Cognitive and behavioral determinants of HPV vaccination willingness and Behavior among female university students in Karnataka, India

Human papillomavirus (HPV) vaccination remains a critical public health strategy for preventing HPV-related diseases; however, vaccination uptake continues to be influenced by multiple psychological and contextual factors. This study examines the determinants of willingness to vaccinate (WTV) and vaccination behavior (VB) by integrating constructs from the Health Belief Model, Protection Motivation Theory, and the 3Cs framework, including perceived severity (PS), perceived vulnerability (PV), complacency (COM), and vaccine confidence (CONF). A cross-sectional survey design was employed to collect data on individuals' perceptions, attitudes, willingness to vaccinate, and vaccination behavior. The study tested the direct effects of PS, PV, COM, and CONF on WTV, the mediating role of WTV in predicting VB, and the moderating effects of HPV vaccine recommendations and HPV-related information sources on the proposed relationships. The findings demonstrate that perceived severity, perceived vulnerability, and vaccine confidence positively influence willingness to vaccinate, whereas complacency negatively affects willingness. WTV significantly mediates the relationships between PS, PV, COM, CONF, and vaccination behavior. Moderation analysis revealed limited but significant moderating effects: HPV vaccine recommendations and HPV-related information sources strengthened selected relationships within the model, while several proposed moderation effects were not statistically supported. This study provides an integrated framework for understanding HPV vaccination behavior by combining cognitive, motivational, and contextual determinants. The findings highlight the importance of enhancing risk awareness, reducing complacency, strengthening vaccine confidence, and leveraging effective recommendations and information channels to improve HPV vaccine uptake. These insights offer practical implications for designing targeted public health communication and vaccination promotion strategies.