Parental Decision-Making for Themselves and Their Children in a Metropolis of China: Comparing Influenza and Rotavirus Vaccination Under the Behavioral and Social Drivers Framework

Background: Parents serve as the primary decision-makers for childhood vaccination while also making decisions regarding their own vaccination, yet vaccination decision drivers are typically studied separately by vaccine type or target population. Methods: This study investigated parental decision-making processes for two self-paid and non-National Immunization Program vaccines in China, childhood rotavirus vaccine and adult influenza vaccine, by utilizing a structured survey grounded in the World Health Organization Behavioral and Social Drivers of Vaccination framework. Spearman’s rank correlation coefficients were used to assess the consistency of parental attitudes toward the two vaccines across behavioral and social driver domains. Structural equation models were conducted separately for childhood and adult vaccines to examine decision-making pathways. Results: The findings indicated that parental drivers related to awareness, social processes, and practical issues showed a high consistency across adult and childhood vaccination decisions (r > 0.7), whereas the consistency in vaccination behaviors remained low (r = 0.21). Compared with adult vaccination, childhood vaccination decisions were more strongly influenced by vaccine safety concerns and healthcare practitioners’ recommendations, which emerged as key drivers. Furthermore, family norms emerged as an effectively shared driver of vaccination decisions for both adult and childhood vaccines (adult: β = 0.784; childhood: β = 0.970). Conclusions: By jointly synthesizing adult and childhood vaccination decisions from a parental perspective, this study provides crucial evidence to support the development of integrated, family-centered strategies to improve vaccine uptake.