The influence of descriptive norms and media trust on male HPV vaccination willingness: an extended protection motivation theory approach

Purpose Human papillomavirus (HPV) poses a substantial health risk to men, yet male vaccination remains under-prioritized in China. This study examines how five Protection Motivation Theory (PMT) cognitions (perceived severity, perceived vulnerability, response efficacy, self-efficacy, and response cost), together with descriptive norms and media trust, shape Chinese men’s willingness to receive the HPV vaccine. We further assess both direct effects and indirect (mediated) pathways linking these factors to vaccination willingness. Participants and methods A nationwide online quota survey collected 3,013 valid responses from men aged 18–45 across 120 Chinese cities. Five-point Likert scales assessed perceived severity, perceived vulnerability, response efficacy, self-efficacy, and response cost (Protection Motivation Theory constructs), as well as descriptive norms, media trust, and HPV vaccination willingness. Structural equation modeling (AMOS 29.0) estimated direct paths while controlling for age, education, income, and marital status as covariates, and bias-corrected bootstrapping was used to test indirect (mediated) effects. Results Vaccination willingness was positively associated with perceived severity ( β = 0.307, 95% CI [0.241, 0.372]), perceived vulnerability ( β = 0.175, 95% CI [0.052, 0.303]), response efficacy ( β = 0.297, 95% CI [0.228, 0.357]), self-efficacy ( β = 0.133, 95% CI [0.041, 0.215]), descriptive norms ( β = 0.183, 95% CI [0.126, 0.239]), and media trust ( β = 0.133, 95% CI [0.052, 0.251]) (all p < 0.01). Perceived response cost was negatively associated with willingness ( β = −0.314, 95% CI [−0.372, −0.246], p < 0.001). Descriptive norms indirectly promoted willingness via perceived severity and response efficacy; media trust exerted three indirect paths through perceived severity, perceived vulnerability, and response efficacy. Conclusion Men’s cognitive appraisal of HPV risks and their coping efficacy underpin vaccination intentions. Social cues (descriptive norms) and reliable information sources (media trust) reinforce these cognitions, amplifying willingness both directly and through PMT constructs. Interventions should normalise male vaccination, enhance message credibility, and alleviate financial or procedural burdens to broaden HPV vaccine uptake among men.