Stages of HPV Vaccine Hesitancy Among Guardians of Female Secondary School Students in China

Zheng Wei, Yang Liu, Liuren Zhang, Xiu Sun, Qijing Jiang, Zhenwei Li, Yue Wu, Chuanxi Fu, Zheng Wei, Yang Liu, Liuren Zhang, Xiu Sun, Qijing Jiang, Zhenwei Li, Yue Wu, Chuanxi Fu

Abstract

Purpose: Female secondary school students are the primary recommended population for human papillomavirus (HPV) vaccines. However, vaccine hesitancy may affect uptake. In this study, we assessed the vaccine hesitancy levels among the guardians of female secondary school students in China.

Methods: We developed a questionnaire and conducted cross-sectional surveys among guardians of secondary school girls aged 12-19 years in mainland China based on the Increasing Vaccination Model and the Precaution Adoption Process Model.

Results: We collected 3,225 valid samples. Among the participating guardians, 53.9% were vaccine hesitant, although only 0.9% had refused HPV vaccines. Some individual characteristics of guardians (e.g. sex, education/income level) were associated with understanding HPV vaccines. Better knowledge of HPV vaccines and communication with reliable sources of information were associated with vaccine nonhesitancy. Practical barriers such as vaccine shortage and busy schedules prevented nonhesitant guardians from vaccinating their children.

Discussion: A substantial proportion of the guardians surveyed were HPV vaccine hesitant. Promoting HPV knowledge and communication with reliable sources (e.g. clinical doctors) could help fight against vaccine hesitancy.

Keywords: Adolescent health; HPV vaccine; Vaccine hesitancy.

Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Stages of vaccine attitudes and behaviors based on the Increasing Vaccination Model and the Precaution Adoption Process Model. Stages (a–d) are hesitant stages and (e-f) nonhesitant stages.
Figure 2
Figure 2
Probability density functions of scores in vaccine necessity, importance, safety, and HPV vaccine conspiracy beliefs and individual characteristics of participating guardians and their children.
Figure 3
Figure 3
The associations between vaccine hesitancy versus knowledge on HPV and social influences (with guardians as influence recipients) and the association between the transition between “decided” and “vaccinated” stages and practical barriers. The specific values used to create these figures can be found in the Appendix.

References

    1. World Health Organization Vaccines and immunisation. Available at:
    1. World Health Organization Ten threats to global health. 2019. Available at:
    1. The Lancet Child Adolescent Health Vaccine hesitancy: A generation at risk. Lancet Child Adolesc Health. 2019;3:281.
    1. Lo N.C., Hotez P.J. Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatr. 2017;171:887–892.
    1. Paules C.I., Marston H.D., Fauci A.S. Measles in 2019 - going backward. N Engl J Med. 2019;380:2185–2187.
    1. Schmid P., Rauber D., Betsch C., et al. Barriers of influenza vaccination Intention and behavior - a systematic review of influenza vaccine hesitancy, 2005 - 2016. PLoS One. 2017;12:e0170550.
    1. Larson H.J. The state of vaccine confidence. The Lancet. 2018;392:2244–2246.
    1. Lin C., Tu P., Beitsch L.M. Confidence and receptivity for COVID-19 vaccines: A rapid systematic review. Vaccines (Basel) 2020;9:16.
    1. Arbyn M., Weiderpass E., Bruni L., et al. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health. 2020;8:e191–e203.
    1. World Health Organization Human papillomavirus vaccines: WHO position paper, May 2017-Recommendations. Vaccine. 2017;35:5753–5755.
    1. Malagón T. Reasons for optimism about eliminating cervical cancer in China. Lancet Public Health. 2019;4:e434–e435.
    1. World Health Organization Summary of the WHO position paper on vaccines against human papillomavirus (HPV) 2017. Available at:
    1. Szilagyi P.G., Albertin C.S., Gurfinkel D., et al. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine. 2020;38:6027–6037.
    1. Sweileh W.M. Bibliometric analysis of global scientific literature on vaccine hesitancy in peer-reviewed journals (1990-2019) BMC Public Health. 2020;20:1252.
    1. Zou Z., Fairley C.K., Ong J.J., et al. Domestic HPV vaccine price and economic returns for cervical cancer prevention in China: A cost-effectiveness analysis. Lancet Glob Health. 2020;8:e1335–e1344.
    1. Zhao F., Qiao Y. Cervical cancer prevention in China: A key to cancer control. Lancet. 2019;393:969–970.
    1. Yang R., Penders B., Horstman K. Addressing vaccine hesitancy in China: A Scoping review of Chinese Scholarship. Vaccines (Basel) 2019;8:2.
    1. Yu W., Cao L., Liu Y., et al. Two media-reported vaccine events in China from 2013 to 2016: Impact on confidence and vaccine utilization. Vaccine. 2020;38:5541–5547.
    1. Simms K.T., Hanley S.J.B., Smith M.A., et al. Impact of HPV vaccine hesitancy on cervical cancer in Japan: A modelling study. Lancet Public Health. 2020;5:e223–e234.
    1. Larson H.J., Jarrett C., Eckersberger E., et al. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012. Vaccine. 2014;32:2150–2159.
    1. World Health Organization Report of the SAGE working group on vaccine hesitancy. Available at:
    1. MacDonald N.E., Hesitancy SWGoV. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33:4161–4164.
    1. Quinn S.C., Jamison A.M., An J., et al. Measuring vaccine hesitancy, confidence, trust and flu vaccine uptake: Results of a national survey of White and African American adults. Vaccine. 2019;37:1168–1173.
    1. Brewer N.T., Chapman G.B., Rothman A.J., et al. Increasing vaccination: Putting psychological science into action. Psychol Sci Public Interest. 2017;18:149–207.
    1. Shapiro G.K., Tatar O., Dube E., et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine. 2018;36:660–667.
    1. Perez S., Shapiro G.K., Tatar O., et al. Development and validation of the human papillomavirus attitudes and beliefs scale in a national Canadian sample. Sex Transm Dis. 2016;43:626–632.
    1. Betsch C., Schmid P., Heinemeier D., et al. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS One. 2018;13:e0208601.
    1. Dudley M.Z., Privor-Dumm L., Dubé È., MacDonald N.E. Words matter: Vaccine hesitancy, vaccine demand, vaccine confidence, herd immunity and mandatory vaccination. Vaccine. 2020;38:709–711.
    1. Shapiro G.K., Tatar O., Amsel R., et al. Using an integrated conceptual framework to investigate parents’ HPV vaccine decision for their daughters and sons. Prev Med. 2018;116:203–210.
    1. Perez S., Tatar O., Gilca V., et al. Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys. Vaccine. 2017;35:4713–4721.
    1. Luyten J., Bruyneel L., van Hoek A.J. Assessing vaccine hesitancy in the UK population using a generalized vaccine hesitancy survey instrument. Vaccine. 2019;37:2494–2501.
    1. Kempe A., Saville A.W., Albertin C., et al. Parental hesitancy about Routine childhood and influenza vaccinations: A national survey. Pediatrics. 2020;146:e20193852.
    1. Shapiro G.K., Holding A., Perez S., et al. Validation of the vaccine conspiracy beliefs scale. Papillomavirus Res. 2016;2:167–172.
    1. Ning L., Niu J., Bi X., et al. The impacts of knowledge, risk perception, emotion and information on citizens’ protective behaviors during the outbreak of COVID-19: A cross-sectional study in China. BMC Public Health. 2020;20:1751.
    1. National Bureau of Statistics National data-data query: Average household income of China in 2020. Available at:
    1. Sonawane K., Zhu Y., Montealegre J.R., et al. Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: A nationwide, cross-sectional survey. Lancet Public Health. 2020;5:e484–e492.
    1. Huon J.F., Grégoire A., Meireles A., et al. Evaluation of the acceptability in France of the vaccine against papillomavirus (HPV) among middle and high school students and their parents. PLoS One. 2020;15:e0234693.
    1. Karafillakis E., Simas C., Jarrett C., et al. HPV vaccination in a context of public mistrust and uncertainty: A systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother. 2019;15:1615–1627.
    1. Lane S., Macdonald N.E., Marti M., et al. Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017. Vaccine. 2018;36:3861–3867.
    1. Hu H., Wei X., Ren Z., et al. Investigation on acceptance of HPV vaccination and its determinants among the parents of junior high school students in Guangzhou City. Chin J Dis Control Prev. 2014;07:659–662.
    1. Lane S., MacDonald N.E., Marti M., Dumolard L. Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015-2017. Vaccine. 2018;36:3861–3867.
    1. Wong L.P., Wong P.F., Megat Hashim M.M.A.A., et al. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother. 2020;16:1611–1622.
    1. Wang Q., Zhang W., Cai H., Cao Y. Understanding the perceptions of Chinese women of the commercially available domestic and imported HPV vaccine: A semantic network analysis. Vaccine. 2020;38:8334–8342.
    1. Luisi M.L.R. From bad to worse II: Risk amplification of the HPV vaccine on Facebook. Vaccine. 2021;39:303–308.
    1. Yu Y., Xu M., Sun J., et al. Human papillomavirus infection and vaccination: Awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of Teenage daughters in Weihai, Shandong, China. PLoS One. 2016;11:e0146741.
    1. Zhang S.K., Pan X.F., Wang S.M., et al. Knowledge of human papillomavirus vaccination and related factors among parents of young adolescents: A nationwide survey in China. Ann Epidemiol. 2015;25:231–235.
    1. Zhang H., Yu D., Liu C., et al. Parental acceptance of junior high school students for human papillomavirus vaccination: A survey at one school in Wuhan. J Public Health Prev Med. 2014;01:49–52.
    1. Wang W., Ma Y., Wang X., et al. Acceptability of human papillomavirus vaccine among parents of junior middle school students in Jinan, China. Vaccine. 2015;33:2570–2576.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera