E-health literacy and herpes zoster vaccination intention: Health belief pathways and socioeconomic inequalities.

BACKGROUND: Herpes zoster (HZ) poses a growing health burden, yet vaccine uptake remains low in China. Amid ongoing digital transformation, eHealth literacy has emerged as a key factor in vaccination decisions. This study aimed to examine its association with HZ vaccination intention through Health Belief Model (HBM) constructs, focusing on variations across socioeconomic status (SES).

METHODS: A cross-sectional survey was conducted among 2047 adults (18-59 years) in Shanghai from October to December 2022. Participants completed questionnaires assessing HZ vaccination intention, eHealth literacy, and HBM-related beliefs (perceived benefits, threat, barriers, and cues to action). SES was derived from education, income, and occupation using latent class analysis. Structural equation modelling was used to test direct and mediated pathways, with SES-stratified analyses.

RESULTS: Only 10.3% of participants reported vaccination intention. eHealth literacy was positively associated with perceived benefits (β = 0.331, P < 0.001) and threat perception (β = 0.239, P < 0.001), and negatively associated with perceived barriers (β = -0.051, P = 0.024). Vaccination intention was positively associated with perceived threat (β = 0.193, P < 0.001) and cues to action (β = 0.220, P < 0.001), and negatively with perceived barriers (β = -0.259, P < 0.001). Associations between eHealth literacy and HBM constructs were stronger among high-SES participants.

CONCLUSIONS: eHealth literacy is associated with HZ vaccination intention through multiple cognitive pathways, with distinct patterns across SES groups. Tailored strategies are needed to promote more equitable HZ vaccine uptake. High-SES groups may benefit from better online information, while external support is more crucial for disadvantaged groups.