HPV Vaccination Decision-Making Stages and Associated Factors Among Young Men Who Have Sex with Men in Thailand
Abstract
Objective: To examine human papillomavirus (HPV) vaccination stages and identify key determinants of HPV vaccination decision stages among young Thai men who have sex with men.
Material and Methods: This cross-sectional study recruited 397 young men who have sex with men (YMSM) aged 18-26 years. Data collection utilized an electronic questionnaire covering general information, health and sexual risk behaviors, HPV knowledge and attitudes, self-efficacy, subjective norms, and contextual perceptions of the HPV vaccine. Multivariate multinomial logistic regression was used to analyze the factors associated with vaccination across three stages: unawareness, undecided, and decided to vaccinate.
Results: YMSM in Thailand fell into three HPV vaccination decision-making stages: 42.3% unaware/unengaged, 39.8% undecided, and 17.9% committed to vaccination. Subjective norms had the strongest influence: participants with higher norms were more likely to be committed to vaccinating versus the undecided (adjusted odds ratio [AOR]=5.56, 95% confident interval [CI]: 2.30-13.45) or unaware (AOR=2.54, 95% CI: 1.05-6.14). Positive attitudes increased the odds of a vaccination commitment versus undecided (AOR=4.85, 95% CI: 1.78-13.21) and unaware participants (AOR=4.58, 95% CI: 1.41-12.23). Higher self-efficacy was associated with vaccination commitment versus undecided (AOR=2.94, 95% CI: 1.01-8.51) and unaware participants (AOR=3.31, 95% CI: 1.17-9.37). Neither HPV knowledge nor contextual perceptions were significantly associated with the decision-making stages.
Conclusion: Subjective norms and positive attitudes were the primary drivers of HPV vaccination decisions among YMSM in Thailand. Interventions targeting social influences and attitude change may be more effective than knowledge-based approaches alone for promoting vaccine uptake in this population.
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