Human papillomavirus vaccination uptake: a longitudinal study showing ethnic differences in the influence of the intention-to-vaccinate among parent-daughter dyads

Abstract

Introduction: It is unclear what role daughters play in the decision-making process regarding HPV vaccination. Therefore, we explored the impact of HPV vaccination intention among parents and their 12-13 year-old daughters on HPV vaccination uptake.

Methods: In February 2014 parents/guardians and their 12-13 year-old daughters were invited to complete a questionnaire about socio-psychological determinants of the decision-making process regarding HPV vaccination. Vaccination status of the daughter was retrieved from the national vaccination database after the last possible vaccination date in 2014. The association between HPV vaccination uptake and intention, and determinants of intention, was jointly assessed using a generalized structural equation model, stratified by origin of parents (Dutch versus non-Dutch).

Results: In total, 273 Dutch parent-daughter dyads and 165 non-Dutch dyads were analyzed for this study. HPV vaccination uptake was 90% (246/273) and 84% (139/165) in the Dutch and non-Dutch group, respectively. In the Dutch group, high parental intention (β = 2.3, 95%CI 1.2-3.3) and high daughters' intention (β = 1.5, 95%CI 0.41-2.6) were significantly associated with HPV vaccination uptake. In the non-Dutch group, high daughters' intention (β = 1.2, 95%CI 0.16-2.2) was significantly associated with HPV vaccination, but high parental intention was not (β = 0.52, 95%CI -0.47-1.5). Attitude was the most prominent socio-psychological determinant associated with vaccination intention among all groups.

Conclusion: In the non-Dutch group, only daughters' intention was significantly associated with HPV vaccination uptake, whereas in the Dutch group both the parents' and the daughters' intention were significantly associated with uptake. The role of the child in the decision-making process might need to be taken into account when developing new interventions focused on increasing HPV vaccination uptake, especially among individuals of non-Dutch origin.

Keywords: HPV; Human papillomavirus; The Netherlands; parent-daughter dyads; vaccination; vaccination acceptability; vaccination intention; vaccination uptake.

Figure 1.

Heat map of the marginal prediction of HPV vaccination uptake corresponding to each combination of HPV vaccination intention among parents and their daughters. (a). Dutch parent-daughter dyads. (b). Non-Dutch parent-daughter dyads. Circle size is proportional to the number of parent-daughter dyads for a given combination of intentions; non-observed combinations were omitted from the graph. The color of the circle indicates that ≥80% (green), 60–79% (yellow), 40–59% (orange), 20–39% (pink) or <20% (red) of daughters for a given combination were vaccinated against HPV

Figure 2.

Generalized structural equation model including determinants of the intention of parents and daughters associated with HPV vaccination uptake. 2a. Dutch parent-daughter dyads. 2b. Non-Dutch parent-daughter dyads. The numbers next to each pathway indicate the regression coefficient (β) and the 95% confidence interval. ε indicates the random error component within the individual regression models. In the Dutch GSEM: the pathway between attitude and past experiences with cervical cancer was removed from the model as it was not significant