Understanding medical students' practices and perceptions towards vaccination in China: A qualitative study in a medical university.

The qualitative study aims to understand and conceptualize Chinese medical students' practices and perceptions towards vaccination. Focus groups (n = 5) were conducted through convenience sampling in a medical university in October 2016 in Anhui, China. Two years later, 6 participants among them were follow-up interviewed. All the interviews were audio-recorded, then transcribed verbatim, and analyzed using constant comparative method. Opinions of 22 participants (13 females, 9 males) were collected. Results revealed that hepatitis B vaccination was discussed the most frequently, and most of participants were vaccinated against (or had documented immunity to) hepatitis B before or during their clinical internship. None of the participants reported other vaccines uptake. Three dimensions of themes were identified: (i) at individual level, the factor "feeling less infection risk" might strengthen their perceived barriers. The factors "laziness" and "fluke mind" would be used to rationalize their inactive practices about vaccination; (ii) at social level, themes involved "inactive organizational behaviors", "suggestions from people around", and "social norms". Decision-making of medical students' vaccination was more relying on themselves and influenced more by their classmates before or during their internship, rather than being influenced more by their families/universities as before. (iii) at professional level, there are two contradictions about the participants' behaviors and attitudes. One is that they may have inappropriate behaviors because of their lack of knowledge, but sometimes they seem too satisfied about their medical knowledge to vaccination. The other is that there are both vigilance response and desensitization to occupational infection risk. It is suggested that efforts should be strengthened to spread scientific knowledge of infectious diseases and immunization as long as medical students enter the university. Publicity and organizational activities should be strengthened, and related researches should be carried out by the government or scholars.