Cognitive factors associated with willingness to receive three important vaccines among older adults: A protection motivation theory perspective

Vaccines against influenza, pneumococcal pneumonia, and herpes zoster are pivotal for infectious disease control in older adults, yet vaccination coverage remains suboptimal. Guided by Protection Motivation Theory (PMT), this cross-sectional study identified cognitive factors of overall willingness toward the three important vaccines among adults aged ≥60 y, to inform population-level intervention strategies. A representative sample of 420 older adults was recruited from Chengdu, China, via multistage stratified sampling between August and October 2024. Partial least squares structural equation modeling was applied to analyze associations between PMT cognitive constructs, health status, and overall vaccination willingness. Results showed moderate overall willingness to receive the three vaccines (16.7 ± 5.0, range: 5-25), with PMT explaining 57.6% of its variance (R² = 0.576). Four PMT cognitive factors significantly predicted vaccination willingness: three had positive associations - perceived vulnerability (b = 0.128, p < .01), self-efficacy (b = 0.396, p < .001), and response efficacy (b = 0.289, p < .001) - with self-efficacy being the strongest predictor; whereas response cost (b = -0.102, p < .01) exerted a negative effect. Health status moderated the perceived severity → vaccination willingness pathway (diff b = -0.189, p < .05); specifically, perceived severity positively correlated with willingness among older adults with poor health (b = 0.143, p < .05). Findings suggest that, except among older adults with poor, physical health tailored public health intervention policies to boost older adults' overall willingness for the three key vaccines should prioritize targeting vaccination-related beliefs (self-efficacy, benefits, costs, and risk of infection) rather than disease severity.