Willingness and influencing factors of herpes zoster vaccination intention among Chinese residents: a study based on framing effects

Objective This study investigated how framing effects influence Chinese residents’ willingness to receive the herpes zoster vaccine. Methods Based on gain-loss framing theory, two versions of the questionnaire were developed: a gain-framed version (Questionnaire A) and a loss-framed version (Questionnaire B). Using convenience sampling, 1,184 participants were enrolled through online and offline channels. Statistical analyses included independent-samples t-tests, one-way analysis of variance (ANOVA), multivariate regression, propensity score matching (PSM), and partial least squares structural equation modeling (PLS-SEM). Results (1) Multivariate regression models showed high explanatory power, with adjusted R 2 values of 0.796 (gain-framed), 0.822 (loss-framed), and 0.800 (overall). These values should be interpreted with caution because attitude is conceptually close to vaccination intention. (2) Two chain mediation pathways showed significant indirect associations: framing → information credibility → attitude → vaccination intention (FR → IC → AT→IT) and framing → vaccine price acceptance → attitude → vaccination intention (FR → PC → AT→IT) (both p < 0.001), suggesting that framing was associated with attitude and intention through respondents’ perceived message credibility and price acceptance. (3) A significant framing × gender interaction was observed ( B = 0.446, p < 0.001). Stratified regression showed that loss-framed messages were associated with higher vaccination intention among males ( β = 0.341; p < 0.001), whereas no statistically significant framing effect was found among females ( p = 0.108). (4) A significant framing × herpes zoster (HZ) awareness interaction was also detected ( B = 0.313; p = 0.002), indicating that individuals who were aware of HZ responded more positively to loss-framed messages. (5) Monthly income ( β = 0.645; p < 0.001) and HZ awareness ( β = 0.110; p < 0.001) were identified as important independent predictors. Conclusion Framing effects on herpes zoster vaccination intention differed by gender and disease awareness. Gain-framed messages showed greater explanatory value in the full sample; however, loss-framed messages were associated with stronger vaccination intention among males and HZ-aware individuals, whereas no statistically significant framing effect was observed among females. The chain mediation pathways indicated statistically significant indirect associations among cognition, attitude, and behavioral intention, but did not confirm a psychological mechanism. Monthly income was identified as an important predictor of vaccination intention. These findings may provide a reference for developing more differentiated and targeted vaccine communication strategies.