Factors that Predict Parental Willingness to Have Their Children Vaccinated against HPV in a Country with Low HPV Vaccination Coverage

Polish literature on factors associated with adolescent human papillomavirus (HPV) vaccination is scant, despite the fact that uptake is one of the poorest in the European Union (EU). Within the EU, Poland is one of eight countries where HPV vaccination is yet to have been made part of a free-of-charge mandatory form of immunisation programme. Thus, this study sought to assess HPV awareness and to identify independent predictors for parental willingness to have their children vaccinated against HPV. The hope is that such evidence could be used to inform strategies to improve vaccination uptake in this at-risk population.

A cross-sectional study was conducted from June 2013 to October 2014 among parents of high school students (age of about 17 years) from the city of Zgorzelec whose children had not been vaccinated against HPV. Questionnaires were distributed to the parents (mean age 42 years, 70.9% females) via the respective schools during parent–teacher meetings.

Almost half of the parents (201; 44.7%) had never heard of HPV. The most common sources of HPV knowledge were television (53.8%), internet (41.4%), and leaflets (32.4%), followed by a gynaecologist (25.2%), a paediatrician (11.4%), and a nurse (11%); this was a multiple-choice question. Only 36.2% of participants knew about the possible clinical outcomes of HPV infection and correctly selected HPV as a risk factor for cervical cancer; 31.3% identified HPV as a sexually transmitted pathogen.

The researchers speculate that the low awareness and poor knowledge regarding HPV observed in the study population may be attributed to the fact that 44.4% of study participants had only primary education. Parents with a better educational background may have more access to health information. Furthermore, television, internet, and leaflets, not medical staff, were the main sources of the parents' information on HPV; this may include incomplete or incorrect information.

Regarding parents' attitudes toward HPV, 414 (92.0%) stated that vaccines are effective in disease prevention; 155 (34.4%) were concerned that vaccination would make their children more likely to have sex; 169 (37.6%) considered their child as being at risk regarding serious consequences of HPV infection; and 194 (43.1%) were concerned about possible side effects of vaccination. Regarding the latter finding, the researchers point to the fact that the study population received information mainly from the mass media, which tend to report predominantly on speculated negative outcomes of vaccines in general and the HPV vaccine in particular.

Regarding parental willingness to vaccinate their adolescent children against HPV, 383 (85.1%) were willing to have their children undergo vaccination, 19 (4.2%) had a negative attitude, and 48 (10.7%) were not sure. Parents were asked who, in their opinion, would have the most significant influence concerning their decision-making regarding child/children HPV immunisation. Three hundred (66.7%) reported that any decision would be significantly influenced by a physician's recommendation; almost one-third (142; 31.5%) would make their own decision; and 8 participants would possibly base their decision on recommendations made by family/friends.

Multivariable logistic regression analyses indicated that being employed (odds ratio (OR) 2.09; 95% confidence interval (CI): 1.10-3.86), having positive attitudes toward vaccines (OR 3.02; 95% CI: 1.34-6.49), previous information about HPV (OR 2.02; 95% CI: 1.17-3.51), and concerns about the side effects of the HPV vaccine (OR 0.60; 95% CI: 0.35-0.99) were independent predictors of parents' willingness to vaccinate.

The article outlines implications of the findings for HPV immunisation policy. For instance, the fact that parents were not confident regarding the safety of the HPV vaccine indicates that parents should be informed that it is a cancer-prevention vaccine that can offer substantial benefits and might reduce the likelihood of serious outcomes. The results also showed that being informed about HPV was associated with greater odds of parental willingness to immunise their child. Although healthcare providers play an influential role in parents' decisions to vaccinate their children against HPV, the results of the study show that providers are not yet fully promoting the vaccine. Therefore, gynaecologists, paediatricians, and general practitioners (GPs) are encouraged to increase their role in the communication and delivery of vaccination for this specifically vulnerable group at visits made by adolescents and their parents.

The researchers also suggest that clinicians consider informing parents directly through messages by telephone, text, letter, postcard, or other media. Another tool used to provide information about HPV for the parents of adolescent children in Poland could be education by qualified experts during periodic parent–teacher meetings. In addition, media campaigns aimed at motivating parents to vaccinate their children against HPV could also be used. Future interventions should be more tailored, focusing especially on vulnerable subgroups identified in this study that are particularly difficult to reach, such as unemployed parents.

In conclusion, attitudes regarding their child being vaccinated against HPV were positive among Polish parents, even though awareness and knowledge of HPV in this group were low. Most of the significant factors that influenced their willingness were modifiable, such as being informed about HPV and having positive attitudes toward vaccines. In addition, making HPV vaccines part of standard immunisations in Poland would be valuable, according to researchers. Finally, further quantitative but also qualitative studies on factors that affect parents' or caregivers' decision not to vaccinate children against HPV would be instructive.