The relationship between perceptions and self-paid hepatitis B vaccination: A structural equation modeling approach

Abstract

BackgroundMalaysia has a comprehensive, publicly-funded immunization program for hepatitis B (HepB) among infants, but adults must pay for the vaccine. The number of HepB carriers among adults is expected to increase in the future; therefore, we examined the impact of five constructs (cues to action, perceived barriers, perceived benefit, perceived severity, and perceived susceptibility) on adults’ willingness to pay (WTP) for HepB vaccine; secondarily, we examined the association between perceived barriers and perceived benefits.MethodsAdults were selected through a stratified, two-stage cluster community sample in Selangor, Malaysia. The reliability, convergent validity, and discriminant validity of the measurement model were assessed before implementing a partial least squares structural equation model (PLS-SEM) to evaluate the significance of the structural paths.ResultsA total of 728 participants were enrolled. The five constructs all showed adequate internal reliability, convergent validity, and discriminant validity. There was a significant, positive relationship to WTP from constructs (perceived barriers [Path coefficient (β) = 0.082, P = 0.036], perceived susceptibility [β = 0.214, P<0.001], and cues to action [β = 0.166, P<0.001]), and the model all together accounted for 8.8% of the variation in WTP. There was a significant, negative relationship between perceived barriers and perceived benefit [β = -0.261, P<0.001], which accounted for 6.8% of variation in perceived benefit.ConclusionsPolicy and programs should be targeted that can modify individuals’ thoughts about disease risk, their obstacles in obtaining the preventive action, and their readiness to obtain a vaccine. Such programs include educational materials about disease risk and clinic visits that can pair HepB screening and vaccination.

Acceptance of a COVID-19 Vaccine in Southeast Asia: A Cross-Sectional Study in Indonesia

“…One important finding is that those who had a higher perceived risk to be infected with COVID-19 were more likely to accept the vaccine, but only for the 95% effective vaccine. Previous studies in Asia have found that perceived risk or perceived susceptibility to an infection is associated with positive support for vaccination (29,30,39). Another study also found that high perceived risk was associated with COVID-19 vaccine acceptance among general community members in Saudi Arabia (40) and among HCWs in China (41).…”

“…In the region of southeast Asia, studies have been conducted to assess the acceptance of a vaccine against infectious diseases (21)(22)(23)(24)(25)(26)34). This present study was conducted to understand how the COVID-19 vaccine, when available, will be accepted by the general population in Indonesia, by asking individuals about a hypothetical vaccine-an approach used in many past studies (21,26,(28)(29)(30). Understanding vaccine acceptance in Indonesia is important, given the large population and because the country has relatively high vaccine hesitancy for existing vaccines and relatively low vaccination coverage (18,19).…”

“…Currently no COVID-19 vaccine is available and therefore we framed the study questions around a hypothetical vaccine, in an approach that was similar to previous studies (21,26,(28)(29)(30). Due to limitations in doing face-to-face research during the current active COVID-19 outbreak in Indonesia, we did an online crosssectional study between March 25 and April 6, 2020.…”

Risk behaviours related to hepatitis B virus infection among adults in Malaysia: A cross-sectional household survey

“…This study was part of the Malaysian Hepatitis B Project. [45][46][47] Selangor was chosen because it is the most populated state in Malaysia and has the highest number of households (Department of Statistic Malaysia, 2015). The protocol used in this study was approved by Universiti Putra Malaysia, Selangor, Malaysia.…”

“…Based on the conservative assumption that 50% of participants would be at high risk for HepB, a 5% margin of error with a confidence interval of 95% and Selangor's population of 5.79 million people, 48 385 respondents were required for this study. However, because this study was part of Malaysian Hepatitis B Project [45][46][47] whose main objective was to assess the willingness-to-pay (WTP) for HepB vaccine, 45 the sample size was calculated to answer the main project's objective. Based on a formula from the literature, 49 the minimum sample size required was 683.…”