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

Abstract

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.