Effects of Message Framing on HPV Vaccination Decision-making - A Survey Experiment among Chinese Male College Students

Sep 29, 2026

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Human papillomavirus (HPV) represents a major public health challenge and China’s expansion of gender-neutral vaccination to include males raises new decision-making needs. This quasi-experimental pre-post survey study tested four message frames—control, personal health risks, partner risks, and both risks—on HPV vaccination intention, decisional readiness, and perceived responsibility. Among 612 male college students, baseline awareness of male eligibility was 41.8%, and all frames improved outcomes; both-risk frames produced the largest effects. Results support targeted education for upcoming gender-neutral strategy.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Methods and Intervention Design

Outcomes and Statistical Analysis

Key Findings and Implications

Article History and Keywords

RESEARCH ARTICLE Effects of message framing on HPV Vaccination decision-making: A Survey experiment among Chinese male college students Xiaomin Wanga, Bo Yanb, and Xiaohe Wanga aSchool of Public Administration, Hangzhou Normal University, Hangzhou, China; bInstitute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China ABSTRACT Human papillomavirus (HPV) is a major public health concern affecting both sexes. China adopted a gender-neutral HPV vaccination strategy, expanding recommendations to include males. College students, a high-risk group for HPV exposure, were a priority target for vaccination campaigns. This study compares how four message frames (control, personal health risks, partner risks, both risks) influenced HPV vaccination intention, decisional readiness, and perceived responsibility among Chinese male college students. We conducted a quasi-experimental pre-post survey among 612 male students from three Chinese universities (December 2024–January 2025) . Participants were randomly assigned to four message-framing groups. Demographic distributions were compared using Chi-square and Kruskal-Wallis tests. Intervention effects were analyzed via McNemar’s tests and multivariable logistic regression. Among participants, 41.8%(n = 256) were unaware of male eligibility for HPV vaccination. Post-intervention, all groups showed improvements in vaccination intention, decisional readiness, and perceived responsibility. Both risk groups consistently exhibited the largest effect sizes across all outcomes (p < .001) . For example, vaccination intention in both risk groups increased from 7.2% pre-intervention to 21.6% post-intervention (p < .001) . Compared to the control message frame, none of the other frames showed a pairwise significant difference after adjusting for baseline characteristics (adjusted p > .017) . The low baseline awareness of male HPV vaccine eligibility highlighted the urgency of targeted education. These findings directly informed China’s upcoming gender-neutral HPV vaccination strategy. ARTICLE HISTORY Received 17 October 2025 Revised 5 December 2025 Accepted 14 December 2025 KEYWORDS Message framing; human papillomavirus; vaccination; China Introduction Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection, with most individuals contracting it during their sexual activity, often asymptomatically. 1 Persistent infection with high-risk HPV types (e.g., HPV 16 and 18) can lead to severe health consequences, including cancer.2 Cervical cancer remains the fourth most common cancer in women worldwide3; however, HPV also significantly impacts men, causing cancers of the anus, penis, and oropharynx.4 Globally, HPV accounted for approximately 690,000 new cancer cases in 2018, with a disproportionate burden on women (620,000 cases) compared to men (70,000 cases) .5 Substantial evidence supports HPV vaccination as a cost-effective strategy to mitigate HPV-related cancers.6,7 Randomized trials demonstrate that vaccination reduced the incidence of cervical precancerous lesions by preventing high-risk HPV infection.8 A systematic review of 60 million individuals further confirmed the direct impact and herd effects of HPV vaccination programs in both sexes, with protection sustained for up to 8 years’ post-vaccination.9 Despite these benefits, male vaccination rates remained inadequate with 6% initiation and 5% completion globally, 10 undermining efforts to curb HPV transmission. Moreover, men served as critical vectors in transmitting HPV to female partners, amplifying the overall disease burden. 11, 12 CONTACT Xiaohe Wang, PhD [xhewang@163.com](xhewang@163.com) School of Public Administration, Hangzhou Normal University, No. 2318 Yuhangtang Road, Yuhang District, Hangzhou 311121, China. Supplemental data for this article can be accessed online at [https://doi.org/10.1080/21645515.2025.2606516](https://doi.org/10.1080/21645515.2025.260

FAQs

How were the message frames defined in the study?

The study compared four frames: a control message, personal health risks, partner risks, and both risks. Participants were randomly assigned to these groups before and after the intervention.

What participant characteristics were measured and how were demographics compared?

Demographic distributions were compared across groups using Chi-square and Kruskal-Wallis tests. Baseline characteristics were also used when adjusting significance tests for outcome differences.

Which message frame had the strongest impact on vaccination-related outcomes?

Both risk groups consistently showed the largest effect sizes across vaccination intention, decisional readiness, and perceived responsibility (p < .001). For intention, increases from 7.2% pre-intervention to 21.6% post-intervention were reported for both-risk frames.

Sep 29, 2026

Upload by dawugda