Disease prevention without relapse: Processes of change for HPV vaccination

Abstract

Background: Humanpapillomavirus is the most prevalent sexually transmitted infection in theUnited States and is associated with 70% of cervical cancers as well as over90% of genital warts. Although the HPV vaccine appears in the US immunizationschedule during adolescence, a large percentage of women reach adulthoodwithout being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change(POC) construct provides an assessment of participants’ experiences with HPVvaccination and is a central component of computer-tailored interventionsdesigned to increase compliance with medical recommendations, such as vaccination.This study describes development and validation of a POC measure forincreasing HPV vaccination among young adult women. Methods: Cross-sectionalmeasurement development was conducted using an online survey to reach a sampleof 340 female college students representing vaccinated and unvaccinatedwomen. Factor analytic structural equation modeling as well as evaluations ofthe stage by POC were used to evaluate the validity of the POC measure.Results: Confirmatory analyses supported the theoretically expected ten-factor,fully correlated model as the best fit for the data. Expected Stage of Changeto POC relationships were also confirmed insofar as each POC was significantlyassociated with Stage of Change, with the exception of dramatic relief.Follow-up analyses suggested that individuals in the Precontemplation stageused all POC less frequently than individuals in all other stages. Conclusions: The POC measure was foundto be internally and externally valid in a sample of college-attending women.The POC measure developed may be used to tailor stage-matched interventionsthat increase use of experiential and behavioral strategies important forincreasing HPV vaccination in this high-risk population.