
==== Front
BMC Nurs
BMC Nurs
BMC Nursing
1472-6955
BioMed Central London

39252081
2324
10.1186/s12912-024-02324-x
Research
Influential factors and willingness to advocate for HPV vaccination among male nursing interns in China
Wang Huizi 1
Liu Fei 1
Zhang Hui aihuier2007@163.com

1
Chen Ning 2
Wang Chen 3
1 https://ror.org/03wnrsb51 grid.452422.7 0000 0004 0604 7301 Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong China
2 grid.410638.8 0000 0000 8910 6733 Department of Gastrointestinal Endoscopy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
3 https://ror.org/013xs5b60 grid.24696.3f 0000 0004 0369 153X Fu Xing Hospital, Capital Medical University, Beijng, China
9 9 2024
9 9 2024
2024
23 62826 6 2024
3 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

Human papillomavirus (HPV) infection significantly contributes to the global cancer burden. Understanding the factors influencing male clinical interns’ willingness to promote HPV vaccination is crucial for developing effective public health strategies in China.

Methods

This study employed a stratified random sampling method to select 1,980 male clinical interns from five provinces in China between January and March 2024. Data were collected on participants’ demographic characteristics, HPV-related clinical experience, and knowledge. The Theory of Planned Behavior framework, encompassing attitudes, subjective norms, and perceived behavioral control, was used to examine factors influencing the willingness to promote the HPV vaccine. Logistic regression analyses were conducted to identify factors associated with the willingness to promote the HPV vaccine.

Results

Among the respondents, 72.29% were willing to encourage others to receive the HPV vaccine. Significant factors influencing this willingness included older age (OR = 3.065, P ≤ 0.001), higher monthly household income (OR = 1.449, P = 0.025), participation in the diagnosis and treatment of HPV-related diseases (OR = 3.458, P ≤ 0.001), positive attitude towards the vaccine (OR = 13.503, P = 0.004), and strong perceived behavioral control (OR = 2.364, P = 0.006).

Conclusion

This study highlights the critical role of practical experience and targeted education in promoting HPV vaccination among male clinical interns in China. Enhancing the training and education of this group is essential for improving HPV vaccine advocacy and supporting public health efforts to reduce HPV-related diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-024-02324-x.

Keywords

Human papillomavirus
HPV vaccine
Male nursing interns
Willingness to promote
China
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcIntroduction

Human papillomavirus (HPV) infection is a significant contributor to the global cancer burden [1]. Approximately 91.0%, 75.0%, 63.0%, and 91.0% of cervical, vaginal, penile, and anal cancer cases, respectively, are attributed to HPV infection [2]. With the increasing burden of HPV-related diseases, particularly cervical cancer, the HPV vaccine has garnered extensive global attention as a preventive measure [3].

According to the World Health Organization (WHO), by the end of 2022, 130 member countries had integrated the HPV vaccine into their national immunization programs [4]. In line with the WHO’s global initiative to eliminate cervical cancer, mainland China initiated pilot programs in several cities beginning in 2020 [5]. These programs offer free HPV vaccinations to girls aged 13–15, aiming to increase vaccine coverage and reduce the incidence of HPV-related diseases among young women. Currently, the HPV vaccination rate in China is relatively low, with only 11.0% of women nationwide having received the HPV vaccine [6]. Intern nursing students, who are generally young and in their final year of training, are at heightened risk for HPV infection and its associated complications [7]. Research indicates that young people, particularly adolescents and young adults, are at a higher risk of HPV infection due to their high levels of sexual activity [8]. This risk is especially pronounced in males who have not received the HPV vaccine, making them more susceptible to infection [9]. Additionally, nursing interns working in hospitals and clinics frequently come into contact with various patients and potential pathogens. Although HPV is primarily transmitted through sexual contact, it can also spread through direct skin and mucous membrane contact with infected bodily fluids or tissues, increasing the risk of infection [10]​. Pu et al. [11] and Acikgoz et al. [7] both found that nursing interns have a relatively weak understanding of human papillomavirus (HPV) and cervical cancer prevention.As future healthcare professionals, it is crucial for this group to possess comprehensive knowledge about HPV infections, as well as the skills necessary for promoting and advocating for HPV vaccination [12]. At present, there is a lack of research specifically focused on the perspectives of male nursing interns on the HPV vaccine. In mainland China, men are unable to receive the HPV vaccine, but their efforts to encourage those around them to get vaccinated can effectively increase the overall vaccination rate [13]. Encouraging men to advocate for HPV vaccination signifies that HPV prevention is not solely a women’s responsibility, it is equally important for men [14]. HPV can also cause various cancers in men, such as penile, anal, and oropharyngeal cancers [1]. Emphasizing the vaccine’s protective benefits for all genders helps to eliminate gender biases and promote broader vaccine uptake. In addition, as more men enter the nursing profession, they become an increasingly significant segment of the healthcare workforce. This growing team has a duty to promote health initiatives, including HPV vaccination. Advocating for HPV vaccination not only fosters herd immunity but also underscores men’s active participation and responsibility in health prevention efforts. This engagement helps to emphasize that preventing HPV is a shared responsibility, thereby enhancing overall public health and contributing to a comprehensive approach to combating HPV-related diseases.

The Theory of Planned Behavior (TPB) states that an individual’s behavioral intentions are influenced by their attitudes, subjective norms, and perceived behavioral control [12]. The TPB helps identify the specific beliefs and social influences that affect these interns’ willingness to advocate for vaccination. Attitudes towards the vaccine include their beliefs about its effectiveness and safety, while subjective norms involve the perceived social pressure from peers, family, and professional circles to support vaccination [8]. Perceived behavioral control refers to their confidence in their ability to effectively advocate for the vaccine [15]. This comprehensive approach is crucial for designing targeted interventions that address specific barriers and leverage facilitators to enhance vaccination advocacy.

Grounded in the TPB, this study aims to understand the cognitive and attitudinal aspects of this specific group toward the HPV vaccine, investigating various factors that influence these future healthcare leaders in promoting the widespread adoption of the HPV vaccine. This includes assessing the level of knowledge and awareness of HPV and its associated risks among male nursing interns, evaluating their attitudes towards the HPV vaccine, investigating the influence of subjective norms on their willingness to promote the vaccine, examining their perceived behavioral control regarding advocacy for the HPV vaccine, and identifying the barriers and facilitators to HPV vaccination promotion among male nursing interns.These insights are intended to improve the willingness and rate of HPV vaccination in China, contributing to better public health outcomes.

Methods

Study design and participants recruitment

From January to March 2024, we employed stratified random sampling to select five province (Shandong, Henan, Hebei, Shanxi, Anhui) in China. The selection of these specific provinces was guided by economic indicators to ensure a diverse representation of regions with varying levels of economic development. The stratification aimed to include both more and less economically developed provinces, allowing the study to capture a broader range of perspectives and challenges.

For the selection of hospitals within each province, we compiled a comprehensive list of all tertiary hospitals. To ensure true randomness in the selection process, we used Microsoft Excel’s random number generator function to randomly select two hospitals from each province’s list. This approach ensured that the selected hospitals were diverse in terms of patient demographics and clinical practices, thus enhancing the generalizability of the study’s findings.

We conducted an online questionnaire survey using Questionnaire Star among male clinical interns. The study established clear inclusion and exclusion criteria to ensure consistency and relevance of the subjects. Inclusion criteria were: (1) participants must be male; (2) participants must be nursing interns during the 2023–2024 academic year(the 2023–2024 cohort of nursing interns all had completed their theoretical coursework and were in their final year, engaged in clinical internships. This ensured that all participants had the necessary foundational knowledge and were applying it in a clinical setting); (3) participants must be capable of independently and completely finishing the questionnaire and willing to participate in the study. 4) participants must have passed the hospital entrance assessment; (5) participants must have completed the obstetrics and gynecology nursing course and passed the theoretical exam to ensure foundational knowledge of HPV-related topics. Exclusion criteria were: (1) individuals not participating in clinical internships during the study period; (2) female participants. All respondents participated voluntarily and provided informed consent. After compiling a preliminary questionnaire, we invited 20 nursing interns and 3 instructors in the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) to conduct a pilot test. Based on the pilot test results, the questionnaire was revised to ensure clarity, readability, and logicality. To ensure data quality, automated controls were set up on the online platform to prevent multiple submissions and ensure all required questions were answered.

Sample size

Using the sample size calculation formula \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:n=\frac{{Z}_{\alpha\:/2}^{2}\cdot\:P\left(1-P\right)}{{d}^{2}}$$\end{document},and referencing previous research findings, the willingness of medical staff in China to promote the HPV vaccine is 63.7% [16]. Assuming \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{Z}_{\alpha\:/2}$$\end{document}=1.96, d= 5%, and P=63.7%, substituting these values into the formula gives n=356. Considering a 10% data loss or non-response rate, the final sample size was determined to be 396 individuals. To ensure representation from each of the five provinces, the total sample size was evenly distributed, resulting in 396 individuals per province. Thus, the overall sample size was determined to be 1980 individuals. This approach ensures that each province is adequately represented in the study, allowing for balanced and meaningful regional analysis. Although this method does not strictly follow the proportional distribution of medical staff populations in each province, it facilitates comprehensive regional comparisons and ensures that each province contributes equally to the overall sample size.

Instruments

General Information Questionnaire: This self-designed questionnaire includes questions about age, education level, family background, personal monthly expenditure, family monthly income, major, sexual behavior, and family history of cancer.

HPV-Related Clinical Experience Questionnaire: This consists of three items base on previous study [11], including “Have you been involved in the diagnosis and treatment of HPV-related diseases (e.g., cervical cancer, anal cancer)?“, “Have you received health education related to HPV and HPV vaccines?“, and “Have you provided counseling on HPV vaccines to patients?“. Each item is answered with a binary “Yes” or “No”.The Cronbach’s alpha for this questionnaire was 0.75.

HPV-Related Knowledge and Health Behavior Questionnaire: This 13-item questionnaire, self-designed based on previous literature [17–19], assesses participants’ knowledge of HPV and their health behavior intentions based on the TPB. The HPV-related knowledge section consists of 10 items, such as “HPV infection always has obvious symptoms” and “HPV only infects women”. Each correct answer scores one point, with a total score of ≥ 5 indicating a high level of HPV-related knowledge [20]. Research by Shah et al. [18] supports this scoring threshold, indicating that individuals who achieve this score are well-prepared to engage in effective health education and vaccination advocacy, which is essential for informed clinical practice and public health interventions. The Cronbach’s alpha for the knowledge section was 0.88, indicating high internal consistency.

The HPV health behavior intention section includes items related to the Theory of Planned Behavior, assessing attitudes towards HPV (e.g., “Promoting HPV vaccination has a positive impact on health”), subjective norms (e.g., “People around me, such as family, friends, and colleagues, support me in promoting HPV vaccination”), and perceived behavioral control (e.g., “I can overcome challenges and successfully promote HPV vaccination”). This section exhibited robust internal consistency with a Cronbach’s alpha of 0.84. Additionally, a single item “Would you proactively recommend and encourage your patients, family, and friends to get the HPV vaccine?” is used to measure participants’ willingness and enthusiasm in promoting HPV vaccination(see the whole questionnaire in Appendix 1).

Ethical considerations

This study was approved by the Ethics Committee of the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital). The questionnaire was distributed through the Questionnaire Star platform. Participants accessed the questionnaire page by scanning the QR code provided by Questionnaire Star. To ensure the independence and reliability of the data, the system allowed only one response per WeChat account and IP address. At the beginning of the questionnaire, we included an informed consent form. Participants could only proceed to answer the questions after clicking the “I voluntarily participate in this study” button. To protect data security and privacy, all responses were anonymized, and data transmission was encrypted. The Questionnaire Star platform adheres to strict data protection regulations, ensuring that personal information is securely stored and only accessible to authorized researchers. Upon completion of the survey, we promptly reviewed the collected questionnaire data and established the final database accordingly.

Data analysis

Statistical description and inference were performed using SPSS version 26.0. Categorical data were expressed as frequencies and percentages. Univariate analysis was conducted using the Chi-square test (X² test) to analyze the association between demographic characteristics, HPV-related clinical experience, and the willingness to promote the HPV vaccine. Variables with a p-value less than 0.05 in the univariate analysis were included as independent variables in the multivariate analysis. Multicollinearity among independent variables was checked to ensure the robustness of the model using appropriate diagnostics. Variables with statistical significance in the univariate analysis were included as independent variables in a multivariate analysis. Logistic regression was employed to identify factors independently associated with the willingness to promote the HPV vaccine, with the willingness to promote the HPV vaccine as the dependent variable. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test, and assumptions of logistic regression were evaluated by examining residuals and influential observations.

Results

Demographic characteristics

A total of 1,431 male nursing interns were willing to encourage people around them to get the HPV vaccine, accounting for 72.29%. The willingness to promote the HPV vaccine among male interns showed statistically significant differences in relation to age, education level, monthly household income, and relationship status (P < 0.05).(See in Table 1).

Table 1 General information of respondents and their willingness to promote HPV Vaccine

Factors	Respondents	Willing to Promote	Willingness Rate(%)	X2 Value	P Value	
Age				44.267	≤ 0.001	
<20 years	654	341	51.90			
20–22 years	1094	890	81.28			
23–25 years	215	199	92.86			
>25 years	20	10	50			
Education				13.234	≤ 0.001	
High school	95	35	36.84			
Junior college	1505	1100	73.09			
Bachelor’s degree	385	300	77.92			
Family background				2.174	0.140	
urban	615	475	77.24			
Rural	1365	955	70.07			
Monthly Expenditure						
<1500 yuan	1020	695	68.14	6.900	0.075	
1500–2000 yuan	740	545	73.65			
2000–2500 yuan	145	130	89.66			
>2500 yuan	80	65	81.25			
Monthly Household Income				11.780	0.008	
<5000yuan	645	420	65.12			
5000–8000 yuan	805	570	70.81			
8000–13,000 yuan	390	310	79.49			
>13,000 yuan	145	135	93.10			
Relationship Status				15.645	≤ 0.001	
In a relationship	515	295	57.28			
Single	1470	1140	77.55			

HPV clinical experience and promotion willingness

A total of 150 male nursing interns had provided counseling on the HPV vaccine to patients, and 83.33% of them expressed a willingness to promote the vaccine. Of the 379 male interns who had participated in the diagnosis or treatment of patients with HPV-related diseases, 52.63% were willing to promote the vaccine. Additionally, 713 male interns had received health education about HPV and its vaccine, with 72.03% indicating a willingness to promote the vaccine. Among these factors, only participation in the diagnosis or treatment of HPV-related diseases was significantly correlated with the willingness to promote the HPV vaccine (See in Table 2).

Table 2 Univariate Analysis of HPV-Related clinical experience and willingness to promote HPV Vaccine

Factors	Respondents	Willing to Promote	Willingness Rate (%)	X2 Value	P Value	
Provided counseling on HPV vaccine				1.975	0.160	
Yes	150	125	83.33			
No	1830	1305	71.39			
Participated in diagnosis/treatment of HPV diseases						
Yes	379	199	52.63	18.138	≤ 0.001	
No	1601	1232	76.94			
Received health education about HPV/vaccine						
Yes	713	514	72.03	0.008	0.930	
No	1267	917	72.44			

Health behaviors and HPV vaccine promotion

Among the 1878 male nursing interns with a high level of HPV knowledge, 1392 (74.18%) expressed a willingness to promote the HPV vaccine. Of the 1805 interns with a positive attitude towards the HPV vaccine, 1421 (78.72%) were willing to promote it. In the group of 1850 male clinical interns who perceived positive subjective norms, 1431 (77.36%) indicated a willingness to promote the HPV vaccine. Additionally, among the 1740 interns with strong perceived behavioral control, 1326 (76.22%) were willing to promote the vaccine. As detailed in Table 3, all four indicators showed a significant correlation with the willingness to promote the HPV vaccine.

Table 3 Univariate analysis of HPV knowledge, health behaviors, and promotion willingness

Factors	Respondents	Willing to Promote	Willingness Rate
(%)	X2 Value	P value	
Level of HPV Knowledge				9.009	0.003	
Low	102	71	70.00			
High	1878	1392	74.18			
Attitude				84.941	≤ 0.001	
Weak	175	10	5.71			
Strong	1805	1421	78.72			
Subjective Norms				72.590	≤ 0.001	
Weak	130	0	0			
Strong	1850	1431	77.36			
Perceived Behavioral Control				22.207	≤ 0.001	
Weak	240	105	43.75			
Strong	1740	1326	76.22			

Factors influencing willingness to promote HPV Vaccine

In this study, variables with statistical significance (P < 0.05) identified through univariate analysis were included as independent variables in a multivariate logistic regression model. The dependent variable was whether the participants were willing to encourage patients, family members, and friends to receive the HPV vaccine, with responses coded as 0 for “no” and 1 for “yes.” The multivariate analysis employed the “enter” method, where all selected independent variables were included in the model simultaneously.The results indicated that older age (OR = 3.065, P ≤ 0.001), higher monthly household income (OR = 1.449, P = 0.025), participation in the diagnosis or treatment of HPV-related diseases (OR = 3.458, P ≤ 0.001), positive attitude (OR = 13.503, P = 0.004), and stronger perceived behavioral control (OR = 2.364, P = 0.006) were significant factors promoting male interns’ advocacy for HPV vaccination to patients, family members, and friends, as illustrated in Table 4.

Table 4 Multivariate analysis of factors influencing willingness to promote HPV Vaccine

Factor	β	SE	Wald x2	p Value	OR Value	95% CI	
Age	1.120	0.256	19.146	≤ 0.001	3.065	1.856∼5.062	
Monthly Household Income	0.371	0.166	4.991	0.025	1.449	1.047∼2.006	
Participation in the Diagnosis/Treatment of HPV-Related Diseases	1.241	0.345	12.936	≤ 0.001	3.458	1.759∼6.799	
Attitude	2.603	0.894	8.486	0.004	13.503	2.343∼77.809	
Perceived Behavioral Control	0.860	0.451	3.638	0.006	2.364	0.977∼5.720	

Discussion

This study surveyed 1,980 male nursing interns, with 72.29% willing to encourage those around them to receive the HPV vaccine. This rate is lower than that found in national multicenter surveys of male university students (90%) [21], male nurses in Shaanxi Province (85.29%) [22], and males in foreign studies (82-92%) [23]. Compared to employed male nurses, nursing interns may be more focused on their studies and the development of clinical skills, potentially paying less attention to public health promotion. This intense focus on academic and clinical skill acquisition can lead to a narrower scope of practice, where immediate patient care and mastering technical competencies take precedence over broader public health initiatives. Consequently, the time and mental resources available for promoting public health, such as advocating for HPV vaccination, may be limited. Additionally, they may not have received the same level of health education and practical experience as employed nurses, which could lead to less comprehensive knowledge about the HPV vaccine [24].

Compared to other large-scale national multicenter cross-sectional studies, this study focused on typical cities in inland China. Despite improvements in economic development and the allocation of medical and health resources in these cities, there remains a gap compared to the average levels in developed coastal cities. For instance, a study conducted in western China found that the HPV vaccination rate among university students was significantly lower than in the more developed eastern coastal regions [25]. This disparity may influence the willingness of local male nursing interns to promote the HPV vaccine. It also underscores the imbalance in public health resources and the dissemination of health information between regions, highlighting the need for targeted efforts in future HPV vaccine immunization programs.

Compared to literature reviews on the willingness of males in developed countries to recommend the HPV vaccine, China’s HPV vaccine-related policies were initiated later. Many developed countries, such as the United States and the United Kingdom, have already included the HPV vaccine in their national immunization programs and provide free vaccines to eligible populations. For instance, the United States initiated its HPV vaccination program in 2006 and began recommending the vaccine for males in 2011, incorporating extensive public education campaigns, school-based vaccination initiatives, and widespread availability in healthcare facilities [26]. Similarly, the United Kingdom launched its program in 2008 and extended it to males in 2019, which has resulted in high vaccination coverage rates due to systematic strategies that facilitate widespread public education and access to vaccination services [27].In contrast, China’s HPV vaccination program began approximately a decade later. This delay, combined with less coordinated policies, has resulted in lower vaccination rates and awareness, especially in less developed inland regions. Although awareness of the HPV vaccine has gradually increased in recent years, the lack of extensive policy support and universal education means that overall understanding and willingness to recommend the HPV vaccine among males in China is not as high as in developed countries. These systematic differences highlight the importance of comprehensive public education and accessible vaccination programs in improving vaccine uptake and coverage, particularly for male beneficiaries.

The findings of this study demonstrate that older age and higher monthly household income are significant factors in increasing male interns’ willingness to promote the HPV vaccine, aligning with the research outcomes of Deng et al. [2] and Wang et al. [12]. As individuals age, they typically place greater importance on health and possess a more comprehensive understanding of health risks and preventive measures, thereby acknowledging the critical role of vaccines in preventing HPV [28]. Additionally, higher monthly household income signifies a greater financial capacity to bear the costs associated with vaccination. In the mainland Chinese market, there are five HPV vaccines available: the bivalent imported vaccine Cervarix® (GlaxoSmithKline), the quadrivalent Gardasil® and the nine-valent Gardasil® 9 (both produced by Merck), and the domestic bivalent vaccines Cecolin® (Xiamen Innovax) and Walvax® (Walvax Biotechnology). The cost of the three-dose series ranges from 1000 to 4000 RMB [29]. Moreover, the vaccine is not yet covered by the medical insurance system, so most people need to pay out of pocket for vaccination.Considering that the average monthly disposable income in China was approximately 3,268 RMB nationwide, with urban areas at about 4,319 RMB and rural areas at about 1,808 RMB in 2023,these costs represent a substantial financial burden [30]. Additonally, our study showed that families with monthly incomes below 5,000 RMB had only 65.12% vaccination willingness, which increases significantly to 93.10% in families with incomes above 13,000 RMB. This indicates that the high out-of-pocket costs are unaffordable for many households, particularly those with lower incomes, indirectly affecting the willingness to promote the vaccine, especially among interns with limited financial resources [31].Currently, the HPV vaccine is not fully included in the National Immunization Program (NIP), individual provinces in China have issued implementation plans aimed at accelerating the elimination of cervical cancer, targeting high HPV vaccination coverage by 2030.Moreover, the recent approval of a two-dose schedule for the nine-valent HPV vaccine for females aged 9–14 by the National Medical Products Administration (NMPA) marks a significant step forward in reducing financial and logistical barriers to vaccination. This policy change is expected to make the vaccination process more affordable and convenient, thereby increasing the vaccination rate among Chinese people. In recent years, gender-neutral vaccination (GNV) programs have become increasingly common. By the end of 2019, 33 WHO member countries had started vaccinating boys, with six countries planning to implement GNV in 2020/21 [32]. In China, although current vaccination programs have not yet fully achieved gender neutrality, the introduction of two affordable domestically-produced HPV vaccines also suggests that China should consider prioritizing the implementation of GNV. This approach would not only achieve gender equality and improve protection against HPV infections and related diseases for both males and females but also enhance the program’s resilience as vaccination coverage rates change. Furthermore, the implementation of GNV could significantly increase vaccination rates among males, thereby providing herd immunity to protect unvaccinated females and reducing the incidence of HPV-related cancers.

The study results indicate that participation in the diagnosis and treatment of HPV-related diseases, a positive attitude towards the HPV vaccine, and strong perceived behavioral control are key factors influencing male clinical interns’ willingness to actively promote the HPV vaccine. These findings align with those reported by Zhang et al. [33] and Yi et al. [34]. Engagement in the diagnosis and treatment of HPV-related diseases provides male clinical interns with a deeper understanding of HPV transmission, disease progression, and its potential impacts on individual health. This hands-on experience enhances their comprehensive understanding of the disease and the importance of preventive measures. International studies similarly demonstrate that clinicians involved in cervical cancer screenings are more likely to recommend HPV vaccination compared to general family medicine clinicians [35]. Therefore, it is imperative for teaching hospitals to offer more opportunities for nursing interns to participate in HPV-related clinical practices and to organize clinical case discussions with experienced physicians sharing their insights. Such practice-oriented education is crucial in modern medical training, as it improves interns’ practical skills and clinical judgment, better preparing them as future healthcare providers who can effectively promote HPV vaccination and reduce HPV-related disease incidence and transmission.

The multivariate analysis indicates that attitude has the most significant impact on interns’ willingness to promote the HPV vaccine. For male nursing interns, a positive attitude typically arises from trust in the vaccine’s preventive efficacy, a thorough understanding of its importance, and the comprehensive knowledge gained through medical education and practice [36]. Consequently, medical schools should integrate detailed content about HPV and its vaccines into their curricula, covering mechanisms of action, preventive effects, and public health significance. Furthermore, regular training sessions and seminars on HPV vaccines should be organized, inviting field experts to share the latest research findings and practical experiences, thereby enhancing interns’ positive attitudes towards vaccine promotion.

Notably, this study found that the level of HPV knowledge did not significantly correlate with the willingness to promote the vaccine, contrary to the findings of Dai et al. [21]. While this finding contrasts with the majority of the existing literature, which often emphasizes the importance of HPV knowledge in vaccine promotion, it can be attributed to the specific context and background of male nursing interns. Existing studies predominantly focus on general populations or university students who may not have the same level of medical training. Our research indicates that male nursing interns, due to their comprehensive medical education, have already attained a high level of HPV knowledge, making further increases in knowledge less impactful on their willingness to promote the vaccine. Therefore, their knowledge level is no longer the primary driver for promoting the HPV vaccine. Instead, other factors, such as perceived behavioral control, may play a more decisive role in this process.The experiences accumulated during their internships, including patient communication, successful HPV vaccine recommendations, and the methods and strategies learned from mentors, can enhance their perceived behavioral control [13]. These experiences help them better address potential challenges in promoting the HPV vaccine, such as vaccine hesitancy and misconceptions. Additionally, the availability of necessary resources plays a significant role in perceived behavioral control [37]. Teaching hospitals should provide interns with ample educational resources and practical opportunities, while also offering material and logistical support, such as vaccine supplies and vaccination clinics, which are foundational for implementing effective vaccine promotion strategies. This comprehensive support system, encompassing both educational resources and material support, not only increases interns’ capabilities and confidence in promoting the HPV vaccine but also strengthens their perception of being able to successfully do so.

Conclusion

This study identifies critical factors influencing male clinical interns’ willingness to promote the HPV vaccine, including age, household income, clinical experience with HPV-related diseases, attitudes towards the vaccine, and perceived behavioral control. The focus on male interns provides a novel perspective, emphasizing the importance of integrating practical experiences and targeted education into medical training programs. Moreover, this study not only prepares future healthcare professionals to better advocate for HPV vaccination but also supports broader public health initiatives aimed at reducing the incidence of HPV-related diseases nationwide. However, the study’s limitations include the use of self-reported questionnaires, which may introduce information bias, and the selection of inland cities in China, which may affect the generalizability of the results. Although several countries have adopted gender-neutral vaccination (GNV), this approach has not been implemented in China due to the relatively late initiation of HPV vaccination programs. As a result, our study did not include questions regarding the participants’ willingness to receive HPV vaccination themselves under catch-up programs. Future research should employ diverse data collection methods and include a broader range of locations to further validate these findings and enhance HPV vaccination strategies. Additionally, it should explore participants’ willingness to receive HPV vaccination themselves under catch-up programs to provide more comprehensive insights.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Author contributions

Huizi Wang, Fei Liu, Hui Zhang, Ning Chen, and Chen Wang all contributed significantly to the study. Huizi Wang and Fei Liu designed the study and conducted the data collection. Hui Zhang performed the data analysis. Ning Chen and Chen Wang contributed to the interpretation of the results. All authors were involved in drafting and revising the manuscript and have approved the final version for submission.

Funding

No funds were received for this article.

Data availability

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital (NO. S467). Written informed consent was obtained from the participants before including them in the study. They were assured of confidentiality.

Consent for publication

This is not applicable.

Competing interests

The authors declare no competing interests.

Abbreviations

HPV Human papillomavirus

WHO World Health Organization

TPB Theory of Planned Behavior

NIP National Immunization Program

Publisher’s note

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

Huizi Wang and Fei Liu contributed equally to this work and share first authorship.
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