How information exposure shapes risk perceptions and vaccination intentions among gay, bisexual, and other men who have sex with men: Cross-sectional survey study

Background: Exposure to information about mpox may shape distinct perceptual processes that influence vaccination intent. Understanding how such information impacts perceived risk and vaccination intention is crucial for designing effective risk communication and public health messaging, particularly among populations at high risk such as gay, bisexual, and other men who have sex with men (GBMSM). 

Objective: This study examined the specific pathways through which mpox information exposure and associated perceptual processes influence vaccination intent. Differences between GBMSM in Beijing and Hong Kong were also examined to explore potential contextual influences. 

Methods: We conducted a cross-sectional survey of mpox-unvaccinated GBMSM in Hong Kong (n=470) and Beijing (n=519) between November 2023 and March 2024. Structural equation modeling was conducted to estimate the direct and indirect effects of information exposure, perceptual processes (eg, perceived control and threat perceptions), and perceived risk on vaccination intent. Multigroup structural equation modeling was used to estimate the effect measure modification by city. 

Results: Exposure to positive mpox information significantly enhanced perceived control (β=0.33; P=.001) and increased vaccination intention through heightened perceived risk of contracting mpox (β=0.27; P<.001) in the following 6 months. The indirect effect of positive information exposure on vaccination intent via perceived control and risk was significant in Hong Kong (B=0.01; Wald test: Z=3.05 and P=.002) but not in Beijing (B=−0.01; P=.25). Conversely, negative information exposure primarily increased threat perceptions (Hong Kong: B=0.33 and P=.001; Beijing: B=0.93 and P<.001) but did not consistently translate to increased perceived risk of contracting mpox (Hong Kong: B=−0.10 and P=.31; Beijing: B=0.20 and P=.11). Notable contextual differences emerged between Beijing and Hong Kong—participants in Beijing reported higher levels of information exposure (eg, international mpox statistics; mean score 2.17, SD 0.97 vs 1.79, SD 0.89; P<.001) and more nonregular sex partners (mean 2.20, SD 6.73 vs 1.65, SD 3.37; P=.02), but the associations among information exposure, perceived risk, and vaccination intent were weaker than in Hong Kong participants. 

Conclusions: Positive mpox-related information strongly promotes vaccination intent by enhancing perceived control and amplifying perceived risk, particularly in settings with accessible vaccination programs such as Hong Kong. Conversely, negative information appears less effective in driving vaccination intention. Tailored, stigma-free communication is crucial for improving vaccination uptake, especially in mainland China, where subsidized vaccines are scarce and perceptual pathways linking information exposure to vaccination intent are relatively weak. Enhancing access to vaccines and addressing contextual barriers can further optimize the impact of such interventions. Copyright © 2025 Doug Cheung, Luyao Xie, Lijuan Wang, Siyu Chen, Xinge Li, Zheng Zhang, Xinyue Chen, Shen Ge, Fuk-yuen Yu, YuanFang, Zihuang Chen, Zhennan Li, Fenghua Sun, Phoenix Mo, Yingjie Liu, Zixin Wang.