Effects of message framing on HPV Vaccination decision-making: A Survey experiment among Chinese male college...

Human papillomavirus (HPV) is a major public health concern affecting both sexes. China adopted a gender-neutral HPV vaccination strategy, expanding recommendations to include males. College students, a high-risk group for HPV exposure, were a priority target for vaccination campaigns. This study compares how four message frames (control, personal health risks, partner risks, both risks) influenced HPV vaccination intention, decisional readiness, and perceived responsibility among Chinese male college students. We conducted a quasi-experimental pre-post survey among 612 male students from three Chinese universities (December 2024-January 2025). Participants were randomly assigned to four message-framing groups. Demographic distributions were compared using Chi-square and Kruskal-Wallis tests. Intervention effects were analyzed via McNemar's tests and multivariable logistic regression. Among participants, 41.8% (n = 256) were unaware of male eligibility for HPV vaccination. Post-intervention, all groups showed improvements in vaccination intention, decisional readiness, and perceived responsibility. Both risk groups consistently exhibited the largest effect sizes across all outcomes (p < .001). For example, vaccination intention in both risk groups increased from 7.2% pre-intervention to 21.6% post-intervention (p < .001). Compared to the control message frame, none of the other frames showed a pairwise significant difference after adjusting for baseline characteristics (adjusted p > .017). The low baseline awareness of male HPV vaccine eligibility highlighted the urgency of targeted education. These findings directly informed China's upcoming gender-neutral HPV vaccination strategy.