Association of the HPV vaccination intention‒behavior gap with ehealth literacy and health beliefs among chinese female college students: cross-sectional study

Abstract

Abstract With the strengthening of public health, Chinese female college students have shown higher levels of HPV vaccination intention, but the actual vaccination rate is very low. This significant intention–behavior gap has become a major challenge for the prevention and control of HPV among colleges and universities. This study aims to explore the intention–behavior gap for HPV vaccine uptake among Chinese female college students on the basis of eHealth literacy (eHL) and the health belief model (HBM). A cross-sectional survey was conducted from June 16 to July 16, 2024, to assess socioeconomic status, eHL and HBM among female college students at Guangdong Medical University. Descriptive statistics were calculated, and binary logistic regression analysis was performed using SPSS 29.0 to identify significant independent associations between female college students’ HPV vaccination intentions and behavior. Among the 2884 valid participants with an intention to receive an HPV vaccination, only 41.3% had converted from intention to uptake (≥ 1 dose).The key influencing factors included being from urban areas (adjusted OR: 1.24; 95% CI 1.04– 1.47; p  = 0.018), monthly consumption (adjusted OR: 1.24; 95% CI 1.13–1.37; p  < 0.001), household income (adjusted OR: 1.10; 95% CI 1.01 –1.21; p  = 0.029), and parental education level (adjusted OR: 1.23; 95% CI 1.13–1.33; p  < 0.001). Moreover, the participants’ eHL level positively influenced their HPV vaccination conversion rate (adjusted OR: 1.02; 95% CI 1.00–1.04; p  = 0.036). For HBM, trust in formal information had a significant positive influence on HPV vaccination conversion rate (adjusted OR: 1.10; 95% CI 1.04–1.16; p  = 0.002), whereas perceived behavioral barriers had a significant negative influence (adjusted OR: 0.72; 95% CI 0.66 – 0.79; p  < 0.001). This study confirms a substantial HPV vaccination intention‒behavior gap among Chinese female college students, influenced by socioeconomic factors, eHL, and health beliefs—specifically trust in formal information and perceived barriers. Therefore, we suggest that targeted measures should be undertaken to reduce socioeconomic gaps, improve the eHL of those with pre-existing vaccination intention, enhance institutional trust in formal medical institutions and authoritative information channels, and reduce the psychological and practical obstacles to HPV vaccination to effectively bridge the intention–behavior gap and thereby improve vaccination coverage female college students in China.