Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 16, 2025
Date Accepted: Oct 27, 2025
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
ABSTRACT
Background:
To boost hepatitis B vaccination coverage in France, identifying factors likely to encourage a favourable opinion of this vaccine is essential. Health literacy (HL) 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.
Objective:
This study explored the pathways 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.
Methods:
The analysis used data from the SLAVACO-Wave 3 survey, conducted in December 2021 among a representative sample of French adults. Favourable and unfavourable opinions of hepatitis B vaccination were measured using a 5-point Likert scale, while HL was assessed using the HLS19-Q12 questionnaire. A structural equation model examined the relationship between HL and hepatitis B vaccination opinions, taking into account the potential mediating role of trust in the healthcare system (i.e., government health agencies and medical doctors).
Results:
Findings showed that individuals with a favourable opinion of hepatitis B vaccination (74.4%) had a higher HL level than those with a negative/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 healthcare system. The indirect effect of HL was estimated at 0.072 (CI95% [0.046-0.099]), accounting for 56.5% of the total effect. This effect was particularly pronounced in people over 50 (0.085 [0.042-0.129], accounting for 72.2% of the total effect). Goodness-of-fit indicators were satisfactory.
Conclusions:
Enhancing HL might positively influence hepatitis B vaccination opinions and uptake through greater trust in the healthcare system.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.