Peer-reviewed article
Subjective norms and perceived behavior control are more critical than attitudes in HPV vaccination: An investigation in China.
Naiyang Shi, Shixin Xiu, Jiayu Wang, Yuan Shen, Hui Jin ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why HPV vaccination rates are very low among Chinese female adolescents aged 9-15, using a survey of 1,627 students in Wuxi City. Only 3.9% of participants had received HPV vaccination. The research found that what other people think (subjective norms) and belief in one's ability to get vaccinated (perceived behavioral control) matter more than personal attitudes in determining whether girls actually get vaccinated. The study suggests interventions should focus on reducing practical barriers to vaccination and involve schools and communities.
Key points
- HPV vaccination rate was only 3.9% (63/1,627) among surveyed female adolescents in China
- Subjective norms (what others think) had direct significant impact on vaccination behavior, especially when perceived behavioral control was high
- Participants trusted HPV vaccine benefits but had low trust in its safety
- Personal attitudes and perceived behavioral control did not directly influence vaccination behavior through intentions
- Vaccination decisions differed between families with medical backgrounds and non-medical families
Limitations
The study is cross-sectional, so it cannot establish causation or how vaccination decisions change over time. The very low baseline vaccination rate (3.9%) may limit generalization to populations with higher initial uptake.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Behavioral interventions targeting subjective norms and perceived behavioral control through school and community-based activities to reduce external barriers to vaccination
- Population
- Female adolescents aged 9-15 in Wuxi City, China (1,627 surveyed)
Key finding
Subjective norms directly influenced vaccination behavior with significant impact when perceived behavioral control was high