Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study
12 affiliations
- 1Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences
- 2Vanke School of Public Health, Tsinghua University
- 3Institute for Healthy China, Tsinghua University
- 4School of Public Health, Capital Medical University
- 5Department of Medicine, Rutgers University
- 6Nanyang Technological University
- 7School of Pharmaceutical Sciences, Tsinghua University
- 8Department of Economic Management, Huazhong Agricultural University
- 9School of Public Health, Zhejiang University School of Medicine
- 10Department of Health Data Science, Anhui Medical University
- 11MOE Key Laboratory of Population Health Across Life Cycle
- 12China Medical Board, Beijing Office
Abstract
Background: Childhood vaccination is a cost-effective intervention for preventing vaccine-preventable diseases. However, the specific mechanisms by which parental education level influences willingness to vaccinate (WTV) for self-paid child vaccines remain unexplored.
Objectives: This study investigates the mediating roles of family income, vaccine awareness, and trust in self-paid child vaccines in the relationship between parental education and WTV for self-paid child vaccines, including pentavalent, EV71, varicella, and flu vaccines in China.
Methods: A survey of 2,212 households with children under five in Hangzhou, Zhejiang Province, was conducted. Mediation analysis was used to assess the effects of family income, vaccine awareness, and trust on WTV.
Results: Our findings indicate that family income was an important pathway linking parental education to WTV, particularly for flu and varicella vaccines. After family income was introduced, the association between parental education and WTV was attenuated, suggesting that income may play an important mediating role. For the pentavalent vaccine, vaccine awareness and trust in self-paid vaccines also attenuated this association. These findings suggest that, although economic factors are important, non-economic factors such as vaccine awareness and trust in self-paid vaccines should also be considered.
Conclusion: Addressing financial barriers is crucial for increasing vaccine uptake for self-paid child vaccines in developing countries. Public health strategies should prioritize financial assistance programs and targeted communication efforts to build trust and ensure equitable access to essential vaccinations.
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BibTeX
@article{xie2026parental,
title = {{Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study}},
author = {Linbo Xie and Zhihan Wu and Qiao Zhang and Kehan Wang and Ziyan Zhu and Zihan Wang and Peiyao Li and Siyu Chen and Junfang Xu and Min Yuan and Jiming Zhu},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1804018},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1804018/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study
AU - Linbo Xie
AU - Zhihan Wu
AU - Qiao Zhang
AU - Kehan Wang
AU - Ziyan Zhu
AU - Zihan Wang
AU - Peiyao Li
AU - Siyu Chen
AU - Junfang Xu
AU - Min Yuan
AU - Jiming Zhu
PY - 2026
DA - 2026/10/14
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1804018
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1804018/full
AB - Background: Childhood vaccination is a cost-effective intervention for preventing vaccine-preventable diseases. However, the specific mechanisms by which parental education level influences willingness to vaccinate (WTV) for self-paid child vaccines remain unexplored. Objectives: This study investigates the mediating roles of family income, vaccine awareness, and trust in self-paid child vaccines in the relationship between parental education and WTV for self-paid child vaccines, including pentavalent, EV71, varicella, and flu vaccines in China. Methods: A survey of 2,212 households with children under five in Hangzhou, Zhejiang Province, was conducted. Mediation analysis was used to assess the effects of family income, vaccine awareness, and trust on WTV. Results: Our findings indicate that family income was an important pathway linking parental education to WTV, particularly for flu and varicella vaccines. After family income was introduced, the association between parental education and WTV was attenuated, suggesting that income may play an important mediating role. For the pentavalent vaccine, vaccine awareness and trust in self-paid vaccines also attenuated this association. These findings suggest that, although economic factors are important, non-economic factors such as vaccine awareness and trust in self-paid vaccines should also be considered. Conclusion: Addressing financial barriers is crucial for increasing vaccine uptake for self-paid child vaccines in developing countries. Public health strategies should prioritize financial assistance programs and targeted communication efforts to build trust and ensure equitable access to essential vaccinations.
SN - 2296-2565
ER -