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

Figures & data

Figure 1. Flow chart of participants’ enrollment.

MSMO, men who have sex with men only; MSMW, men who have sex with men and women.

Table 1. Constructs and corresponding items in the model.

Constructs	Items	Measures
Information	I1	Have you ever heard of HPV?
	I2	Have you ever heard of HPV-related diseases?
	I3	Using condom can reduce HPV infection
	I4	Both men and women can be infected with HPV
	I5	HPV can cause genital warts and malignant tumors such as cervical/penile/skin cancers
	I6	HPV is mainly transmitted through sexual contact
	I7	Most HPV infection have no visible symptoms
	I8	Have you ever heard of the HPV preventive vaccine?
	I9	HPV vaccine can effectively prevent cervical/anal cancer/genital warts.
	I10	What is the best time to be vaccinated against HPV?
	I11	Who can be vaccinated against HPV?
	I12	Does the HPV vaccine protect against all types of HPV infection?
Motivation	M1	How likely do you think you are to be infected with HPV?
	M2	How much of a threat do you think HPV is to you?
Behavioral skills	BS1	Have you ever been tested for sexually transmitted diseases?
	BS2	Have you ever initiated counseling on sexually transmitted diseases?
	BS3	Have you ever been tested for HIV?
	BS4	Have you ever initiated HIV counseling?
Risky sexual behavior	RSB1	In the last six months, number of male sexual partners (casual and regular):
	RSB2	In the last six months, Unprotected sex with men:

I, information; M, motivation; BS, Behavioral skills; RSB, Risky sexual behavior.

Table 2. Participant characteristics of the MSMO and MSMW groups.

Variables	Total	MSMO	MSMW	p
N (%)	914(100)	710(77.68)	204(22.32)
Sociodemographic Characteristics, n (%)
Age(years)				.365
15–30	611(66.85)	480(67.61)	131(64.22)
31–45	303(33.15)	230(32.39)	73(35.78)
Household registration				.220
Urban	544(59.52)	415(58.45)	129(63.24)
Rural	370(40.48)	295(41.55)	75(36.76)
Ethnicity				.978
Han nationality	874(95.62)	679(95.63)	195(95.59)
Ethnic minorities	40(4.38)	31(4.37)	9(4.41)
Education level^a				.153
Junior high and below	64(7.00)	48(6.76)	16(7.84)
Senior high school/Vocational high school/Technical secondary school	151(16.52)	110(15.49)	41(20.10)
Junior college	219(23.96)	172(24.23)	47(23.04)
College and above	480(52.52)	380(53.52)	100(49.02)
Employment status				<.001
Employed^①	673(73.63)	498(70.14)	175(85.78)
Student^#	166(18.16)	153(21.55)	13(6.37)
Unemployed/Retired	75(8.21)	59(8.31)	16(7.84)
Marital status				<.001
Unmarried^①	669(73.19)	578(81.41)	91(44.61)
Married^#	212(23.19)	103(14.51)	109(53.43)
Divorce/widowed	33(3.61)	29(4.08)	4(1.96)
Monthly disposable income (RMB)^a				<.001
≤1000	65(7.11)	58(8.17)	7(3.43)
1001–3000	196(21.44)	176(24.79)	20(9.80)
3001–5000	233(25.49)	179(25.21)	54(26.47)
5001–10000	288(31.51)	206(29.01)	82(40.20)
>10000	132(14.44)	91(12.82)	41(20.10)
Score, M (P25, P75)
Risky sexual behavior^a	2(2,3)	2(2,4)	2(2,3)	<.001
Information^a	20(16, 22)	20(15,22)	20(17,22)	.320
Motivation^a	6(4,7)	6(4,7)	5.5(3,8)	.181
Behavioral skills^a	2(0,4)	2(0,4)	0(0,3)	<.001
Promotional attitude^a, n (%)				.008
Against	14(1.53)	10(1.41)	4(1.96)
Neutral	125(13.68)	86(12.11)	39(19.12)
Approve	775(84.79)	614(86.48)	161(78.92)
Vaccination intention, n (%)				.016
Unwilling	163(17.83)	115(16.20)	48(23.53)
Willing	751(82.17)	595(83.80)	156(76.47)

^aTested by the Mann-Whitney U test, other by χ² test.

^#Had statistical difference between two-by-two comparisons compared to ①.

MSMO, men who have sex with men only; MSMW, men who have sex with men and women.

Table 3. Correlations between variables in the MSMO and MSMW groups.

	MSMO					MSMW
Constructs	1	2	3	4	5	1	2	3	4	5
1. Risky sexual behavior	1.000					1.000
2. Information	0.191***	1.000				−0.108	1.000
3. Motivation	0.301***	0.233***	1.000			0.197**	−0.050	1.000
4. Behavioral skills	0.495***	0.184***	0.270***	1.000		0.314***	0.121	0.224**	1.000
5. Promotional attitude	0.175***	0.311***	0.134***	0.160***	1.000	−0.043	0.383***	−0.043	0.096	1.000
6. Vaccination intention	0.171***	0.267***	0.211***	0.167***	0.375***	0.109	0.067	0.171*	0.120	0.280***

MSMO, men who have sex with men only; MSMW, men who have sex with men and women.

*p < .05，**p < .01, ***p < .001.

Figure 2. The adjusted standardized path estimates in the extended information-motivation-behavioral skills model.

*p < .05, **p < .01, ***p < .001.

Table 4. The adjusted standardized parameter estimates of the multi-group model.

Path	MSMO		MSMW		t	p
	β	p	β	p
Risky sexual behavior →Information	0.243	<.001	−0.235	.107	2.773	.006
Risky sexual behavior →Motivation	0.452	<.001	0.289	.019	0.428	.669
Risky sexual behavior →Behavioral skills	0.563	<.001	0.646	<.001	−0.429	.668
Risky sexual behavior →Promotional attitude	0.235	.137	−0.069	.826	0.781	.435
Risky sexual behavior →Vaccination intention	−0.037	.808	0.049	.890	−0.184	.854
Information →Behavioral skills	0.117	.041	0.467	<.001	−2.039	.041
Information →Promotional attitude	0.539	<.001	0.519	.013	0.015	.988
Information →Vaccination intention	0.093	.327	−0.176	.490	0.786	.432
Motivation →Behavioral skills	0.055	.402	0.121	.319	−0.363	.717
Motivation →Promotional attitude	−0.005	.960	−0.069	.591	0.337	.736
Motivation →Vaccination intention	0.208	.027	0.260	.057	0.008	.994
Behavioral skills →Promotional attitude	−0.043	.727	0.063	.818	−0.353	.724
Behavioral skills →Vaccination intention	0.069	.518	0.067	.823	0.008	.993
Promotional attitude →Vaccination intention	0.485	<.001	0.565	.001	−0.369	.712
Information <—> Motivation	0.245	<.001	0.112	.256	0.711	.477

MSMO, men who have sex with men only; MSMW, men who have sex with men and women.

Data availability statement

Data analyzed during the current study are available from the corresponding author on reasonable request.