Analysis of public awareness, attitudes, and determinants of non-National Immunization Program vaccines among adults in three provinces and one municipality of China

Objective To assess the public’s knowledge, attitudes, and influencing factors regarding non‑National Immunization Program (non‑NIP) vaccines in China, so as to provide scientific reference for enhancing public understanding of such vaccines.Methods A multi-stage mixed sampling method was employed to conduct a questionnaire survey among 4,000 permanent residents aged ≥18 years in three eastern, central, and western provinces/municipality (Shandong Province, Anhui Province, Gansu Province, and Shanghai Municipality). Data on demographic characteristics, vaccine-related knowledge, vaccination attitudes, and information acquisition channels were collected. Descriptive analysis, analysis of variance, and multivariable linear regression were applied for statistical analysis.Results A total of 4,105 valid questionnaires were obtained. Awareness scores were relatively higher for influenza vaccine, pneumococcal vaccine, and varicella vaccine (mean scores: 1.59, 1.37, and 1.30, respectively), and lower for rotavirus vaccine, pentavalent combined vaccine, and Hib vaccine (0.94, 0.89, and 0.87, respectively). Among core knowledge items, recognition of “disease prevention” scored highest (3.29 ± 1.02), whereas “adverse reactions” scored lowest (3.01 ± 1.09). Multivariable regression analysis indicated that residents in township areas had significantly higher knowledge scores than urban community residents (B = 0.066, P = 0.012); individuals trusting “Internet Key Opinion Leaders (KOLs)/celebrity blogs” scored significantly higher than those trusting “staff of vaccination clinics” (B = 0.512, P = 0.007), while those relying on “relatives and friends’ recommendations” and “non‑official media reports” had lower scores (B = −0.466 and −0.353, both P < 0.001). Attitudinally, the public generally recognized the preventive value of vaccines (e.g., “choosing vaccination based on disease severity” scored 3.73), but had concerns about safety (e.g., “minimize paid vaccines” scored 3.03).Conclusion Public knowledge of non‑NIP vaccines in China is generally low and uneven. Key influencing factors include information acquisition channels, residential environment, educational level, and occupation. Strengthening professional health education at the grassroots level and standardizing online information dissemination are essential to improve public scientific understanding and promote rational vaccination attitudes.