Community perspectives on hepatitis B transmission and vaccination among adults in Northwest Ethiopia: a qualitative study

Abstract

Background: Hepatitis B virus (HBV) infection remains a major public health problem in sub-Saharan Africa, including Ethiopia, where adult vaccination uptake is limited. While quantitative studies have assessed knowledge and attitudes, little is known about how culturally embedded beliefs shape community perceptions of HBV transmission and vaccination. Objectives: This study explored adult community perspectives on HBV transmission and vaccination in Northwest Ethiopia. Design: A qualitative study using conventional content analysis. Methods: The study was conducted in Debre Tabor between December 2025 and February 2026. Data were collected through 20 in-depth interviews and six focus group discussions involving 68 adults selected through purposive sampling. Interviews were conducted in Amharic, audio-recorded, transcribed verbatim, translated into English, and analyzed inductively using Open Code software. Trustworthiness was ensured through independent coding, member checking, and reflexive documentation. Results: Three major themes emerged: (1) fragmented knowledge and moral framing of risk, (2) coexistence of biomedical and cultural explanatory models, and (3) the vaccine paradox-acknowledged benefits amid persistent barriers. A dominant culturally embedded belief attributed HBV to bat exposure (“wof zura”), often reducing the perceived relevance of vaccination. Although participants recognized disease severity, perceived personal susceptibility was low and frequently linked to moral behavior. Structural barriers including limited awareness of adult vaccination, cost concerns, and uncertainty about service availability further constrained uptake. Healthcare provider recommendation and community-based health education were identified as key facilitators. Conclusion: HBV vaccination decisions among adults are shaped by culturally grounded explanatory beliefs, low perceived susceptibility, and structural barriers. Context-sensitive health education and strengthened provider-initiated recommendations are critical for improving adult HBV vaccine uptake, thereby contributing to the global goal of eliminating viral hepatitis as a public health threat by 2030.