Influenza Vaccination Preferences Among Adults Aged 60 Years and Older in Beijing, China.

Abstract

Importance: Influenza vaccination coverage among older adults remains suboptimal in China despite free vaccination policies in some regions. Understanding their preferences may inform strategies to improve uptake.

Objective: To quantify preferences for influenza vaccination attributes and assess preference heterogeneity by prior influenza vaccination history.

Design, setting, and participants: This community-based survey study was conducted at 2 districts in Beijing, China, where influenza vaccination is provided free of charge for adults aged 60 years or older. A convenience sample of adults aged 60 years or older was included from 6 Beijing subdistricts and participated in a discrete choice experiment conducted from August to September 2025.

Main outcomes and measures: Stated choice among 2 hypothetical influenza vaccination profiles and an opt-out option. Attributes included vaccine effectiveness, risk of mild adverse effects, vaccination venue and operating hours, outreach method, information source, and message content. Conditional logit, mixed logit, scenario simulations, and vaccination-history interaction analyses were performed.

Results: Among 514 participants included in the analyses, the median age was 71 years (IQR, 65-79 years), and 356 (69.3%) were women. Higher vaccine effectiveness was associated with greater vaccination preference (β = 2.12; 95% CI, 1.37 to 2.88), whereas higher perceived risk of mild adverse effects was associated with lower preference (β = -5.53; 95% CI, -7.83 to -3.22). Participants preferred community-based vaccination settings, telephone reminders (β = 1.06; 95% CI, 0.76 to 1.36), information from government or community organizations (β = 0.78; 95% CI, 0.54 to 1.02), and messages emphasizing protection of family members (β = 0.50; 95% CI, 0.26 to 0.74). Increasing vaccine effectiveness from 20% to 80% and reducing perceived risk of adverse effects from 20% to 5% were associated with 30.74- and 19.96-percentage-point (pp) increases in the model-estimated choice probability, respectively. Compared with participants with prior vaccination, never-vaccinated participants had a greater preference for opting out (difference in β = 1.07; 95% CI, 0.11 to 2.03), greater sensitivity to mild adverse effect risk (difference in β per 10-pp increase, -0.49; 95% CI, -0.93 to -0.05), and lower responsiveness to vaccine effectiveness (difference in β per 10-pp increase, -0.18; 95% CI, -0.31 to -0.04).

Conclusions and relevance: In this discrete choice experiment of older adults in Beijing, influenza vaccination preferences were associated with vaccine profiles, trusted communication, and community-based service delivery. Prior vaccination history identified differences in benefit-risk weighting that may inform broad and targeted vaccination strategies.