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in major cities, while many northern midland and mountainous areas continue to face
difficulties in service provision and public acceptance (Ministry of Health, 2016). In
addition to structural constraints, individual perceptions and healthcare-seeking
behavior play an important role. Limited preventive health habits, uncertainty about
service quality, and weaknesses in professional training and insurance coverage have
reduced the trust of Vietnamese citizens and reinforced the tendency to bypass primary
care (Nguyen et al., 2020). Although the government has reaffirmed its commitment to
expanding the family doctor model by 2030 (Ministry of Health, 2019), a clear gap
remains between policy intentions and actual service use.
Theoretically, healthcare utilization is influenced not only by service availability but
also by individual-level psychological factors. Behavioral intention is widely recognized as
a key predictor of healthcare use and is shaped by individuals’ attitudes and underlying
beliefs (Ajzen, 1991). Yet, empirical research on healthcare-seeking behavior in Vietnam
remains limited and has largely focused on system-level issues rather than on these
psychological mechanisms. Moreover, while the Health Belief Model and the Theory of
Planned Behavior have been widely applied to explain preventive health behaviors, their
combined use to examine family doctor service utilization remains underexplored,
particularly in developing healthcare systems. In the post-COVID-19 period, the growing
demand for proactive, continuous, and personalized healthcare further highlights the
importance of understanding intention-based mechanisms underlying preventive
healthcare decisions (Zahid & Sharma, 2023). This study addresses this gap by examining
the determinants of intention to use family doctor services among residents in Northern
Vietnam, contributing to health behavior research and providing practical insights for
strengthening primary healthcare.
2. Theoretical Background and Hypothesis Development
2.1. Theoretical background
The Health Belief Model (HBM) is a foundational framework for explaining
preventive health behaviors, originally developed to understand why individuals fail to
participate in health prevention programs (Rosenstock, 1966). The model posits that
health-related behavior is shaped by individuals’ perceptions of health threats and their
evaluations of recommended actions. Specifically, perceived susceptibility and perceived
severity jointly form perceived threat, while perceived benefits and perceived barriers
reflect individuals’ assessments of the effectiveness of a behavior and the obstacles that
may discourage action (Rosenstock, 1966; Janz and Becker, 1984). Individuals are more
likely to adopt preventive behaviors when perceived threat is salient and perceived
benefits outweigh perceived barriers.
HBM has been widely applied across various healthcare contexts, including
vaccination, screening, and primary care utilization (Champion and Skinner, 2008;
Carpenter, 2010). In recent years, scholars have increasingly integrated HBM with
intention-based frameworks such as the Theory of Planned Behavior (TPB) to better
explain how health beliefs translate into evaluative judgments and behavioral intentions
(Ajzen, 1991; Ong et al., 2023). Within TPB, attitude toward behavior represents an
individual’s overall evaluation of performing a behavior and is consistently identified as a
key determinant of behavioral intention.
In the context of family doctor services, the integration of HBM and TPB is
particularly appropriate. The use of family doctor services is primarily preventive rather
than treatment-oriented, requiring individuals to make proactive decisions based on

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