Abstract
Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of 34±11.9 years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.
Highlights
Cervical cancer is the second most common cancer in women and is the most common cancer among women in developing countries
Physician recommendation is an important predictor of human papillomavirus (HPV) vaccine acceptance; physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost
HPV vaccines are licensed and available in Vietnam; a growing body of literature including prior work in Vietnam (Dinh et al, 2007; Breitkopf et al, 2009) suggests that patient and provider characteristics are both influential with regard to recommendation and administration of HPV vaccines (Caskey et al, 2009; Do et al, 2009; Gargano et al, 2013; Kester et al, 2013; Perkins et al, 2013)
Summary
Cervical cancer is the second most common cancer in women and is the most common cancer among women in developing countries. Half a million women are newly affected by cervical cancer each year and more than half die from the disease (International Agency for Research on Cancer [IARC], 2012). Of the estimated 266,000 annual cervical cancer deaths in 2012, almost nine out of ten occur in less developed countries (IARC, 2012). In Vietnam, cervical cancer is the fifth most frequent cancer among women, with approximately 5,174 new diagnoses and 2,472 deaths each year (Bruni et al, 2014). This largely preventable cancer has the highest age-specific incidence of all cancers among women 15-44 years of age, at 9.6 per 100,000 women in Vietnam (Bruni et al, 2014). In Vietnam, vaccine cost and effectiveness influence decisions surrounding HPV uptake among mothers (Poulos et al, 2011) as well
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