How can the health belief model and self-determination theory predict both influenza vaccination and vaccination intention ? A longitudinal study among university students

Psychol Health. 2018 Jun;33(6):746-764. doi: 10.1080/08870446.2017.1401623. Epub 2017 Dec 5.


Background and objective Seasonal influenza is frequent among students and often responsible for impaired academic performance and lower levels of general health. However, the vaccination rate in this population is very low. As the seasonal influenza vaccine is not compulsory in France, it is important to improve the vaccination uptake by identifying predictors of both intention and behaviour. This study investigated the effect of decisional balance, motivation and self-efficacy on vaccination acceptance using the Extended Health Belief Model (HBM) and Self-Determination Theory (SDT). Design and Main Outcome Measures University students were invited to fill in an online survey to answer questions about their influenza vaccination intention, and HBM and SDT constructs. A one-year longitudinal follow-up study investigated vaccination behaviour. Results Autonomous motivation and self-efficacy significantly influenced the intention to have the influenza vaccine, and vaccine behaviour at one-year follow-up. Intention predicted a significant proportion of variation (51%) in behaviour, and mediated the effect of these predictors on vaccination behaviour. Conclusion These results suggest that motivation concepts of the Self-Determination Theory can be adequately combined with the Health Belief Model to understand vaccination behaviour.

Keywords: Self-Determination theory (SDT); autonomous motivation; extended Health Belief Model (HBM); influenza vaccine; seasonal flu; self-efficacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Decision Making
  • Female
  • Follow-Up Studies
  • France
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / prevention & control*
  • Intention*
  • Longitudinal Studies
  • Male
  • Models, Psychological*
  • Motivation
  • Personal Autonomy
  • Psychological Theory*
  • Self Efficacy
  • Students / psychology*
  • Students / statistics & numerical data
  • Universities
  • Vaccination / psychology*
  • Young Adult


  • Influenza Vaccines