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Joyce Apted, RN, MSN, CPNP
Abstract
Background. The human papillomavirus (HPV) vaccine was licensed for use in females in 2006 and for males in 2009 to prevent genital warts and HPV related cancers. Despite the availability of the vaccine and previous research indicating a willingness or intention of parents to vaccinate their children, vaccination rates remain low. Objectives. To identify and compare, based on child gender, the primary factors that influence actual parental acceptance leading to vaccination or non-acceptance of the HPV vaccine. Search strategy. A systematic search of Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychoInfo, and Pubmed for peer reviewed articles in the English language from 2007 to 2014 using the keywords: decision making, HPV vaccine, adolescents, parents. Selection criteria. Articles were included if the study reported factors affecting the decision to accept or decline the HPV vaccine identified by the parents of children and adolescents less than 18 years of age. Articles were excluded if: 1) the article was not available, 2) the outcomes of the study were not relevant to the objective of this review, 3) the study was not done in the U.S., 4) the study was not original research, 5) the study was a duplicate found in another database, 6) vaccine recipients were over 17 years of age, 7) the vaccination decision was intentional or hypothetical versus actual. Data collection and analysis. A single reviewer assessed study eligibility and extracted data related to actual parental HPV vaccine acceptance or non-acceptance and the primary factors influencing their decision. Main results. Six studies enrolling 698 parents of children less than 18 years of age who were eligible to receive the HPV vaccine were included in this review. Four studies enrolled a total of 195 parents of females deciding to accept or decline the HPV vaccine. Two studies enrolled a total of 420 parents of males deciding to accept or decline the HPV vaccine. Using constructs from the Health Belief Model to organize the findings from this review, parents of females and males declined the HPV vaccine for their child most often due to reasons that fell within the construct of perceived barriers. Within this construct, parents of females declined the vaccine most often due to concerns related to vaccine safety, lack of information, and the perceived potential for future health problems due to the vaccine. Perceived barriers for the parents of males included not knowing that males could get the vaccine and a general lack of information. The common factor identified by parents of females and males within this construct is a lack of information. A lack of self-efficacy was the second most commonly identified construct in the Health Belief Model for parents of females and males declining the HPV vaccine. Within this construct, however only one study whose participants were parents of males reported a lack of self-efficacy as the primary reason for declining the vaccine. Parents of both females and males identified factors within the construct, perceived susceptibility. Within this construct, having a child of young age or who is not yet or likely to become sexually active soon was reported as the primary reason parents declined the vaccine for females in one study. Reasons for vaccine acceptance were similar for parents regardless of gender. Provider recommendation was the primary reason reported by parents of females and males for accepting the vaccine for their child. A desire to protect their child from disease was the second most frequently reported reason parents of females and males accepted the vaccine for their child. Reviewer’s conclusions. Provider recommendation is the most common reason reported by parents of females and males for accepting the HPV vaccine. Parents of females and males decline the vaccine most often for varying reasons and concerns that fall most often under the construct of perceived barriers. A lack of information is the most commonly reported reason for declining the vaccine within this construct for parents of females and males. Results from this review emphasize the importance of provider communication of factual information and vaccine recommendation for parents of females and males.