The role of socioeconomic status and attitude in the association between herpes zoster knowledge and practice among residents in China: A moderated mediation model.

BACKGROUND: Attitudes play a mediating role in the relationship between knowledge of herpes zoster and health practices. Populations with different socioeconomic statuses (SES) show disparities in the knowledge, attitudes, and practices. This study aimed to test the mediating role of attitudes, and to explore the moderating effect of SES. RESEARCH DESIGN AND METHODS: The participants completed questionnaires to collect data in respect of socio-demographic characteristics, knowledge about herpes zoster, attitudes, and practices. Structural equation modeling (SEM) and moderated mediation analyses were used in this study. RESULTS: The awareness rate of herpes zoster was 60.17%, the total awareness rate was 31.73%, the positive attitudes rate was 38.19%, the practice intention rate was 77.82%. The SEM results indicated that knowledge of herpes zoster significantly and positively predicted attitudes toward the disease (β = 0.72, 95%CI: 0.68-0.74), which in turn significantly and positively predicted practices (β = 0.19, 95%CI: 0.15-0.24). In the moderated mediation analysis, SES moderated both the path from knowledge to attitudes (β = 0.07, P < 0.001) and the path from attitudes to practices (β = -0.02, P < 0.001). The predictive effect of knowledge on attitudes was stronger among high SES residents (βsimple = 1.09) than among low SES residents (βsimple = 0.89), whereas the predictive effect of attitudes on practices was weaker among high SES residents (βsimple = 0.06) than among low SES residents (βsimple = 0.11). The mediating effect was weaker among residents with high SES than among those with low SES (Effect = -0.033, 95%CI: -0.059--0.009). CONCLUSIONS: The overall KAP regarding herpes zoster among residents in Qingdao was acceptable, but specific disease knowledge was insufficient. SES moderated the mediating effect of attitudes on the relationship between knowledge and practices. These findings can inform local herpes zoster prevention strategies.