Using protection motivation theory to predict monkeypox vaccination intention among adults in Chongqing, China

The global spread of monkeypox represents a significant public health challenge. Vaccination is the cornerstone of pandemic control, and understanding the psychological factors underlying vaccination decisions is crucial. This study aimed to investigate the predictors of monkeypox vaccination intention among Chinese adults.

A cross-sectional online survey was conducted among a convenience sample of adults in Chongqing, China, from March to April 2025. The questionnaire assessed sociodemographic characteristics, knowledge of monkeypox, and constructs from the Protection Motivation Theory (PMT). Structural equation modeling (SEM) was employed to test the direct and indirect paths between the PMT constructs and vaccination intention.

Of 805 valid respondents, 290 intended to vaccinate. CFA confirmed good reliability/validity of PMT scales (Cronbach's α: 0.789-0.937). SEM showed good fit (CFI = 0.97, RMSEA = 0.04). Severity perception (β=0.14) and self-efficacy (β=0.13) positively predicted intention, while response cost (β=-0.26) negatively predicted it (all p<0.05). Knowledge had indirect effects via risk perception, response efficacy, and self-efficacy. Age was directly negatively associated with the vaccination intention.

During the study period, no monkeypox vaccine had been approved for marketing in China, and routine vaccination was not recommended for the general public; in this context, willingness to receive a monkeypox vaccine among adults in Chongqing was relatively low. The Protection Motivation Theory provides a valuable framework for understanding vaccination intention. If vaccines are included in future routine recommendations, interventions should emphasize severity, reduce barriers, and build public confidence to increase uptake.