Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 15;11(12):1856.
doi: 10.3390/vaccines11121856.

Evaluation of Theoretical Frameworks to Detect Correlates of HPV Vaccination in the Midwest, US, Using Structural Equation Modeling

Abraham Degarege  1 , Shinobu Watanabe-Galloway  1 , Kristyne Mansilla  1 , Rahel M Sileshi  1 , Edward S Peters  1
Affiliations

Evaluation of Theoretical Frameworks to Detect Correlates of HPV Vaccination in the Midwest, US, Using Structural Equation Modeling

Abraham Degarege et al. Vaccines (Basel). .

Abstract

Knowledge of a valid, well-designed, and targeted theory-based framework helps better characterize reasons for HPV vaccine hesitancy and identify promising approaches to increase vaccination rates for eligible individuals. This study evaluated health theories in explaining factors affecting HPV vaccination and used a theoretical framework to identify direct and indirect predictors and mediators of HPV vaccination. A cross-sectional survey regarding HPV vaccine uptake and related factors was conducted among 1306 teenagers and young adults in the Midwest, US, in March and April 2023. Structural equation modeling confirmed fit of the framework based on the Integrated Health Theory (IHT) to the HPV vaccine data (Comparative Fit Index = 0.93; Tucker-Lewis Index = 0.92; Root Mean Square Error of Approximation = 0.053). While willingness to uptake the HPV vaccine directly predicted increased uptake (p < 0.001), perceived benefits (p < 0.001) and barriers (p < 0.023) about the vaccine indirectly predicted increased and decreased uptake, respectively. In turn, beliefs about susceptibility (p = 0.005) and severity (p < 0.001) of HPV infection and associated cancers and barriers to vaccination in general (p < 0.001) indirectly predicted willingness to uptake the vaccine. In conclusion, IHT can be appropriate in examining predictors of HPV vaccine uptake in teenagers and young adults in the US, particularly in the Midwest.

Keywords: HPV vaccine uptake; SEM; US; health theories.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proposed health theory-derived frameworks to understand predictors of HPV vaccine uptake among teenagers and young adults in the Midwest, US.
Figure 2
Figure 2
Measurement model of the constructs of integrated health theory predicting HPV vaccine uptake among teenagers and young adults in the Midwest, US, March/April 2023. L1 = benefits/facilitators of HPV vaccination; L2 = barriers to HPV vaccination; L3 = susceptibility to HPV infection and associated cancers; L4 = severity of HPV infection and associated cancers; L5 = benefits of vaccination; L6 = barriers to vaccination; L7 = awareness and knowledge about HPV infection and associated cancers and HPV vaccine. Details of names of items measuring the constructs are provided in Table 1.
Figure 3
Figure 3
Integrated health theory-derived structural equation model explaining factors predicting HPV vaccination willingness and uptake among teenagers and young adults in Midwest, US, March/April, 2023. Parameter estimates are standardized regression coefficients. Only statistically significant coefficients are provided in this figure. Model fit statistics CFI (=0.932), TLI (=0.924) and RMSEA (=0.053, 95% CI = 0.051, 0.055).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cancers Associated with Human Papillomavirus, United States—2015–2019. [(accessed on 22 October 2023)]; Available online: https://www.cdc.gov/cancer/uscs/about/data-briefs/no31-hpv-assoc-cancers....
    1. Moyer V.A., U.S. Preventive Services Task Force Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann. Intern. Med. 2012;156:880–891. doi: 10.7326/0003-4819-156-12-201206190-00424. - DOI - PubMed
    1. Lewis R.M., Laprise J.F., Gargano J.W., Unger E.R., Querec T.D., Chesson H.W., Brisson M., Markowitz L.E. Estimated Prevalence and Incidence of Disease-Associated Human Papillomavirus Types Among 15- to 59-Year-Olds in the United States. Sex. Transm. Dis. 2021;48:273–277. doi: 10.1097/OLQ.0000000000001356. - DOI - PMC - PubMed
    1. Senkomago V., Henley S.J., Thomas C.C., Mix J.M., Markowitz L.E., Saraiya M. Human Papillomavirus-Attributable Cancers—United States, 2012–2016. MMWR Morb. Mortal Wkly Rep. 2019;68:724–728. doi: 10.15585/mmwr.mm6833a3. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention HPV-Associated Cancer Statistics. [(accessed on 19 January 2021)]; Available online: https://www.cdc.gov/cancer/hpv/statistics/index.htm.

LinkOut - more resources