5C psychological antecedents of vaccine hesitancy toward maternal RSV vaccines and infant monoclonal antibodies among pregnant and postpartum women and their partners in China: A multicenter, dyadic survey design, cross-sectional study

Abstract

We assessed vaccine hesitancy toward two novel respiratory syncytial virus (RSV) immunization strategies, maternal vaccines and infant monoclonal antibodies (mAbs), among 4422 couples across eight Chinese provinces, via a multicenter cross-sectional survey with convenience sampling from medical institutions. Vaccine hesitancy was measured using the 5C scale (confidence, complacency, constraints, calculation, collective responsibility), with total scores (higher indicating lower hesitancy) as the primary outcome. Linear mixed-effects models analyzed sociodemographic and pregnancy-related factors. Women had marginally lower total 5C scores than partners for maternal vaccines (45.88 [SD 5.90] vs. 46.25 [5.74]; Cohen’s d = –0.06, 95% CI: −0.09 to −0.03; p < .001), with no significant difference for mAbs. For both strategies, calculation scored highest in both sexes. Within-couple correlations across domains for the same strategy were low (r ranged from 0.31 to 0.48). In multivariable models, older age, rural residence and lower income were associated with greater hesitancy for both strategies (e.g. age: maternal vaccines, β = −0.09, 95% CI: −0.12 to −0.05; mAbs, β = −0.09, 95% CI: −0.12 to −0.06). Among women, third-trimester status and prior children were each independently associated with higher hesitancy. Prior influenza vaccination during pregnancy was associated with lower hesitancy toward maternal vaccines (β = 0.73, 95% CI: 0.32 to 1.13) but not mAbs. Ultimately, Chinese expectant and new parents show a hesitancy profile toward RSV immunization strategies dominated by active information-seeking. Prenatal counseling and broader communication efforts should include both parents. Efforts should prioritize older, rural, and lower-income couples.