# Assessing Knowledge, Attitudes, and Practices Towards Herpes Zoster and Vaccination in Japan Using the Capability-Opportunity-Motivation-Behavior Model: a Mixed-Methods Study

## TL;DR

This study explores public and physician knowledge, attitudes, and practices regarding herpes zoster and vaccination in Japan, identifying barriers and potential solutions.

## Contribution

The study applies the COM-B model to understand and address low HZ vaccination rates in Japan through mixed-methods research.

## Key findings

- Public awareness of HZ and vaccination is high, but knowledge and vaccination rates remain low.
- Physician recommendation significantly influences public vaccination intent, but is hindered by perceived patient unwillingness and cost.
- Government support could improve discussions and uptake of HZ vaccination.

## Abstract

To assess knowledge, attitudes, and practices (KAP) towards herpes zoster (HZ) and HZ vaccination in Japan.

This mixed-methods study was conducted across two phases. In Phase 1, concept elicitation interviews were conducted with the public (N = 24) and physicians (N = 6), and the Capability-Opportunity-Motivation-Behavior model of behavioral change was used to identify themes surrounding KAP. These themes were validated in Phase 2 via self-administered quantitative surveys conducted with a larger group of respondents (public: N = 600; physicians: N = 60).

Despite high awareness of HZ (92.9%–94.0%) and HZ vaccination (76.0%–80.4%) among the public, knowledge about HZ, HZ vaccination rates (13.1%–32.0%), and intention to vaccinate (12.6%–18.2% among non-HZ-vaccinated respondents) were low. Public respondents were likely to vaccinate against HZ upon physician recommendation (78.7%–84.0%), but physician recommendation was limited by barriers including perceived low patient willingness (51.7%) and vaccine cost (51.7%). Various forms of government support could encourage patient-physician discussions regarding HZ and aid HZ vaccination uptake among the public (30.0%–53.3%).

These findings may inform public health strategies to overcome barriers to HZ vaccine uptake in Japan.