A Comprehensive Evaluation of Hepatitis B Awareness, Knowledge Gaps, Health‐Seeking Behaviour, Risk Perceptions, and Vaccination Status Among University Students in Bangladesh: A Cross‐Sectional Study

ABSTRACT

Background

Hepatitis B virus (HBV) infection is a significant public health problem globally. In Bangladesh, viral hepatitis is the most common liver disease, with approximately 10 million people infected with HBV.

Methods

The study was a cross‐sectional survey in which 440 respondents were randomly selected using Cochran's formula. The duration of the study was about 6 month (24th August 2024 to 28th February 2025). Data was gathered using a predesigned and structured questionnaire, which was distributed among the students. The collected data were then analysed utilizing Microsoft Excel 2016 and Stata 17 software for statistical processing and interpretation.

Results

Overall, the study found that respondents had a high level of awareness of hepatitis B, with most participants recognizing the disease and its major transmission routes and health consequences. Vaccine‐related knowledge was moderate, whereas hepatitis B vaccination uptake remained relatively low among the respondents and their family members. The mean (±SD) awareness, vaccine knowledge, and perception scores were 37.18 ± 11.16, 25.00 ± 10.88, and 22.38 ± 4.71 (each measured on a 50‐point scale), respectively. Multivariable logistic regression analysis showed that male participants were more likely to be vaccinated against hepatitis B than female participants (aOR = 1.74, 95% CI: 1.14–2.67). Participants with low awareness also had higher odds of being vaccinated than those with high awareness (aOR = 2.17, 95% CI: 1.09–4.36), while no significant association was observed for moderate awareness.

Conclusion

Less than half of the respondents had received the hepatitis B vaccine, with the most common reason for non‐vaccination being a lack of awareness of their vaccination status. Slightly over half of the respondents demonstrated satisfactory knowledge, attitudes, and practices regarding hepatitis B. These findings underscore the need for targeted education on hepatitis B infection, its risk factors, and the importance of vaccination among students in Bangladesh.

1. Introduction

Hepatitis B is a hepatic infection induced by a blood‐borne virus that is widespread globally [1]. In the healthcare context, hepatitis B (HB) is regarded as a significant global public health problem, as it is a potentially lethal viral infection caused by the hepatitis B virus (HBV) [2]. This virus can be readily spread between infected individuals, mostly by perinatal transmission (from mother to child at birth) or horizontal transmission (exposure to infected blood), unsafe sexual contact, and intravenous drug use [3, 4, 5, 6]. WHO estimates that 240 million people were living with chronic hepatitis B infection in 2024, with 0.9 million new infections each year and resulted in an estimated 1.1 million deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer) [7]. It is believed that over two billion individuals worldwide have been acutely infected with HBV, with around 350 million suffering from chronic infection [3]. Completion of the recommended hepatitis B vaccination series provides approximately 98%–100% protection against HBV infection [8]. For the best protection, the vaccine should be given three times, once now, and once again in 1 month and in 6 to 12 months [9]. Infection with the hepatitis B virus (HBV) is a significant public health issue worldwide, especially in Bangladesh. Viral hepatitis is the most frequent liver disease in Bangladesh. According to the National Strategic Plan for Viral Hepatitis 2020–2030, the estimated prevalence of hepatitis B virus infection in Bangladesh is approximately 5.4%, placing the country within the intermediate‐prevalence category, although the burden varies across geographic areas and population groups. The broader estimate of more than 10 million people living with viral hepatitis in Bangladesh includes different forms of viral hepatitis and should not be interpreted as the number of HBV infections alone [10]. Bangladesh has an intermediate chronic HBV prevalence estimated at 2%–6%, however, epidemiology may vary between geographic locations and socio‐demographic factors [11]. Bangladesh introduced hepatitis B vaccination into the Expanded Programme on Immunization in 2003 and achieved nationwide implementation by 2005; it is now administered through the pentavalent infant‐vaccination schedule. According to the latest WHO–UNICEF estimate, coverage with the third hepatitis B‐containing vaccine dose was approximately 92% in 2025. The National Strategic Plan for Viral Hepatitis 2020–2030 further prioritizes timely birth‐dose vaccination, prevention of mother‐to‐child transmission, vaccination of healthcare workers and other high‐risk groups, blood and injection safety, surveillance, screening, linkage to care, and treatment. However, high childhood coverage may not ensure adequate protection among older university students with uncertain or incomplete vaccination histories [12, 13]. Among Bangladeshi healthcare workers, hepatitis B vaccination coverage was 66.6% in a 2020–21 multicenter study across 11 hospitals [14]. It is crucial for individuals to understand the basics of hepatitis B and determine their HBV status. A positive test can pose significant risks to the individual, their family, and society. University students must be knowledgeable about hepatitis B and take necessary procedures to avoid its spread. This study aimed to analyse hepatitis B knowledge and vaccination status among students of Gopalganj Science and Technology University. The participants of this study were undergraduate general student. The median knowledge, attitude, and practice (KAP) scores were 54 (50–60), 19 (17–21), and 20 (19–23) accordingly, with a modestly favourable correlation. A total of 46 students (25.98%) achieved a high KAP score (≥ 102) [15]. There were no additional selection criteria. From April 28 to May 4, 2024, pre‐clinical medical students in Bangladesh participated in a web‐based, single‐centre, descriptive cross‐sectional study. Sixty‐one (34%) pupils were vaccinated against hepatitis B, with 18% receiving all three doses plus a booster dose. The most common reason for non‐vaccination was lack of awareness of vaccination status (43%). The findings revealed that about one‐third (37.9%) of the 807 participants had been vaccinated against hepatitis B, with an overall mean knowledge score of 11.506 ± 5.403, and mean scores for attitude and practice of 5.435 ± 1.038 and 4.252 ± 1.776, respectively [16]. From January to April 2023, a cross‐sectional survey was done with 737 nursing students from the nursing schools of Khulna and Barisal divisions in Bangladesh. The mean scores for knowledge, attitude, and practice were 11.42 (±2.88), 4.33 (±1.91), and 4.27 (±2.056), respectively [17]. A questionnaire‐based poll was done with 500 college students in the city of Dhaka, Bangladesh. In the study, 89% of the people who answered said they had heard of hepatitis B, and 55% of them were female. Among people who knew about hepatitis B, 30% said that blood transfusion was a way the virus could spread, 20% and 17% said mother‐to‐baby and sharing needles and syringes, respectively, 15% said that having sex without protection could spread the virus, and the rest said nothing about it [18]. A cross‐sectional study conducted among 90 adult patients at a community‐based medical college hospital in Bangladesh between July 2022 and June 2023 reported that 44.4% identified blood as a route of HBV transmission, whereas 22.2% incorrectly believed that HBV could be transmitted through water [19]. A cross‐sectional study conducted among 120 nurses in Bangladesh reported that 25.0% had good knowledge, 43.3% demonstrated a favourable attitude, and 56.7% reported good preventive practices regarding HBV [20]. On the other hand, nurses have an information rate of 30.0%, an attitude rate of 30.8%, and a practice rate of 29.2%, that are all bad concerning HBV. Among 662 international students at Universiti Putra Malaysia, the response rate was 71.49%; 50.3% demonstrated better knowledge of hepatitis B, 52.7% demonstrated better knowledge of hepatitis C, 54.8% had a positive attitude, and 77.6% reported safer practices regarding hepatitis B and C [21]. Although previous studies in Bangladesh have examined hepatitis B knowledge and vaccination among medical students, nursing students, healthcare workers, and selected clinical populations, evidence among general university students remains limited. General undergraduate students may not routinely receive occupational health education or institutionally organized hepatitis B vaccination. Moreover, previous studies have often evaluated knowledge, attitudes, or vaccination status separately, with limited assessment of how awareness, vaccine knowledge, risk perception, testing behaviour, vaccination uptake, and willingness to receive vaccination are associated after adjustment for sociodemographic factors. Therefore, an integrated assessment of these dimensions among general university students is needed. Accordingly, this study aimed to assess hepatitis B awareness, vaccine‐related knowledge, risk perception, testing behaviour, vaccination status, and willingness to receive vaccination among undergraduate students at Gopalganj Science and Technology University. It also aimed to identify factors independently associated with vaccination status and future willingness to receive the vaccine using multivariable logistic regression analysis.

2. Materials and Methods

2.1. Study Design

In the present study, a cross‐sectional quantitative design was utilized to explore the extent of awareness gap and vaccination status regarding hepatitis B among Gopalganj Science and Technology University (GSTU) students. The duration of this study was 24th August 2024 to 28th February 2025. This cross‐sectional quantitative study was conducted among undergraduate students at Gopalganj Science and Technology University, Gopalganj, Bangladesh, from 24 August 2024 to 28 February 2025. The design was appropriate for estimating the distribution of hepatitis B awareness, knowledge, perceptions, testing behaviour, and vaccination status at a defined point in time and for examining associations between these outcomes and selected participant characteristics. In Figure 1 we have shown the full study design of our research.

Figure 1.

Study design.

2.2. Study Participants

All the undergraduate students at Gopalganj Science and Technology University (GSTU) were considered as the study population. The required sample size was calculated using Cochran's formula with a 95% confidence level (Z = 1.96), a 5% margin of error (d = 0.05), and an assumed prevalence of 50% (p = 0.50). Because no reliable prior estimate of the primary outcome was available among general university students in the study setting, p = 0.50 was selected to provide the most conservative estimate and the maximum required sample size. The minimum required sample size was 385 participants. To account for anticipated non‐response and potential data loss, the target number of completed questionnaires was increased to 440. Exactly 500 eligible students were approached to achieve this target, of whom 440 completed the questionnaire, corresponding to an approximate response rate of 88%. All 440 completed questionnaires were included in the final analysis.

2.3. Data Collection

Following the sampling procedure, 500 eligible undergraduate students were approached individually by a team of five trained data collectors. Students who were available on campus completed a paper‐based questionnaire administered by the research team, whereas those who were not readily available in person received the same questionnaire electronically through Google Forms. The online questionnaire was shared only with the contacted students and was not distributed through public social‐media groups or open invitations. A total of 440 students completed the questionnaire, yielding an approximate response rate of 88%. All returned questionnaires were screened for eligibility, completeness, duplicate submissions, out‐of‐range values, and logical inconsistencies. All 440 questionnaires satisfied the predefined data‐quality criteria; therefore, no completed questionnaire was excluded during data cleaning.

2.4. Questionnaire Deployment

The questionnaire was adapted from previously published hepatitis B instruments [22] and modified according to the study objectives. It comprised six sections: (1) sociodemographic characteristics; (2) general awareness and previous experience with hepatitis B; (3) knowledge of HBV transmission, prevention, risk groups, and long‐term complications; (4) vaccination‐related knowledge and personal vaccination practices; (5) diagnosis, testing accessibility, and risk‐factor‐related knowledge; and (6) perceptions, discrimination, willingness to accept free vaccination, and public opinion regarding HBV prevention. The instrument included binary, multiple‐choice, Likert‐scale, and one optional open‐ended item and was administered in both English and Bangla. The term ‘government role’ was not treated as a separate composite variable; it referred to participants’ opinions regarding publicly supported free hepatitis B vaccination [23]. Responses to the relevant closed‐ended item are presented in Table 3, while optional written opinions are summarized descriptively in Figure 3. For factual awareness and vaccine‐knowledge items, each correct response was assigned one point, whereas an incorrect or ‘do not know’ response was assigned zero. Negatively worded perception items, where applicable, were reverse‐coded. Domain scores were converted to a 50‐point scale using the formula: standardised score = (obtained raw score/maximum possible raw score) × 50. Participants were classified as having low, moderate, or high levels using the predefined cut‐offs. The complete questionnaire and scoring key were not included as supplementary material but are available from the corresponding author upon reasonable request.

Table 3.

Hepatitis B vaccination knowledge of respondents.

Category	Option	Count (%)
Vaccine dose knowledge	I don't know	205 (46.59%)
	One dose	11 (2.50%)
	Two doses	41 (9.32%)
	Three doses	183 (41.59%)
Ideal vaccination time	As a newborn	197 (44.77%)
	I don't know	144 (32.73%)
	Only after being infected	15 (3.41%)
	Only if exposed to high‐risk environment	84 (19.09%)
Willingness to take free vaccine	Already been vaccinated	59 (13.41%)
	Yes, definitely	277 (62.95%)
	Maybe, if I get more information	81 (18.41%)
	No, I don't trust vaccines	23 (5.23%)
Belief that vaccine provides lifelong protection	Agree	253 (57.50%)
	Neutral	153 (34.77%)
	Disagree	27 (6.14%)
	Strongly disagree	7 (1.59%)
Perceived duration of vaccine protection	Lifetime	275 (62.50%)
	10–20 years	54 (12.27%)
	5–10 years	77 (17.50%)
	Less than 5 years	34 (7.73%)
Priority group for vaccination	All of them	342 (77.73%)
	Pregnant women	43 (9.77%)
	People with diabetes	29 (6.59%)
	College students	26 (5.91%)
Personal number of vaccine doses taken	0	256 (57.73%)
	1	49 (11.14%)
	2	56 (12.73%)
	3	70 (15.91%)
	4	10 (2.27%)

Figure 3.

Perceptions of free hepatitis B vaccination among university students: A word cloud analysis.

2.5. Pilot Study

Before the main data collection, the questionnaire was pilot‐tested among 10 undergraduate students from different faculties of Gopalganj Science and Technology University who were not included in the final study sample. The pilot study assessed the clarity, comprehensibility, structure, logical flow, completion time, and practical feasibility of the questionnaire. The average completion time was approximately 12 min. Based on participants’ feedback, three complex questions were simplified, explanatory examples were added, and the Likert‐scale response anchors were refined to improve clarity and discrimination. No formal expert‐panel content‐validity index or internal‐consistency coefficient was calculated; therefore, the instrument is described as an adapted and pilot‐tested questionnaire rather than a formally validated instrument. Data obtained during the pilot study were excluded from the main analysis.

2.6. Statistical Analysis

Data were processed using Microsoft Excel 2016 and analysed using Stata version 17. Categorical variables were summarized as frequencies and percentages, while the awareness, vaccine‐knowledge, and perception scores were presented as means and standard deviations. Separate univariable binary logistic regression analyses were conducted to estimate the crude associations of the prespecified independent variables with hepatitis B vaccination status and willingness to receive vaccination. All independent variables were then entered simultaneously into the corresponding multivariable binary logistic regression models, regardless of their significance in the univariable analyses, to obtain adjusted estimates while controlling for potential confounding. Multicollinearity was assessed using the variance inflation factor, with VIF values below 5 considered indicative of no problematic multicollinearity. Findings are reported as crude odds ratios and adjusted odds ratios with 95% confidence intervals. All tests were two‐sided, and a p value below 0.05 was considered statistically significant. Brief responses to the optional open‐ended question regarding free hepatitis B vaccination were summarized descriptively through word‐frequency analysis and presented as a word cloud; this supplementary visualization was not treated as a formal qualitative or mixed‐methods analysis. All prespecified independent variables were entered simultaneously into the multivariable models irrespective of their univariable p‐values. No additional post‐estimation tests of model calibration, discrimination, influence, or statistical power were performed; therefore, interpretation was limited to the estimated adjusted associations.

2.7. Ethics Statement

Participation was voluntary, and verbal informed consent was obtained from all participants before questionnaire administration. No personally identifiable information was collected, and all responses were kept anonymous and confidential. The study was investigator‐initiated and conducted independently for academic research purposes, without institutional sponsorship or external funding. Formal ethics committee approval was not sought or obtained prior to data collection, and this has been transparently acknowledged as a limitation of the study. However, if an official ethical clearance certificate from the University's authorized ethics body is required for the submission process, we are able to obtain and provide it. The relevant university authority had already been informed of the study before its commencement, and we can arrange the necessary formal documentation if requested.

3. Results

Among the 440 university students included in the study, 51.36% (n = 226) were male and 48.64% (n = 214) were female (Table 1). Nearly two‐thirds of the participants (61.14%, n = 269) resided in rural areas, while 38.86% (n = 171) were from urban areas. The majority of participants (77.50%, n = 341) were older than 23 years, whereas 22.50% (n = 99) were aged 23 years or younger. Most respondents were unmarried (89.32%, n = 393), with only 10.68% (n = 47) being married. Regarding academic session, more than half of the participants (53.18%, n = 234) were enroled in middle academic sessions, followed by 30.45% (n = 134) in recent sessions and 16.36% (n = 72) in earlier sessions

Table 1.

Sociodemographic characteristics of the study participants (n = 440).

Characteristic	Category	n (%)
Gender	Female	214 (48.64)
	Male	226 (51.36)
Area of residence	Rural	269 (61.14)
	Urban	171 (38.86)
Age group	≤ 23 years	99 (22.50)
	> 23 years	341 (77.50)
Marital status	Married	47 (10.68)
	Unmarried	393 (89.32)
Academic session	Earlier sessions	72 (16.36)
	Middle sessions	234 (53.18)
	Recent sessions	134 (30.45)

Table 2 shows the awareness, experiences, and perception towards hepatitis B among respondents with their “Yes” and “No” answers in detail. Most of the respondents (95%) knew hepatitis B, and 5% didn't know it. This meant that just over a quarter (27.27%) had been tested and more than two‐thirds (72.73%) had never undergone a test. In terms of vaccination, 42.27% were vaccinated, 57.73% were not vaccinated, but 72.50 would be willing to vaccinate in the future, and 27.50% would be unwilling to vaccinate. 60.45% (n = 266) of the university students believed that people with hepatitis B face discrimination, while 39.55% (n = 174) thought that they do not face discrimination; fifty‐five percent had been relaxed, a great deal like other patients; 45% created not.”

Table 2.

General information of respondents.

Category	Yes, n (%)	No, n (%)
Heard about hepatitis B	418 (95.00%)	22 (5.00%)
Tested for hepatitis B	120 (27.27%)	320 (72.73%)
Vaccinated	186 (42.27%)	254 (57.73%)
Willing to be vaccinated in the future	319 (72.50%)	121 (27.50%)
Faced discrimination	266 (60.45%)	174 (39.55%)
Comfortable with hepatitis B patients	241 (54.77%)	199 (45.23%)
Consider hepatitis B a common disease (GSTU)	198 (45.00%)	242 (55.00%)
Knowing an infected person	187 (42.50%)	253 (57.50%)
Know hepatitis B is a viral disease	276 (62.73%)	164 (37.27%)
Testing accessibility available	291 (66.14%)	149 (33.86%)

Perception about hepatitis B being a common disease in the GSTU context that, 45% agreed, while 55% disagreed, that they knew someone infected, while 42.50% said know and 57.50% said no. Regarding knowledge of the disease, 63.73% knew the disease is viral, while 37.27% did not. Accessibility: 66.14% thought the test was accessible and 33.86% thought it was inaccessible. The general awareness is high, but testing and vaccination low, a considerable amount refused to vaccinate, social attitudes are mixed and the disease is not fully understood, warranting both awareness and stigma reduction campaigns.

Respondent's knowledge and experience on hepatitis B vaccination are shown in Table 3. While 41.59% got the correct answer (three), nearly half (46.59%) did not know how many doses of vaccine were needed. When concerning about the appropriate time for vaccination, 44.77% answered as a newborn, while 33.73% were not sure. Nearly two‐thirds (62.95 percent) would accept a free vaccine, while 57.50 percent felt vaccinated individuals were protected for life. 62.50% identified the duration of protection as lifelong.

With reference to priority groups, 77.73% agreed that everyone should be vaccinated. Elsewhere, 57.73% of respondents had never been vaccinated; the discrepancy between knowledge and practice is evident. In general, although the public has a high level of understanding about vaccine benefits, personal vaccination coverage rates are low.

(Table 4) It reflected among the subjects in their awareness of HB; 40% as a life‐ threatening, 40.45% that it is a serious disease but curable, (14.32%) were uncertain. The majority of subjects (88.64%) were aware that no one, regardless of age, is free from risk. Most (82.27%) correctly mentioned blood contact, unprotected sex, and transmission from mother to child as the main modes of infection, whereas others like coughing, mosquito bites, or sharing utensils were less frequently reported misconceptions (5%–8%). For prevention, the majority (83.41%) chose vaccination, followed by execution of drinking clean water, antibiotics, and hand washing. Regarding long‐term effects of HBV infection, the majority (77.50%) correctly responded that hepatitis B is related to liver cirrhosis and cancer (15.6% rated kidney or heart diseases). Altogether, these results suggest an overall good knowledge of the disease, including transmission, prevention, and complications of the disease. In Figure 2, the distribution of vaccination coverage among family members shows that a large proportion of families fall at the extremes. Most families (213) had 0% vaccination coverage, while 55 families achieved 100% coverage. Fewer families were found in the middle coverage ranges, where 74 families were in the 20%–39% range and smaller numbers in the higher mid‐range categories (60%–79% and 80%–99%). Overall, the distribution shows a polarized pattern, with many families either completely unvaccinated or fully vaccinated.

Table 4.

General awareness on hepatitis B.

Category	Option	Count (%)
Severity of hepatitis B	I am not sure	63 (14.32%)
	Life‐threatening	176 (40.00%)
	Not a serious disease	23 (5.23%)
	Serious but treatable	178 (40.45%)
Risk groups	Anyone, regardless of age	390 (88.64%)
	Only children	11 (2.50%)
	Only elderly people	24 (5.45%)
	Only healthcare workers	15 (3.41%)
Beliefs about transmission	Blood contact, unprotected sex, and mother‐to‐child transmission	362 (82.27%)
	Coughing and sneezing	33 (7.50%)
	Mosquito bites	23 (5.23%)
	Sharing food and utensils	22 (5.00%)
Prevention method	Drinking clean water	17 (3.86%)
	Getting vaccinated	367 (83.41%)
	Taking antibiotics	35 (7.95%)
	Washing hands regularly	21 (4.77%)
Long‐term effects	Heart disease	22 (5.00%)
	Kidney failure	50 (11.36%)
	Liver cirrhosis and cancer	341 (77.50%)
	Lung disease	27 (6.14%)

Figure 2.

Distribution of vaccine coverage among the respondents.

Table 5 depicts the distribution of awareness, vaccine knowledge, and perception levels of study participants on hepatitis B. The (66.59%) majority had a high awareness level, 20% moderate, while (13.41%) recorded a low awareness level. In the case of vaccination information, most volunteers showed a high level of knowledge (61.59%), while 21.59% were with low knowledge and 16.82% had moderate knowledge. With regard to the perception level on hepatitis B vaccine, 55% of the respondents had high perception; while 31.36% had moderate perception and 13.64% had low level of perception. Collectively, these results suggest that the majority of participants had a relatively high level of awareness, knowledge, and positive perceptions regarding the hepatitis B vaccine.

Table 5.

Distribution of awareness, vaccine knowledge, and perception levels among participants.

Variable	Category	Frequency	Percentage
Awareness level	High	293	66.59%
	Moderate	88	20.00%
	Low	59	13.41%
Vaccine knowledge level	High	271	61.59%
	Moderate	74	16.82%
	Low	95	21.59%
Perception level	High	242	55.00%
	Moderate	138	31.36%
	Low	60	13.64%

Table 6 Distribution of awareness levels regarding HBV according to sex and residence place among the participants. In general, a larger percentage of female (146) and male (147) participants were aware at the higher levels and had almost similar spread.

Table 6.

Awareness level by gender and residence.

Gender	Awareness level	Rural	Urban	Total
Female	High	92	54	146
	Moderate	26	16	42
	Low	14	12	26
Male	High	94	53	147
	Moderate	23	23	46
	Low	20	13	43
Total		269	171	440

Awareness among rural and urban participants was generally higher in both the genders. Intermediate awareness was found among 42 females and 46 males, whereas low awareness was less frequent, particularly among the girls. These results all suggest hepatitis B awareness is modest among both men and women, although with significant differences by place of residence that may reflect the impact of the residential context on awareness.

Table 7 presents the distribution of vaccine knowledge level by gender and residence. High knowledge was found in 127 (55%) females, whereas male was 144 (61%). In general, higher the male, even in female's knowledge about hepatitis B vaccination was found to be significantly high.

Table 7.

Knowledge level by gender and residence.

Gender	Knowledge Level	Rural	Urban	Total
Female	High	77	50	127
	Moderate	26	11	37
	Low	29	21	50
Male	High	87	57	144
	Moderate	21	16	37
	Low	29	16	45
Total		269	171	440

The factors associated with the status of vaccination against hepatitis B are presented in Table‐8. Multivariable logistic regression analysis identified several factors independently associated with hepatitis B vaccination status (Table 8). After adjusting for potential confounders, we found that male participants had significantly higher odds of being vaccinated than female participants (adjusted odds ratio [aOR] = 1.74, 95% confidence interval [CI]: 1.14–2.67, p = 0.011). Participants with low awareness also had significantly higher odds of being vaccinated than those with high awareness (aOR = 2.17, 95% CI: 1.09–4.36, p = 0.028). In contrast, participants with moderate awareness did not differ significantly from those with high awareness (aOR = 1.03, 95% CI: 0.57–1.85, p > 0.90).

Table 8.

Factors associated with hepatitis B vaccination status: results from unadjusted and adjusted logistic regression analyses.

Characteristic	Unadjusted OR			Adjusted OR
	OR	95% CI	p value	OR	95% CI	p value
Age range
Greater than 23 years	Ref
Less than 23 years	1.01	0.64, 1.58	> 0.9	0.69	0.31, 1.51	0.4
Area	Ref
Rural
Urban	0.99	0.67, 1.46	> 0.9	0.90	0.58, 1.39	0.6
Gender
Female	Ref
Male	1.79	1.22, 2.63	0.003	1.74	1.14, 2.67	0.011
Marital status
Married	Ref
Unmarried	1.64	0.88, 3.21	0.13	1.94	0.95, 4.12	0.075
Session category
Earlier sessions	Ref
Middle sessions	0.71	0.42, 1.21	0.2	0.84	0.46, 1.53	0.6
Recent sessions	0.93	0.53, 1.66	0.8	1.16	0.49, 2.73	0.7
Awareness level
High	Ref
Low	1.07	0.61, 1.88	0.8	2.17	1.09, 4.36	0.028
Moderate	0.66	0.40, 1.07	0.10	1.03	0.57, 1.85	> 0.9
Knowledge level
High	Ref
Low	0.17	0.11, 0.27	< 0.001	0.14	0.08, 0.23	< 0.001
Moderate	0.25	0.15, 0.43	< 0.001	0.23	0.13, 0.41	< 0.001
Categorize perception level
High	Ref
Low	0.81	0.37, 1.76	0.6	1.60	0.65, 3.93	0.3
Moderate	0.74	0.37, 1.51	0.4	1.35	0.61, 2.99	0.5

Abbreviations: CI = Confidence Interval, OR = Odds Ratio.

Besides, Table 9 shows the unadjusted and adjusted logistic regression analyses of factors associated with willingness to receive the hepatitis B vaccine. After adjustment for potential confounders, no statistically significant associations were observed for age, area of residence, gender, session category, awareness level, knowledge level, or perception level. Marital status demonstrated a borderline significant association, with unmarried participants having lower odds of willingness to receive the hepatitis B vaccine than married participants (AOR = 0.44, 95% CI: 0.18–0.96; p = 0.050). Although participants aged less than 23 years also had lower odds of willingness (AOR = 0.46, 95% CI: 0.19–1.08), the association was not statistically significant (p = 0.082).

Table 9.

Factors associated with willingness to receive hepatitis B vaccination: results from unadjusted and adjusted logistic regression analyses.

Characteristic	Unadjusted OR			Adjusted OR
	OR	95% CI	p value	OR	95% CI	p value
Age range
Greater than 23 years	Ref
Less than 23 years	0.89	0.55, 1.48	0.7	0.46	0.19, 1.08	0.082
Area
Rural	Ref
Urban	0.79	0.52, 1.21	0.3	0.85	0.55, 1.31	0.5
Gender
Female	Ref
Male	0.92	0.60, 1.40	0.7	0.94	0.61, 1.45	0.8
Marital status
Married	Ref
Unmarried	0.51	0.21, 1.07	0.094	0.44	0.18, 0.96	0.05
Session category
Earlier sessions	Ref
Middle sessions	0.96	0.52, 1.71	0.9	0.99	0.53, 1.80	> 0.9
Recent sessions	1.13	0.59, 2.15	0.7	2.11	0.83, 5.67	0.12
Awareness level
High	Ref
Low	0.70	0.39, 1.28	0.2	0.59	0.30, 1.16	0.12
Moderate	0.95	0.56, 1.65	0.9	0.81	0.46, 1.47	0.5
Knowledge level
High	Ref
Low	1.05	0.66, 1.67	0.8	1.22	0.73, 2.05	0.4
Moderate	1.45	0.82, 2.63	0.2	1.52	0.84, 2.82	0.2
Categorize perception level
High	Ref
Low	0.85	0.33, 2.06	0.7	0.92	0.34, 2.35	0.9
Moderate	0.74	0.30, 1.62	0.5	0.69	0.28, 1.57	0.4

Abbreviations: CI = Confidence Interval, OR = Odds Ratio.

The word cloud Figure 3 represents university students' comments on free hepatitis B vaccination, and the size of each word reflects frequency and importance. The analysis shows substantial support for the vaccination, as evidenced by the words “yes,” “health,” “good” and “support”; positive attitudes towards the programme. “The students see it as timely, important and useful,” which becomes evident in phrases such as “smart idea,” “great,” and “necessary.” The focus on accessibility and equity is clear in terms like “everyone”, “public” and “free”, demonstrating that students value access for everyone. Furthermore, the words “prevention,” “protection,” and “care” show the understanding of the vaccine's prophylactic effects and usage, and words like “initiative,” “wise,” and “future” might forward encouragement or planning. On the whole, comments reflect that highly supportive of health, social, and public benefits of free hepatitis B vaccination.

4. Discussion

This study assessed hepatitis B awareness, vaccine‐related knowledge, perceptions, testing behaviour, vaccination status, and willingness to receive vaccination among 440 undergraduate students. The participants were almost equally distributed by gender, although most were older than 23 years, unmarried, and from rural areas. These sociodemographic characteristics provide important context for interpreting the findings, as access to health information, preventive services, and vaccination opportunities may differ across demographic and residential groups.

General awareness of hepatitis B was high, with 95.00% of participants reporting that they had heard of the disease. Nevertheless, only 27.27% had previously undergone HBV testing, indicating a substantial gap between general awareness and preventive health‐seeking behaviour. Although 82.27% correctly identified blood contact, unprotected sexual contact, and mother‐to‐child transmission as major transmission routes, some participants continued to report misconceptions involving coughing, mosquito bites, and sharing food or utensils. Furthermore, 77.50% correctly identified liver cirrhosis and cancer as major long‐term consequences of HBV infection. These findings indicate that general awareness was relatively high, but specific gaps and misconceptions remained.

Vaccination‐related knowledge was also uneven. Only 41.59% correctly identified the recommended number of vaccine doses, while 46.59% did not know the required number. Fewer than half of the participants identified the newborn period as the appropriate time to initiate vaccination. Although 77.73% believed that all population groups should receive hepatitis B vaccination and 62.95% stated that they would definitely accept a free vaccine, only 42.27% had received at least one vaccine dose. This difference between favourable attitudes and actual vaccination uptake suggests that knowledge alone may not translate into preventive behaviour.

The vaccination coverage observed in this study was lower than the rates reported among students in Nepal, Saudi Arabia, Uganda, and Pakistan [24, 25, 26, 27, 28]. These differences may reflect variations in the study populations and healthcare contexts. Many previous studies involved medical, nursing, or health‐science students who had greater occupational exposure to blood‐borne infections, more structured infection‐control education, and better access to institutionally organised vaccination services. In contrast, general university students may receive less targeted HBV education and may face financial, informational, or service‐access barriers. Differences in national immunisation programmes, socioeconomic circumstances, cultural perceptions of vaccination, methods of confirming vaccination status, and questionnaire design may also have contributed to the observed variation.

Overall, 66.59% of participants had high awareness, 61.59% had high vaccine knowledge, and 55.00% had a high perception level. The mean awareness, vaccine‐knowledge, and perception scores were 37.18 ± 11.16, 25.00 ± 10.88, and 22.38 ± 4.71, respectively. These findings suggest relatively satisfactory awareness and perceptions but also indicate that vaccine‐specific knowledge and preventive practices require further improvement. Differences between the current findings and earlier studies among medical and nursing students may be related to their greater exposure to formal health education and workplace‐related infection‐prevention requirements [15, 16, 17, 18, 19, 20, 21, 29].

The multivariable analysis identified several factors associated with vaccination status. Male participants had significantly higher odds of being vaccinated than female participants after adjustment for potential confounders (aOR = 1.74, 95% CI: 1.14–2.67). Participants with low and moderate vaccine knowledge had significantly lower odds of vaccination than those with high knowledge (low knowledge: aOR = 0.14, 95% CI: 0.08–0.23; moderate knowledge: aOR = 0.23, 95% CI: 0.13–0.41). Participants with low awareness unexpectedly had higher adjusted odds of vaccination than those with high awareness (aOR = 2.17, 95% CI: 1.09–4.36). This finding should be interpreted cautiously because the cross‐sectional design cannot establish causality, and the observed association may reflect unmeasured factors or differences in how awareness was scored. No clear statistically significant associations were identified between most examined characteristics and willingness to receive vaccination.

Despite the relatively high willingness to receive vaccination in the future, social concerns remained evident. Approximately 60.45% of respondents believed that people living with hepatitis B experience discrimination, while 45.23% were not comfortable interacting with infected individuals. These findings indicate persistent stigma and misinformation. The frequently occurring words in the optional comments concerning free vaccination also suggested generally supportive views regarding accessible vaccination programmes. Therefore, university‐based interventions should combine accurate health education, accessible testing, vaccination services, and stigma‐reduction activities rather than focusing only on general awareness.

5. Strengths and Limitations

This study has several strengths, including its relatively large sample, its focus on general undergraduate students rather than exclusively on healthcare‐related students, the simultaneous assessment of awareness, vaccine knowledge, risk perception, testing behaviour, vaccination status, and willingness to receive vaccination, and the use of multivariable logistic regression to control for potential confounding. Nevertheless, the cross‐sectional design prevents causal and temporal inferences. Awareness, testing behaviour, and vaccination status were self‐reported and may therefore be affected by recall and social‐desirability bias, while vaccination status was not verified using vaccination records or serological markers. Because participants were recruited from a single university, the findings may not be generalisable to all university students in Bangladesh. The quantitative questionnaire also could not fully explain the underlying reasons for vaccine hesitancy, misinformation, or stigma, and residual confounding may remain despite multivariable adjustment.

Overall, the study demonstrates that high general awareness does not necessarily lead to adequate testing or vaccination uptake. Targeted university‐based education, accessible HBV screening and vaccination, clear communication regarding vaccine schedules, and stigma‐reduction programmes are therefore required to improve hepatitis B prevention among general university students.

6. Conclusion

This study found that university students generally had a relatively high level of awareness and vaccine‐related knowledge regarding hepatitis B; however, these levels did not translate into adequate preventive behaviour. Although 95.00% of participants had heard of hepatitis B, only 27.27% had undergone HBV testing and 42.27% had received the vaccine. Nevertheless, 72.50% expressed willingness to receive vaccination in the future, indicating an important opportunity for university‐based intervention. Overall, 66.59% of respondents had high awareness, 61.59% had high vaccine knowledge, and 55.00% demonstrated a high perception level. The multivariable analysis further showed that gender, awareness, and vaccine‐knowledge levels were significantly associated with vaccination status, although the unexpected association between low awareness and higher vaccination odds should be interpreted cautiously. These findings demonstrate a clear gap between awareness, intention, and actual vaccination uptake among general university students. Universities and public‐health authorities should therefore provide targeted hepatitis B education, accessible screening, affordable or free vaccination services, accurate information about vaccine schedules, and stigma‐reduction programmes. Future research should include students from multiple universities, verify vaccination status through records or serological testing where feasible, and use qualitative methods to explore the social, financial, and behavioural barriers influencing HBV testing and vaccination in Bangladesh.

Author Contributions

Ali Ashraf Sakil: data curation, investigation, formal analysis, visualization, resources, writing – original draft, writing – review and editing. Md. Murad Hossain: conceptualization, methodology, investigation, formal analysis, visualization, validation, supervision, resources, writing – original draft, writing – review and editing. Rayhan Ivan Rimon: software, formal analysis, visualization, validation, writing – review and editing. Hasibur Rahaman: writing – review and editing, project administration, methodology. Rafaz Samnan Nahid: writing – review and editing. Md. Shohel Rana: writing – review and editing.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare that they have no known conflict of financial interests or personal relationships that could have appeared to influence the work reported in this paper. No funding is received for this research.

Declaration of AI Involvement

In order to improve linguistic clarity, synthesize theme findings, ensure methodological integrity, strengthen ethical compliance, and improve analytical accuracy, we used OpenAI’, ChatGPT exclusively for academic and research reasons when compiling this work. We carefully examined and updated all text after using this AI‐assisted method to ensure its correctness, consistency, and uniqueness. We declare that the final version of this publication is entirely the authors’ responsibility.

Transparency Statement

The corresponding author, Dr. Md. Murad Hossain, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported. All important aspects of the study have been fully and accurately described, and no relevant information has been intentionally omitted. Any deviations from the study as originally planned have been clearly explained. The authors confirm that the findings are reported truthfully and that the manuscript adheres to the journal's ethical and reporting standards.

Data Availability Statement

The datasets and code that were involved in or examined in the present study can be accessed by the respective author on reasonable request.