Designing equitable influenza vaccination services for older adults in rural China: A discrete choice experiment

Influenza vaccination uptake among older adults in under-resourced rural areas remains very low, notably in China, representing a major health equity challenge. We aimed to identify influenza vaccine service preferences among older adults in a multi-ethnic, low-income region of rural southwest China to inform tailored, equity-oriented vaccination strategies.

We conducted a discrete choice experiment (DCE) survey with 646 adults aged ≥60 years in Guizhou Province, a multi-ethnic, low-income region in southwest China. We integrated the WHO Behaviour and Social Drivers (BeSD) framework to capture modifiable influences on vaccine uptake. The DCE included six service attributes (price, location, service timing, information source, side effects, and vaccine efficacy). A mixed multinomial logit model was used to analyse preferences and estimate willingness-to-pay (WTP), and subgroup analyses explored heterogeneity across key demographic strata.

Older adults preferred receiving influenza vaccines at trusted community health centres and during standard weekday daytime hours. Official sources (government announcements and healthcare professionals) were the most trusted information channels. Even a small risk of mild side effects significantly reduced vaccine acceptance and WTP. Participants were willing to pay up to US$39 more for vaccination at trusted public facilities. Preferences varied across subgroups, differing by age, living arrangement, and prior vaccination history.

Tailoring influenza vaccination services to older adults' stated preferences can enhance equity in low-resource settings. Providing vaccines at trusted community sites during convenient hours, alongside credible information and safety assurances, may substantially improve uptake among underserved older adults. These findings highlight the importance of preference-informed, context-specific service design for improving coverage in ageing, low-resource communities, with implications for similar settings globally.