Development and Validation of the Human Papillomavirus Attitudes and Beliefs Scale in a National Canadian Sample

Abstract

Parents' human papillomavirus (HPV) vaccination decision-making is strongly influenced by their attitudes and beliefs toward vaccination. To date, psychometrically evaluated HPV vaccination attitudes scales have been narrow in their range of measured beliefs and often limited to attitudes surrounding female HPV vaccination. The study aimed to develop a comprehensive, validated and reliable HPV vaccination attitudes and beliefs scale among parents of boys. Data were collected from Canadian parents of 9- to 16-year-old boys using an online questionnaire completed in 2 waves with a 7-month interval. Based on existing vaccination attitudes scales, a set of 61 attitude and belief items were developed. Exploratory and confirmatory factor analyses were conducted. Internal consistency was evaluated with Cronbach's α and stability over time with intraclass correlations. The HPV Attitudes and Beliefs Scale (HABS) was informed by 3117 responses at time 1 and 1427 at time 2. The HABS contains 46 items organized in 9 factors: Benefits (10 items), Threat (3 items), Influence (8 items), Harms (6 items), Risk (3 items), Affordability (3 items), Communication (5 items), Accessibility (4 items), and General Vaccination Attitudes (4 items). Model fit at time 2 were: χ/df = 3.13, standardized root mean square residual = 0.056, root mean square error approximation (confidence interval) = 0.039 (0.037-0.04), comparative fit index = 0.962 and Tucker-Lewis index = 0.957. Cronbach's αs were greater than 0.8 and intraclass correlations of factors were greater than 0.6. The HABS is the first psychometrically-tested scale of HPV attitude and beliefs among parents of boys available for use in English and French. Further testing among parents of girls and young adults and assessing predictive validity are warranted.