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Beyond autonomy: cultural habitus and social scaffolding in elderly vaccination in post-pandemic Hong Kong
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DOI：10.1057/s41599-026-08652-4.png)
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Abstract
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The COVID-19 pandemic reshaped vaccination behaviors, yet post-pandemic attitudes toward routine immunization among older adults remain underexplored in aging societies like Hong Kong. This study explores the impact and implications of the pandemic on influenza and pneumococcal vaccination among older adults, with a focus on behavioral, social, and cultural drivers of uptake. Guided by the Integrated Model for Behavioral Prediction (IMBP), the Critical Medical Anthropology (CMA) framework, and WHO’s Behavioral and Social Drivers of Vaccination (BeSD) tools, we conducted in-depth interviews with 22 elderly individuals and 4 service providers between March and July 2024. Thematic analysis identified multi-level influences shaping elderly vaccination behavior. We found that the pandemic heightened vaccination awareness among elderly adults in Hong Kong, yet awareness of pneumococcal vaccines remained comparatively low. Despite a strong emphasis on personal autonomy in vaccination decisions, older adults often relied on family assistance, peer encouragement, and organizational outreach—collectively forming a “social scaffolding” that helps older adults navigate vaccination barriers and build vaccine confidence. Cultural habitus acted as a powerful motivator for elderly vaccination. “No jab, no dim sum”—many elderly individuals opted for vaccination to maintain their social and cultural habits under the Vaccine Pass policy amid the pandemic. However, tensions between autonomy and perceived social norms raised concerns about the long-term sustainability of routine vaccination programs beyond the pandemic. Additionally, practical barriers persist, including digital exclusion, complex eligibility criteria, and fragmented data management, which may further hinder vaccine uptake among older adults. The study highlights the dynamic interplay of autonomy, social scaffolding, and cultural habitus in shaping elderly vaccination behaviors in Hong Kong. To enhance future vaccine uptake, strategies should move beyond addressing individual-level behavioral barriers and integrate culturally sensitive, community-anchored approaches.
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