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

Objectives To assess knowledge, attitudes, and practices (KAP) towards herpes zoster (HZ) and HZ vaccination in Japan. Methods 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). Results 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%). Conclusion These findings may inform public health strategies to overcome barriers to HZ vaccine uptake in Japan.