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Influenza vaccination is an evidence-based intervention for older adults. However, vaccination coverage remains low and uneven in China, indicating persistent evidence-practice gap. Although older adults often express willingness to be vaccinated, uptake often varies across different implementation contexts. Therefore, we explored how implementation determinants govern vaccination uptake.

We conducted a comparative qualitative study using semi-structured interviews with older adults in Beijing and Guizhou. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR), and data were analyzed thematically and mapped to CFIR domains to compare determinants across sites.

Seventy-six participants were enrolled, including 40 from Beijing and 36 from Guizhou. Across both locations, many participants expressed willingness to be vaccinated but did not always follow through, reflecting an intention-uptake gap. Determinants in the Outer Setting and Process/Inner Setting domains were most significant in shaping vaccination uptake. Trusted communication and institutional triggers, including clinician recommendations and community reminders, facilitated vaccination uptake in Beijing. These cues were less available in Guizhou, where fragmented information contributed to delays and non-uptake.

Implementation strategies should make influenza vaccination a more routine and system-supported component of healthy aging services. This requires stronger service delivery systems and standardized communication.