Vaccine · 2026
An integrated health belief model and protection motivation theory approach to understanding herpes zoster vaccination intention among older adults in China.
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Qu Shujuan, Zhou Min, Campy Kathryn S, Bu Pingyuan
Аннотация
OBJECTIVE: Herpes zoster (HZ) poses a significant public health burden among ageing populations. Despite the availability of a safe and effective recombinant zoster vaccine (RZV) in China since 2020, uptake remains suboptimal. This study integrates the Health Belief Model (HBM) and Protection Motivation Theory (PMT) to elucidate the psychosocial determinants of HZ vaccination intention among Chinese adults aged ≥50 years.
METHODS: A multicenter, cross-sectional survey was conducted across eight Chinese cities from September to December 2025. A total of 964 community-dwelling adults completed validated questionnaires measuring HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action), PMT appraisal processes (threat appraisal, coping appraisal, including response efficacy and self-efficacy), and vaccination intention. Data were analyzed using structural equation modeling and multi-group analysis to test hypothesized pathways and examine subgroup heterogeneity.
RESULTS: The integrated model explained 88.4% of the variance in vaccination intention. Threat appraisal (β = 0.497) was a stronger predictor than coping appraisal (β = 0.204). Perceived barriers exerted a significant direct negative effect on intention (β = -0.258). Key HBM constructs significantly influenced the PMT appraisal processes: perceived susceptibility and severity positively predicted threat appraisal, while perceived benefits, cues to action, response efficacy, and self-efficacy positively predicted coping appraisal. Multi-group analyses revealed significant moderation by education level and prior HZ history.
CONCLUSION: The integration of HBM and PMT provides a superior explanatory framework for HZ vaccination intention. The findings highlight the dominant role of threat appraisal in this context and the critical direct impact of practical barriers. The mechanisms are not universal but are moderated by demographic and experiential factors, underscoring the need for stratified, tailored intervention strategies to address vaccine hesitancy in an ageing population.
METHODS: A multicenter, cross-sectional survey was conducted across eight Chinese cities from September to December 2025. A total of 964 community-dwelling adults completed validated questionnaires measuring HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action), PMT appraisal processes (threat appraisal, coping appraisal, including response efficacy and self-efficacy), and vaccination intention. Data were analyzed using structural equation modeling and multi-group analysis to test hypothesized pathways and examine subgroup heterogeneity.
RESULTS: The integrated model explained 88.4% of the variance in vaccination intention. Threat appraisal (β = 0.497) was a stronger predictor than coping appraisal (β = 0.204). Perceived barriers exerted a significant direct negative effect on intention (β = -0.258). Key HBM constructs significantly influenced the PMT appraisal processes: perceived susceptibility and severity positively predicted threat appraisal, while perceived benefits, cues to action, response efficacy, and self-efficacy positively predicted coping appraisal. Multi-group analyses revealed significant moderation by education level and prior HZ history.
CONCLUSION: The integration of HBM and PMT provides a superior explanatory framework for HZ vaccination intention. The findings highlight the dominant role of threat appraisal in this context and the critical direct impact of practical barriers. The mechanisms are not universal but are moderated by demographic and experiential factors, underscoring the need for stratified, tailored intervention strategies to address vaccine hesitancy in an ageing population.