Parental Consent to HPV Vaccination for Their Daughters: The Effects of Knowledge and Attitudes
Okoronkwo, Chimere, Sieswerda, Lee E., Cooper, Robin, Binette, Darlene, Todd, Melanie, The Canadian Journal of Human Sexuality
Abstract: This program evaluation examined the role that factors such as knowledge and attitudes played in influencing parents' decisions regarding the vaccination of their daughters with the Human Papillomavirus (HPV) vaccine in a publicly-funded school-based HPV vaccination program in Thunder Bay, Ontario. In April 2011, a self-administered mail-based survey was administered to parents of grade 9 girls in schools in the City of Thunder Bay who were eligible for the HPV vaccination in the previous school year (2009/2010). Factors measured included: knowledge regarding HPV and the HPV vaccine, and attitudes towards the HPV vaccine in particular and vaccinations in general. We performed descriptive statistics and multivariate analyses of key explanatory variables. A total of 188 completed surveys were analyzed. The difference in the mean scores of the parents who gave consent (n=126) for their daughters to receive the HPV vaccine and parents that did not give consent (n=62) was statistically significant (p=0.022). Those who declined to give consent had stronger negative attitudes towards the HPV vaccine. Our results indicate that the effect of knowledge on the decision to give consent was confounded by strong negative attitudes. Overall, the findings suggest that a sustained education campaign designed to increase parent's knowledge about HPV and the HPV vaccine, especially prior to the commencement of school in the fall, should be considered. In addition, engaging family physicians to educate parents may increase the number that consent to have their daughters vaccinated against HPV.
Human Papillomavirus (HPV) is among the most common sexually transmitted infections (STI) in Canada. It is estimated that approximately 75% of sexually active individuals are infected with HPV at least once within their lifetime (Health Canada, 2010). Protection against strains of HPV that lead to cervical cancer and cause genital warts can be achieved through immunization with the HPV vaccine. The HPV vaccine does not eliminate or protect against previously acquired HPV, thus, it is important for an individual to receive the vaccine prior to becoming sexually active (Constantine & Jerman, 2007; HealthLink, 2010).
In July 2006, Gardasil[R] vaccine was approved for use in Canada for females aged 9 to 26 years (Wilson & Deeks, 2010). Beginning in the 2007/2008 school year in Ontario, a 3-dose series of Gardasil[R] vaccine was made available to females in Grade 8 on a voluntary basis through the publicly-funded school-based immunization programs offered locally by public health units (Wilson & Deeks). In the Thunder Bay District, by the third year of the vaccination program implementation, the uptake of the first dose was still low, with less than 60% of eligible girls receiving the vaccine (Ministry of Health and Long-Term Care, 2011). This finding contrasted with expectations based on studies done prior to the introduction of HPV vaccine into school-based immunization programs which predicted an uptake of between 70-80% (Brabin, Roberts, Farzaneh, & Kitchener, 2006; Marlow, Waller, & Wardle, 2007; Ogilvie et al., 2007).
Since the HPV vaccination program targets young adolescents, the Thunder Bay District Health Unit (TBDHU) requires parental consent for vaccination. This means that uptake is dependent on parents' attitudes and beliefs about the benefits and potential harms of the HPV vaccine. As noted by Ogilvie et al. (2007), "... parental attitudes play a crucial role in vaccination uptake and can provide direction for messaging and education in support of vaccination uptake." Dempsey, Abraham, Dalton, and Ruffin (2009) suggest that "... successful HPV vaccination programs are hinged upon parental attitudes, opinions, and motivation for vaccination" (p. 531). An understanding of the reasons why parents decline HPV vaccination for their daughters is a critical step in designing effective interventions to promote the uptake of the vaccine. …