Protecting the Next Generation: Elaborating the Health Belief Model to Increase HPV Vaccination Among College-Age Women

This study guides social marketing campaigns to increase human papillomavirus (HPV) vaccination among young women by elaborating the health belief model (HBM). A self-administered, anonymous, web-based questionnaire was e-mailed to all entering female college students at a large, public university in the mid-Atlantic region of the United States. Findings elaborate the HBM constructs of perceived threat, benefits, barriers, and cues to action. Almost all participants had heard about the HPV vaccine and the majority of first-year students had received at least one shot in the vaccination series. Results expand understandings of perceived threat in relation to the HPV vaccine by explicating misinformation and knowledge gaps. Participants indicated that parents and physicians were their most trusted sources of vaccine information. Television and Internet cues to action were negatively associated with HPV vaccination among these women. Structural equation modeling results affirmed the HBM's fit (comparative fit index = 0.935, normative fit index = 0.921, and root mean square error of approximation = 0.077). This finding suggests the importance of multimodal sources of information, expanding the dichotomous internal and external cues to action. Perceptions of vaccine safety remained a significant barrier to the uptake of HPV vaccination among participants. Racial disparities between White and non-White students could have a considerable impact on the established inequality in HPV vaccination rates in the United States. Results inform future social marketing campaign messages and strategies based on the HBM.