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

• Main Authors: Rajamoorthy, Yogambigai, Radam, Alias, Mohd Taib, Niazlin, Ab Rahim, Khalid, Wagner, Abram Luther, Mudatsir, Mudatsir, Munusamy, Subramaniam, Harapan, Harapan
• Format: Article
• Language: English
• Published: Public Library of Science 2018
• Online Access: http://psasir.upm.edu.my/id/eprint/74261/1/The%20relationship%20between%20perceptions%20and%20self-paid%20hepatitis%20B%20vaccination.pdf; http://psasir.upm.edu.my/id/eprint/74261/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283584/pdf/pone.0208402.pdf

Background: Malaysia 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. Methods: Adults 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. Results: A 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. Conclusions: Policy 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.