Skip to main content

Advertisement

Log in

Influencing factors of Chinese male circumcision acceptance willingness: a health belief model approach

  • Published:
Current Psychology Aims and scope Submit manuscript

Abstract

Although circumcision has been promoted worldwide, the Chinese male circumcision rate has been far below the world average. By refining the health belief model, we further explored the factors that influence the willingness of Chinese men to be circumcised. This study conducted a sample survey of male willingness to accept circumcision surgery in all provinces of China. Linear regression equation and structural equation model were used to explore the influencing factors of Chinese male-circumcision acceptance willingness. The results showed that trust in the health system and health knowledge were the fundamental factors influencing willingness for male circumcision, related to perceived susceptibility, severity and perceived benefit. However, perceived barriers did not seem to affect Chinese men's willingness to circumcision. This study found that Chinese men's health decisions about whether to undergo circumcision were not only related to perceived susceptibility, perceived benefits, and perceived severity, but also their age, education, and pressure from acquaintances and trust in the health system. Extensive science popularization to the public plays an important role in reducing circumcision hesitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

References

  • Abelson, J., Miller, F. A., & Giacomini, M. (2009). What does it mean to trust a health system?: A qualitative study of Canadian health care values. Health Policy, 91(1), 63–70.

    Article  PubMed  Google Scholar 

  • Alhakami, A. S., & Slovic, P. (1994). A psychological study of the inverse relationship between perceived risk and perceived benefit. Risk Analysis, 14(6), 1085–1096.

    Article  PubMed  Google Scholar 

  • Bailey, R. C., Moses, S., Parker, C. B., Agot, K., Maclean, I., Krieger, J. N., & Ndinya-Achola, J. O. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet, 369(9562), 643–656.

    Article  Google Scholar 

  • Barattucci, M., Pagliaro, S., Ballone, C., Teresi, M., Consoli, C., Garofalo, A., & Ramaci, T. (2022). Trust in science as a possible mediator between different antecedents and COVID-19 booster vaccination intention: an integration of health belief model (HBM) and theory of planned behavior (TPB). Vaccines, 10(7), 1099.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ben, K. L., Xu, J. C., Lu, L., Yao, J. P., Min, X. D., Li, W. Y., & Cao, X. M. (2008). Promoting male circumcision in China for preventing HIV infection and improving reproductive health.National Journal of Andrology, 14(4), 291-297.

  • Ben, K. L., Xu, J. C., Lu, L., Lü, N. Q., Cheng, Y., Tao, J., & Li, P. S. (2009). Male circumcision is an effective" surgical vaccine" for HIV prevention and reproductive health. National Journal of Andrology, 15(5), 395–402.

    PubMed  Google Scholar 

  • Brown, S. A. (2005). Measuring perceived benefits and perceived barriers for physical activity. American Journal of Health Behavior, 29(2), 107–116.

    Article  PubMed  Google Scholar 

  • Cappella, J. N. (2017). Vectors into the future of mass and interpersonal communication research: Big data, social media, and computational social science. Human Communication Research, 43(4), 545–558.

    Article  PubMed  PubMed Central  Google Scholar 

  • Conner, M., & Armitage, C. J. (1998). Extending the theory of planned behavior: A review and avenues for further research. Journal of Applied Social Psychology, 28(15), 1429–1464.

    Article  Google Scholar 

  • Crawford, D. A. (2002). Circumcision: A consideration of some of the controversy. Journal of Child Health Care, 6(4), 259–270.

    Article  PubMed  Google Scholar 

  • Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1–28.

    Article  PubMed  Google Scholar 

  • Dent, J., Gaspar, N., Njeuhmeli, E., & Kripke, K. (2019). Age targeting and scale-up of voluntary medical male circumcision in Mozambique. PLoS ONE, 14(2), e0211958.

    Article  PubMed  PubMed Central  Google Scholar 

  • Diddana, T. Z., Kelkay, G. N., Dola, A. N., & Sadore, A. A. (2018). Effect of nutrition education based on health belief model on nutritional knowledge and dietary practice of pregnant women in Dessie Town, Northeast Ethiopia: A cluster randomized control trial. Journal of Nutrition and Metabolism, 18(1), 1–10.

    Article  Google Scholar 

  • Dorgan, K. A., Lang, F., Floyd, M., & Kemp, E. (2009). International medical graduate–patient communication: A qualitative analysis of perceived barriers. Academic Medicine, 84(11), 1567–1575.

    Article  PubMed  Google Scholar 

  • Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50.

    Article  Google Scholar 

  • Forsythe, S., Liu, C., Shannon, D., & Gardner, L. C. (2006). Development of a scale to measure the perceived benefits and risks of online shopping. Journal of Interactive Marketing, 20(2), 55–75.

    Article  Google Scholar 

  • Frisch, M., & Earp, B. D. (2018). Circumcision of male infants and children as a public health measure in developed countries: A critical assessment of recent evidence. Global Public Health, 13(5), 626–641.

    Article  PubMed  Google Scholar 

  • Frisch, M., Aigrain, Y., Barauskas, V., Bjarnason, R., Boddy, S. A., Czauderna, P., & Wijnen, R. (2013). Cultural bias in the AAP’s 2012 technical report and policy statement on male circumcision. Pediatrics, 131(4), 796–800.

    Article  PubMed  Google Scholar 

  • Fu, L., Tian, T., Yao, K., Chen, X. F., Luo, G., Gao, Y., & Zou, H. (2022). Global pattern and trends in penile cancer incidence: population-based study. JMIR Public Health and Surveillance, 8(7), e34874.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice. John Wiley & Sons.

  • Gebru, T., Lentiro, K., & Jemal, A. (2018). Perceived behavioural predictors of late initiation to HIV/AIDS care in Gurage zone public health facilities: a cohort study using health belief model. BMC Research Notes, 11(1), 1–6.

    Article  Google Scholar 

  • Guvenc, G., Akyuz, A., & Açikel, C. H. (2011). Health belief model scale for cervical cancer and Pap smear test: Psychometric testing. Journal of Advanced Nursing, 67(2), 428–437.

    Article  PubMed  Google Scholar 

  • Henry, J. W., & Stone, R. W. (1994). A structural equation model of end-user satisfaction with a computer-based medical information system. Information Resources Management Journal (IRMJ), 7(3), 21–33.

    Article  Google Scholar 

  • Hermanto, H., & Katmini, K. (2021). Application of HBM Theory (Health Belief Model) to Preventing Behavior of Hypertension Complications in Public Health Center Raas, Sumenep Regency. Journal for Quality in Public Health, 5(1), 149–159.

    Article  Google Scholar 

  • Hu, G., Zheng, Y., Abualigah, L., & Hussien, A. G. (2023). DETDO: An adaptive hybrid dandelion optimizer for engineering optimization. Advanced Engineering Informatics, 57, 102004.

    Article  Google Scholar 

  • Hull, T. H., & Budiharsana, M. (2001). Male circumcision and penis enhancement in Southeast Asia: Matters of pain and pleasure. Reproductive Health Matters, 9(18), 60–67.

    Article  PubMed  Google Scholar 

  • Hunting, K., & Gleason, B. L. (2011). Essential case studies in public health: Putting public health into practice. Jones & Bartlett Publishers.

  • Hwang, K. K. (1987). Face and favor: The Chinese power game. American Journal of Sociology, 92(4), 944–974.

    Article  Google Scholar 

  • Jackson, D. L., Gillaspy, J. A., Jr., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14(1), 6–23.

    Article  PubMed  Google Scholar 

  • Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1–47.

    Article  PubMed  Google Scholar 

  • Jeihooni, A. K., & Rakhshani, T. (2019). The effect of educational intervention based on health belief model and social support on promoting skin cancer preventive behaviors in a sample of Iranian farmers. Journal of Cancer Education, 34, 392–401.

    Article  PubMed  Google Scholar 

  • Jiang, J. J., & Yang, Y. B. (2011). Acceptability and related factors of male circumcision among farmer workers in coal mine. Chinese Journal of Public Health, 27(3), 282–283.

    Google Scholar 

  • Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166(4), 182–186.

    Article  PubMed  Google Scholar 

  • Keetile, M., & Rakgoasi, S. D. (2014). Male Circumcision; willingness to undergo safe male circumcision and HIV risk behaviors among men in Botswana. African Population Studies, 28(3), 1345–1361.

    Article  Google Scholar 

  • Kelava, A. (2016). A review of confirmatory factor analysis for applied research. Journal of Educational and Behavioral Statistics, 41(4), 443–447.

    Article  Google Scholar 

  • Kenny, D. A., & McCoach, D. B. (2003). Effect of the number of variables on measures of fit in structural equation modeling. Structural Equation Modeling, 10(3), 333–351.

    Article  Google Scholar 

  • Lappalainen, R., Saba, A., Holm, L., Mykkanen, H., Gibney, M. J., & Moles, A. (1997). Difficulties in trying to eat healthier: Descriptive analysis of perceived barriers for healthy eating. European Journal of Clinical Nutrition, 51(2), S36.

    PubMed  Google Scholar 

  • Li, Y., Lv, X., Liang, J., Dong, H., & Chen, C. (2022). The development and progress of health literacy in China. Frontiers in Public Health, 10, 1034907.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lieber, E., Chin, D., Li, L., Rotheram-Borus, M. J., Detels, R., Wu, Z., National Institute of Mental Health (NIMH) Collaborative HIV Prevention Trial Group. (2009). Sociocultural contexts and communication about sex in China: informing HIV/STD prevention programs. AIDS Education & Prevention, 21(5), 415–429.

    Article  Google Scholar 

  • Ma, Y. (2020). Ambitious and anxious: How Chinese college students succeed and struggle in American higher education. Columbia University Press.

  • MacArthur, K. R. (2017). Beyond health beliefs: The role of trust in the HPV vaccine decision-making process among American college students. Health Sociology Review, 26(3), 321–338.

    Article  Google Scholar 

  • Mangombe, K., & Kalule-Sabiti, I. (2018). Predictors of male circumcision among men aged 15–35 years in Harare, Zimbabwe. Journal of Biosocial Science, 50(2), 193–211.

    Article  PubMed  Google Scholar 

  • McFarland, D. M. (2013). Associations of demographic variables and the Health Belief Model constructs with Pap smear screening among urban women in Botswana. International Journal of Women's Health, 19(15),709–716.

  • Mor, Z., Kent, C. K., Kohn, R. P., & Klausner, J. D. (2007). Declining rates in male circumcision amidst increasing evidence of its public health benefit. PLoS ONE, 2(9), e861.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morris, B. J., Gray, R. H., Castellsague, X., Bosch, F. X., Halperin, D. T., Waskett, J. H., & Hankins, C. A. (2011). The strong protective effect of circumcision against cancer of the penis. Advances in Urology, 2011, 812368.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morris, B. J., Mindel, A., Tobian, A. A., Hankins, C. A., Gray, R. H., Bailey, R. C., & Wodak, A. D. (2012). Should male circumcision be advocated for genital cancer prevention?. Asian Pacific journal of cancer prevention:APJCP, 13(9), 4839.

  • Morris, B. J., Wamai, R. G., Henebeng, E. B., Tobian, A. A., Klausner, J. D., Banerjee, J., & Hankins, C. A. (2016). Estimation of country-specific and global prevalence of male circumcision. Population Health Metrics, 14(1), 1–13.

    Google Scholar 

  • Musa, D., Schulz, R., Harris, R., Silverman, M., & Thomas, S. B. (2009). Trust in the health care system and the use of preventive health services by older black and white adults. American Journal of Public Health, 99(7), 1293–1299.

    Article  PubMed  PubMed Central  Google Scholar 

  • Norman, P. A. U. L., & Conner, P. (2005). Predicting health behaviour: A social cognition approach. Predicting Health Behaviour, 1(478), 17–18.

    Google Scholar 

  • Pan, L. Y., & Chiou, J. S. (2011). How much can you trust online information? Cues for perceived trustworthiness of consumer-generated online information. Journal of Interactive Marketing, 25(2), 67–74.

    Article  Google Scholar 

  • Pan, L., Zhang, A., Shen, R., & Wang, Z. (2012). Acceptability of early infant male circumcision among Chinese parents: Strategy implications of HIV prevention for China. BMC Public Health, 12, 1–6.

    Article  Google Scholar 

  • Pearlman, R. L., Patel, V., Davis, R. E., Ferris, T. S., Gruszynski, K., Elledge, T., & Nahar, V. K. (2021). Effects of health beliefs, social support, and self-efficacy on sun protection behaviors among medical students: testing of an extended health belief model. Archives of Dermatological Research, 313, 445-452.

  • Rennie, S., Muula, A. S., & Westreich, D. (2007). Male circumcision and HIV prevention: Ethical, medical and public health tradeoffs in low-income countries. Journal of Medical Ethics, 33(6), 357–361.

    Article  PubMed  PubMed Central  Google Scholar 

  • Saqlain, M., Munir, M. M., Rehman, S. U., Gulzar, A., Naz, S., Ahmed, Z., & Mashhood, M. (2020). Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan. Journal of Hospital Infection, 105(3), 419–423.

    Article  PubMed  Google Scholar 

  • Sharifirad, G. R., Tol, A., Mohebi, S., Matlabi, M., Shahnazi, H., & Shahsiah, M. (2013). The effectiveness of nutrition education program based on health belief model compared with traditional training. Journal of Education and Health Promotion, 13(2), 1–5.

    Google Scholar 

  • Sullivan, S. G., Ma, W., Duan, S., Li, F., Wu, Z., & Detels, R. (2009). Attitudes towards circumcision among Chinese men. JAIDS Journal of Acquired Immune Deficiency Syndromes, 50(2), 238–240.

    Article  PubMed  Google Scholar 

  • Teng, T., & Shao, Y. (2011). Scientific approaches to AIDS prevention and control in China. Advances in Dental Research, 23(1), 10–12.

    Article  PubMed  Google Scholar 

  • Tjosvold, D., Law, K. S., & Sun, H. F. (2003). Collectivistic and individualistic values: Their effects on group dynamics and productivity in China. Group Decision and Negotiation, 12, 243–263.

    Article  Google Scholar 

  • Vollrath, M., Knoch, D., & Cassano, L. (1999). Personality, risky health behaviour, and perceived susceptibility to health risks. European Journal of Personality, 13(1), 39–50.

    Article  Google Scholar 

  • Wang, Z., Lau, J. T., & Gu, J. (2012). Acceptability of circumcision among clients of female sex worker in Hong Kong. AIDS and Behavior, 16, 1836–1845.

    Article  PubMed  Google Scholar 

  • Wang, Z., Feng, T., Lau, J. T., & Kim, Y. (2016). Acceptability of voluntary medical male circumcision (VMMC) among male sexually transmitted diseases patients (MSTDP) in China. PLoS ONE, 11(2), e0149801.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, J., Lu, X., Lai, X., Lyu, Y., Zhang, H., Fenghuang, Y., & Fang, H. (2021). The changing acceptance of COVID-19 vaccination in different epidemic phases in China: A longitudinal study. Vaccines, 9(3), 191.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, H., Huang, Z., Zhou, J., Zhang, X., & Liang, C. (2019). Clinical outcomes and risk factors in patients circumcised by Chinese Shang Ring: a prospective study based on age and types of penile disease. Therapeutics and Clinical Risk Management, 19(15), 1233–1241.

    Article  Google Scholar 

  • Wawer, M. J., Tobian, A. A., Kigozi, G., Kong, X., Gravitt, P. E., Serwadda, D., & Gray, R. H. (2011). Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. The Lancet, 377(9761), 209–218.

    Article  Google Scholar 

  • Webster, R., & Heeley, E. (2010). Perceptions of risk: understanding cardiovascular disease. Risk Management and Healthcare Policy, 10(3), 49–60.

    Article  Google Scholar 

  • Wei, S., Ma, M., Wu, C., Yu, B., Jiang, L., Wen, X., & Shi, M. (2021). Using search trends to analyze web-based interest in lower urinary tract symptoms-related inquiries, diagnoses, and treatments in Mainland China: Infodemiology study of Baidu index data. Journal of Medical Internet Research, 23(7), e27029.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weinstein, N. D. (2000). Perceived probability, perceived severity, and health-protective behavior. Health Psychology, 19(1), 65.

    Article  PubMed  Google Scholar 

  • Wong, L. P., Alias, H., Wong, P. F., Lee, H. Y., & AbuBakar, S. (2020). The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Human Vaccines & Immunotherapeutics, 16(9), 2204–2214.

    Article  Google Scholar 

  • Wong, M. C., Wong, E. L., Huang, J., Cheung, A. W., Law, K., Chong, M. K., & Chan, P. K. (2021). Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong. Vaccine, 39(7), 1148–1156.

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organization. (2008). Male circumcision: Global trends and determinants of prevalence, safety and acceptability. World Health Organization Press.

  • Yang, X., Abdullah, A. S., Wei, B., Jiang, J., Deng, W., Qin, B., & Liang, H. (2012). Factors influencing Chinese male’s willingness to undergo circumcision: a cross-sectional study in western China. PloS one, 7(1), e30198.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zare, M., Ghasemi, M., Zahedi, A., Golalipour, K., Mohammadi, S. K., Mirjalili, S., & Abualigah, L. (2023). A Global best-guided firefly algorithm for engineering problems. Journal of Bionic Engineering, 20, 1–30.

    Article  Google Scholar 

  • Zheng, L., & Zheng, Y. (2014). Online sexual activity in Mainland China: Relationship to sexual sensation seeking and sociosexuality. Computers in Human Behavior, 36, 323–329.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express special thanks to Jun Liu for the valuable suggestions provided during the writing process of this article. We also extend our gratitude to the insightful recommendations from the reviewers, which have played a significant role in enhancing the quality of this manuscript.

Funding

This research was funded by National Social Science Foundation Youth Project “Research on the Influence of Social bots on the Climate of False Opinions in International Communication” and Major projects of Jiangsu Provincial Department of Education “Research on the Influence of Social Bots on the Climate of False Opinions in International Communication and its Regulation”, grant number 21CXW028 and 2021SJZDA151. This research is the phased achievements of Collaborative Innovation Center for New Urbanization and Social Governance of Soochow University.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jun Liu.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the by the Institutional Reviews Board of Soochow University(ES-20221003HC).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflicts of interest

The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, M., Chen, Z., Liu, X. et al. Influencing factors of Chinese male circumcision acceptance willingness: a health belief model approach. Curr Psychol 43, 18474–18486 (2024). https://doi.org/10.1007/s12144-024-05647-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12144-024-05647-9

Keywords

Navigation