Human Papillomavirus Vaccine Decision-making Research Articles

A systematic approach to map the adolescent human papillomavirus vaccine decision and identify intervention strategies to address vaccine hesitancy

ObjectivesUnsubstantiated safety concerns with human papillomavirus (HPV) vaccines continue to linger. This study sought to identify factors that influence the adolescent HPV vaccine decision and systematically identify intervention functions and strategies likely to be effective in reducing vaccine hesitancy. Study designThis is a qualitative focus group study. MethodsFocus groups were conducted with female adolescents (aged 14–16 years) in Cork and Kerry. During focus groups, the trained facilitator used a semistructured, Theoretical Domains Framework (TDF)–based topic guide to prompt discussion. Transcripts were thematically analysed using the TDF and Behaviour Change Wheel. Behaviour Change Technique Taxonomy version 1 was used to suggest intervention functions and strategies for addressing HPV vaccine hesitancy. ResultsA total of 50 adolescents (96% vaccinated), participated in 10 focus groups. The key themes were presented by means of the relevant TDF domains. Seven domains were selected as the most relevant: knowledge, social influences, beliefs about capabilities, optimism, beliefs about consequences, emotion and environmental context and resources. Five intervention functions were identified, education, persuasion, enablement, modelling and environmental restructuring, and linked to 11 relevant Behaviour Change Technique (BCTs). Potential intervention strategies were developed. ConclusionsThis study provided a detailed insight into behavioural factors influencing the vaccine decision-making process. It was identified that awareness and knowledge about HPV and its health sequelae was low. Lack of information is a well-recognised determinant of vaccine hesitancy. Therefore, education was recommended as a key area to address in future intervention studies.

Caregiver acceptance of a patient navigation program to increase human papillomavirus vaccination in pediatric clinics: a qualitative program evaluation

ABSTRACT Objective: The purpose of this evaluation was to examine the acceptability of a multi-component patient navigator (PN) intervention program designed to decrease barriers to human papillomavirus (HPV) vaccination among caregivers of adolescents. We sought to understand the most important components of the program from the caregivers’ perspective and to evaluate remaining barriers to vaccination. Method: Caregivers of children 9–17 years old (N = 102) participated in qualitative semi-structured interviews with questions informed by the Theory of Planned Behavior. These interviews assessed experiences with a PN program which offered HPV vaccination, scheduling, and reminders in pediatric clinics. We included randomly selected 46 program participant transcripts and 11 decliner transcripts. A thematic approach was used to analyze transcripts for themes related to acceptability of HPV vaccination, important program components, and any problems encountered. Results: Major themes included: reasons for making HPV vaccination decision, helpful program components and suggestions for improvement, and remaining barriers to vaccination. Those who declined vaccination stated that their child was too young or not ready to think about sex, or they did not have enough information to make a decision. However, they felt that PNs were respectful of their decision. Program participants felt that vaccination was an important way to prevent cancer. Program participants had often not been aware of the vaccine and felt that having it explained was very helpful. Conclusion: This program evaluation found that caregivers of pediatric patients, even those who declined the HPV vaccine, appreciated the program and felt it provided important information about the vaccine.

Beyond the responsibility binary: analysing maternal responsibility in the human papillomavirus vaccination decision.

With the human papillomavirus (HPV) vaccine positioned as the "right tool" to protect girls' health and sexual health, public discourse positions parents as "responsible" if they vaccinate, "irresponsible" if they do not. The problem with this binary, however, is that it cannot account for the full spectrum of responsibilities and social norms that parents enact in vaccine decisions. In this paper, and in the context of low HPV vaccination rates, I confront this binary and encourage a fuller view of adolescent health and sexual health. Using data from qualitative semi-structured interviews with 28 Canadian mothers tasked with consenting to the HPV vaccine, I examine the complexity of this responsibility. I find HPV vaccine-consenting mothers have normative conceptualisations of responsibility aligned with dominant interpretations of public health. Rather than expressing irresponsibility, some non-HPV vaccine-consenting mothers articulated alternate responsibilities, aligned with broad efforts to manage their teens' sexual health and sexuality. They extend responsibility beyond cancer protection vis-à-vis vaccines to a general responsibility for daughters' sexual health and self-esteem. In conclusion, I recommend the need for a broader public health approach to HPV, which includes, and goes beyond vaccination. Moreover, I suggest that some of these alternate responsibilities be viewed as complementary to vaccination.

Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial

ABSTRACT There is a critical need for campaigns and interventions to increase rates of human papillomavirus (HPV) vaccination among U.S. adolescents. Healthcare providers are key stakeholders in parents’ HPV vaccine decision-making. The current study presents the evaluation of secondary outcomes in a multi-component communication-based intervention to improve healthcare providers’ communication about HPV vaccination. Evaluation was conducted via surveys of providers participating in a 12-month randomized controlled trial. Findings suggest use of communication components (combined use of the presumptive approach [PA] with all patients, and motivational interviewing and a fact sheet with vaccine hesitant parents) contributed to providers in the intervention group reporting higher perceived levels of parental HPV vaccine acceptance than control providers, as well as increased vaccination rates in the intervention arm in the main RCT.

Persuasive messaging for human papillomavirus vaccination by adolescent providers in a five-country multi-site study

Strong persuasive messaging by providers is a key predictor for patient acceptance of prophylactic human papillomavirus vaccination. We aimed to determine optimal messaging to promote human papillomavirus adolescent vaccination across different geographical sites. Adolescent providers (n = 151) from Argentina, Malaysia, South Africa, South Korea, and Spain were surveyed on messages, family decision makers, and sources of communication to best motivate parents to vaccinate their adolescent daughters overall, and against human papillomavirus. Multivariate logistic regression assessed the likelihood of recommending messages specifically targeted at cervical cancer with providers' characteristics: gender, medical specialization, and previous administration of human papillomavirus vaccination. Mothers were considered the most important human papillomavirus vaccination decision makers for their daughters (range 93%-100%). Television was cited as the best source of information on human papillomavirus vaccination in surveyed countries (range 56.5%-87.1%), except Spain where one-on-one discussions were most common (73.3%). Prevention messages were considered the most likely to motivate parents to vaccinate their daughters overall, and against human papillomavirus, in all five countries (range 30.8%-55.9%). Optimal messages emphasized cervical cancer prevention, and included strong provider recommendation to vaccinate, vaccine safety and efficacy, timely vaccination, and national policy for human papillomavirus vaccination. Pediatricians and obstetricians/gynecologists were more likely to cite that the best prevention messages should focus on cervical cancer (OR: 4.2, 95% CI: 1.17 to 15.02 vs other medical specialists). Provider communication messages that would motivate parents to vaccinate against human papillomavirus were based on strong recommendation emphasizing prevention of cervical cancer. To frame convincing messages to increase vaccination uptake, adolescent providers should receive updated training on human papillomavirus and associated cancers, while clearly addressing human papillomavirus vaccination safety and efficacy.

Exploring the Need of HPV Education Programs in Korean American Communities

ABSTRACTGiven the significantly higher cervical cancer risks faced by Korea Americans (KA), the aim of this study was to explore cultural influences and barriers affecting human papillomavirus (HPV) vaccination decisions and preferred educational methods to effectively deliver HPV information. Focus groups included 20 KA parents. This study found a lack of knowledge about HPV and the vaccine, along with negative perceptions about the vaccine, affects HPV vaccination decision-making. Ineffective conversations and a lack of HPV vaccine recommendations by health care providers influenced by cultural beliefs were found to be another major barrier. These findings reveal new insights to guide the development of HPV education programs.

HPV-Related Cancer Prevention and Control Programs at Community-Based HIV/AIDS Service Organizations: Implications for Future Engagement.

Background: People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and, men who have sex with men (MSM) are disproportionately affected by genital warts and cancers caused by human papillomavirus (HPV). We assessed community-based HIV/AIDS service organizations' (ASOs) staff awareness, knowledge, attitudes, and beliefs about HPV and effective cancer prevention tools, namely HPV vaccination, Pap, and HPV tests. The potential engagement of ASO staff in future efforts to reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM was explored.Methods: In May-June 2016, staff were recruited from three ASOs located in the South United States Census region—a geographical area disproportionately affected by HIV/AIDS. Participants completed a 30-min self-administered, 118-item paper and pencil survey about HPV and cancer. Data analysis was conducted using Stata/SE 14.2.Results: ASO staff (n = 30) were 83% non-Hispanic Black, 40% lesbian/gay, and worked with people living with HIV for an average of 11.4 ± 7.7 years. All reported hearing of HPV and 77% had heard of the HPV vaccine (n = 23). While all knew HPV can cause cervical cancer, only 67% knew HPV can cause anal cancer. Most (61%) thought the HPV vaccine could prevent cervical cancer. Fewer (39–48%) thought the HPV vaccine could prevent anal, oral, penile, vaginal, and vulvar cancers. All were willing to encourage MSM and female clients to talk to a healthcare provider about HPV vaccination. Almost all were willing to promote HPV vaccination to clients (91–95%) and navigate clients to adult safety net HPV vaccine providers (86–95%). More than half (59–67%) thought they could positively influence their MSM and female clients' HPV vaccine decision-making.Conclusion: HPV vaccination and the Pap and HPV tests are effective cancer prevention tools that can reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM. Engaging ASO staff in cancer prevention efforts may increase HPV vaccination rates and early detection of HPV-related cancers among HIV-positive women and MSM. Exploring ASOs as community-based settings for promoting effective cancer prevention tools may foster opportunities to reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM.

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons

Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9–16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the ‘decided not to vaccinate’ stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

The incidence of human papillomavirus (HPV)-related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed. To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination. A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents. The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice's patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention. Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (≥1 dose) and completion (≥3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices' records and augmented with state immunization information system data. Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5-absolute percentage point increase in HPV vaccine series initiation and a 4.4-absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components. A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients. clinicaltrials.gov Identifier: NCT02456077.

Cross-sectional associations between psychological traits, and HPV vaccine uptake and intentions in young adults from the United States.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and can lead to the development of genital warts, and cancers throughout the body. Despite the availability of HPV vaccines for over a decade, uptake in the United States among adolescents and young adults remains well below national targets. While most efforts to improve HPV vaccine uptake have rightly focused on adolescents, there is still a tremendous opportunity to improve vaccination among young adults who have not been vaccinated against HPV. To that end, we report an exploratory examination of associations between HPV vaccination status and intentions with psychological traits that may impact HPV vaccine uptake with a national, demographically diverse sample of young adults (N = 1358) who completed an online survey. These psychological traits conceptually mapped onto motivations to: 1) understand health-related information, 2) deliberate, 3) manage uncertainty, and 4) manage threats. We found notable gender differences for the association of these motivations and vaccination status. For women, higher interest in and ability to understand health-related information seemed to distinguish those who reported receiving the HPV vaccine from those who did not. For men, less need to deliberate and greater needs to manage threat and uncertainty seemed to be the distinguishing motives for those who reported receiving the HPV vaccine compared to those who did not. Results for vaccination intentions were less consistent, but there was some evidence to indicate that, regardless of gender, greater health-related information interest and understanding and need to manage uncertainty and threats were associated with increased intention to receive the HPV vaccine, while greater need to deliberate was associated with decreased vaccination intentions. These results suggest that there are psychological differences that are associated with HPV vaccination decisions and that these motivations should be considered in efforts to improve HPV vaccine uptake.

Psychosocial correlates of HPV vaccine acceptability in college males: A cross-sectional exploratory study

BackgroundMost college males are not immunized against the human papillomavirus (HPV) and are at high risk of HPV infection. Most research of correlates of HPV vaccine acceptability in college males has assessed vaccine acceptability as a binary outcome, e.g., vaccinated or not vaccinated, without considering that some students may not even be aware that the HPV vaccine can be given to males. Our objective was to evaluate the psychosocial correlates of HPV acceptability in college males, based on multiple stages of HPV decision-making. MethodsWe used an online questionnaire to collect data from college men aged 18–26 enrolled at three Canadian universities between September 2013 and April 2014. Vaccine acceptability assessment was informed by the six-stage decision-making Precaution Adoption Process Model (PAPM). We sought information on socio-demographics, health behaviors, HPV vaccine benefits and barriers, worry, susceptibility, severity related to HPV infection and social norms. HPV and HPV vaccine knowledge was measured with validated scales. Psychosocial correlates of HPV vaccine acceptability were assessed with bivariate and multivariate multinomial logistic regression. Actual and perceived HPV and HPV vaccine knowledge scores were calculated. ResultsThe final sample size was 428. Most male college students were unaware that the HPV vaccine could be given to males, unengaged or undecided about getting the HPV vaccine. Significant correlates of higher HPV vaccine acceptability were: increased HPV knowledge, having discussed the HPV vaccine with a healthcare provider, and social norms. Being in an exclusive sexual relationship was significantly associated with lower HPV vaccine acceptability. Students' actual HPV and HPV vaccine knowledge was low and positively correlated to their perception about their HPV knowledge. ConclusionsWe provided a fine-tuned analysis of psychosocial correlates of HPV vaccine acceptability in college males who are in the early stages of HPV vaccine decision-making. Interventions are needed to increase HPV and HPV vaccine knowledge in college males.

To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls, boys, and parents in the Netherlands: a Q-methodological study

BackgroundDespite the introduction of Human papillomavirus (HPV) vaccination in national immunization programs (NIPs), vaccination rates in most countries remain relatively low. An understanding of the reasons underlying decisions about whether to vaccinate is essential in order to promote wider spread of HPV vaccination. This is particularly important in relation to policies seeking to address shortfalls in current HPV campaigns. The aim of this study was to explore prevailing perspectives concerning HPV vaccination among girls, boys, and parents, and so to identify potential determinants of HPV vaccination decisions in these groups.MethodPerspectives were explored using Q-methodology. Forty-seven girls, 39 boys, and 107 parents in the Netherlands were asked to rank a comprehensive set of 35 statements, assembled based on the health belief model (HBM), according to their agreement with them. By-person factor analysis was used to identify common patterns in these rankings, which were interpreted as perspectives on HPV vaccination. These perspectives were further interpreted and described using data collected with interviews and open-ended questions.ResultsThe analysis revealed four perspectives: “prevention is better than cure,” “fear of unknown side effects,” “lack of information and awareness,” and “my body, my choice.” The first two perspectives and corresponding determinants of HPV vaccination decisions were coherent and distinct; the third and fourth perspectives were more ambiguous and, to some extent, incoherent, involving doubt and lack of awareness and information (perspective 3), and overconfidence (perspective 4).ConclusionsGiven the aim of publically funded vaccination programs to minimize the spread of HPV infection and HPV-related disease and the concerns about current uptake levels, our results indicate that focus should be placed on increasing awareness and knowledge, in particular among those in a modifiable phase.

Impact of a Provider Communication Training Intervention on Adolescent Human Papillomavirus Vaccination: A Cluster Randomized, Clinical Trial

Abstract Background Effective human papillomavirus (HPV) vaccines have been available in the US for several years but are underutilized. Provider communication about the vaccine is a key factor influencing uptake, yet effective communication tools are lacking or untested. Our objective was to evaluate the impact of a Motivational Interviewing-based 5-component provider HPV vaccine communication intervention on adolescent HPV vaccine uptake. Methods This was a cluster randomized controlled trial of 16 primary care practices in the Denver area that included 188 medical providers and 43,132 adolescent (11–17 years old) patients. The 5-components of the intervention included an HPV fact library to create practice-specific HPV fact sheets, a tailored parent education website, HPV-related disease images, an HPV vaccine decision aid, and 2 hours of in-person communication training on using a presumptive vaccine recommendation followed by Motivational Interviewing (MI) if parents were vaccine hesitant. Each practice participated in a series of 4 intervention development meetings over a 6 month period (8/2014 – 1/2015) before launching the intervention. Primary outcomes were differences between control and intervention practices over time (i.e., “difference in difference” (DID)) in HPV series initiation (≥1 dose), and completion (≥3 doses) among 11–17 year old patients seen between 09/01/2013-08/31/2014 and 2/1/2015-1/31/2016. Vaccination data were obtained from clinics’ records and augmented with a state immunization registry. Results Adolescents in the intervention practices had a significantly higher odds of HPV series initiation over time than those in control practices (DID Adjusted Odds Ratio (AOR) 1.46, 95% Confidence Interval (CI) 1.31–1.62) and completion (AOR 1.56, 95% CI 1.27–1.92). This translated into a 9.5 absolute percentage point (PP) increase in HPV series initiation, and a 4.4 PP increase in HPV series completion in intervention practices over control practices. The intervention had a greater impact in pediatric compared with family medicine practices, and in private practices compared with public. Conclusion Implementation of a 5-component HPV vaccine provider communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients. Disclosures A. Dempsey, Merck, Pfizer, Sanofi pasteur: Consultant, no research funding

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting.

Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina ( n = 24) and Vietnamese ( n = 24) women, and PPOSBC staff ( n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men's HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother-daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.

Parents’ involvement in the human papillomavirus vaccination decision for their sons

ObjectivesParents are critical to ensure sufficient human papillomavirus (HPV) vaccine coverage. No studies to date have examined how mothers and fathers perceive their own, their partners’ and their sons’ involvement in HPV vaccination decision-making process. MethodsAn online survey methodology was used to collect data from a national sample of Canadian parents (33% fathers, 67% mothers, Mage=44) who had a 9–16years old son (n=3117). Main outcome measuresParent’s perception of their self-involvement, partner-involvement and son’s involvement in the decision to get their son the HPV vaccine were measured on a Likert scale and were classified as ‘no involvement’, ‘moderate involvement’ and ‘high involvement’. ResultsMothers and fathers both perceive that they themselves and their partners should be highly involved in their son’s HPV vaccination decision. Son’s involvement was reported as moderate and influenced by age. Significant gender differences were found for self and partner involvement, but the effect sizes were small. ConclusionMothers and fathers both perceive that they themselves and their partners should be significantly involved in their son’s HPV vaccination decision. A dyad decision-making model involving both parents for HPV vaccine decision-making is suggested with a stronger recommendation for a triad decision-making model involving both parents as well as the child/adolescent. Gender stereotypes of females perceiving themselves as the sole decision-maker or fathers not wanting to be involved in their children’s health decision were not supported.

Development and validation of measures to evaluate adolescents' knowledge about human papillomavirus (HPV), involvement in HPV vaccine decision-making, self-efficacy to receive the vaccine and fear and anxiety

ObjectivesWe describe the development and validation of measures of human papillomavirus (HPV)/HPV vaccination knowledge, fear/anxiety about vaccination, involvement in HPV vaccine decision-making, and self-efficacy with regard to getting the vaccine, designed to evaluate the efficacy of an intervention to affect these domains (collectively termed the HAVIQ: HPV Adolescent Vaccine Intervention Questionnaire). Study designLiterature search, cognitive interviews and cross-sectional survey. MethodsA literature search identified existing items that were modified for the present measures. Experts reviewed draft measures for face and content validity. Cognitive interviews with adolescents were also used to assess content validity. Adolescents completed the measures and an internal reliability analysis of each measure was performed. ResultsThe four experts concurred that the measures had face validity. Cognitive interviews identified items requiring refinement. Content validity was examined with ten experts and was deemed acceptable. There were 1800 adolescents who completed the measures; Cronbach's alpha was >0.6 for three of the four measures. The four final measures are brief, comprising 25 items in total. ConclusionsThe measures are robustly developed and validity-tested. The HAVIQ may be used in research settings to evaluate adolescents' knowledge and experiences of the process of HPV vaccination in a school-based vaccination programme.

Psychosocial determinants of parental human papillomavirus (HPV) vaccine decision-making for sons: Methodological challenges and initial results of a pan-Canadian longitudinal study.

BackgroundHPV vaccination decision-making is a complex process that is influenced by multiple psychosocial determinants. Given the change in policy recommendation to include males in routine HPV vaccination, our goals were to assess the HPV vaccination uptake in Canada, to understand where Canadian parents were situated in the HPV vaccine decision-making process for their son, how they changed over time and which psychosocial determinants were relevant for this process.MethodsWe used an online survey methodology and collected data from a nationally representative sample of Canadian parents of boys aged 9–16 at baseline (T1, February 2014) and at 9 months’ follow-up (T2). Our analyses were guided by the Precaution Adoption Process Model (PAPM), a theoretical health behavior model that classifies parents in one of six stages: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate and those who had already vaccinated their sons. Rigorous methods were used to filter out careless responders: response variance, bogus items, psychometric antonyms and psychometric synonyms.ResultsAt T1 and T2, we received 3,784 and 1,608 respectively completed questionnaires; after data cleaning 3,117 (T1) and 1,427 (T2) were retained. Less than 3% of boys were vaccinated at both time points. At both T1 and T2, most parents (over 70%) belonged to the earlier vaccination adoption stages: 57% were unaware (T1) and 15.3% (T2); 20.9% were unengaged (T1) and 32.4% (T2); and 9.1% were undecided (T1) and 25.2% (T2). At follow-up, 37.7% of participants did not move from their initial PAPM decision-making stage. Most parents (55%) preferred to receive information from their healthcare provider (HCP) but only 6% (T1) and 12% (T2) had actually spoken with a HCP about the HPV vaccine for their son.ConclusionsHPV vaccination uptake in Canadian boys was very low in the absence of a publicly funded HPV vaccination programs for boys. Optimal HPV information preferences were identified and can be used in interventions to increase HPV knowledge and increase HPV vaccine uptake. Intentions to vaccinate or planning to speak to one’s HCP did not translate into action for most parents over the 9-month follow up; this finding is critical to consider to inform implementation strategies. Methodological challenges are described and suggestions for future research are offered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3828-9) contains supplementary material, which is available to authorized users.

“We've Been Together. We Don't Have It. We're Fine.” How Relationship Status Impacts Human Papillomavirus Vaccine Behavior among Young Adult Women

BackgroundVaccination against the human papillomavirus (HPV) has the potential to significantly reduce morbidity and mortality associated with genital warts and HPV-related cancers. However, HPV vaccination rates continue to be suboptimal among the “catch-up” population of 18- to 26-year-old women. One consistent risk factor for nonvaccination is being in a relationship. This study aimed to understand how relationship status and vaccination status impact risk perceptions and perceived need for the HPV vaccine among young adult women. MethodsIn-depth interviews were conducted with a sample (n = 50) of recently HPV vaccinated and unvaccinated college women, and stratified by four relationship categories. Comparative thematic analysis was used to assess relationship status and HPV risk perceptions. ResultsWomen in relationships perceived their risk of HPV to be low, which they attributed to monogamy and few sexual partners. Women in dating relationships reported higher HPV risk, which was linked to unprotected sex and sexual activity. In contrast, single women stated that their low risk for HPV was due to sexual inactivity. ConclusionsThis study builds on the epidemiological literature, by understanding how relationship status impacts HPV vaccination among young adult women. Relationship status contributed to HPV risk perceptions and vaccination decisions among these women. Perceptions were framed based on sexual behavior, such as monogamy or number of sexual partners. Future efforts should tailor health messages to young adult women's specific risk misperceptions about HPV.

The role of human papillomavirus (HPV)-related stigma on HPV vaccine decision-making among college males

ABSTRACTObjective: The goals of the present study are (1) to identify sociodemographic and psychosocial predictors of human papillomavirus (HPV)-related stigma and (2) to examine the relationship between HPV-related stigma in predicting HPV vaccine decision-making among college males. Participants: Six hundred and eighty college males aged 18–26 from 3 Canadian universities were recruited from September 2013 to April 2014. Methods: Participants completed a self-report survey assessing HPV-related stigma, psychosocial predictors of HPV-related stigma, and HPV vaccine decision-making. The results were analyzed using variance analyses and linear regressions. Results: Ethnicity, province of residence, and perceived severity of HPV were found to significantly influence HPV-related stigma. In addition, HPV-related stigma was higher in those unaware of the availability of the HPV vaccine for males. Conclusions: Promotion efforts should concentrate on Asian minorities and should avoid HPV severity messaging, as these may lead to higher HPV-related stigma, which in turn may act as a barrier to vaccination.

Modifiable and Non-Modifiable Factors Associated with HPV Vaccine Decision-Making among American Indian Women College Students

Cervical cancer is a preventable disease that is highly prevalent among American Indian (AI) women. Some types of the Human papillomavirus (HPV) has been identified as causing cervical cancer in women and other less common cancers such as cancer of the anus, vagina, vulva, and oral cavity. Two vaccines, Gardasil® and Cervarix®, are available for primary protection against HPV. Despite its proven efficacy, additional efforts are needed to improve HPV update among AI women. Our project was designed to assess HPV vaccine readiness among AI college students, and identify factors that influence their decision-making. Modifiable risk factors are ideal to identify in that they can be targeted for health behavior education and intervention. Further, risk factors once identified can be tailored for designing effective interventions in high-risk communities.