The Relationship of Health Beliefs with Information Sources and HPV Vaccine Acceptance among Young Adults in Korea

The human papillomavirus (HPV) vaccine has been found to reduce HPV-related diseases, including cervical cancer or genital warts, and is recommended for both males and females. Despite the proven efficacy and safety of the vaccine, uptake rates have not been satisfactory due to lack of awareness and various other barriers, particularly in Asian countries. In that context, this study examined (i) the psychological processes that affect decision making for HPV vaccination and (ii) how the use of various information sources differently affects the health beliefs of Korean young adults, based on the health belief model (HBM).

In line with the HBM, prior studies have revealed that perceived susceptibility, perceived severity, and perceived benefits are positively associated with the intention to get vaccinated against HPV, whereas various perceived barriers are negatively related with vaccinating intention. In addition to commonly referenced perceived barriers in the vaccination context (e.g., concerns about vaccine safety, high vaccine cost), prior research has identified 2 barriers among Asians, which are social stigma about getting the HPV vaccine (e.g., being perceived as promiscuous or indicative of infidelity to their partners) and talking about sex-related topics (e.g., talking about issues dealing with sex as embarrassing and taboo).

A cross-sectional study was conducted with those who had not received any HPV shots. Participants were recruited from undergraduate communication classes at one of the major universities in Seoul, Korea, using a traditional paper questionnaire. Among 360 surveys distributed between November 2016 and March 2017, there were 323 valid responses. The mean age of participants was 21.30 (standard deviation (SD) = 2.46), and 55.1% were female.

With regard sources of HPV information, the following was found: family and friends 140 (43.3%); newspapers and magazines 96 (29.7%); radio 10 (3.1%); television 123 (38.1%); internet 139 (43.0%); social media 97 (30.0%); and healthcare providers 61 (18.9%). As Table 4 in the paper shows, hearing about HPV from health care providers increased perceived susceptibility to HPV, while hearing about HPV from print media, including newspapers and magazines, increased perceived severity. Hearing from different information sources did not influence the perceived benefits, perceived vaccine safety barriers, and perceived logistic barriers. Using the internet decreased perceived barriers to talking with others regarding the HPV vaccine, and using the internet along with family and friends as sources for HPV information decreased perceived barriers regarding social norms. Hearing about the HPV on social media increased these perceived barriers.

As shown in Table 3, attitude was found to have a positive relationship with perceived benefits and a negative relationship with perceived barriers regarding vaccine safety. Attitude, however, showed a positive relationship with perceived logistic barriers. Intention (free shot) had positive relationships with perceived susceptibility, perceived severity, and perceived benefits and a negative relationship with perceived barriers regarding vaccine safety. Intention (paid shot) showed positive relationships with perceived susceptibility, perceived severity, and perceived benefits and a negative relationship with vaccine safety-regarded barriers. Male students showed greater intention to obtain the HPV vaccine than female students when it was offered for free. Being male was positively associated with perceived susceptibility to HPV as well as perceived vaccine safety concerns, but it was negatively associated with perceived barriers regarding discussing the vaccine and social norms.

In short, perceived susceptibility, perceived severity, perceived benefits, and perceived vaccine-safety concerns were found to predict attitudes and intentions to obtaining the HPV vaccine, as found in prior research. One of the contributions of this study is treating perceived barriers as multidimensional, especially incorporating possible cultural barriers. Such culturally relevant barriers - social stigma barriers and talking with others about the HPV vaccine - were not found to be associated with attitudes and intentions. These results imply that the view of the HPV vaccine as socially unacceptable might not affect one's own attitudes and intentions to get vaccinated. However, it may have indirect impacts on others' vaccine acceptability, and such perceptions may be easily amplified through the internet, social media, and interpersonal communication, suggesting the need for future research.

These findings support prior studies that showed positive relationships between the use of interpersonal sources and vaccine uptake. Most traditional media, including television, radio, newspapers, and magazines, were not effective in affecting health beliefs for increased vaccine acceptance, except for print media's association with perceived severity. It has been documented that reading news from newspapers, compared with watching television news, engages individuals in more cognitive information processing that allows attention to be paid to the details of provided information. Print media, therefore, may have led participants to pay more attention to HPV-related severity information.

The internet was found to be effective in decreasing barriers such as having HPV-related talks or social stigma, but social media increased such barriers. As reported here, it is possible that the formats of social media (e.g., short texts, hyperlinks) may limit its ability to provide detailed information or may easily circulate rumours or misinformation (e.g., "promiscuous people get HPV"), indicating the need for further research on the contents of respective information sources and their influences on health behaviours.

The report lays out several practical implications for promoting HPV vaccination:

• Communication practitioners for HPV vaccine promotion need to strategically employ various information sources. This study suggests that mass media campaigns utilising traditional mass media (e.g., television, radio, newspapers, and magazines) may not be of any effect. Promotions using interpersonal information sources are recommended. The internet and social media are also suggested to be used to foster an atmosphere of social acceptance regarding the HPV vaccine. Misinformation or the stigmatising atmosphere on social media needs to be monitored and managed so as not to negatively affect people's vaccination acceptance.
• Communication practitioners need to understand specific barriers that prevent a certain cultural group from getting the vaccine. As detailed above, this study found that social norm-related barriers reduced young Koreans' intention to get vaccinated, even when the vaccine was offered for free. Different cultures have differing health-related beliefs, and understanding of such beliefs should precede further promotion of specific health behaviours.