Analysis of factors influencing HPV vaccination willingness of parents of students in China based on the theory of planned behavior

Abstract

To examine HPV vaccination willingness and its associated factors among parents of female primary and secondary school students in China, and to provide evidence for improving local HPV vaccination coverage. This cross-sectional study recruited parents of female primary and secondary school students in Heze City using stratified sampling. A TPB-based questionnaire was administered through an online self-administered survey. Multivariable logistic regression and structural equation modeling were used to examine factors associated with HPV vaccination willingness and behavioral intention. A total of 506 parents of female primary and secondary school students were included in this cross-sectional study. Among them, 320 parents (63.24%) reported that they were willing to arrange HPV vaccination for their daughters, whereas the reported actual vaccination uptake was 17.98%. Multivariable logistic regression analysis showed that higher parental education, a monthly household income of RMB 5,000–10,000, a family history of cancer, and higher attitude toward the behavior, subjective norm, and behavioral intention scores were associated with greater HPV vaccination willingness. In the TPB structural equation model, attitude toward the behavior (standardized path coefficient = 0.49, p < 0.01) and subjective norm (standardized path coefficient = 0.25, p < 0.01) were positively associated with behavioral intention, whereas perceived behavioral control showed a significant negative path coefficient (β = −0.10, p < 0.01). This negative association was interpreted in light of the fact that the PBC items primarily measured perceived barriers rather than facilitating control. Parents of female primary and secondary school students in Heze City have a moderate willingness to vaccinate against HPV, but the actual vaccination rate is low.