Research Article: A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt

Date Published: May 4, 2010

Publisher: Public Library of Science

Author(s): Gina Ogilvie, Maureen Anderson, Fawziah Marra, Shelly McNeil, Karen Pielak, Meena Dawar, Marilyn McIvor, Thomas Ehlen, Simon Dobson, Deborah Money, David M. Patrick, Monika Naus, Linda Wright

Abstract: Analysis of a telephone survey by Gina Ogilvie and colleagues identifies the parental factors associated with HPV vaccine uptake in a school-based program in Canada.

Partial Text: The vaccine for the human papillomavirus (HPV) is an important tool in the prevention of cervical cancer [1]–[5]. In order to maximize the benefit of the HPV vaccine for cervical cancer prevention and for programs to be cost-effective, vaccine programs should be offered to girls prior to the commencement of sexual activity [6]–[8]. Because of the age at which the HPV vaccine is given in many jurisdictions, parents will often need to provide consent. Careful reflection on parents’ perspectives and concerns about this vaccine is essential in order to ensure optimal uptake rates. Studies on parental attitudes and intention-to-vaccinate have shown that despite the outstanding clinical efficacy and reassuring side-effect profile of this vaccine, concerns remain about the vaccine and about the willingness of parents to have their daughters receive HPV vaccination [9]–[18]. In a recent systematic review on the topic, global HPV vaccine acceptability among parents ranged from 54.9% to 81.0% [19], and studies have highlighted issues such as vaccine safety, impact on sexual practices, age of daughter, awareness of HPV, education, and cervical cancer screening history among many others as key predictors of HPV vaccine acceptance. However, most studies have primarily focused on factors predicting parental intention to have a daughter receive the HPV vaccines and were conducted prior to the approval of the HPV vaccine or implementation of a publicly funded vaccine program. In contrast, data on factors influencing parental decisions for actual or real HPV vaccine receipt in publicly funded and delivered vaccine programs for girls is limited [20]. As publicly funded HPV vaccines programs are now being planned it is critical that parental factors associated with actual uptake of the HPV vaccine are understood.

This program evaluation was carried out between January 18, 2009, and March 19, 2009, 4 mo after the provincial HPV vaccine program commenced. Of the 23,614 girls in grade 6 in the province of British Columbia, contact information was available for 20,161 from 14 of 16 health service areas (85.4%) in iPHIS. 5,489 of 20,161 eligible households, stratified by health authority, were randomly contacted by the research team. Of the 4,335 numbers in service (78.9%), 304 did not speak English. Of the remaining 4,031 eligible to complete the survey, 2,025 parents agreed to complete the survey (50.2%).

This program evaluation offers important insights into factors that are associated with parental decisions about receipt of the HPV vaccine in pre-adolescent girls in a program where neither the cost of the vaccine nor access to health care are barriers. In this population-based evaluation of a publicly funded, school-based HPV vaccine program for girls aged 11 y in Canada, parents reported that 65.1% of eligible girls received the first dose of the HPV vaccine, compared to reported receipt of 88.4% for the hepatitis B vaccine, and 86.5% for the meningitis C vaccine. Parents cited vaccine efficacy, advice from a physician, and concerns about daughters’ health as the main reasons for choosing to have daughters receive the vaccine. In contrast, concerns about vaccine safety, a desire to wait until their daughter was older, and lack of information were main reasons for not having daughters receive the vaccine. In multivariate modeling, overall attitudes to vaccines and the HPV vaccine, limited concern about the influence of the HPV vaccine on sexual behaviour, and receiving childhood vaccines were associated with having a daughter receive the HPV vaccine. In contrast, family composition (two parents), having more children, and higher education were associated with not having a daughter receive the HPV vaccine. Of note, none of the following factors were associated with decisions to receive the HPV vaccine: religious affiliation, country of birth, or a self-reported history of abnormal Pap smears or cervical cancer.



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