JMIR Publications

ABSTRACT

Background:

Vaccine hesitancy remains a persistent global challenge, especially in the context of major public health emergencies. While individual-level factors have been studied, whether and how household and community contexts shape hesitancy clustering has received little attention.

Objective:

This study aimed to assess household- and community-level clustering of persistent vaccine hesitancy and identify key associated factors and intervention targets.

Methods:

A large-scale, multicenter, household-based survey was conducted among Chinese adults across four provinces in March 2023. Persistent COVID-19 booster vaccine hesitancy (CBVH) was defined as hesitancy reported for both current and future booster intentions within the same survey. Three-level logistic regression models were used to quantify variance attributable to individual, household, and community levels, and to identify associated factors. Network analysis was further used to examine interrelationships among key factors and identify central intervention targets.

Results:

Among 5407 participants, 27.02% exhibited persistent CBVH, with 27.85% for past hesitancy and 29.55% for future hesitancy. A substantial proportion (over 77%) of hesitancy variance was attributable to household and community clustering. Self-efficacy, perceived benefits, trust in vaccine developers, and knowledge of vaccine emerged as protective factors, while perceived barriers, perceived severity, household income, chronic disease, history of allergies, and living in the eastern province were associated with higher hesitancy. Network analysis revealed perceived barriers, perceived benefits, perceived severity, self-efficacy, and trust in vaccine developers as central nodes, with the network structure remaining stable over time.

Conclusions:

Household and community clustering highlights the need for group interventions. Effective strategies should prioritize household-centered vaccine education, community-based vaccine counseling services, and transparent communication of vaccine information to reduce vaccine hesitancy and strengthen preparedness for future infectious disease outbreaks. Clinical Trial: Not applicable.