Despite a long-standing efficient national cervical cancer screening program for women aged 30 to 60 (uptake 66%) [1
], 600 new cases of cervical cancer are still diagnosed every year in the Netherlands, and 200 of these patients will eventually die from the disease [2
]. The major cause of cervical cancer is persistent infection by the Human Papilloma Virus (HPV) [3
], the most common sexually transmitted infection among young women [2
]. Of all HPV types, types 16 and 18 are responsible for about 70% of cervical cancer cases [4
]. To prevent persistent HPV infection, two vaccines have been licensed in Europe: Cervarix® GSK and Gardasil®. The Dutch Health Council estimated that the annual number of new cervical cancer cases in the Netherlands could be reduced by 50% by adding universal HPV vaccination of 12-year-old girls to the cervical cancer screening program [2
]. The Dutch government decided to implement the Cervarix® GSK vaccine for this age group in the National Immunization Program (NIP), starting in 2010. Each year, the new cohort of 12-year-old girls will be invited to receive the HPV vaccination. The full schedule for this non-mandatory, free vaccine includes three injections (i.e., baseline, at one month and at six months).
In 2009, a HPV vaccination catch-up campaign was organized for girls born between 1993 and 1996 (at that time, 13 to 16 years of age). As with other NIP campaigns, this campaign was coordinated by the National Institute for Public Health and the Environment (RIVM). The accompanying information campaign consisted of an information pamphlet sent to the home addresses of the girls invited, a website with information about the HPV vaccination for girls and parents, and references to a help line. The Community Health Services, which is responsible for the local implementation of the HPV vaccination, organized local mass vaccination sites for girls.
The Dutch NIP, initially implemented in 1999, is one of the most cost-effective public health programs with a consistently high and stable vaccine coverage [6
]. About 95% of infants and young children in the Netherlands are vaccinated under the universal childhood vaccination program [7
]. The expected participation rate for the HPV campaign was 70%, for several reasons (e.g., the novelty of the vaccine, a new age group, the targeting only of girls and a vaccine targeting sexual transmitted infection) [8
]. However, the 2009 participation rate turned out to be much lower, with 57%, 56% and 52% of the invited girls completing one, two, and three vaccinations, respectively [9
]. The participation rate remained low in 2010 and 2011 (56% and 54%, respectively) [10
In response to this rather low participation rate, research into the social-psychological determinants of the HPV vaccination decision was initiated to provide direction for the improvement of future HPV vaccine communication to girls and parents used by public health officials to improve vaccination uptake. Because dropout after the first HPV injection (i.e., those who received only one dose) was low in 2010 (5%), these insights into the decision to receive the vaccination can be used to improve the total vaccination uptake. This paper reports on the outcomes of our research on the social-psychological determinants of the HPV vaccination intentions of girls and parents who were targeted by the Dutch catch-up campaign in 2009.
Because the HPV vaccine has only recently been introduced worldwide, most studies have focused on determinants of future acceptance of the HPV vaccination before implementation [12
]. Reviews indicate that the following factors were most likely to be associated with future acceptance of the HPV vaccine: perceived effectiveness of the vaccine, perceived risks of the vaccine, perceived barriers (e.g., vaccine costs, concerns that the vaccine would promote adolescent sexual behavior), physicians’ recommendations and the opinions of significant others (i.e., subjective norms) [12
]. Only a few studies have examined determinants of HPV vaccination acceptance after implementation of the vaccine [16
]. Most of the determinants found in studies conducted before implementation were confirmed empirically by the studies following implementation of the HPV vaccine [16
]. However, studies conducted after implementation found additional factors: attitude, knowledge, perceived harm and perceived behavioral control [16
Even after implementation of the HPV vaccine, determinants of intention to take the HPV vaccination among girls and parents who do not have to make the decision in the immediate future may differ from those who have actually made the decision and were asked whether they would make it again. Focusing on participants in the latter group is important, because it may improve the explained variance of HPV vaccination intention.
The present study is one of the first to examine determinants of the HPV vaccination intentions among participants who made a decision about the HPV vaccination. In addition, this study is one of the first to examine the extent to which determinants contribute to the HPV vaccination intention. The participants were Dutch girls and their mothers who received an invitation for the first catch-up campaign in 2009.
Given the young age of the girls involved, most studies acknowledge that parents play a large role in their daughters’ HPV vaccination decision [12
]. Some of these studies specifically focused on mothers [16
]. The present study focuses on the HPV vaccination intention of both mothers and girls in order to explore the possible differential impact of the determinants on their HPV vaccination decision making. The research question is as follows: what are the social psychological determinants of the HPV vaccination intentions of girls and their mothers who were targeted by the Dutch catch-up campaign in 2009?