Parents' Willingness to Vaccinate Their Daughters with Human Papillomavirus Vaccine and Associated Factors in Debretabor Town, Northwest Ethiopia: A Community-based Cross-sectional Study

"[D]espite the many benefits of the HPV vaccine, parental willingness and their decision-making largely affect the uptake of the vaccination series and its completion by adolescents..."

Ethiopia launched the quadrivalent human papillomavirus (4vHPV) vaccine in December 2018. The vaccine is delivered primarily through a school-based approach to reach all eligible girls. This study aimed to assess parents' willingness to vaccinate their daughters with HPV vaccine and associated factors in Debre Tabor town, Ethiopia.

A community-based cross-sectional study was conducted from December 15 to February 15, 2021/22 among 721 parents of daughters aged from 9 to 14. A structured and interviewer-administered questionnaire was used to collect the data. Multivariable logistic regression was done, and a p-value of ≤ 0.05 was used to declare the level of significance.

More than half (54%) of the study participants had inadequate knowledge about the HPV infection and HPV vaccination, and 61.4% of parents had a positive attitude toward HPV infection and its vaccination for their daughters. More than two-thirds (68.4%) of the respondents had positive subjective norms, measured by the extent to which their willingness to vaccinate their daughters with the HPV vaccine is influenced by whether their significant social others approve of them taking the vaccine or not. Around 62.1% expressed perceived behavioural control on HPV vaccination for their daughters, meaning they had self-efficacy and confidence with regard to that decision.

Parents' willingness for HPV vaccination was found to be 79.10% (95% confidence interval (CI): 76.00, 82.00). Parents having media exposure, had good knowledge of HPV infection and HPV vaccine, positive attitudes, and positive perceived behavioural control toward the HPV vaccine had statistically significant association with willingness for the HPV vaccination of their daughters. Specifically:

• Parents who were exposed to mass media were 2.74 (adjusted odds ratio (AOR) = 2.74, 95% CI: 1.31, 5.71) times more likely to vaccinate their daughters with the HPV vaccine compared to those who did not utilise media.
• Parents with good knowledge on HPV infection and HPV vaccinations were 2.85 times more likely to be willing to vaccinate their daughters against HPV compared with their counterparts (AOR = 2.85, 95% CI: 1.54, 5.29).
• The odds of parents' willingness to vaccinate their daughters against HPV were 5.10 times higher among parents having a positive attitude toward HPV infection and its vaccination when compared with those with unfavourable attitudes (AOR = 5.10, 95% CI: 3.01, 8.66).
• Parents who had positive perceived behavioural control toward HPV vaccination were 4.75 times more likely to be willing to vaccinate their daughters with the HPV vaccine as compared to parents having negative perceived behavioural control (AOR = 4.75, 95% CI: 2.96, 7.60).

Reflecting on the findings, the researchers recommend the following, for example:

• Seek to fill gaps in HPV vaccination awareness and understanding through public health education programmes for parents, especially those with a negative attitude toward the HPV vaccine.
• Strengthen vaccine promotion through multimedia communication about HPV infection and its prevention.
• Address parental safety concerns and promote positive beliefs about the vaccine.
• Administer the HPV vaccine at the community level (in villages), which may facilitate acceptance and uptake of the vaccine.