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.