Factors affecting parents’ willingness to pay for dengue vaccination for children in endemic areas, Indonesia: A multicenter crosssectional study

Abstract

Objective: To predict parents’ willingness to pay for dengue fever vaccination through the perception of dengue vaccine based on the Health Belief Model (HBM).

Methods: A multicenter crosssectional study was conducted on parents who had children aged ≤ 5 years and were participating in integrated health service post activities in 3 districts/cities with the highest incidence of dengue fever in Southeast Sulawesi. The instruments used to collect data in this study consisted of a participant characteristics questionnaire, a dengue vaccine perception questionnaire based on the HBM, and a willingness to pay for dengue vaccine questionnaire. Chi-square test and multivariate logistic regression analysis were used to determine the correlation between the perceived HBM subscales and willingness to pay for dengue vaccination.

Results: A total of 310 people participated in this study with an average age of (29.9±5.6) years. Most of them were females (284/310, 91.7%), 80.9% (251/310) had a high education status and 87.4% (271/310) had direct experience with DF. The results showed good perceptions including Perceived Susceptibility (adjusted OR 3.7, 95% CI 2.7-6.3, P<0.001), Perceived Severity (adjusted OR 2.8, 95% CI 1.7-5.5, P<0.001), Perceived Benefits (adjusted OR 2.8, 95% CI 1.7-4.5, P<0.001), and Cues to Action (adjusted OR 3.1, 95% CI 1.9-5.1, P<0.001) were positively correlated with willingness to pay for the dengue vaccine comparing with poor perceptions, whereas Perceived Barriers showed no significant effect on willingness to pay for the dengue vaccine.

Conclusions: These results suggest that a person’s willingness to pay for dengue vaccine increases with their understanding of the risks and advantages of immunization as well as encouraging outside incentives. As a result, these elements are crucial in raising community involvement in the immunization campaign.

Keywords

Helath Belief Model / Dengue / Dengue vaccine / Willingness to pay

References

[1] Mersha ADG, Van Der Sterren I, Van Leeuwen LPM, Langerak T, Hakim MS, Martina B, et al. The role of antibody-dependent enhancement in dengue vaccination. Trop Dis Travel Med Vaccines 2024; 10(1): 22.

[2] Sathees S, Amarasekara D, Jayasekara P, Rajapakse P, Sumaiya LF. Dengue fever presenting with cerebellitis: A case report. Asian Pac Trop J Med 2025; 18(1): 44-46.

[3] Bhattacharjee B, Patel H, Karad R, Teja V, Mondal A, Haldar SN, et al. Dengue hemorrhagic fever with rectus sheath hematoma: A case report. Asian Pac Trop J Med 2024; 17(3): 136-138.

[4] Hamed M. Knowledge, attitude, and practices toward dengue fever among the public: A cross-sectional study in the western region of Saudi Arabia. Front Public Health 2024; 12: 1327427.

[5] Bailey PG, Adams L, Wong JM, Poehling KA, Chen WH, McNally V, et al. Dengue vaccine: Recommendations of the advisory committee on immunization practices, United States, 2021. MMWR Recomm Rep 2021; 70(6): 1-16. doi: 10.15585/mmwr.rr7006a1.

[6] Santiago RC, Pérez-Guerra CL, Vélez-Agosto NM, Colón-Burgos C, Marrero-Santos KM, Partridge SK, et al. Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico. Hum Vaccin Immunother 2024; 20(1): 2323264. doi: 10.1080/21645515.2024.2323264.

[7] Editorial Board of EClinicalMedicine. Dengue as a growing global health concern. EClinicalMedicine 2024; 77: 102975. doi: 10.1016/j.eclinm.2024.102975.

[8] Salam MR, Apriyanti R, Midha Hayatin L, Sundari Dinata A. Faktor determinasi pengetahuan terhadap dengue vaccine: Cross-sectional study pada orang tua di Sulawesi Tenggara. HIJP 2024; 16(2): e1469. doi: 10.36990/hijp.v16i2.1469.

[9] Godói IP, Santos AS, Reis EA, Lemos LLP, Brandão CMR, Alvares J, et al. Consumer willingness to pay for dengue vaccine (CYD-TDV, Dengvaxia®) in Brazil: Implications for future pricing considerations. Front Pharmacol 2017; 8: 41. doi: 10.3389/fphar.2017.00041.

[10] Kabir KMA, Hagishima A, Tanimoto J. Hypothetical assessment of efficiency, willingness-to-accept and willingness-to-pay for dengue vaccine and treatment: A contingent valuation survey in Bangladesh. Hum Vaccin Immunother 2021; 17(3): 773-784.

[11] Tricou V, Yu D, Reynales H, Biswal S, Saez-Llorens X, Sirivichayakul C, et al. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Global Health 2024; 12(2): e257-e270.

[12] Jahromi AS, Jokar M, Abdous A, Sharifi N, Abbasi T, Rahmanian V. Global systematic review and meta-analysis of knowledge, attitudes, and practices towards dengue fever among the general population. Asian Pac Trop J Med 2024; 17(5): 191-207.

[13] Satari HI, Adilla SF. Dengue vaccine safety in children. Sari Pediatri 2019; 21(2): 129.

[14] Khon S, Seenprachawong U. The public demand for a dengue fever vaccine: A contingent valuation survey in Phnom Penh, Cambodia. Int J Econ Financ Issues 2020; 10(6): 129-138.

[15] Supadmi W, Perwitasari DA, Abdulah R, Suwantika AA. Knowledge, acceptance and willingness to pay for dengue vaccine in Yogyakarta and Jakarta. Epidemiol Biostat Public Health 2020; 17(2): 132-144.

[16] Shitu K, Wolde M, Handebo S, Kassie A. Acceptance and willingness to pay for COVID-19 vaccine among school teachers in Gondar City, Northwest Ethiopia. Trop Med Health 2021; 49(1): 63.

[17] Akintunde TY, Tassang AE, Okeke M, Isangha SO, Musa TH. Perceived vaccine efficacy, willingness to pay for COVID-19 vaccine and associated determinants among foreign migrants in China. Electron J Gen Med 2022; 19(3): em376. doi: 10.29333/ejgm/11920.

[18] Chew NWS, Cheong C, Kong G, Phua K, Ngiam JN, Tan BYQ, et al. An Asia-acific study on healthcare workers’ perceptions of, and willingness to receive, the COVID-19 vaccination. Int J Inf Dis 2021; 106: 52–60.

[19] Indraswari NLA, Wirawan DN, Kardiwinata , MP , Januraga PP. Willingness to pay for dengue vaccine among parents of elementary school students in Denpasar. Public Health Prev Med Arch 2021; 9(2): 120-125.

[20] Goruntla N, Chintamani SH, Bhanu P, Samyuktha S, Veerabhadrappa KV, Bhupalam P, et al. Predictors of acceptance and willingness to pay for the covid-19 vaccine in the general public of India: A health belief model approach. Asian Pac Trop J Med 2021; 14(4): 165-175.

[21] Churio BYT, Martínez-Vega RA, Rodriguez-Morales AJ, Díaz-Quijano RG, Luna-González ML, Diaz-Quijano FA. Determinants of felt demand for dengue vaccines in the North Caribbean region of Colombia. Ann Clin Microbiol Antimicrob 2017; 16(1): 38.

[22] Southeast Sulawesi Health Office. Southeast Sulawesi health profile 2022. Kendari: Southeast Sulawesi Provincial Health Office; 2023.

[23] Berger C, Ben-Shalom U, Tarant Z, Longo J, DeDonno M. The influence of the health belief model on the decision to get the COVID-19 vaccine: An international survey study of college students. Inquiry: J Health Care Organ Provision Financ 2023; 60: 1-12. doi: 10.1177/00469580231164229.

[24] Erawan MASP, Zaid Z, Pratondo K, Lestari AY. Predicting COVID-19 vaccination intention: The role of health belief model of muslim societies in Yogyakarta. Al-Sihah: Public Health Sci J 2021; 13(1): 36-50.

[25] Dewi RA, Sutawardana JH, Nistiandani A. Perception of COVID-19 vaccination based on health belief model and the acceptance of COVID-19 booster vaccination. Nurse Media J Nurs 2023; 13(1): 121-131.

[26] Seangpraw K, Pothisa T, Boonyathee S, Ong-Artborirak P, Tonchoy P, Kantow S, et al. Using the health belief model to predict vaccination intention among COVID-19 unvaccinated people in Thai communities. Front Med 2022; 9: 890503. doi: 10.3389/fmed.2022.890503.eCollection2022.

[27] Akinyemi PA, Owoade IA, Fajobi O, Wuraola FO, Elugbaju OT. Determinants of willingness to pay for COVID-19 vaccines among residents of Osun State, South-West Nigeria. J Com Med and PHC 2021; 33(2): 1-18. doi: 10.4314/jcmphc.v33i2.1.

[28] Palanca-Tan R. Willingness to pay for an annual vaccine in an endemic COVID-19 scenario: A contingent valuation study in Metro Manila, Philippines. Swiss J Econ Stat 2023; 159(1): 12. doi: https://doi.org/10.1186/s41937-023-00116-9.

[29] Wong LP, Alias H, Wong PF, Lee HY, AbuBakar S. The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Hum Vaccin Immunother 2020; 16(9): 2204-2214.

[30] Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health 2018; 2(3): 223-228.

[31] Fitrijaningsih F. Community acceptance of the COVID-19 vaccination based on health behavior theory (health belief model and theory of planned behavior). Muhammadiyah Int Public Health Med Proc 2021; 1(1): 763–774.

[32] Kuhfeldt KJ, Kaiser JL, Morgan AJ, Ngoma T, Hamer DH, Fink G, et al. Motivation, cues to action, and barriers to COVID-19 vaccine uptake: A qualitative application of the health belief model among women in rural Zambia. Am J Trop Med Hyg 2024; 111(5): 1118-1126.

[33] Li X, Yang L, Tian G, Feng B, Jia X, He Z, et al. Understanding influencing attributes of COVID-19 vaccine preference and willingness-to-pay among Chinese and American middle-aged and elderly adults: A discrete choice experiment and propensity score matching study. Front Public Health 2023; 11: 1067218.

[34] Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding covid-19 vaccine demand and hesitancy: A nationwide online survey in China. PLoS Negl Trop Dis 2020; 14(12): e0008961.

[35] Nugrahani RR, Budihastuti UR, Pamungakasari EP. Health belief model on the factors associated with the use of HPV vaccine for the prevention of cervical cancer among women in Kediri, East Java. J Epidemiol Public Health 2017; 2(1): 70–81.