Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Purnima Madhivanan

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Kristopher Fennie

Second Advisor's Committee Title

committee member

Third Advisor's Name

Tan Li

Third Advisor's Committee Title

committee member

Fourth Advisor's Name

Dionne Stephens

Fourth Advisor's Committee Title

committee member

Keywords

HPV, vaccine, acceptability, India, Mysore, Parents

Date of Defense

2-19-2019

Abstract

This study examined factors that directly affect, mediate, and moderate parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1,609 parents of adolescent girls (778 urban and 831 rural) attending schools in Mysore between February 2010 and October 2011. A validated questionnaire in Kannada was used to assess parental attitudes and beliefs related with HPV infection, cervical cancer, HPV vaccine and general vaccinations. Structural equation modeling was used to estimate parameters and check if a proposed model based on the integrative behavior theory (IBT) could fit the current data.

More than two-thirds (78.0%) of the parents would accept vaccinating their daughters with HPV vaccine. HPV vaccine acceptance significantly increased with an increase in the perception of parents about the benefits (standardized regression coefficient (β = 0.39) or sources of information about HPV vaccine (β = 0.24), but the rate decreased significantly with an increase in the perception about barriers to HPV vaccination (β = -0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β = 0.20), and beliefs about benefits (β = 0.20) or barriers (β = -0.25) to vaccination in general on HPV vaccine acceptance were significantly mediated by parental attitudes or source of information about HPV vaccine. Geographical living area significantly moderated the effect of awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β = 0.33), and the effect of religion on norms related to HPV vaccination (β = 0.19). Fit of the proposed model to the data was acceptable. [Root Mean Square Error of Approximation (RMSEA)= 0.025, 95% CI=0.024, 0.026; Comparative Fit Index (CFI)=0.92 and Tucker–Lewis Index (TLI)=0.91]

In conclusion, the current study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their adolescent daughters with HPV vaccine in Mysore district, India. Provision of health education interventions tailored against negative attitudes and beliefs about HPV vaccine and vaccination in general will be important for the Indian communities to promote HPV vaccination.

Identifier

FIDC007058

ORCID

0000-0002-5738-0521

Included in

Epidemiology Commons

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