Introduction Preschool children experience high influenza infection rates and play a key role in transmission, yet vaccination coverage in China remains suboptimal.Theory Based on the Knowledge–Attitude–Belief–Practice model and the WHO 3Cs model, the influenza vaccine–related knowledge may influence vaccination decisions indirectly by shaping confidence and reducing complacency.Method This cross-sectional study was conducted in Wuhan in September 2024 using a multistage, kindergarten-based random sampling approach. Four kindergarten schools were included, with approximately 410 parents sampled from each, yielding 1,336 valid responses (response rate: 81.5%). The questionnaire assessed influenza-related, vaccine-related knowledge, attitudes (confidence and complacency), vaccination willingness for their children. The generalized structural equation model (GSEM) with 1,000 bootstrap samples assessed the direct effect of vaccine-related knowledge on parental vaccination willingness and its indirect effects via confidence and complacency.Results The mean age of the parents was 33.78 years, and 79.5% were female. 60.2% of parents were willing to vaccinate their children against influenza. Vaccine-related knowledge was significantly associated with parents’ willingness to vaccinate their children (adjusted odds ratio aOR = 1.125, 95% confidence interval CI: 1.063–1.190, p < 0.001). This association was partially mediated through confidence (indirect effect proportion: 45.3%, p < 0.001) and complacency (24.1%, p < 0.001). A statistically significant direct effect remained (aOR = 1.084, 95% CI: 1.025–1.146, p = 0.005), accounting for 30.6% of the total effect.Discussion Vaccine-related knowledge, rather than influenza-related knowledge, may be influential in shaping vaccination intention. Public health strategies could shift toward prioritizing vaccine-specific knowledge, while integrating informational and attitudinal components.
Wu et al. (2026) studied this question.