Abstract
BackgroundMany studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. This study investigated the utility of the Health Belief Model (HBM) in predicting HPV vaccine uptake in Kenya, focusing on the importance of promotion, probing willingness to vaccinate as precursor of uptake and exploring the added value of personal characteristics.MethodsLongitudinal data were collected before and after a pilot HPV vaccination program in Eldoret among mothers of eligible girls (N = 255). Through pathway modeling, associations between vaccine uptake and the HBM constructs, willingness to vaccinate and adequate promotion were examined. Adequate promotion was defined as a personal evaluation of promotional information received. Finally, baseline cervical cancer awareness and socio-demographic variables were added to the model verifying their direct, mediating or moderating effects on the predictive value of the HBM.ResultsPerceiving yourself as adequately informed at follow-up was the strongest determinant of vaccine uptake. HBM constructs (susceptibility, self-efficacy and foreseeing father’s refusal as barrier) only influenced willingness to vaccinate, which was not correlated with vaccination. Baseline awareness of cervical cancer predicted uptake.ConclusionsThe association between adequate promotion and vaccination reveals the importance of triggers beyond personal control. Adoption of new health behaviors might be more determined by organizational variables, such as promotion, than by prior personal beliefs. Assessing users’ and non-users’ perspectives during and after implementing a vaccination program can help identifying stronger determinants of vaccination behavior.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-016-0211-7) contains supplementary material, which is available to authorized users.
Highlights
Many studies investigate Human Papillomavirus (HPV) vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest
This study examined whether the Health Belief Model (HBM) can be applied to predict HPV vaccine uptake in Kenya, a country with little research on HPV vaccine acceptability and uptake
Its determinants vaccine confidence, complacency and convenience, might offer a better insight in the ‘state of preparedness’ and willingness of people to vaccinate against cervical cancer as opposed to acceptability or intention to vaccinate, which are mostly used in formative research [44]
Summary
Many studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. There is the belief that the vaccines might promote promiscuity past research does not support these claims [12, 13] These acceptability studies apply (health) behavior theories that include a variety of factors (e.g. attitudes, beliefs, perceived barriers) which are believed to influence the likelihood of a certain action [14, 15]. By investigating these theories’ constructs, researchers aim to identify determinants of vaccine uptake and refusal to incorporate them in vaccination strategies. The HBM is often extended with two more constructs: (5) self-efficacy, indicating the ‘expectancies about one’s own competence to perform the behavior’ and (6) cues to action (CTA), i.e. ‘the specific stimuli necessary to trigger the decisionmaking process’ [18,19,20]
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