Parents' beliefs about human papilloma virus vaccination

Document Sample
Parents' beliefs about human papilloma virus vaccination Powered By Docstoc
					Parents’ beliefs about
human papilloma virus vaccination

Dr Richard de Visser
School of Psychology
University of Sussex
rd48@sussex.ac.uk
background

Human Papilloma Virus (HPV) is the cause of genital warts
and almost all cases of cervical cancer

because HPV is sexually transmitted, vaccines will be most
effective when given before people become sexually active

from September 2008 government immunisation programme
has included free routine HPV vaccination of girls aged 12-13

cervarix targets 2 oncogenic strains: HPV-16, HPV-18
parents’ beliefs about acceptability of HPV vaccination

in general, intention to vaccinate children is related to:
    knowledge
    beliefs about vaccine efficacy and safety

knowledge about HPV and cervical cancer is poor

US review: strongest influences on HPV vaccine acceptability:
   greater belief in vaccine efficacy
   greater perceived likelihood of HPV infection

acceptance also affected by concern that HPV vaccine may
   influence sexual behaviour
   reduce condom use
study aims

HPV vaccination    = usual concerns about vaccines
                   + sexual activity in teenagers


aims
to examine knowledge of HPV - cervical cancer links

to identify correlates of likelihood of accepting vaccination
for children

to determine the relative importance of
         beliefs about vaccines in general
         knowledge and beliefs about HPV
         beliefs about sexual activity in teenagers
study 1    pre-vaccination program        (early 2008)

353 questionnaires completed by parents of school-aged
children in Brighton & Hove

neutrally-worded recruitment for a study of “vaccination”
rather than HPV vaccination

leaflets + notices in newsletters at government- and church-
administered primary schools
email notices distributed via both universities


sample representative of Brighton in terms of demographics
and uptake of other childhood vaccines
HPV knowledge                                       3.4 / 10
I would like more information about HPV vaccination  5.1 / 7


vaccine acceptability                                5.2 / 7
HPV knowledge                                       3.4 / 10
I would like more information about HPV vaccination  5.1 / 7


vaccine acceptability                                     5.2 / 7
correlates belief in protection from vaccines (general)
             belief in safety of vaccines (general)
             wary about vaccines post-MMR
             uptake of childhood vaccines
HPV knowledge                                       3.4 / 10
I would like more information about HPV vaccination  5.1 / 7


vaccine acceptability                                       5.2 / 7
correlates belief in protection from vaccines (general)
             belief in safety of vaccines (general)
             wary about vaccines post-MMR
             uptake of childhood vaccines
             perceived physical severity of STIs
             worry about HPV
             perceived benefits of HPV vaccination
             belief that vaccines will encourage unsafe sex
             support sexual health services/info for adolescents
HPV knowledge                                       3.4 / 10
I would like more information about HPV vaccination  5.1 / 7


vaccine acceptability                                       5.2 / 7
correlates belief in protection from vaccines (general)
             belief in safety of vaccines (general)
             wary about vaccines post-MMR
             uptake of childhood vaccines
             perceived physical severity of STIs
             worry about HPV
             perceived benefits of HPV vaccination
             belief that vaccines will encourage unsafe sex
             support sexual health services/info for adolescents
             subjective norm for HPV vaccination
             perceived barriers to HPV vaccination
multivariate correlates of vaccine acceptability

belief in protection from vaccines (general)
belief that STI vaccines will encourage unsafe sex
perceived benefits of HPV vaccination
support sexual health info/services for adolescents
uptake of childhood vaccines
multivariate correlates of vaccine acceptability

belief in protection from vaccines (general)
belief that STI vaccines will encourage unsafe sex
perceived benefits of HPV vaccination
support sexual health info/services for adolescents
uptake of childhood vaccines
belief in safety of vaccines (general) ***
wary about vaccines post-MMR
subjective norm for HPV vaccination
multivariate correlates of vaccine acceptability

belief in protection from vaccines (general)
belief that STI vaccines will encourage unsafe sex
perceived benefits of HPV vaccination
support sexual health info/services for adolescents
uptake of childhood vaccines
belief in safety of vaccines (general)
wary about vaccines post-MMR
subjective norm for HPV vaccination


girls   adjusted R2 = .63       F(8) = 47.31, p < .01
boys    adjusted R2 = .57       F(5) = 63.12, p < .01
impact of brief information

pre
I would like my child(ren)         mean = 4.3 / 7
    to be vaccinated against HPV
    HPV is a sexually transmitted infection that is common among
sexually active young women. It causes over 70% of all cases of
cervical cancer.
    HPV vaccination protects women against genital warts and
significantly reduces the risk of cervical cancer. It is most effective
when administered before women become sexually active.
    The Department of Health has concluded that all 12- and 13-
year-old girls should receive the HPV vaccine in the first year of
secondary school to protect them against HPV and cervical cancer.
    Last October, the Department of Health announced that from
September 2008 the government immunisation program will include
routine HPV vaccination of girls aged 12–13 years.
    From September 2009 there will be a 2-year ‘catch-up’
vaccination program for girls up to age 18.
    Currently there are no plans to extend HPV vaccination to
adolescent boys. However, wide-scale vaccination of boys could be
important in developing immunity in the population.
impact of brief information

pre
I would like my child(ren)         mean = 4.3 / 7
    to be vaccinated against HPV

post
I would like my daughter(s)        mean = 5.3 / 7
I would like my son(s)             mean = 5.1 / 7
    to be vaccinated against HPV
impact of brief information

pre
I would like my child(ren)               mean = 4.3 / 7
    to be vaccinated against HPV

post
I would like my daughter(s)              mean = 5.3 / 7
I would like my son(s)                   mean = 5.1 / 7
    to be vaccinated against HPV


brief information led to a significant
increase in vaccine acceptability        t(352)= 16.61, p < .01

greater desire for more information      r = .13, p = .01
= greater increase post-information
study 2    during vaccination program     (early 2009)

240 questionnaires completed by parents of school-aged
children in East + West Sussex

131 parents of 12-13 year old girls offered HPV vaccine
124 accepted
95% uptake - comparable to other childhood vaccines
study 2    during vaccination program     (early 2009)

240 questionnaires completed by parents of school-aged
children in East + West Sussex

131 parents of 12-13 year old girls offered HPV vaccine
124 accepted

correlates of vaccine uptake or intention
    belief in protection from vaccines (general)
    belief in safety of vaccines (general) ***
    uptake of childhood vaccines
    worry about STIs
    perceived benefits of HPV vaccination
    support sexual health services/info for adolescents
multivariate correlates of vaccine uptake

perceived benefits of HPV vaccination
uptake of childhood vaccines
worry about STIs

   83% correctly classified   F(3) = 34.21, p < .01
increasing uptake / removing barriers

significant multivariate correlates in both studies
   uptake of other childhood vaccines

   perceived benefits of HPV vaccination
increasing uptake / removing barriers

significant multivariate correlates in both studies
   uptake of other childhood vaccines

   perceived benefits of HPV vaccination

other significant multivariate correlates
   support for sexual health services/info for adolescents
   belief that vaccines will affect sexual activity
increasing uptake / removing barriers

significant multivariate correlates in both studies
   uptake of other childhood vaccines

   perceived benefits of HPV vaccination

other significant multivariate correlates
   support for sexual health services/info for adolescents
   belief that vaccines will affect sexual activity

   vaccine safety (general)
      first death in the UK following HPV vaccination
      USA 23+million quadrivalent HPV vaccines
             death rate ~1 / million
             rates of adverse events similar to other vaccines
future work

planned study starting later this year looking at adolescents’
beliefs about STI vaccines


collaboration on qualitative and/or quantitative research
references

Brewer N & Fazekas K. Predictors of HPV vaccine acceptability: A theory-
informed systematic review. Prev Med 2007; 45: 107-114.

de Visser R & McDonnell E. Correlates of parents' reports of acceptability
of Human Papilloma Virus vaccination for their school-aged children.
Sexual Health, 2008; 5: 331-338.

Slade BA, Leidel L, Vellozzi C, et al. Postlicensure safety surveillance for
quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009;
302: 750-757.