Behavioral and structural determinants of HPV vaccination among adult men in China: a qualitative study using the COM-B model

Human papillomavirus (HPV) vaccination is recommended for both males and females; however, uptake among adult men in China remains low. Understanding behavioral and structural determinants may inform gender-neutral HPV prevention strategies. This qualitative study used semistructured interviews and reflexive thematic analysis guided by the Capability–Opportunity–Motivation–Behavior (COM-B) model. Data were collected in February 2026 at a tertiary hospital health examination center in Qingdao, China. A purposive sample of 25 adult men aged 18–45 years attending routine health examinations was recruited. Interviews explored knowledge of HPV, attitudes toward vaccination, relational influences, and interactions with health services. Recruitment continued until data saturation was achieved, defined as the point at which no new themes or concepts emerged from successive interviews. Among 25 participants (mean [SD] age, 31.5 [5.8] years; 14 [56%] married), 20 (80%) had heard of HPV, 4 (16%) knew that men could receive HPV vaccination, and 2 (8%) had been vaccinated. Three themes were identified. First, HPV was commonly framed as a women’s health issue, limiting men’s perceived susceptibility and reducing self-initiated motivation for vaccination. Second, vaccination motivation was often relationally mediated, with participants reporting willingness to vaccinate when encouraged by partners. Third, opportunity-related structural barriers, including limited clinician recommendation and perceived vaccine cost, constrained translation of vaccination intentions into behavior. HPV vaccination decisions among Chinese adult men appear shaped primarily by motivational determinants, supported by limitations in HPV-related knowledge and perceived susceptibility, as well as opportunity-related structural barriers within the health system. Interventions to increase uptake may benefit from de-gendered public health communication strategies that move beyond the “cervical cancer vaccine” framing, alongside stronger clinician engagement and efforts to reduce structural barriers.