Model of Factors Explaining Human Papillomavirus Vaccination Intention of Men Who Have Sex with Men in Thailand: A Cross-Sectional Study
DOI:
https://doi.org/10.60099/prijnr.2026.275627Keywords:
Human papillomavirus, Intention, Men who have sex with men, Structural equation modeling, Theory of Planned Behavior, VaccinationAbstract
Human papillomavirus is a leading cause of sexually transmitted infections worldwide, particularly affecting men who have sex with men. While vaccination remains the most effective strategy for preventing HPV, limited evidence exists regarding the factors influencing vaccine intention in this population. This descriptive, cross-sectional study developed and tested the Model of Factors explaining human papillomavirus vaccination intention using the extended Theory of Planned Behavior, which included attitude, subjective norms, perceived behavioral control, sexual risk behaviors, and human papillomavirus knowledge. The participants were 331 men who have sex with men residing in four provinces across four regions of Thailand, via multi-stage random sampling. Data were collected using online questionnaires, including the Demographic Data Form, the Attitude toward the Behavior Subscale, the Subjective Norm Subscale, the Perceived Behavioral Control Subscale, the Sexual Risk Behavior Questionnaire, the Mid-Adult Human Papillomavirus Vaccine Knowledge Scale, and the Behavioral Intention Subscale. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and structural equation modeling.
The findings showed that the participants had a high intention to receive the human papillomavirus vaccination. Attitude, subjective norms, and perceived behavioral control collectively explained intention, accounting for 39.5% of the variance. Subjective norms have a strong influence on intention, both directly and indirectly, through attitude and perceived behavioral control. Sexual risk behaviors and knowledge of human papillomavirus did not significantly influence vaccination intention. The findings can be applied to develop programs to promote human papillomavirus vaccination intention by reinforcing positive attitudes, supporting subjective norms such as peer groups, and enhancing perceived behavioral control over human papillomavirus vaccination. However, this intervention must be tested before it can be used in practice.
References
World Health Organization. Human papillomavirus and cancer. 2024 [cited 2025 Apr 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer
U.S. Centers for Disease Control and Prevention. Chapter 11: Human Papillomavirus. 2024 [cited 2025 Apr 28]. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-11-human-papillomavirus.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html
Meites E, Wilkin TJ, Markowitz LE. Review of human papillomavirus (HPV) burden and HPV vaccination for gay, bisexual, and other men who have sex with men and transgender women in the United States. Hum Vaccin Immunother 2022;18(1):2016007. doi: 10.1080/21645515.2021.2016007.
Chidobem I, Tian F, Ogbuokiri E, Mgbodile F, Mgbodile C, Jokar TO, et al. Trends in HPV and HPV vaccine awareness among gay and bisexual males in the U.S. Vaccines. 2022;10(4):604. doi: 10.3390/vaccines10040604.
He W, Pan H, Lin B, Zhong X. Analysis of HPV vaccination willingness amongst HIV-negative men who have sex with men in China. Vaccines. 2021;9(10):1069. doi: 10.3390/vaccines9101069.
Kusters JMA, Brouwer JGM, van Benthem BHB, Heijne JCM, Schim van der Loeff MF. Global type-specific genital human papillomavirus prevalence in men, by sexual orientation: a systematic review and meta-analysis. J Infect Dis. 2023;228(8):1023-32. doi: 10.1093/infdis/jiad109.
Yunihastuti E, Teeratakulpisarn N, Jeo WS, Nilasari H, Rachmadi L, Somia IKA, et al. Incidence, clearance, persistence and factors related with high-risk anal HPV persistence in South-East Asian MSM and transgender women. AIDS. 2020;34(13):1933-41. doi: 10.1097/QAD.0000000000002654.
Gatechompol S, Teeratakulpisarn N, Wittawatmongkol O, Teeraananchai S, Kerr SJ, Chalermchockcharoenkit A, et al. Incidence, persistence, and factors associated with HPV infection among male adolescents with and without perinatally acquired HIV infection. J Acquir Immune Defic Syndr. 2020:85(5):553-60. doi:10.1097/QAI.0000000000002499.
Supindham T, Chariyalertsak S, Utaipat U, Miura T, Ruanpeng D, Chotirosniramit N, et al. High prevalence and genotype diversity of anal HPV infection among MSM in northern Thailand. PLoS One. 2015;10(5):e0124499. doi: 10.1371/journal.pone.0124499.
Hudrudchai S, Thato R. Factors predicting human papillomavirus vaccination intention among men who have sex with men receiving sexual health services. Kuakarun J nurs. 2021;28(1):56–69 (in Thai).
Wheldon CW, Daley EM, Walsh-Buhi ER, Baldwin JA, Nyitray AG, Giuliano AR. an integrative theoretical framework for HPV vaccine promotion among male sexual minorities. Am J Mens Health. 2018;12(5):1409-20. doi:10.1177/1557988316652937.
Nadarzynski T, Frost M, Miller D, Wheldon CW, Wiernik BM, Zou H, et al. Vaccine acceptability, uptake and completion amongst men who have sex with men: a systematic review, meta-analysis and theoretical framework. Vaccine. 2021;39(27):3565-81. doi: 10.1016/j.vaccine.2021.05.013.
Kreupimy S, Thato R. Factors predicting intention to take human papillomavirus vaccine among men who have sex with men students. Kuakarun J Nurs. 2016; 23(1):102–17 (in Thai).
Malathummarat R, Srisuriyawet R, Leelukkanaveera Y. Predictors of HPV vaccine intention among young men who have sex with men in Chonburi Province. J Royal Thai Army Nurses. 2022; 23(2):540–50 (in Thai).
Fongkaew K, de Lind van Wijngaarden JW, Tepjan S, Chonwanarat N, Akkakanjanasupar P, Newman PA. 'No test, no disease': multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand. Cult Health Sex. 2022;24(9):1199-1214. doi: 10.1080/13691058.2021.1938237.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.
Ajzen I. The theory of planned behavior: frequently asked questions. Hum Behav Emerg Technol. 2020;2(4):314–24. doi: 10.1002/hbe2.195.
Catalano HP, Knowlden AP, Birch DA, Leeper JD, Paschal AM, Usdan SL. Using the theory of planned behavior to predict HPV vaccination intentions of college men. J Am Coll Health. 2017;65(3):197-207. doi:10.1080/07448481.2016.1269771.
Pan H, He W, Lin B, Zhong X. Factors influencing HPV vaccination willingness among men who have sex with men in China: a structural equation modeling analysis. Hum Vaccin Immunother. 2022;18(1):2038504. doi:10.1080/21645515.2022.2038504.
Kufaine N. Understanding characteristics of extended theory of planned behavior: systematic literature review. Open J Philos. 2024; 14(04):848–58. doi:10.4236/ojpp.2024.144057.
Chen Q, Zhou T, Zhong X. Factors related to HPV vaccination intention among MSM in China: a Bayesian network model. Int J Environ Res Public Health. 2022;19(23):15532. doi:10.3390/ijerph192315532.
Ferrer-Urbina R, Leal-Soto F, Bravo N, Huaranca C, Pérez J, Salinas T, et al. Scale of risk behaviors, associated with STI/HIV-AIDS, for young Chileans. Europ Proced Soc Behav Sci.2018; 60(99):800-9. doi:10.15405/epsbs.2019.04.02.99.
Garg A, Wheldon CW, Galvin AM, Moore JD, Griner SB, Thompson EL. The development and psychometric evaluation of the Mid-adult Human Papillomavirus Vaccine Knowledge Scale in the United States. Sex Transm Dis. 2022;49(6):423-28. doi:10.1097/OLQ.0000000000001615.
Mann-Barnes T, Bhimla A, Coronado M, Lin T, Duro-Aina A, Park H, Ma GX. Factors that predict HPV vaccination behavior among young men-who-have-sex-with-men in the Greater Philadelphia region. J Racial Ethn Health Disparities. 2023;10(5):2167–74. doi:10.1007/s40615-022-01396-2.
Gray JR, Grove SK, Sutherland S. Burns & Grove’s the practice of nursing research: appraisal, synthesis, and generation of evidence. 8th ed. St. Louis: Elsevier; 2017.
Hair JF, Babin BJ, Anderson RE, Black WC. Multivariate data analysis. 8th ed. Saddle River, New Jersey: Pearson Prentice Hall; 2019.
Wolgast A, Schwinger M, Hahnel C, Stiensmeier-Pelster J. Handling missing data in structural equation models in R. Electron J Res Educ Psychol. 2017;15(1):5–47. doi:10.14204/ejrep.41.16125.
The National Economic and Social Development. Thailand’s management of regional and spatial development. 2008; 12-13. Available from: https://www.nesdc.go.th/nesdb_en/ewt_w3c/ewt_dl_link.php?nid=4162
Lemeshow S, Hosmer DW, Klar J, Lwanga SK, World Health Organization. Adequacy of sample size in health studies. Chichester: Wiley; 1990.
World Health Organization. Process of translation and adaptation of instruments. Geneva: World Health Organization; 2018.
Kline RB. Principles and practice of structural equation modeling. 4th ed. New York: The Guilford Press; 2016.
Koskan A, Stecher C, Helitzer D. College males' behaviors, intentions, and influencing factors related to vaccinating against HPV. Hum Vaccin Immunother. 2021;17(4):1044-51. doi: 10.1080/21645515.2020.1819101.
Shen F, Du Y, Cao K, Chen C, Yang M, Yan R, et al. Acceptance of the human papillomavirus vaccine among general men and men with a same-sex orientation and its influencing factors: a systematic review and meta-analysis. Vaccines. 2023;12(1):16. doi: 10.3390/vaccines12010016.
Pow J, Clarke L, McHale S, Gray-Brunton C. A systematic review and thematic synthesis exploring how gay, bisexual and other men who have sex with men (GBMSM) experience HPV and HPV vaccination. Hum Vaccin Immunother. 2025;21(1):2490440. doi: 10.1080/21645515.2025.2490440.
Comer D, Warner NZ, Noone C. Human papilloma virus vaccination in gay and bi men: predictors, dynamic norms, and connectedness to the LGBT+ community. Vaccine. 2024;42(23):126014. doi: 10.1016/j.vaccine.2024.05.062.
Chin KY, Ekeuku SO, Hamzah MR. The role of healthcare providers in promoting human papillomavirus vaccines among men who have sex with men: a scoping review. Vaccines. 2022; 10(6):930. doi: 10.3390/vaccines10060930.
Shi G, Lin B, Pan H, He W, Zhong X. Using an extended information-motivation-behavioral skills model to explain HPV vaccination intention among men who have sex with men only and men who have sex with men and women. Hum Vaccin Immunother. 2024;20(1). doi:10.1080/21645515.2024.2327150.
Zhang R, Wong NS, Chung SL, Kwan CK, Kwan TH, Lee SS. Uptake and service preferences of human papillomavirus vaccination in men who have sex with men. Hum Vaccin Immunother. 2025;21(1):2440956. doi: 10.1080/21645515.2024.2440956.
Ajzen I, Joyce N, Sheikh, Cote NG. Knowledge and the prediction of behavior: the role of information accuracy in the theory of planned behavior. Basic Appl Soc Psychol. 2011;33(2):101–17. doi:10.1080/01973533.2011.568834.
Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. London: Psychology Press;2010.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Pacific Rim International Journal of Nursing Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
