Application of an extended information-motivation-behavioral skills model to predict HPV vaccine acceptability among Chinese gay, bisexual, and other men who have sex with men

Background: Human papillomavirus (HPV) causes substantial disease burden among gay, bisexual, and other men who have sex with men (GBMSM), yet HPV vaccination pathways for men remain evolving in mainland China. Purpose: To apply a culturally adapted, extended Information-Motivation-Behavioral Skills (IMB) model to identify psychosocial pathways associated with HPV vaccine acceptability among Chinese GBMSM. Methods: A cross-sectional online survey was conducted between December 2024 and January 2025 among 1,045 GBMSM living in mainland China. Measures included HPV-related information, health beliefs, anticipated regret, subjective norms, self-efficacy, and HPV vaccine acceptability. Measurement and structural equation models estimated direct and indirect pathways. Results: HPV vaccine acceptability was moderate (mean 3.40, SD 1.14). Subjective norms were the strongest predictor of acceptability (β = 0.68, p < .001), with additional positive effects from health beliefs (β = 0.17, p < .01), information (β = 0.14, p < .001), and self-efficacy (β = 0.13, p = .02). Anticipated regret showed a positive indirect effect through self-efficacy (unstandardized B = 0.056, 95% CI 0.01 to 0.12) but a negative direct association with acceptability (β = -0.11, p = .03). Conclusions: HPV vaccine acceptability among Chinese GBMSM was shaped predominantly by social norms, with self-efficacy acting as a key pathway through which psychosocial factors were associated with acceptability.