Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis

Abstract

BackgroundLicensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV.MethodsTwenty-one adolescent males (ages 13–17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis.ResultsParents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision.ConclusionParents and sons play an active role in the decision-making process, with an individual’s role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.

A model of health care provider decision making about HPV vaccination in adolescent males

“…These studies have found that public insurance status, Hispanic race, lower family income, having received flu vaccine, increased perceived vaccine effectiveness, peer acceptance and anticipated inaction regret, were associated with increased vaccine uptake or uptake intent in males (6)(7)(8)(9)(10).…”

Provider communication about HPV vaccination: A systematic review

“…4,[18][19][20]71,74,[76][77][78] However, the extent to which parents communicated about HPV vaccination beyond giving consent varied, with qualitative studies suggesting that parents from racial/ethnic minorities or with lower socioeconomic status were less likely to be engaged by providers and more likely than parents from more socially privileged backgrounds to defer to providers' advice. 19,71,73,74,77 Parents were also more likely to follow providers' advice without question when they received a strong, unambiguous recommendation.…”

“…80 Studies suggested that parent-adolescent decisions were largely concordant and that most dyads ultimately reached agreement about the vaccination decision, but they sometimes looked to providers for guidance in the case of initial disagreement. 76,81 Interestingly, one qualitative study noted that adolescents' participation in medical dialog was often subtle and included non-verbal forms of communication such as nods, suggesting that adolescents' communication role could be easy to overlook. 76 …”

“…76,81 Interestingly, one qualitative study noted that adolescents' participation in medical dialog was often subtle and included non-verbal forms of communication such as nods, suggesting that adolescents' communication role could be easy to overlook. 76 …”

“…18,80 In contrast, other studies found that adolescents did play a role in communication and decision-making in clinical settings, one which increased with age, maturity, and social privilege. 18,27,71,73,76,80 For some parents, the desire to maximize adolescents' role was even a reason for delaying HPV vaccination. 80 Studies suggested that parent-adolescent decisions were largely concordant and that most dyads ultimately reached agreement about the vaccination decision, but they sometimes looked to providers for guidance in the case of initial disagreement.…”