Health Belief Model and HPV Vaccination Uptake in Young Adults
This paper applies two behavioral health theories to real-world vaccination and empowerment challenges. Part One uses the Health Belief Model to analyze why HPV vaccine uptake remains low among young adults in the United States and globally, examining constructs such as perceived susceptibility, seriousness, benefits, barriers, and cues to action through findings from multiple studies. Part Two applies the Theory of Planned Behavior to evaluate a randomized controlled trial that tested an educational intervention aimed at improving healthcare empowerment among reproductive-age women, assessing how attitudes, subjective norms, and perceived behavioral control contributed to behavioral intention and empowerment outcomes.
- Introduction: HPV Vaccination and the Health Belief Model: HPV vaccine context and model overview
- Perceived Susceptibility and Seriousness of HPV: Beliefs about HPV risk and severity
- Perceived Benefits and Barriers to HPV Vaccination: Benefits perception versus cost and access barriers
- Cues to Action for Increasing Vaccine Uptake: Education campaigns and school-based strategies
- Theory of Planned Behavior Applied to Healthcare Empowerment: TPB constructs applied to empowerment intervention
- Intervention Design, Findings, and Limitations: Session outcomes and theory limitations discussed
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What makes this paper effective
- Systematically applies each construct of the Health Belief Model to empirical evidence from multiple studies, keeping theory and data tightly integrated throughout.
- Uses quantitative findings (percentages, participant counts) to ground abstract theoretical constructs in concrete, measurable outcomes.
- Transitions cleanly from a broad model application in Part One to a specific article critique in Part Two, demonstrating versatility in theoretical application.
Key academic technique demonstrated
The paper demonstrates construct-by-construct theoretical mapping — a core academic technique in health behavior research. Rather than applying a theory as a vague lens, the author anchors each named construct (e.g., perceived seriousness, subjective norms) to specific study findings, making explicit how empirical data confirms, complicates, or extends each theoretical component.
Structure breakdown
The paper is divided into two clearly delineated parts. Part One moves sequentially through the five constructs of the Health Belief Model, using Calderon-Mora et al. (2020) and Donadiki et al. (2014) as primary evidence sources. Part Two pivots to a single article review structured around the Theory of Planned Behavior, covering the intervention's design, outcomes by construct, and a brief critical reflection on the theory's limitations. The reference list follows APA formatting throughout.
Introduction: HPV Vaccination and the Health Belief Model
Cervical cancer is a fundamental health concern for nations globally. The World Health Organization (WHO) recommends the human papillomavirus (HPV) vaccine as an effective way to prevent HPV-related conditions, including cervical cancer (Alsulami et al., 2023). The vaccine is available for young children aged between 9 and 12, although young adults aged between 13 and 26 may also receive a catch-up immunization if they did not begin or complete the vaccination series before age 12 (Alsulami et al., 2023). According to Kamolratanakul and Pitisuttithum (2021), the HPV vaccine is 80 percent effective in preventing HPV-related infections. However, uptake of the HPV vaccine among young adults in the United States and globally remains low. The Health Belief Model provides a framework for understanding the possible reasons for this trend.
The Health Belief Model postulates that the decision to screen for, prevent, or control illness depends on an individual's perceived susceptibility to the disease, perceived seriousness, perceived benefits and barriers, cues to action, and self-efficacy (Alsulami et al., 2023).
Perceived Susceptibility and Seriousness of HPV
Perceived susceptibility is a measure of an individual's belief that they can contract a disease (Alsulami et al., 2023). Young adults are more likely to get vaccinated if they believe they are at risk of getting infected with HPV (Calderon-Mora et al., 2020). Calderon-Mora et al. (2020) conducted a study of 599 women in the United States to identify the psychosocial factors that influence HPV vaccination rates. Of the 599 women, only 93 (representing 15.5 percent) believed they were at risk of getting HPV, and only 13 percent believed they were likely to get such an infection within the next ten years. In another study by Donadiki et al. (2014), approximately 30 percent of female university students in Greece did not see the need to get vaccinated because they did not believe the vaccines were effective in preventing cervical cancer and other conditions. Moreover, 92.5 percent did not get vaccinated because they believed their sexual behavior was safe and, therefore, they were not at risk of getting HPV. Donadiki et al. (2014) conclude that there is a need to intensify efforts to increase knowledge of the overall nature of HPV and individual susceptibility among young adults as a way of encouraging more people to get vaccinated.
Perceived seriousness is a measure of how serious an individual perceives a disease and its consequences to be (Calderon-Mora et al., 2020). Young adults are more likely to get vaccinated if they believe HPV poses a significant threat to their health. In their study, Calderon-Mora et al. (2020) found that a majority of women in the United States — over 86 percent — agreed that HPV would disrupt their physical health, romantic relationships, and overall quality of life. However, Donadiki et al. (2014) found that approximately 20 percent of university students did not understand the potential harms of HPV or that failure to obtain the vaccine increased the risk of developing cervical cancer or genital warts. This lack of awareness regarding the severity of HPV and its consequences reduces young adults' inclination to seek vaccination.
Perceived Benefits and Barriers to HPV Vaccination
Perceived benefits refer to how much one believes that taking a preventive action will reduce the risk of acquiring an illness (Donadiki et al., 2014). In the context of HPV, this construct focuses on how much one believes the vaccine reduces the risk of serious health consequences. The study by Calderon-Mora et al. (2020) found that most young adults have a reasonable understanding of the vaccine's benefits. For instance, 86 percent of participants believed vaccination would help them lead healthier lives. At the same time, only 72 percent of participants believed the vaccine's benefits outweighed its risks (Calderon-Mora et al., 2020). Donadiki et al. (2014) reported a similar finding from a sample of female university students in Greece: 45 percent of young adults interviewed did not believe the HPV vaccine was safe, while 49 percent did not believe that taking the vaccine would protect them against cervical cancer. Generally, the study found that participants who scored higher on the perceived benefits measure were more likely to be vaccinated (Donadiki et al., 2014). The authors therefore conclude that more advocacy through public health education programs is needed to address attitudes and risk perceptions about the vaccine, and that such programs would help spread positive information about the benefits of HPV vaccination to increase uptake among young adults.
Perceived barriers are the psychological or physical factors that prevent young adults from getting the HPV vaccine. According to Calderon-Mora et al. (2020), the most common barriers preventing vaccine uptake were lack of adequate information, limited accessibility, and cost. For instance, 82 percent of parents with female children and 88 percent of those with male children indicated they would get their children vaccinated if it was offered free or at a very low cost (Calderon-Mora et al., 2020). Donadiki et al. (2014) also found that young adults who lacked insurance coverage were less likely to get vaccinated due to cost-related concerns. Additionally, 56 percent of parents who participated in the Calderon-Mora et al. (2020) study indicated that they did not know where to obtain the vaccine for their children.
Donadiki et al. (2014) further found that factual misconceptions among young adults prevented vaccination. Participants in stable relationships and those with a single sexual partner were less likely to get vaccinated because they believed they were not at risk of HPV (Donadiki et al., 2014). Additionally, participants who did not believe in the efficacy and safety of vaccines generally, or who did not believe the vaccine would prevent HPV infection, were more likely to refuse vaccination (Donadiki et al., 2014). This indicates that young adults may decline vaccination because of misperceptions about their susceptibility, the severity of HPV, and the benefits of the vaccine.
Parental consent also emerged as a significant barrier to vaccine uptake among young adults. Calderon-Mora et al. (2020) found that young adults whose parents consented to the vaccine were more likely to be vaccinated than those who lacked parental consent. The study therefore recommends more educational programs targeting parents to address misconceptions and concerns about vaccine safety.
Theory of Planned Behavior Applied to Healthcare Empowerment
The selected article is titled "Effectiveness of an Educational Intervention Using Theory of Planned Behavior on Healthcare Empowerment among Married Reproductive-Age Women: A Randomized Controlled Trial" (Sabouri et al., 2020). The article sought to determine the effectiveness of an educational intervention designed to improve healthcare empowerment levels among 488 women of reproductive age. The authors use the constructs of the Theory of Planned Behavior to design the educational intervention. The article defines healthcare empowerment as a health improvement process in which "people gain greater control over their decisions, lifestyles, and activities affecting their health" (Sabouri et al., 2020, p. 1).
The Theory of Planned Behavior suggests that intention is a fundamental factor in behavioral change. Intention is, in turn, driven by three constructs: one's attitude towards the behavior, perceived behavioral control, and subjective norms. Perceived behavioral control refers to the extent to which an individual perceives that they have control over their behavior, while subjective norms concern how one perceives others — such as friends and relatives — to view that behavior. Participants were divided into a control group (245) and an intervention group (243), and baseline scores were obtained for behavioral intention, attitudes towards health empowerment, behavioral beliefs, subjective norms, and perceived behavioral control using a 44-item questionnaire.
The intervention group attended four one-hour educational sessions weekly over the course of one month. The sessions were grounded in the constructs of the Theory of Planned Behavior. The first session sought to eliminate subjective obstacles to effective healthcare empowerment and improve participants' attitudes toward forming a positive relationship with health experts (attitudes). The second session addressed normative beliefs about pregnancy prevention and subjective norms about healthcare empowerment (subjective norms). The third session focused on increasing behavioral control by educating participants on time management, vaccination in health promotion, and available health improvement services (behavioral control). The final session sought to increase outcome evaluations by educating participants on the importance of pap-smear tests and breast cancer screenings. Participants also received targeted social media messages and text messages throughout the intervention period to complement in-session instruction.
References
Alsulami, F., Sanchez, J., Rabionet, S., Popovici, L., & Baraka, M. A. (2023). Predictor of HPV vaccine uptake among foreign-born college students in the US: An exploration of the role of acculturation and the health belief model. Vaccines, 11(2), 422. DOI: 10.3390/vaccines11020422
Boston University. (2022). The theory of planned behavior. Boston University. https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/BehavioralChangeTheories3.html
Calderon-Mora, J., Ferdous, T., & Shokar, N. (2020). HPV vaccine beliefs and correlates of uptake among Hispanic women and their children on the US-Mexico border. Cancer Control, 27(1), 1–9. DOI: 10.1177/1073274820968881
Donadiki, E. M., Jimenez-Garcia, R., Hernandez-Barrera, V., Sourtzi, P., Carrasco-Garrido, P., Andres, A., Jimenez-Trujillo, I., & Velonakis, E. G. (2014). Health belief model applied to non-compliance with HPV vaccine among female university students. Public Health, 128(3), 268–273. DOI: 10.1016/j.puhe.2013.12.004
Kamolratanakul, S., & Pitisuttithum, P. (2021). Human papillomavirus vaccine efficacy and effectiveness against cancer. Vaccines, 9(12), 1413. DOI: 10.3390/vaccines9121413
Sabouri, M., Shakibazadeh, E., Mohebbi, B., Tol, A., Yaseri, M., & Babaee, S. (2020). Effectiveness of an educational intervention using theory of planned behavior on healthcare empowerment among married reproductive-age women: A randomized controlled trial. Journal of Education and Health Promotion, 9(1), 1–8.
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