Annals of Behavioral Medicine

, Volume 44, Issue 2, pp 171–180 | Cite as

Predicting Human Papillomavirus Vaccine Uptake in Young Adult Women: Comparing the Health Belief Model and Theory of Planned Behavior

Original Article

Abstract

Background

Although theories of health behavior have guided thousands of studies, relatively few studies have compared these theories against one another.

Purpose

The purpose of the current study was to compare two classic theories of health behavior—the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB)—in their prediction of human papillomavirus (HPV) vaccination.

Methods

After watching a gain-framed, loss-framed, or control video, women (N = 739) ages 18–26 completed a survey assessing HBM and TPB constructs. HPV vaccine uptake was assessed 10 months later.

Results

Although the message framing intervention had no effect on vaccine uptake, support was observed for both the TPB and HBM. Nevertheless, the TPB consistently outperformed the HBM. Key predictors of uptake included subjective norms, self-efficacy, and vaccine cost.

Conclusions

Despite the observed advantage of the TPB, findings revealed considerable overlap between the two theories and highlighted the importance of proximal versus distal predictors of health behavior.

Keywords

Theory testing Health behavior theory Cervical cancer prevention Vaccination 

Notes

Acknowledgments

We thank members of the Women’s Health research team (Khadija Andrews, Kristina Banda, Kathleen Burns, Michelle DiMarco, Sophia Harvey, Elizabeth Howe, Jessica Kraich, Lisa Langenderfer, Meghan McLeod, Mallory McRoberts, Kristina Martinez, Shella Mesa, Samantha O’Hara, Virginia Parker, Victoria Patronis, Michelle Poole, Alana Resmini, and Jennifer Rice, Stephanie Urena, and Becky Wiesenfeld) for their assistance with this project. This research was supported in part by a grant from the National Cancer Institute of the National Institutes of Health (R03-CA138069).

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Supplementary material

12160_2012_9366_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 22 kb)

References

  1. 1.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50: 179–211.CrossRefGoogle Scholar
  2. 2.
    Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975; 13: 10–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Conner M, Norman P, eds. Predicting health behavior. 2nd ed. Buckinghman, UK: Open University Press; 2005.Google Scholar
  4. 4.
    Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: An intro to theory and research. Reading, MA: Addison-Wesley; 1975.Google Scholar
  5. 5.
    Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988; 15: 175–183.PubMedCrossRefGoogle Scholar
  6. 6.
    Abraham C, Sheeran P. Health belief model. In M. Conner and P. Norman, eds. Predicting health behavior. Buckinghman, UK: Open University Press; 2005: 28–80.Google Scholar
  7. 7.
    Conner M, Sparks P. Theory of planed behaviour and health behavior. In M. Conner and P. Norman, eds. Predicting health behavior. Buckinghman, UK: Open University Press; 2005: 171–222.Google Scholar
  8. 8.
    Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. 1974; 2: 328–335.Google Scholar
  9. 9.
    Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: Are we moving in the right direction? Health Educ Res. 2005; 20: 275–290.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinstein ND. Testing four competing theories of health-protective behavior. Health Psychol. 1993; 12: 324–333.PubMedCrossRefGoogle Scholar
  11. 11.
    Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychol Bull. 2001; 127: 142–161.PubMedCrossRefGoogle Scholar
  12. 12.
    Brewer NT, Rimer BK. Perspectives on health behavior theories that focus on individuals. In: Glanz K, Rimer BK, Viswanath K, eds. Health behavior and health education: Theory, research, and practice. San Francisco, CA Jossey-Bass; 2008: 149–165.Google Scholar
  13. 13.
    Champion VL, Skinner CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, eds. Health behavior and health education: Theory, research, and practice. San Francisco, CA Jossey-Bass; 2008: 45–65.Google Scholar
  14. 14.
    Bonetti D, Johnston M, Clarkson J, Turner S. Applying multiple models to predict clinicians' behavioural intention and objective behaviour when managing children's teeth. Psychol Health. 2009; 24: 843–860.PubMedCrossRefGoogle Scholar
  15. 15.
    McClenahan C, Shevlin M, Adamson G, Bennett C, O'Neill B. Testicular self-examination: A test of the health belief model and the theory of planned behaviour. Health Educ Res. 2007; 22: 272–284.PubMedCrossRefGoogle Scholar
  16. 16.
    Tavares LS, Plotnikoff RC, Loucaides C. Social-cognitive theories for predicting physical activity behaviours of employed women with and without young children. Psychol Health Med. 2009; 14: 129–142.PubMedCrossRefGoogle Scholar
  17. 17.
    Weinstein ND, Rothman AJ. Commentary: Revitalizing research on health behavior theories. Health Educ Res. 2005; 20: 294–297.PubMedCrossRefGoogle Scholar
  18. 18.
    Markowitz LE, Dunne EF, Saraiya M, et al. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007; 56: 1–24.Google Scholar
  19. 19.
    Centers for Disease Control and Prevention. FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010; 59: 626–629.Google Scholar
  20. 20.
    Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007; 356: 1915–1927.CrossRefGoogle Scholar
  21. 21.
    Paavonen J, Naud P, Salmeron J, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): Final analysis of a double-blind, randomised study in young women. Lancet. 2009; 374: 301–314.PubMedCrossRefGoogle Scholar
  22. 22.
    Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Prev Med. 2007; 45: 107–114.PubMedCrossRefGoogle Scholar
  23. 23.
    Zimet GD, Liddon N, Rosenthal SL, Lazcano-Ponce E, Allen B. Chapter 24: Psychosocial aspects of vaccine acceptability. Vaccine. 2006; 24 Suppl 3: S3/201–209.Google Scholar
  24. 24.
    Allen JD, Mohllajee AP, Shelton RC, et al. Stage of adoption of the human papillomavirus vaccine among college women. Prev Med. 2009; 48: 420–425.PubMedCrossRefGoogle Scholar
  25. 25.
    Brewer NT, Gottlieb SL, Reiter PL, et al. Longitudinal predictors of HPV vaccine initiation among adolescent girls in a high-risk geographic area. Sex Transm Dis. 2011; 38: 197–204.PubMedCrossRefGoogle Scholar
  26. 26.
    Conroy K, Rosenthal SL, Zimet GD, et al. HPV vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. J Womens Health. 2009; 18: 1679–1686.CrossRefGoogle Scholar
  27. 27.
    Roberts ME, Gerrard M, Reimer R, Gibbons FX. Mother-daughter communication and human papillomavirus vaccine uptake by college students. Pediatrics. 2010; 125: 982–989.PubMedCrossRefGoogle Scholar
  28. 28.
    Rosenthal SL, Weiss TW, Zimet GD, et al. Predictors of HPV vaccine uptake among women aged 19–26: Importance of a physician's recommendation. Vaccine. 2011; 29: 890–895.PubMedCrossRefGoogle Scholar
  29. 29.
    Reiter PL, Brewer NT, Gottlieb SL, McRee AL, Smith JS. Parents' health beliefs and HPV vaccination of their adolescent daughters. Soc Sci Med. 2009; 69: 475–480.PubMedCrossRefGoogle Scholar
  30. 30.
    Weinstein ND. Misleading tests of health behavior theories. Ann Behav Med. 2007; 33: 1–10.PubMedCrossRefGoogle Scholar
  31. 31.
    Gerend MA, Shepherd JE. Correlates of HPV knowledge in the era of HPV vaccination: A study of unvaccinated young adult women. Women Health. 2011; 51: 25–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Gerend MA, Shepherd MA, Shepherd JE. The multidimensional nature of perceived barriers: Global versus practical barriers to HPV vaccination. Health Psychol. 2011. doi: 10.1037/a0026248.
  33. 33.
    Gerend MA, Shepherd JE. Using message framing to promote acceptance of the human papillomavirus vaccine. Health Psychol. 2007; 26: 745–752.PubMedCrossRefGoogle Scholar
  34. 34.
    Gerend MA, Shepherd JE, Monday KA. Behavioral frequency moderates the effects of message framing on HPV vaccine acceptability. Ann Behav Med. 2008; 35: 221–229.PubMedCrossRefGoogle Scholar
  35. 35.
    Weinstein ND, Kwitel A, McCaul KD, et al. Risk perceptions: Assessment and relationship to influenza vaccination. Health Psychol. 2007; 26: 146–151.PubMedCrossRefGoogle Scholar
  36. 36.
    Fazekas KI, Brewer NT, Smith JS. HPV vaccine acceptability in a rural Southern area. J Womens Health. 2008; 17: 539–548.CrossRefGoogle Scholar
  37. 37.
    Boehner CW, Howe SR, Bernstein DI, Rosenthal SL. Viral sexually transmitted disease vaccine acceptability among college students. Sex Transm Dis. 2003; 30: 774–778.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwarzer R, Renner B. Social-cognitive predictors of health behavior: Action self-efficacy and coping self-efficacy. Health Psychol. 2000; 19: 487–495.PubMedCrossRefGoogle Scholar
  39. 39.
    Muthén B, Muthén L. Mplus Version 3.12. 1998.Google Scholar
  40. 40.
    Newsom J. Practical approaches to dealing with nonnormal and categorical variables. Available at http://www.upa.pdx.edu/IOA/newsom/semclass/ho_estimate2.pdf. Accesibility verified March 12, 2011.

Copyright information

© The Society of Behavioral Medicine 2012

Authors and Affiliations

  1. 1.Department of Medical Humanities and Social Sciences, College of MedicineFlorida State UniversityTallahasseeUSA
  2. 2.Department of Clinical Sciences, College of MedicineFlorida State UniversityTallahasseeUSA

Personalised recommendations