Abstract
INTRODUCTION: Hepatitis B virus (HBV) infection remains a significant global health threat, with over 296 million individuals living with chronic HBV and more than 820,000 annual deaths due to related complications. Healthcare workers (HCWs) are at heightened risk due to occupational exposure, especially in sub-Saharan Africa, where HBV prevalence and health system limitations compound their vulnerability. Despite the availability of an effective vaccine, adherence to the three-dose HBV vaccination schedule among HCWs in Nigeria remains suboptimal. This study seeks to explore the psychosocial and digital factors influencing non-adherence to the HBV vaccination schedule among HCWs in Nigeria, with the aim of informing more targeted and effective interventions. METHODOLOGY: A cross-sectional survey was conducted among 530 healthcare workers at FMC Keffi to assess Hepatitis B vaccine uptake and its determinants. Data were collected using a structured, pre-validated questionnaire covering vaccination status, knowledge, attitudes, barriers, and digital access. Statistical analyses included descriptive statistics, Chi-square tests, binary logistic regression, mediation (PROCESS Model 4), and moderation analyses. These methods evaluated the direct and indirect effects of knowledge, attitudes, occupational exposure, and digital intervention beliefs on vaccine adherence, with gender assessed as a moderating variable. RESULTS AND DISCUSSION: Among 530 healthcare workers at FMC Keffi, only 19.4% were fully vaccinated against Hepatitis B, while 72.6% had received at least two doses. Mediation analysis showed that knowledge had no significant direct or indirect effect on vaccine uptake (p = 0.21), whereas attitude was a strong predictor (B = - 9.85, p < 0.001). Occupational exposure significantly influenced adherence (χ2 = 33.00, p < 0.001), as none of the unexposed were fully vaccinated. Gender moderated the attitude-uptake link, with females showing stronger associations. Digital access remained low, limiting the effectiveness of digital intervention strategies. CONCLUSION: This study concludes that HBV vaccine adherence among healthcare workers is influenced more by attitudinal factors, occupational exposure, and gender dynamics than by knowledge alone. Digital intervention strategies remain underutilized due to limited access. To improve vaccine uptake, health systems must adopt multifaceted approaches that prioritize behavioral insights, gender sensitivity, and equitable access to digital health resources.