ArticleJMIR public health and surveillance2026
Mediation Analysis of the Relationship Between Health Literacy and the French General Population's Opinions on Hepatitis B Vaccination: Representative Cross-Sectional Survey of the SLAVACO Project.
Article in JMIR public health and surveillance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn France, reluctance toward hepatitis B vaccination remains high, despite the availability of a safe and effective vaccine to prevent this infection. To boost vaccination coverage, it is therefore essential to identify the factors that are likely to encourage a more favorable opinion of this vaccine. Health literacy (HL) is one such factor. It refers to the individual ability to access, understand, critically appraise, and apply health information to make informed decisions about health issues for oneself and for others.
objectiveThis study explored the mechanisms through which HL might affect opinions about hepatitis B vaccination, both directly and indirectly, by relevant factors, including opinions about vaccination in general, trust in government health agencies, and trust in medical doctors.
methodsThe analysis used data from the SLAVACO-Wave 3 (Suivi Longitudinal des Attitudes à l'Égard d'un Vaccin Contre la COVID-19) survey, conducted in December 2021 among a representative sample of French adults (N=1932). Favorable and unfavorable opinions of hepatitis B vaccination were measured using a 5-point Likert scale, while HL was assessed using the HLS
resultsFindings showed that individuals with a favorable opinion of hepatitis B vaccination (1437/1932, 74.4%) had a higher HL level than those with a negative or neutral opinion (62.6 vs 57.0, P<.001). The association between HL and hepatitis B vaccination opinions was fully mediated by trust in the health care system. The indirect effect of HL was estimated at 0.068 (95% CI 0.042-0.093), accounting for 52.4% (0.068/0.1297) of the total effect. This effect was particularly pronounced in people over 50 years (0.084, 95% CI 0.042-0.126, accounting for 0.084/0.1306, 64.3% of the total effect). Goodness-of-fit indicators were satisfactory.
conclusionsEnhancing HL might positively influence hepatitis B vaccination opinions and uptake through greater trust in the health care system. From a public health perspective, strategies should go beyond providing clear information and access to vaccines and actively work to strengthen trust in health care institutions and professionals. National campaigns correcting misconceptions about hepatitis B vaccination could be complemented by targeted interventions for groups most likely to hold negative opinions. Repeating this survey in the post-COVID-19 context could also reveal different trends, given evolving public perceptions of vaccines and health authorities.
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