Hepatitis B Vaccination Intention and Influencing Factors among College Students in Huanggang, Hubei, China: A Protection Motivation Theory-Based Cross-Sectional Study
Abstract
Objective: This study assessed the intention to receive the hepatitis B vaccine and identified influencing factors among college students in Huanggang, China, using the Protection Motivation Theory (PMT).
Material and Methods: A cross-sectional study was conducted between April and May 2025. Data were collected via PMT-based questionnaire measuring knowledge, preventive behaviors, perceived severity, perceived susceptibility, response efficacy, self-efficacy, and response cost. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v27.0 to examine associations between variables and vaccination intention.
Results: Among the 1,130 participants, 58.9% intended to receive the hepatitis B vaccine. In bivariate analyses, higher hepatitis B knowledge, vaccine knowledge, preventive behaviors, and favorable PMT constructs were positively associated with intention. Multivariate logistic regression confirmed independent associations: hepatitis B knowledge (odds ratio [OR]=1.41, 95% confidence interval [CI]: 1.02-1.95), vaccine knowledge (OR=1.49, 95% CI: 1.11-2.00), preventive behaviors (OR=1.60, 95% CI: 1.15-2.23), perceived severity (OR=1.05, 95% CI: 1.01-1.10), self-efficacy (OR=1.10, 95% CI: 1.02-1.18), and response efficacy (OR=1.16, 95% CI: 1.04-1.29) were positive predictors, whereas perceived response cost (OR=0.85, 95% CI: 0.79-0.91) was a negative predictor. Sociodemographic factors were not significant after adjustment.
Conclusion: The findings offer insights into hepatitis B vaccination behavior among college students. This evidence-based information could inform the future direction for improving hepatitis B vaccination rates in university settings by focusing health education on the severity of the hepatitis B consequences and the efficacy and safety of the vaccination, all of which could reduce the psychological and practical barriers.
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Easterbrook PJ, Luhmann N, Bajis S, Min MS, Newman M, Lesi O, et al. WHO 2024 hepatitis B guidelines: an opportunity to transform care. Lancet Gastroenterol Hepatol 2024;9:493-5.
Yan M, Ye H, Chen Y, Jin H, Zhong H, Pan B, et al. Economic burden of hepatitis B patients and its influencing factors in China: a systematic review. Health Econ Rev 2024;14:99.
Yan R, Sun M, Yang H, Du S, Sun L, Mao Y. 2024 latest report on hepatitis B virus epidemiology in China: current status, changing trajectory, and challenges. Hepatobiliary Surg Nutr 2025;14:66.
Song C, Lv J, Liu Y, Chen JG, Ge Z, Zhu J, et al. Associations between hepatitis B virus infection and risk of all Cancer types. JAMA Netw Open 2019;2:e195718.
Zhang M, Li C, Cai Q, Qu M, Meng J, Fan H, et al. The state of the incidence and mortality of hepatitis B in China from 2004 to 2021: A spatiotemporal characteristics and trend analysis [homepage on the Internet]. Research Square; 2023 [cited 2025 Oct 11]. Available from: https://doi.org/10.21203/rs.3.rs-2562959/v1.
Han B, Zheng R, Zeng H, Wang S, Sun K, Chen R, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent 2024;4:47-53.
Burns GS, Thompson AJ. Viral hepatitis B: clinical and epidemiological characteristics. Cold Spring Harb Perspect Med 2014;4:a024935.
Mironova M, Ghany MG. Hepatitis B Vaccine: four decades on. Vaccines (Basel) 2024;12:439.
Shan S, Zhao X, Jia J. Comprehensive approach to controlling chronic hepatitis B in China. Clin Mol Hepatol 2024;30:135-43.
Cui F, Shen L, Li L, Wang H, Wang F, Bi S, et al. Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy, China. Emerg Infect Dis 2017;23:765-72.
Wang L, Liu N, Miao N, Zhang G, Wang F, Wang H. Trends and age-period-cohort effect on acute hepatitis B incidence - China, 2005-2021. China CDC Wkly 2024;6:727-33.
Bai X, Chen L, Liu X, Tong Y, Wang L, Zhou M, et al. Adult Hepatitis B Virus Vaccination Coverage in China from 2011 to 2021: A Systematic Review. Vaccines (Basel) 2022;10:900.
Chen Q, Ma J, Wu R, Wang Y, Ma X, Zheng X, et al. Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: insights from the expanded theory of planned behavior. Hum Vaccin Immunother 2025;21:2452026.
Hall EW, Weng MK, Harris AM, Schillie S, Nelson NP, Ortega-Sanchez IR, et al. Assessing the cost-utility of universal hepatitis B vaccination among adults. J Infect Dis 2022;226:1041-51.
Anutebeh EN, Tatah L, Feteh VF, Aroke D, Assob JCN, Choukem SP. Immune response to hepatitis B vaccine following complete immunization of children attending two regional hospitals in the Southwest region of Cameroon: a cross sectional study. BMC Infect Dis 2021;21:1205.
Yu P, Hongyan H, Qi Y, beam O, Junyu M, Sha H, et al. To investigate the behavior, attitude and effect of propaganda and education activities on hepatitis B among college students. Nurs Sci 2021;10:517.
Liu C, Nicholas S, Wang J. The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study. BMC Public Health 2020;20:1219.
Ling M, Kothe EJ, Mullan BA. Predicting intention to receive a seasonal influenza vaccination using protection motivation theory. Soc Sci Med 2019;233:87-92.
Wang PW, Ahorsu DK, Lin CY, Chen IH, Yen CF, Kuo YJ, et al. Motivation to have COVID-19 Vaccination explained using an extended protection motivation theory among university students in China: the role of information sources. Vaccines (Basel) 2021;9:380.
Chowdhury MZI, Turin TC. Variable selection strategies and its importance in clinical prediction modelling. Fam Med Community Health 2020;8:e000262.
Nunez E, Steyerberg EW, Nunez J. Regression modeling strategies. Rev Esp Cardiol (Engl Ed) 2011;64:501-7.
Khodaveisi M, Salehi Khah M, Bashirian S, Karami M, Khodaveisi M. The effect of health belief model-based training on preventive behaviors of hepatitis B in addicts. Int J High Risk Behav Addict 2018;7:e58579.
Alanazi FTH, Alharbi BN, Aljuaid TH, Alammar FA, Almarzouq YF, Albalawi I, et al. The impact of vaccinations on disease prevention: A comprehensive analysis of their role in enhancing global public health and reducing morbidity and mortality rates. Int J Health Sci 2024;8:1885-907.
Sok S, Chhoung C, Sun B, Ko K, Sugiyama A, Akita T, et al. Knowledge of hepatitis B infection, hepatitis B vaccine, and vaccination status with its associated factors among healthcare workers in Kampot and kep provinces, Cambodia. BMC Infect Dis 2024;24:658.
Natour RT, Midlej A, Mahajna E, Kopelman Y, Abo-Mouch S, Baker FA. Chronic hepatitis B beyond clinical burden: Psychosocial effects and impact on quality of life. J Viral Hepat 2024;31:12-20.
Cadeddu C, Castagna C, Sapienza M, Lanza TE, Messina R, Chiavarini M, et al. Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: a systematic review. Hum Vaccin Immunother 2021;17:4470-86.
Diniarti F, Said MSM, Abd Rashid N, Poddar S. Behavioral prevention of HBV transmission in urban communities toward global elimination of hepatitis in 2030: a systematic review. Healthc Low Resour Settings 2024;12. doi: 10.4081/hls.2024.12072.
Yang H, Yangyuen S, Sombateyotha K. Human papillomavirus vaccination intention and its associated factors among female medical college students in Hubei, China: a cross-sectional study. J Educ Health Promot 2024;13:302.
Floyd DL, Prentice-Dunn S, Rogers RW. A meta-analysis of research on protection motivation theory. J Appl Soc Psychol 2000;30:407-29.
Milne S, Sheeran P, Orbell S. Prediction and intervention in health-related behavior: a meta-analytic review of protection motivation theory. J Appl Soc Psychol 2000;30:106-43.
K GR, D HK, Madalageri NK, Rangareddy H. Awareness and knowledge of hepatitis B vaccination among newly enrolled first-year medical undergraduates in South India: a cross-sectional survey. Cureus 2024;16:e73567.
Horváth T, Csupor D, Győrffy Z, Varga Z. [Internet-based health communication opportunities (blogs, podcasts, video channels) and the social media]. Orv Hetil 2022;163:132-9.
Palom A, Almandoz E, Madejón A, Rando-Segura A, Pérez-Castaño Y, Vico J, et al. Community strategy for Hepatitis B, C, and D screening and linkage to care in Mongolians living in Spain. Viruses 2023;15:1506. doi: 10.3390/v15071506.
Srivastava T, Chavda B, Brien K, Kuter B, Feemster K, Shen A. A systematic review of student vaccine attitudes and vaccine policy on college and university campuses, 2000-2022. J Am Coll Health 2024:1-13. doi: 10.1080/07448481.2024.2409687.
Zimmerman M. The value and limitations of self-administered questionnaires in clinical practice and epidemiological studies. World Psychiatry 2024;23:210-2.
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