HPV vaccination willingness and behavior among nursing female students in China based on the protection motivation theory: A cross-sectional study

Female nursing students show high intention yet low uptake of HPV vaccination, which undermines cervical cancer prevention efforts. To examine the mechanisms influencing their vaccination behavior, this study developed and validated an intention-behavior transition model based on Protection Motivation Theory, thereby providing a theoretical foundation for designing targeted interventions and improving vaccination coverage. A total of 631 female nursing students from universities in Wuhan were selected by the convenience sampling method and were surveyed using a General Information Questionnaire, Protection Motivation Questionnaire, and HPV Vaccination Willingness and Behavior Questionnaire, and a structural equation model was constructed using AMOS 24.0 software. 69.3% of the 631 female nursing students had HPV vaccination intention, and 13.3% had vaccination behavior. The results of structural equation model fitting showed that threat appraisal significantly affected female nursing students’ willingness to receive HPV vaccination (β = 0.209, <i>P</i> &lt; .002) and behavior (β = -0.198, <i>P</i> = .002). Coping appraisal significantly influenced their willingness to vaccinate (β = -0.085, <i>P</i> &lt; .008) and behavior (β = -0.170, <i>P</i> &lt; .001). Willingness to vaccinate significantly influenced vaccination behavior (β = 0.627, <i>P</i> &lt; .001). The Protection Motivation Theory is applicable for explaining the decision-making mechanism regarding HPV vaccination among female nursing students, as both threat appraisal and coping appraisal collectively influence the intention-behavior transition process. This study provides theoretical support for formulating immunization promotion policies targeted at this population; however, future research should expand sample diversity to enhance the generalizability of the findings.