Guardians' willingness to vaccinate primary and secondary school girls against human papillomavirus and associated factors in ethnic autonomous prefectures of Qinghai Province, China: A cross-sectional study based on the Health Belief Model and Theory of Planned Behavior.
This cross-sectional school-based survey in six ethnic autonomous prefectures of Qinghai found that guardians’ willingness to vaccinate girls against HPV was associated with ethnicity, attitudes, subjective norms, perceived behavioral control, cues to action, and perceived barriers.
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This cross-sectional school-based survey in six ethnic autonomous prefectures of Qinghai found that guardians’ willingness to vaccinate girls against HPV was associated with ethnicity, attitudes, subjective norms, perceived behavioral control, cues to action, and perceived barriers.
Research significance
The study provides associative evidence that culturally tailored school and primary-care recommendations, clear vaccine information, and logistical support may improve guardians’ willingness; whether these strategies causally increase HPV vaccine uptake and ultimately reduce HPV-related cervical cancer requires prospective implementation studies.
Source abstract
Cervical cancer is a preventable threat to women's health, and human papillomavirus (HPV) vaccination is key primary prevention. Caregiver hesitancy may affect vaccination of age-eligible girls.We examined caregivers' willingness to vaccinate primary and secondary school girls against HPV and factors in six ethnic autonomous prefectures of Qinghai Province. From December 2024 to February 2025, we conducted a cross-sectional survey of caregivers of girls in selected classes at 12 schools, using multistage cluster convenience sampling. The questionnaire included Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Perceived Social Support Scale (PSSS) items. Factors were assessed with univariable and four-step hierarchical multiple linear regression, sequentially entering sociodemographic, HBM, TPB, and PSSS blocks. Willingness correlated with perceived susceptibility and severity, cues to action, attitudes, perceived behavioral control, and subjective norms. In univariable analyses, all HBM, TPB, and social-support dimensions except perceived barriers were positively associated with willingness. Hui caregivers had lower willingness, while higher education, middle income, and party/government-agency or public-institution employment predicted higher willingness. In hierarchical multiple regression, Hui ethnicity vs. Han ethnicity predicted lower willingness (B = -0.229, P = .003). Cues to action (β = 0.121, P = .024), perceived barriers (β = 0.128, P < .001), attitudes (β = 0.203, P < .001), perceived behavioral control (β = 0.107, P = .001), and subjective norms (β = 0.323, P < .001) were positively associated. HPV vaccination promotion should be tailored to Qinghai's ethnic autonomous prefectures, with authoritative school and primary-care recommendations, clear vaccine information, and vaccination-process support, while identifying barriers. Future qualitative and prospective implementation studies should clarify decision-making mechanisms and assess intervention acceptability and effects on vaccine uptake in resource-limited settings.