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

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 (beta) = 0.082, P= 0.036], perceived susceptibility [beta = 0.214, P<0.001], and cues to action [beta = 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 [beta = -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.