# Addressing Gaps in Knowledge, Attitudes, and Practices in Thailand for Integrating Vaccines into a Comprehensive Dengue Management and Control Programme

## TL;DR

This study explores how knowledge, attitudes, and practices in Thailand affect dengue vaccine acceptance, aiming to improve vaccination rates and control efforts.

## Contribution

The study is one of the first in Thailand to combine the KAP and COM-B frameworks to identify behavioral and motivational factors influencing dengue vaccine uptake.

## Key findings

- 68% of respondents showed high willingness to vaccinate against dengue.
- Vaccine hesitancy is primarily driven by concerns about side effects and cost.
- Willingness to vaccinate is positively associated with reflective motivation and physical opportunity.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Dengue continues to place a substantial clinical and economic burden on Thailand, yet gaps in knowledge, prevention practices and vaccine awareness hinder effective dengue control.Understanding behavioural drivers of dengue vaccine acceptance provides critical insight into population-level barriers that limit the success of national prevention and immunisation programmes.

Dengue continues to place a substantial clinical and economic burden on Thailand, yet gaps in knowledge, prevention practices and vaccine awareness hinder effective dengue control.

Understanding behavioural drivers of dengue vaccine acceptance provides critical insight into population-level barriers that limit the success of national prevention and immunisation programmes.

Public health significance—Why is this work of significance to public health?
This is one of the first studies in Thailand to integrate both the KAP and COM-B frameworks to identify the behavioural, environmental and motivational determinants influencing dengue prevention and vaccine uptake.Findings highlight specific, measurable motivational factors, as well as safety and cost concerns, which directly affect willingness to vaccinate and can impede nationwide dengue control strategies.

This is one of the first studies in Thailand to integrate both the KAP and COM-B frameworks to identify the behavioural, environmental and motivational determinants influencing dengue prevention and vaccine uptake.

Findings highlight specific, measurable motivational factors, as well as safety and cost concerns, which directly affect willingness to vaccinate and can impede nationwide dengue control strategies.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health
Strengthening public communication on vaccine safety, improving accessibility through primary care, schools and workplaces, and empowering healthcare providers to address hesitancy can substantially increase vaccine willingness.Policymakers should integrate dengue vaccination into multi-pronged prevention efforts, combining education, vector control, and convenient delivery models, to support equitable access and build a sustainable national dengue management strategy.

Strengthening public communication on vaccine safety, improving accessibility through primary care, schools and workplaces, and empowering healthcare providers to address hesitancy can substantially increase vaccine willingness.

Policymakers should integrate dengue vaccination into multi-pronged prevention efforts, combining education, vector control, and convenient delivery models, to support equitable access and build a sustainable national dengue management strategy.

Dengue remains a significant health burden in Thailand, with over 160,000 cases reported in 2023. Although two dengue vaccines are approved, uptake remains limited. This study assessed Knowledge, Attitudes, and Practices (KAP) toward dengue and behavioural drivers of vaccine willingness using the Capability, Opportunity, Motivation–Behaviour (COM-B) framework, which posits that health behaviours arise from capability (knowledge/skills), opportunity (environmental/social enablers), and motivation (beliefs/drivers). A cross-sectional online survey was conducted in September 2024 among 600 Thai adults aged 20–60 years. The questionnaire, adapted from the GEMKAP study, generated composite KAP and COM-B scores (0–100%). Willingness to vaccinate was measured on a 0–10 Juster scale, with multivariable regression identifying behavioural predictors. Of 600 respondents, 40% were male, with a median age of 40 years, and 23% were in high-dengue-burden areas. Knowledge scores were moderate (51%), and dengue prevention practices were low (40%). The proportion of respondents with high willingness to vaccinate (score 8–10) was 68%, which was positively associated with Reflective Motivation and Physical Opportunity. Hesitancy centred on vaccine side effects (29%) and cost concerns (13%). These findings suggest that despite generally favourable attitudes, vaccine uptake is hindered by safety, cost, and awareness gaps. Physician communication and the integration of vaccines into schools, workplaces, and primary care, along with education and vector control, are key for sustainable national coverage.