Fathers’ participation in the HPV vaccination decision-making process doesn’t increase parents’ intention to make daughters get the vaccine

Abstract Background Vaccine hesitancy has been a growing challenge for public health in recent decades. Among factors contributing to vaccine hesitancy, concerns regarding vaccine safety and Adverse Events (AEs) play the leading role. Moreover, cognitive biases are critical in connecting such concerns to vaccine hesitancy behaviors, but their role has not been comprehensively studied. In this study, our first objective is to address concerns regarding vaccine AEs to increase vaccine acceptance. Our second objective is to identify the potential cognitive biases connecting vaccine hesitancy concerns to vaccine-hesitant behaviors and identify the mechanism they get triggered in the vaccine decision-making process. Methods First, to mitigate concerns regarding AEs, we quantitatively analyzed the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2011 to 2018 and provided evidence regarding the non-severity of the AEs that can be used as a communicable summary to increase vaccine acceptance. Second, we focused on the vaccination decision-making process. We reviewed cognitive biases and vaccine hesitancy literature to identify the most potential cognitive biases that affect vaccine hesitancy and categorized them adopting the Precaution Adoption Process Model (PAPM). Results Our results show that the top frequent AEs are expected mild reactions like injection site erythema (4.29%), pyrexia (3.66%), and injection site swelling (3.21%). 94.5% of the reports are not serious and the average population-based serious reporting rate over the 8 years was 25.3 reports per 1 million population. We also identified 15 potential cognitive biases that might affect people’s vaccination decision-making and nudge them toward vaccine hesitancy. We categorized these biases based on the factors that trigger them and discussed how they contribute to vaccine hesitancy. Conclusions This paper provided an evidence-based communicable summary of VAERS. As the most trusted sources of vaccine information, health practitioners can use this summary to provide evidence-based vaccine information to vaccine decision-makers (patients/parents) and mitigate concerns over vaccine safety and AEs. In addition, we identified 15 potential cognitive biases that might affect the vaccination decision-making process and nudge people toward vaccine hesitancy. Any plan, intervention, and message to increase vaccination uptake should be modified to decrease the effect of these potential cognitive biases.

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Understanding How Adolescents Think about the HPV Vaccine

Vaccines ◽

10.3390/vaccines8040693 ◽

2020 ◽

Vol 8 (4) ◽

pp. 693

Author(s):

Robyn A. Pennella ◽

Katherine A. Ayers ◽

Heather M. Brandt

Keyword(s):

Decision Making ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

The United States ◽

The Body ◽

Decision Making Process ◽

Vaccination Rates ◽

Qualitative Thematic Analysis ◽

Adolescent Attitudes

Despite educational efforts, Tennessee human papillomavirus (HPV) vaccination rates are 43%, among the lowest in the United States. This study examined how adolescents think about the HPV vaccine to identify patterns and misconceptions to enhance educational efforts. Adolescents (ages 11–12) (N = 168) responded to open-ended questions regarding their thinking about the HPV vaccine. Data were analyzed and interpreted using qualitative thematic analysis. Three domains of themes emerged from responses: (1) characteristics of HPV vaccination, (2) knowledge-related themes, and (3) beliefs-related themes. Prevention of HPV and cancer was the most referenced characteristic of HPV vaccination followed by HPV vaccine rates and HPV vaccine efficacy. Student inquiries were mostly centered on HPV vaccine composition, administration, duration and how the vaccine interacts with the body. Some responses indicated a desire for more information about HPV not specific to the HPV vaccine. Overall, adolescent attitudes were positive towards the HPV vaccine. This study highlights specific questions adolescents have about the vaccine that can be used to tailor future HPV educational efforts, empowering adolescents with the knowledge to be more active students in the decision-making process. In addition, the potential for adolescents to serve as community advocates for the vaccine should be considered for future interventions.

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Informing Content and Feature Design of a Parent-Focused HPV Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Groups (Preprint)

10.2196/preprints.28846 ◽

2021 ◽

Author(s):

Elisabeth R.B. Becker ◽

Ross Shegog ◽

Lara S. Savas ◽

Erica L. Frost ◽

C. Mary Healy ◽

...

Keyword(s):

Decision Making ◽

Behavior Change ◽

Focus Groups ◽

Hpv Vaccination ◽

Clinic Visit ◽

Behavior Change Intervention ◽

Vaccination Rates ◽

Knowledge Barriers ◽

Vaccination Decision ◽

Intervention Content

BACKGROUND Human papillomavirus is a common and preventable sexually transmitted infection but vaccination rates in the U.S. among the target age group, 11-12 years old, are lower than national goals. Interventions that address the barriers and facilitators to vaccination are important in improving HPV vaccination rates. Online text-based focus groups are becoming a promising method that may be well-suited for conducting formative research to inform the design of digital behavior change intervention content and features that address HPV vaccination decision making. OBJECTIVE This study explores parental HPV vaccination decision-making processes using an online text-based focus group protocol in order to inform content and feature recommendations for an HPV prevention digital behavior change intervention. METHODS We conducted four online text-based synchronous focus groups via Skype with parents of 11-13-year-old patients within a large urban U.S. pediatric clinic network. RESULTS The 22 parents were majority female, white non-Hispanic, had a graduate or professional degree and had private health insurance for their children. Fifty-six percent of the parents’ 11-13-year-old children had initiated HPV vaccination. Most parents had experience using Skype (82%). Parents requested a text-only chat format (47%) over an audio-visual call format (6%) for their focus group. The three main themes from the qualitative data were (1) HPV vaccination misinformation and confusion; (2) HPV beliefs and attitudes; and (3) facilitators to vaccination. Eleven intervention content and feature recommendations emerged from the themes including: address HPV knowledge barriers using trusted sources; design for a family audience; focus on the framing of messages; report reputable HPV research in a digestible format; and expand the clinic visit experience. CONCLUSIONS Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision making. Among well-educated and well-resourced parents, there is misinformation about HPV and knowledge barriers that influence HPV attitudes and beliefs. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience which lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive digital behavior change intervention to address HPV vaccination decision making among parents.

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Parents Experience with an mHealth Intervention to Influence HPV Vaccination Decision-Making: Mixed Methods Feasibility Study (Preprint)

10.2196/preprints.30340 ◽

2021 ◽

Author(s):

Elisabeth R.B. Becker ◽

Ross Shegog ◽

Lara S. Savas ◽

Erica L. Frost ◽

Sharon P. Coan ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Hpv Vaccine ◽

Rating Scales ◽

Controlled Trial ◽

Hpv Vaccination ◽

Future Research ◽

Mhealth Intervention ◽

Pediatric Clinic ◽

Vaccination Decision

BACKGROUND HPV-attributed cancers are preventable, yet HPV vaccination rates severely lag other adolescent vaccinations. HPVcancerFree is an mHealth intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers and enabling HPV vaccination scheduling and reminders through a smartphone. Evaluating the feasibility and user experience of mHealth interventions are vital components in assessing their quality and success. OBJECTIVE We aimed to evaluate the feasibility of HPVcancerFree using mixed methods data collected from log files, survey measures and qualitative feedback METHODS Study data was evaluated from parents in a large U.S. pediatric clinic network using HPVcancerFree in the intervention arm of a group randomized controlled trial. Log data captured HPVcancerFree retention and use. Post intervention rating scales and items, including the uMARS survey (reflecting engagement, functionality, aesthetics and information), assessed HPVcancerFree utility, usefulness, understandability, appeal, credibility, perceived impact and overall quality. Open-ended responses assessed patient recommendations for HPVcancerFree enhancement. RESULTS The 98 parent participants were mainly female (96%), 41±5.67 years of age, college educated (56%), white, non-Hispanic (56%) and had private health insurance for their children (77%). Parents used HPVcancerFree 197 times with average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5). Mean ratings were highest for information (4.46±0.53) and lowest on engagement (3.74±0.69). Forty-seven percent of parents rated HPVcancerFree as helpful in HPV vaccination decision making and 17% attributed HPV vaccine initiation to HPVcancerFree. Parents reported that HPVcancerFree increased their awareness (89%), knowledge (89%) and HPV vaccination intentions (68%). Most parents rated the four HPVcancerFree components as useful (74-94%). Parents agreed that HPVcancerFree was clear (91%), accurate (91%), and more helpful than other HPV vaccine information they had received (94%), and that they would recommend it to others (85%). Parents suggested increasing awareness about the app, incorporating a tailored reminder system and creating opportunities to engage with adolescents about HPV and sexual health as enhancements for future iterations. CONCLUSIONS HPVcancerFree is a feasible mHealth intervention to support regular pediatric clinic HPV vaccine education. HPVCF was well received by parents. Future research is indicated to determine its efficacy to persuade parents to vaccinate and best promotional strategies to motivate parents to use HPVcancerFree.

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Understanding the Health Behavior Decision-Making Process with Situational Theory of Problem Solving in Online Health Communities: The Effects of Health Beliefs, Message Credibility, and Communication Behaviors on Health Behavioral Intention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094488 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4488

Author(s):

Xiaoting Xu ◽

Honglei Li ◽

Shan Shan

Keyword(s):

Decision Making ◽

Problem Solving ◽

Hpv Vaccination ◽

Decision Making Process ◽

Information Selection ◽

Online Health Communities ◽

Health Decision Making ◽

Health Decision ◽

Situational Theory ◽

Health Communities

Online health communities (OHCs) offer users the opportunity to share and seek health information through these platforms, which in turn influence users’ health decisions. Understanding what factors influence people’s health decision-making process is essential for not only the design of the OHC, but also for commercial health business who are promoting their products to patients. Previous studies explored the health decision-making process from many factors, but lacked a comprehensive model with a theoretical model. The aim of this paper is to propose a research model from the situational theory of problem solving in relation to forecasting health behaviors in OHCs. An online questionnaire was developed to collect data from 321 members of online health communities (HPV Tieba and HPV vaccina Tieba) who have not received an HPV vaccination. The partial least squares structural equation modeling (PLS-SEM) method was employed for the data analysis. Findings showed that information selection and acquisition is able to forecast HPV vaccination intentions, perceived seriousness and perceived susceptibility can directly impact HPV vaccination intention and have an indirect impact by information selection and acquisition, and perceived message credibility indirectly affected HPV vaccination intention via information selection. The current paper supports health motivations analysis in OHCs, with potential to assist users’ health-related decision-making.

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Development and pre/post testing of a decision aid supporting Chinese parental and young women’s HPV vaccination decision-making

Women & Health ◽

10.1080/03630242.2019.1626791 ◽

2019 ◽

Vol 60 (3) ◽

pp. 330-340

Author(s):

Linda Dong-Ling Wang ◽

Wendy Wing Tak Lam ◽

Richard Fielding

Keyword(s):

Decision Making ◽

Decision Aid ◽

Hpv Vaccination ◽

Vaccination Decision

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Vaccination Decision-Making and HPV Knowledge: How Informed and Engaged Are Young Adult HPV Vaccine Recipients in Australia?

Journal of Vaccines ◽

10.1155/2014/495347 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Rebekah C. Laidsaar-Powell ◽

Kirsten J. McCaffery ◽

Tanya Mather ◽

Ilona Juraskova

Keyword(s):

Decision Making ◽

Sexual Health ◽

Hpv Vaccine ◽

Sexual Attitudes ◽

Population Based ◽

Future Research ◽

Decision Making Process ◽

Post Vaccination ◽

Hpv Knowledge ◽

Vaccination Decision

Objectives. To date, there has been limited research on the decision-making process of HPV vaccine recipients. This study aimed to explore HPV-related knowledge, vaccination decision-making, and post vaccination attitudes about sexual behaviour in women who participated in the Australian school- and population-based HPV vaccine program. Materials and Methods. 102 female university students who had received the HPV vaccine (<27 years) completed scales on knowledge, vaccination decision-making, and post vaccination sexual attitudes. Results. HPV-related knowledge was low (M=57%), and women felt moderately involved in the vaccination decision (M=62%). Most women had not changed their sexual attitudes as a consequence of vaccination; however, some reported that since vaccination they feel less concerned about sexual health (19%). There were no significant differences between school- and population-based recipients on HPV knowledge (P=.559) or post vaccination sexual attitudes (P=.709). School-based recipients were significantly less autonomous in their decision-making (P=.001). Conclusion. Poor knowledge indicates a need for provision of information about HPV and post vaccination sexual health. Additionally, policy makers and health professionals may benefit from reiterating the importance of continued sexual health practices to HPV vaccine recipients. Future research should assess whether young women need to be more involved in the informed decision-making process for HPV vaccination.

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Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys

Vaccine ◽

10.1016/j.vaccine.2017.07.043 ◽

2017 ◽

Vol 35 (36) ◽

pp. 4713-4721 ◽

Cited By ~ 7

Author(s):

Samara Perez ◽

Ovidiu Tatar ◽

Vladimir Gilca ◽

Gilla K. Shapiro ◽

Gina Ogilvie ◽

...

Keyword(s):

Decision Making ◽

Hpv Vaccination ◽

Psychosocial Predictors ◽

Vaccination Decision

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Immunize the vaccine rumors: Effects of inoculation messages and tone of voice on HPV vaccine compliance

10.32469/10355/45809 ◽

2014 ◽

Author(s):

◽

Eunhae Park

Keyword(s):

Decision Making ◽

Health Communication ◽

Hpv Vaccine ◽

Positive Attitude ◽

Hpv Vaccination ◽

Communication Strategy ◽

Decision Making Process ◽

Message Content ◽

Human Voice ◽

Tone Of Voice

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] The primary purpose of this study was to develop an effective health communication strategy to guide the decision-making process of parents regarding the HPV vaccine. People are currently surrounded by conflicting information (e.g., hearsay, misinformation, and conspiracy theories) through media, particularly online media. This misinformation can interrupt the decision-making process, making it no longer sufficient for health care practitioners to just issue facts and recommendations. Now, they also need to develop compliance. To do this, based on inoculation theory, this study posited that inoculation messages, as opposed to supportive messages, will work to enhance resistance to future attack messages about HPV vaccine issues. The resistance is assumed to increase positive outcomes of health communication, such as positive attitude and higher intention to vaccinate, and higher intention to share the content with other people. This study also attempts to explore how the tone of voice (human voice vs. organizational voice) interplays with the inoculation message in health communication online. The current study used a 2 (message content: inoculation vs. supportive) ï¿½ 2 (tone of voice: human voice vs. organizational voice) mixed experimental design. The message content served as a between-subjects factor while the tone of voice served as a within-subjects factor. A total of 231 parents who have teenage children were recruited through Amazon Turk to participate in the study. According to the results, people who were exposed to inoculation messages were more likely to have a positive attitude toward HPV vaccination, a higher intention to vaccinate their children, and a higher intention to share the content with others. Unlike the main effects of the inoculation messages, the hypotheses about the tone of voice were not supported except intention to word of mouth. Overall, this study shed a light on vaccine communication, showing that providing people with warnings about possible counter-arguments they may encounter as well as refutations (i.e., inoculation message) can enhance resistance to misinformation about vaccines.

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