Parental Attitudes and Beliefs About Human Papillomavirus (HPV) Vaccination and Vaccine Receipt Among Adolescents in Richmond County, Georgia

  • Herbert N
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Abstract

Results: 1913 questionnaires were included in the analysis. 68% of parents were primarily Spanish-speaking; 40% completed the Spanish version of the survey, and 84% identified as Hispanic. The Cronbach's alpha for the 5-item scale was 0.71. Cronbach alpha was different when stratifying for demographic variables; most notably higher for those using the Spanish vs English version (0.76 vs. 0.64), for those who spoke English vs Spanish at home (0.79 vs. 0.68), and for those with annual household incomes above vs. below $50,000 (0.81 vs. 0.71). Conclusions: The modified trust scale for SLIP(s) showed adequate internal consistency among a sample of predominately Hispanic parents of middle school students. However, internal consistency of this scale was lower among Spanish speakers than English speakers and those with higher incomes. In addition, among this primarily Hispanic population, the Spanish version of the survey demonstrated higher internal consistency. These data suggest a need to further evaluate and modify this scale for populations with significant variation in language variables and socioeconomic status. Purpose: The Advisory Committee on Immunization Practices currently recommends human papillomavirus vaccination (HPV) for males and females ages 9-26 years. Parental attitudes can often influence health decisions, especially those involving vaccines for their adolescents. We investigated parental attitudes and beliefs about human papillomavirus vaccination as well as parental self-reported receipt and series completion for their adolescent. The HPV vaccine series requires three doses, an initial vaccination, a second vaccination 2 months after initial dose and a third vaccination six months after initial dose. Methods: We conducted a three-arm cluster-randomized controlled trial in middle and high schools in Richmond County, Georgia over three years. 11 schools were randomly assigned to one of three treatment arms: Arm 1) No Intervention; Arm 2) an educational brochure about adolescent vaccines mailed home for parents; and Arm 3) a curriculum delivered by teachers in classrooms of adolescents and an educational brochure for parents. Students received the intervention to which the school was assigned. Parents in all arms were surveyed annually to assess attitudes and beliefs about the four recommended adolescent vaccinations (yearly seasonal influenza, meningococcal conjugate, tetanus, diphtheria and pertussis and HPV vaccines), as well as self-report of vaccine receipt by their adolescent. Survey topics included perceived susceptibility, perceived severity and perceived benefits about their child receiving the HPV vaccine. The surveys were administered before delivery of the interventions, Year 1 and in Years 2 and 3. Surveys were administered via telephone and online. Six attitude and belief questions about HPV vaccination were compiled into an attitude scale ranging from 0-6, where 0 means no positive attitudes about HPV vaccination and 6 means respondents indicated very positive attitudes about HPV vaccination. Chi-square tests were performed using SPSS to assess differences. Results: We identified 686 parents in total from the three intervention arms (Arm 1 n ¼ 210, Arm 2 n ¼ 251, Arm 3 n ¼ 225). Results show a range of opinions about HPV vaccination with participants receiving a score of 0 (3.8%), 1 (5.4%), 2 (8.2%), 3 (21.1%), 4 (20.3%), 5 (28%) or 6 (13.3%). Approximately half (48%) of parents reported that their adolescent received at least one dose of HPV vaccine. Higher scores on the attitude and belief scale were associated with the receipt of HPV vaccine (p < .001). Among parents whose adolescent initiated the series, 61% (n ¼ 206) were reported to have completed the three dose series. However, there was no statistically significant association between parental attitudes and series completion. Conclusions: Parents in our sample showed positive attitudes and beliefs about HPV vaccine. 62% of parents scored 4 or greater on the attitudinal scale. These favorable opinions about the HPV vaccine were associated with initial vaccine receipt as reported by parents. Future efforts should be made to promote the benefits of HPV vaccination through sources of information that parents trust. Novel and innovative methods could potentially aid in increasing the rate of series completion among this population. Purpose: To understand why parents do not initiate the HPV vaccine series for their daughters, and to see how these reasons differ in parents of different races, ethnicities, countries of origin, socioeconomic status, and public safety net vs. private practice clinical settings. Methods: We approached parents accompanying 11-17 year old daughters to medical visits in one public safety net hospital and three private practice settings. We performed semi-struc-tured qualitative interviews with parents to determine the primary reasons why their daughters had not started the vaccine series. Interviews were performed in English, Spanish, and Haitian-Creole. Interviews were coded using qualitative methods to identify and evaluate recurring themes. Answers were compared across race/ethnicity, socioeconomic status, and practice settings (public or private), to determine differences in attitudes, perceptions, parent-provider communication , and primary reasons for not initiating vaccination. Electronic medical records were reviewed to confirm vaccination status. Results: 47 parents believed that their daughters had not initiated HPV vaccination; 38 were unvaccinated on medical record review, and these transcripts were analyzed. Nine parents self-identified as Black (including African-Americans and African and Caribbean immigrants), 19 White, 8 Latino, and 2 other races. 14 parents were immigrants and 27 expressed a religious affiliation. Family income ranged from < $20,000 to > $100,000 annually. Parents' level of knowledge about HPV vaccination varied from almost none to very detailed Poster Presentations / 54 (2014) S34eS93 S82

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Herbert, N. (2014). Parental Attitudes and Beliefs About Human Papillomavirus (HPV) Vaccination and Vaccine Receipt Among Adolescents in Richmond County, Georgia. Journal of Adolescent Health, 54(2), S82. https://doi.org/10.1016/j.jadohealth.2013.10.177

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