Abstract
BackgroundHuman papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. This study examined the association between changes in parents’ vaccine attitudes and HPV vaccine receipt in their adolescent children.MethodsA baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11–17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties) from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents’ adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion.ResultsThere were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents’ uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion.ConclusionsReductions in parents’ uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine’s safety profile.
Highlights
Human papillomavirus (HPV) vaccine coverage rates remain low
The purpose of this study was to examine the association between changes in parents’ HPV vaccine attitudes and HPV vaccine uptake in their adolescents, using electronic health records (EHR) data from a north-central Wisconsin integrated healthcare system
Study eligible individuals completed both the baseline and follow-up attitudinal survey and were parents of adolescents who, at baseline: were medically homed to one of the nine Marshfield Clinic Health System (MCHS) regional centers selected for the intervention, were aged 11–16 years, had failed to start or complete the HPV vaccine series (i.e.,
Summary
Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. While multiple causes likely exist, low coverage is hypothesized to be a function of hesitancies, ambivalence, or resistance by many parents who are deciding about their child’s healthcare. In considering their adolescent’s young age and (presumed) timeline until sexual exposure, parents typically underestimate their child’s susceptibility to acquiring sexually transmitted infections or cervical cancer [4, 5]. Parents tend to overestimate the risks of HPV vaccine adverse events [4, 6, 7], some of which are real (e.g., syncope) [8], while causal links to others have been repudiated (e.g., thromboembolism [9], risky sexual behaviors [10]) despite widely available false claims
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