Vaccine Knowledge, Attitudes and Practices Among Men Who Have Sex With Men: a Global Cross-sectional Study

• No Interventions (Other): No interventions because it is a observational cross-sectional study

Primary outcomes

• Vaccine uptake [Baseline, at enrollment in this cross-sectional study]: Percentage(%) of participants who have received at least one dose of HPV vaccine, assessed by self-reported vaccination history

Secondary outcomes

• Vaccine knowledge [Baseline, at enrollment in this cross-sectional study]: Vaccine knowledge will be measured based on participants' scores on the vaccine knowledge items included in the study questionnaire, which will assess general vaccine knowledge and HPV vaccine-specific knowledge. Responses to individual items will be scored according to the predefined scoring criteria and summed to generate domain-specific knowledge scores. Higher scores indicate greater knowledge in the corresponding domain.
• Vaccine attitude [Baseline, at enrollment in this cross-sectional study]: Vaccine attitudes will be measured based on participants' scores on the Vaccination Attitudes Examination Scale included in the study questionnaire, which assesses four dimensions of vaccination attitudes: mistrust of vaccine benefits, worries about unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity. Responses to individual items will be scored according to the predefined scoring criteria and combined to generate an overall vaccine attitude score. Higher scores indicate more negative attitudes toward vaccination.
• Vaccine confidence [Baseline, at enrollment in this cross-sectional study]: Vaccine confidence will be measured based on participants' scores on the Vaccine Confidence Index included in the study questionnaire, which assesses perceptions of vaccine importance, safety, effectiveness, and compatibility with religious beliefs. Responses to individual items will be scored according to the predefined scoring criteria and combined to generate an overall vaccine confidence score. Higher scores indicate greater confidence in vaccines.
• Vaccine hesitancy [Baseline, at enrollment in this cross-sectional study]: Vaccine hesitancy will be measured based on participants' scores on the Vaccine Hesitancy Scale included in the study questionnaire. The scale assesses participants' perceptions of vaccine importance and effectiveness, trust in vaccine information and recommendations, perceived benefits of vaccination, and concerns about vaccine risks and adverse effects. Responses to individual items will be scored according to the predefined scoring criteria and summed to generate a total vaccine hesitancy score. Higher total scores indicate greater vaccine hesitancy.

Sex: Male, ages: 18 Years to any

Inclusion Criteria:

* Participants will be eligible for the study if they meet all of the following conditions:

  1. Have resided in a participating country or region for at least six months.
  2. Are aged 18 years or older.
  3. Self-identify as MSM, with eligibility in certain participating countries and regions potentially extended to transgender women and non-binary individuals who have sexual relations with men, using the same questionnaire.

Exclusion Criteria:

* Participants will be excluded if they meet any of the following conditions:

  1. Are aged under 18 years.
  2. Decline to participate in the study or fail to complete the informed consent process.
  3. Have not resided, or do not currently reside, in a participating country or region.
  4. Submit duplicate responses from the same IP address or device.
  5. Fail data quality checks, including automated or fraudulent submissions and failure to pass human verification procedures.

• Study Protocol, Statistical Analysis Plan, and Informed Consent Form (PDF, 2026-09-07)