Influencing factors of influenza vaccination willingness among the elderly in Wuxi city: A study based on the Behavioral and Social Drivers (BeSD) framework and structural equation modeling

Influenza vaccination hesitancy among the elderly remains a concern, yet detailed data on influencing factors in Wuxi are limited. To fill this gap and provide a scientific basis for intervention and policy optimization, a questionnaire developed by the Chinese Center for Disease Control and Prevention based on the Behavioral and Social Drivers (BeSD) framework was adopted. Stratified random sampling across six districts of Wuxi city yielded 538 valid responses. Structural equation modeling (SEM) was employed to analyze influencing factors. Of the participants, 80.86% (435 individuals) expressed willingness to receive influenza vaccination. SEM fit indices met the standards (RMSEA = 0.054 0.90), indicating a good model fit. Social support was the most significant factor (total effect = 0.774), followed by vaccine safety (total effect = - 0.103) and practical issues (total effect = 0.116). These findings identify social support, vaccine safety cognition, and vaccination convenience as key determinants of influenza vaccination willingness, with social support having the greatest influence. The study underscores the urgent need for multi – dimensional interventions targeting social factors to enhance influenza vaccination uptake among Wuxi's elderly population.