Effect of an IMB Model-Based Education on the Acceptability of HPV Vaccination Among College Girls in Mainland China: A Cluster RCT

"It is...a convincing design to use a theoretical framework such as the IMB model when organizing behavioral intervention with preventive aims, and such theory-based measures can be used for interventions addressing vaccine hesitancy in future government-supported HPV vaccination projects."

Numerous studies have used health behaviour theories, including the information-motivation-behavioural (IMB) skills model, to identify the multifaceted factors and underlying mechanisms of positive health behaviours, such as accepting the human papillomavirus vaccine (HPVV). Female college students in college can be an appropriate catch-up population for HPV vaccination, given that the HPVV was only approved in mainland China in 2016. However, uptake among this population is much lower than in other countries. This multi-centre, online interventional randomised controlled trial (RCT) investigated if IMB-model-based educational materials improved HPVV acceptance and awareness among college women in mainland China.

Created by Fisher to predict and promote healthy behaviours, the IMB includes the following 3 constructs: information (the personal knowledge of health actions), motivation (personal beliefs regarding health actions, such as perceived susceptibility, perceived severity, beliefs about the benefits and barriers, and subjective norms), and behavioural skills (the ability to make decisions and self-efficacy). On the IMB model, individuals who are well-informed about HPV and HPV vaccination, who are motivated to vaccinate themselves, and who can self-make decisions and believe they can uptake the HPV vaccination are likely to overcome barriers to uptake. Furthermore, socio-demographic characteristics are defined as factors that might influence HPV vaccination.

To ensure representativeness, participants were recruited for the school-based intervention from different universities located in 7 geographic regions of China. The baseline survey was completed by 3,739 female university students from the intervention (n = 1,936) and control groups (n = 1,803) between February and April 2020. The theory-based intervention was conducted using a smart application called DingTalk and took about 10 minutes per day for 7 consecutive days. While the control group received some health tips, the intervention group received tailored HPV health education guided by the IMB model and a quiz. One session specifically teaches learners how to introduce their newly gained knowledge on prevention and treatment of HPV infection to family and friends, for sake of obtaining their support for HPV vaccination.

At baseline, the average score of students on 11 HPV-related questions was 5.225 ± 2.739, and only 32.07% (1,199/3,739) of them showed a willingness to be vaccinated against HPV. After the intervention, the intervention group had a higher willingness to vaccinate themselves and to encourage their friends to get the HPVV compared to the control group (40.39% vs 31.56%, 82.67 vs 73.18%, P < .001), and the difference in knowledge scores between the 2 groups was significant (7.917 ± 1.840 vs 5.590 ± 2.859, P < .001). In addition, 8 students in the intervention group self-reported receiving HPVV during the research period.

Based on the findings, the researchers suggest that college women need more in-depth health education, such as the symptoms, treatment, prognosis, and outcomes of HPV-related diseases, which can increase their perceived severity of HPV infection and thus increase their willingness to get vaccinated. "Only when students realize that they are at risk of contracting HPV, will they personally want to take healthy behaviors to protect themselves."

The researchers conclude that this "IMB model-based educational online intervention was specially tailored for Chinese college female students and showed positive effects on the participants' knowledge, motivation, and perceived objective skills toward HPV vaccination. The improvement in these factors contributed to an increased number of female students who intended to uptake the HPV vaccine after the intervention."