HPV vaccine hesitancy and decision-making process in mothers of adolescents

Professor Fong Daniel Yee Tak   (Co-Investigator)

Dr. WANG Tingxuan   (Co-Investigator)

Professor Choi Pui Hang   (Co-Investigator)

Professor Wang Man Ping   (Co-Investigator)

24

2021-06-30

53280

HPV vaccine hesitancy and decision-making process in mothers of adolescents

HPV, mothers, vaccination

NursingPsychosocial and Behavioural Research

Biology and Medicine (M)

202011159215

Seed Fund for PI Research – Basic Research

2020

On-going

Background Evidence has been shown that the human papillomavirus (HPV) vaccine is effective in the prevention of HPV induced cervical cancer and genital warts [1-3]. However, the HPV vaccine uptake rates were still low both globally and locally with an estimate of 1.4% among the female population and 6.1% among females aged 10-20 worldwide [4]. In the U.S., the completion rate of three doses was 51.1% among adolescents aged 13-17 in 2017 [5]. While in Hong Kong, the coverage rate was even lower, with 7%-9% among adolescent girls [6]. Both global and local figures are far below the WHO 2020 Global Vaccine Action Plan of 80% coverage [7]. Vaccinating adolescent girls is one of the most cost-effective preventions for relieving the financial burden caused by cervical cancer [8, 9], and mothers play a determinate role in the decision-making process regarding vaccinating their daughters [10]. It has long-term significance for not only individuals, but also the whole society [11]. Despite evidence that the HPV vaccine is effective, it is not always straightforward for mothers to make decisions regarding vaccinating their daughters [12]. Their ""delay in acceptance or refusal of vaccination despite the availability of vaccination services"", defined by WHO as ""vaccine hesitancy"" [13, 14], are more suitable to be considered as a decision-making process, rather than individual behaviour. Much of the prior research has been focusing on the influencing factors of HPV vaccine promotion. Two traditional theories including Theory of Planned Behaviour (TPB) [15, 16] and Health Belief Model (HBM) [17] have been widely used to illustrate factors leading to low HPV vaccine coverage. However, the two theories focus more on the micro perspective (i.e., attitudes, subjective norms in TPB [18], and health beliefs in HBM [17]) and posit the vaccination outcome as behaviour resulting from a person’s intention. This also raises the gap from current findings as it was found that mothers’ intention to vaccine is high (range 41%-97%), but their actual vaccination rate is low [19-22]. Many studies assess more on factors towards intention [23, 24] and interventions have been conducted from personal intention-behaviour aspect [25, 26], but few are directly targeted on refusal/acceptance, or hesitancy towards the decision-making process. The rationale behind is far more complex and exploration from a comprehensive macro-social system is needed considering emotional, cognitive, cultural, political factors [12, 27]. It raises our attention on assessing mothers’ vaccine hesitancy, their refusal/acceptance, and association with decision-making towards the HPV vaccine. Many clinicians in primary care settings reported an increasing number of parents who refuse the HPV vaccine or inquire about alternative options for their children [28]. Contrary to the current mainstream view of improving HPV vaccine coverage by providing knowledge, a surprising pattern showed that parents who refuse to vaccinate their children tend to have higher educational background while those who accept tend to be lower educated [11]. Prior studies found that higher educated parents have access to more sources to make decisions, such as the Internet, where controversial information and inaccurate opinions may exist regarding the HPV vaccine [29, 30]. Despite long-standing available resources, the acceptability and coverage of the HPV vaccine remain low among adolescent girls in Hong Kong [23]. Existing surveys targeting reasons for not being vaccinated did not measure the vaccine hesitancy of mothers, there is a possibility that some mothers may not accept the vaccine because of their hesitancy to HPV vaccine [31]. Some factors towards vaccine hesitancy may also have influences under the current pandemic. In the 2019/2020 school year, HPV vaccination has just been started to be one of the free vaccines provided by the government. Yet, the prevalence of HPV vaccination update was not boosted as dramatically high. In other words, there are still some unknown factors or barriers in parents who have strong HPV vaccine hesitancy. To develop effective strategies to promote HPV vaccination and given the limited information about HPV vaccine hesitancy, a mixed study with a qualitative approach to explore the potential factors plus quantitative approach to confirm the mechanism of HPV vaccine hesitancy shall better fit the aim of bringing new insight into this area. Purpose To perform a mixed method study to identify factors leading to HPV vaccine hesitancy by using a qualitative approach, and then develop a structural equation model by using qualitative data to further gain information about the mechanism of leading HPV vaccine hesitancy and decision-making process for mothers of adolescents. We aim to eventually translate the findings to practice in the community. Objectives • The primary objective is to identify the factors leading to mothers’ HPV vaccine hesitancy by using a qualitative approach and heighten the findings by using a quantitative approach to enhance their decision-making towards vaccination. • The secondary objectives are: - To examine factors leading to the mother’s vaccine hesitancy by a focus group interview - To develop SEM to assess the HPV vaccine hesitancy and association with decision-making process by qualitative results - To test the SEM by using the data from a quantitative approach - To strengthen the findings and conclusion by the combination of qualitative and quantitative approaches - To enhance mothers’ positive components of HPV vaccine including vaccine confidence and vaccine acceptance towards decision-making process, with reference to SAGE’s ""three Cs model"" (confidence, complacency, and convenience) - To modify the findings to practice in community - And to provide evidence for intervention afterwards regarding vaccine hesitancy and decision-making from qualitative and quantitative approaches to enhance HPV vaccine uptake rate among adolescent girls.