Parental Attitudes Towards Human Papillomavirus (HPV) Vaccination of Boys: Quantitative and Qualitative Results to Guide Development of Effective HPV Vaccine Interventions

Abstract

Incidences of both human papillomavirus (HPV) infection and HPV-related cancers are on the rise in men. However, vaccine uptake is low. Parental consent is required prior to receiving the HPV vaccine. This study examined parental perceptions of the HPV vaccine for boys through survey methods (N = 422) and focus groups (N = 45). This cross-sectional study used a mixed methods approach and was conducted in cooperation with communities in three counties with high rates of cervical cancer in the southeastern United States. Data were collected from January 2010 until August 2012. The study was approved by the affiliated university's Institutional Review Board (IRB) and school officials, parents, and community leaders. A convenience sample of 467 parents with male children was recruited using an IRB approved flyer and data collection occurred in two stages: 1) quantitative survey data collection using the Parental HPV survey (Cronbach's Alpha 0.96), and 2) qualitative focus groups and interviews. Chi square analysis revealed no significant differences between parents who intended to vaccinate their sons and those who did not. Logistic regression was used and to adjust for multi-collinearity, forward likelihood ratio variable selection was used within each block (block 1: demographic covariates, block 2: four HPV scales) (p < 0.10 for entry, p > 0.20 for removal) to select the final logistic regression model identifying predictors of intent to vaccinate. Mothers were 1.68 times more likely than fathers to vaccinate their sons, and African Americans were 1.78 times more likely than Caucasians to vaccinate their sons. Content analysis of transcribed focus groups and interviews provided four emergent themes: Lack of Knowledge about HPV, Unaware that HPV vaccine was for boys, No Correlation between Cancer and Persistent HPV Infection, and Parents did not communicate about HPV through their normative social networks. Awareness of the new HPV immunization guidelines from the Advisory Committee on Immunization Practice (ACIP) at the CDC, for boys, and the increasing rates of mouth, head, and neck cancers secondary to HPV infection are essential to decreasing HPV related cancers. It is important to view parents as members of a community with social networks that are entwined with one another and embedded within their unique cultural, geographic and socioeconomic milieu. However, it is a mistake to assume that parents utilize these social networks for communication about HPV vaccination. In the future, to increase vaccination rates for boys, health care providers must utilize strategies to increase parents' knowledge of HPV vaccination, the connection between HPV infection and persistent infection and HPV related cancers. In addition, fathers should also be included in discussions about vaccinating boys against HPV infection, since this exploratory analysis found that only a small percentage of the fathers had vaccinated their son. While the findings of the study imply that mothers intend to vaccinate their sons, a father or father figure as the male head of the household can also promote HPV vaccination. Points of intervention development include: Knowledge about transmission, the connection between persistent HPV infection/cancer, and HPV vaccination recommendations for both boys and girls.