Exploring Facilitators and Barriers to Initiation and Completion of the Human Papillomavirus (HPV) Vaccine Series among Parents of Girls in a Safety Net System.

Sean O’Leary,Anna Furniss,Steven Lockhart,Miriam Dickinson,Shannon Stokley,Allison Kempe,Juliana Barnard,Amanda Dempsey,Michael Bronsert,Steven Federico

doi:10.3390/ijerph15020185

Abstract

Objective: To assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated (NI) or not completed (NC) the HPV vaccine series, attitudes and other factors important in promoting the series, and whether attitudes differed by language preference. Design/Methods: From August 2013–October 2013, we conducted a mail survey among parents of girls aged 12–15 years randomly selected from administrative data in a Denver safety net system; 400 parents from each group (NI and NC) were targeted. Surveys were in English or Spanish. Results: The response rate was 37% (244/660; 140 moved or gone elsewhere; 66% English-speaking, 34% Spanish-speaking). Safety attitudes of NIs and NCs differed, with 40% NIs vs. 14% NCs reporting they thought HPV vaccine was unsafe (p < 0.0001) and 43% NIs vs. 21% NCs that it may cause long-term health problems (p < 0.001). Among NCs, 42% reported they did not know their daughter needed more shots (English-speaking, 20%, Spanish-speaking 52%) and 39% reported that “I wasn’t worried about the safety of the HPV vaccine before, but now I am” (English-speaking, 23%, Spanish-speaking, 50%). Items rated as very important among NIs in the decision regarding vaccination included: more information about safety (74%), more information saying it prevents cancer (70%), and if they knew HPV was spread mainly by sexual contact (61%). Conclusions: Safety concerns, being unaware of the need for multiple doses, and low perceived risk of infection remain significant barriers to HPV vaccination for at-risk adolescents. Some parents’ safety concerns do not appear until initial vaccination.

Highlights

Attitudinal and logistical factors were identified early on as barriers to human papillomavirus (HPV) vaccination and, despite more than a decade of vaccine availability and recommendation, these barriers persist [1]
Our objectives were to assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated or not completed the HPV vaccine series, attitudes and other factors important in promoting initiation versus completion of the series, and whether attitudes differed by language preference
When results regarding attitudes were stratified into non-initiators and non-completers, this was based on self-reported vaccination status rather than electronic data, as we hypothesized that parental perception of vaccination status was more relevant to attitudinal responses than actual vaccination status

Summary

Introduction

Attitudinal and logistical factors were identified early on as barriers to human papillomavirus (HPV) vaccination and, despite more than a decade of vaccine availability and recommendation, these barriers persist [1]. In studies done prior to and shortly after introduction of the vaccine in 2006, parents consistently were concerned about vaccine safety, and many expressed a low perceived risk of infection. In contrast to the other “new” adolescent vaccines at the time, tetanus-diphtheria-acellular pertussis vaccine (Tdap) and meningococcal conjugate vaccine (MCV), the need for three doses for HPV vaccine posed significant logistical challenges, as completion of the series required additional adolescent visits [2]. Despite the promise of HPV vaccine to prevent cancer, rates of initiation and completion of the series remain low among adolescent girls nationally [3]. There have been relatively few studies among parents who had declined or delayed vaccination

Methods

Results

Discussion

Conclusion