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Overall, these findings suggest that intention to use family doctor services is less
influenced by basic demographic characteristics, but is significantly shaped by individuals’
educational level and economic capacity.
5. Discussion
This study examined an integrated HBM–TPB model to explain the intention to use
family doctor services in Northern Vietnam. Overall, the findings are consistent with prior
research on preventive healthcare behavior, highlighting the central roles of perceived
benefits, perceived barriers, and attitude in shaping behavioral intention.
Consistent with recent empirical evidence, perceived benefits and perceived
barriers emerged as the most influential Health Belief Model constructs in explaining
preventive health service use. In particular, perceived barriers exerted the strongest
influence on attitude toward health behavior, underscoring the importance of practical,
psychological, and structural constraints in shaping individuals’ evaluations of family
doctor services. This pattern aligns with recent studies suggesting that benefit–cost
considerations and perceived obstacles often outweigh risk-related perceptions in
motivating preventive healthcare behaviors (Carpenter, 2010; Norman and Conner, 2017;
Dsouza et al., 2022; Zewdie et al., 2022). Accordingly, intention to use family doctor
services appears to be driven primarily by perceived value and the reduction of barriers
rather than by heightened perceptions of health risk alone.
In line with the Theory of Planned Behavior, attitude toward health behavior
emerged as a key determinant of intention to use family doctor services. This finding
corroborates previous research demonstrating that positive evaluations of healthcare
services substantially enhance individuals’ willingness to engage in preventive care (Lee et
al., 2025; Fang et al., 2025). Moreover, the significant indirect effects observed in this
study confirm attitude as a critical mediating mechanism linking health beliefs to
behavioral intention. The integration of attitudinal evaluations with health belief
constructs therefore supports recent theoretical perspectives advocating combined
cognitive models to improve explanatory power in preventive healthcare contexts.
While perceived severity showed a significant positive association with attitude, its
influence was weaker than that of perceived benefits and perceived barriers. This
suggests that although awareness of the seriousness and consequences of health
problems can contribute to favorable evaluations of preventive services, such perceptions
alone are insufficient to strongly motivate intention in the absence of clear benefits and
manageable access conditions. In contrast, perceived susceptibility did not demonstrate a
significant effect on attitude, a finding that is consistent with a growing body of literature
reporting limited explanatory power of perceived vulnerability in preventive and non-
disease-specific contexts (Coe et al., 2012; Norman and Conner, 2017; Zampetakis and
Melas, 2021). These results indicate that perceived risk, particularly susceptibility, may
play a secondary role when preventive behaviors are not directly associated with
immediate illness or symptoms.
Taken together, the findings reinforce the view that intention toward preventive
health services is primarily shaped by positive evaluations, perceived value, and reduced
barriers rather than perceived vulnerability. This evidence supports prior research
emphasizing the need for interventions that prioritize improving service experience,
reducing practical and psychological obstacles, and strengthening confidence in primary
care systems to promote sustained utilization of preventive healthcare services (Zewdie
et al., 2022; Fang et al., 2025).

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