This Protection Motivation Theory cross-sectional study surveyed 1,130 students aged 18–26 at three universities in Huanggang, Hubei, China, during April–May 2025. The authors dichotomized a 1–10 intention item into low scores of 1–6 and high scores of 7–10; 58.9% were in the high-intention group. In adjusted analysis, hepatitis B knowledge, vaccine knowledge, preventive behaviour, perceived severity, self-efficacy, and response efficacy were associated with higher odds of high intention, while perceived response cost was associated with lower odds. The findings identify intervention targets but do not show that changing them raises actual vaccination uptake.
Key findings
- A total of 666 of 1,130 students, 58.9%, had high intention, whereas only 356, 31.5%, reported completing HBV vaccination in the previous four years.
- Independent positive associations with high intention included HBV knowledge, OR=1.41; vaccine knowledge, OR=1.49; preventive behaviour, OR=1.60; perceived severity, OR=1.05; self-efficacy, OR=1.10; and response efficacy, OR=1.16, all with 95% confidence intervals excluding 1.
- Response cost was inversely associated with high intention, OR=0.85, 95% CI 0.79–0.91. Gender, academic year, and residence were not significant after adjustment; the final model's Nagelkerke R² was 0.265.
Why this matters globally
Universities in settings with substantial HBV burden can use the findings to shape communication about severity, vaccine effectiveness, and confidence while reducing informational, time, access, and cost barriers. On-campus vaccination is a plausible response to the identified mechanisms, but trials or implementation studies with registry-verified series completion are needed because stronger intention may not translate into uptake.
Thai researcher contribution
Cong Zhang, Phatcha Hirunwatthanakul, and Nachalida Yukalang were affiliated with Mahasarakham University's Faculty of Public Health and collaborated with Hannah Wechkunanukul of Torrens University Australia. Mahasarakham University provided ethics approval and public-health theory expertise, but all study sites were in Hubei, so the participants were not Thai students.
Limitations to consider
Simultaneous measurement prevents causal or directional inference. Self-report is vulnerable to social-desirability and recall bias, and a single intention item was dichotomized, discarding continuous information. The sample came from three universities in one city, was 75.1% female, and included a relatively large health-major share, limiting generalizability. Family attitudes, physician recommendations, access, and registry-verified vaccination were not included, and residual confounding remains possible.