The results of this study suggest that overall rates of HPV awareness were high (91.8%), however intention to vaccinate a daughter against HPV remained low (37%). Previous research suggested that knowledge of HPV was not predictive of HPV vaccine acceptance (19
). Almost half of female caregivers in this Alabama study were undecided as to whether or not they intended to vaccinate their daughter against HPV (44.6%).
Several factors that were not associated with intention to vaccinate a daughter against HPV in the bivariate analyses were age, marital status, education, insurance status, urban/ rural location and child’s vaccination history. African Americans were less likely to vaccinate their daughter against HPV than non-Hispanic whites in this study population (18.5% vs. 40.2%, p=0.02). Race was not a predictor in the logistic regression model. In regards to income, caregivers with household income over $80,000 a year were more likely to vaccinate a daughter against HPV than other income levels (47.4%, p=0.02); however, this difference was not significant when intention and undecided groups were evaluated in a 2×2 table.
A history of cervical cancer was associated with intention to vaccinate a daughter against HPV (100%, p
=0.03) even though the numbers were small. Also a history of HPV infection (47.1%, p
=0.08) tended to be associated with intention to vaccinate a daughter against HPV, although it did not reach statistical significance. This finding confirms earlier studies that women’s personal history of HPV infection is associated with intention to vaccinate their daughters (18
Two institutional factors were associated with intention to vaccinate a daughter against HPV. Caregivers who believed that all girls should get the HPV vaccine were more likely to intend to vaccinate their own daughter (79.7%, p<0.0001). Interestingly, cost did not seem to be factor with intention to vaccinate a daughter against HPV. Caregivers who did not intend to vaccinate their daughter still would not vaccinate even if it were free (80%, p<0.0001).
In conclusion, only 16.8% of female caregivers in this study said they did not intend to vaccinate their daughter against HPV, whereas 44.6% were still undecided. This can be viewed as an opportunity to intervene with health promotion and education strategies toward vaccine acceptance. The health care provider should take advantage of this opportunity to address concerns with parents and improve HPV vaccine intentions. This research study examined factors influencing caregiver intention to vaccinate a daughter against HPV. Caregiver intention to vaccinate a daughter against HPV is believed to be influenced by institutional factors, social and environmental factors, and their subsequent interface with the health care system. Institutional factors refer to guidelines regarding vaccination and professional group recommendations such as the American Academy of Pediatrics. Social and environmental factors included cultural attitudes, media coverage, and subjective norms. Caregivers’ interface with the health care system includes physician recommendations, access to care and insurance status. All of these factors interact with and impact caregivers’ personal beliefs about vaccines, sexually transmitted infections and the subsequent decision of whether to vaccinate a daughter against HPV. The physical environment in the conceptual model includes the prevalence of HPV in the community and the history of public health efforts. It is the broad backdrop for individual decisions.
One of the major strengths of this study was the ability to collect statewide data using random digit dialing (RDD) for female caregivers regarding intention to vaccinate their daughters against HPV. Another strength of the study was the specific age range of daughters (10–14 years). This age range provided timely information on the targeted range of adolescents that are currently recommended for HPV vaccination. We designed our study to utilize random digit dialing, providing all female caregivers with a daughter in the specific age range an opportunity to participate if they had access to a landline or cell phone. However, we were unable to recruit a demographically representative sample of the state of Alabama. Minorities and female caregivers with low education income were underrepresented in this study population, limiting the generalizability of the results.