Subjective norms and perceived behavior control are more critical than attitudes in HPV vaccination: An investigation...

Human papillomavirus (HPV) vaccination coverage in Chinese female adolescents aged 9-15 remains inadequately reported. This study explored the behavioral mechanisms that influence vaccination decisions among female adolescents.

An anonymous online cross-sectional investigation was conducted with 1627 eligible female students in Wuxi City, China. A structural equation model (SEM) was used to identify factors that directly or indirectly influenced or moderated HPV vaccination. Theory of Planned Behavior (TPB) was adopted to illustrate the hypotheses of the behavioral mechanism.

The HPV vaccination rate was 3.9 % (63/1627). Participants demonstrated high trust in the benefits of the HPV vaccine but comparatively low trust in its safety. No significant correlation was found between intention and behavior. Both attitudes (ATT) and perceived behavioral control (PBC) were positively correlated with intentions, but did not significantly influence behavior through intentions. Subjective norms (SN) had a significant direct impact on vaccination behavior, particularly when PBC was high. PBC also positively and negatively moderated the relationship between trust and intention and concern and intention, respectively. HPV vaccination uptake was directly influenced by subjective norms in participants from non-medical families but could be indirectly influenced by attitudes through intentions in those from medical families.

SN and PBC were significant predictors of HPV vaccination among adolescent females. Interventions should primarily aim to reduce the external barriers to vaccination and focus on activities within schools and communities.