Factors associated with willingness to receive an adult tetanus booster in China: A cross-sectional study incorporating behavioral factor analysis

Tetanus is vaccine-preventable but potentially fatal. In China, routine adult booster vaccination remains uncommon, and tetanus prevention continues to rely largely on post-injury prophylaxis. Evidence on willingness to receive an adult tetanus booster and its behavioral correlates is limited. We conducted a cross-sectional online survey of 1,522 adults in China to assess willingness to receive a tetanus booster and to examine cognitive, psychological, and service-related factors associated with willingness. The questionnaire collected sociodemographic characteristics, tetanus-related knowledge, and responses to 16 items covering potential promoting factors and barriers. Exploratory factor analysis identified three promoting dimensions (information clarity, service convenience, and opportunity/timing) and two barrier dimensions (accessibility barriers and psychological/cognitive barriers). Multivariable logistic regression was used to examine factors associated with willingness to receive a tetanus booster within the next 6 months under a convenient-vaccination scenario. Overall, 857 participants (56.3%) reported willingness to receive a booster. Information clarity (OR = 1.55, 95% CI: 1.29-1.86), opportunity/timing (OR = 1.21, 95% CI: 1.03-1.49), knowledge of the recommended 10-y booster interval (OR = 1.91, 95% CI: 1.42-2.63), and knowledge of where vaccination could be obtained (OR = 1.44, 95% CI: 1.16-1.84) were positively associated with willingness. Higher psychological/cognitive barrier scores were negatively associated with willingness (OR = 0.67, 95% CI: 0.56-0.79). Accessibility barriers showed a small positive association (OR = 1.16, 95% CI: 1.01-1.34), which warrants cautious interpretation. Basic sociodemographic characteristics were not independently associated with willingness in the adjusted model. In this sample, willingness to receive an adult tetanus booster was more closely related to cognitive, psychological, and service-related factors than to basic sociodemographic characteristics. These findings identify communication and service-delivery targets for future evaluation in adult tetanus booster programs in China.