was defined as no doses by 2 months of age, <2 doses by 4 months, <3 doses by 18 months, and <4 doses by 6 years of age.
Of the 228 parental participants, 82% self-identified their child participant as Black/African-American; the mean age of the children of enrolled participants was 3.83 [± 3.29] years. EFA supported two underlying construct groups (disease knowledge and vaccine attitude) with a strong model fit (RMSEA < 0.001; TLI=1.009). Parents with lower educational attainment (F = 3.095, p = 0.018) and non-full-time employment (F = 4.034, p = 0.004) had significantly lower knowledge scores. On-time polio immunization was associated with more responses of “I Don’t Know” or “Prefer Not to Say” (p < 0.001) and from respondents with older children (p < 0.001) compared to delayed polio-immunization (Table 1). The responses from parents of children with on-time polio immunization had higher polio knowledge scores (p = 0.001) and differed from those who were polio vaccine delayed by employment status (p = 0.033, Table 1). Higher composite vaccine attitude scores (indicating more vaccine concerns) were strongly associated with total vaccine refusal (p = 0.012), supporting the convergent validity of this instrument in distinguishing polio vaccine acceptance behaviors (Figure 1).
Concerns about vaccine safety and efficacy, as well as patterns of ambiguous responding, reflected caregiver hesitancy, attitudes, and knowledge gaps, which may have contributed to delayed or complete avoidance of polio vaccination of their children. Our results suggest that this 6-item survey could be administered to identify families who might benefit from targeted vaccine resources, education, and counseling. Identifying and addressing the needs of parents with knowledge gaps and concerns is critical to improving polio vaccine uptake and reaching polio eradication.
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