Understanding How Parents Decide on Vaccinating Their Child with the Human Papillomavirus (HPV) Vaccine

Abstract

The human papillomavirus (HPV) is the most prevalent sexually transmitted infection and causes certain cancers in females and males. HPV causes 70% of all cervical cancers in women and 90% of all genital warts in women and men. There is currently an HPV vaccine recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) to be administered to girls and boys between the ages of 11 and 12 years. Unfortunately, the uptake for the HPV vaccine remains low for girls and boys nationally and in Hawai‘i due to factors associated with parental decisions to vaccinate their children. This dissertation addresses gaps related to HPV vaccine uptake in Hawaiʻi through three studies which: 1) examines barriers and motivators to HPV vaccine uptake among Hawai‘i parents of teenage children through interviews, 2) determines the prevalence of HPV vaccination uptake by four ethnicities (Native Hawaiian, Filipino, Japanese, and Caucasian) through a population-based survey in Hawai‘i, and 3) evaluates a health education brochure developed and culturally tailored for parents residing in Hawai‘i. There are many factors that contributed to a parent’s decision to vaccinate their child with the HPV vaccine. The parents’ interview reinforced the importance of a physician recommendation and confirmed that health education materials would be helpful to parents, with parents preferring receipt of brochures from their physician. Data from 799 parents through the population-based telephone survey in Hawai‘i found that 55% of parents with daughters had vaccinated their daughter with one or more shots, compared to only 41% of parents with sons. After adjusting for important demographic variables, Caucasian parents of both boys and girls, individuals who have not heard of the HPV vaccine, and parents of young teens regardless of ethnicity, were least likely to vaccinate them with the HPV vaccine. In this survey, the main motivator to vaccinate was a physician recommendation, and the main barrier was the lack of awareness of the HPV vaccine. A four- step protocol was useful in developing an HPV vaccine brochure and testing its attractiveness, acceptability, messenger effectiveness, personal relevancy, and readability with providers and parents in Hawai‘i. The developed HPV vaccine brochure could be disseminated to parents in Hawai‘i to increase HPV vaccination. This dissertation research yielded findings about HPV vaccine uptake in Hawai‘i and produced a health education brochure to assist in increasing uptake by addressing parent-identified barriers and motivators to uptake. The research provides insights into a number of factors that affect parental decisions to vaccinate their 11-to-12-year-old children in Hawai‘i, which will be useful for interventions to improve vaccination rates.