Perspectives on Decision Making About Human Papillomavirus Vaccination Among 11- to 12-Year-Old Girls and Their Mothers

Abstract

Introduction The aims of this qualitative study were to explore (a) the factors influencing mothers’ decisions to vaccinate 11- to 12-year-old daughters against human papillomavirus (HPV) and (b) the mothers’ and daughters’ perspectives about HPV vaccine–related decision making. Methods Participants were girls (N = 33) who had received an HPV vaccine and their mothers (N = 32), recruited from suburban and urban pediatric practices. Semistructured interviews were conducted with girls and mothers separately, and data were analyzed using framework analysis. Results The primary factors influencing mothers’ decisions to vaccinate daughters against HPV were (a) mother’s beliefs and experiences; (b) interactions with clinicians, friends, and family members; and (c) exposure to media reports/marketing. Most daughters believed the decision to be vaccinated was a mutual one, although most mothers believed the decision was theirs. Conclusions This study provides novel insights into perspectives on decision making about HPV vaccination among mothers and 11- to12-year-old daughters, which can be used in interventions to improve vaccination rates.

Provider communication about HPV vaccination: A systematic review

“…4,19,74,78,79 Indeed, some parents indicated a preference for vaccinating in the preteen years specifically because they viewed adolescents as having little say during this 11 Cross-sectional, online survey rout rout F, M 776 National sample of pediatricians and family physicians Gilkey, 2016 60 Cross-sectional, online survey rout rout F, M 1495 National sample of parents of adolescents (ages 11-17) Gilkey, under review 16 Cross-sectional, online survey rout rout F, M 1484 National sample of parents of adolescents (ages [11][12][13][14][15][16][17] (Continued on next page) time. 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.…”

“…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.…”

“…15 Qualitative studies suggested that these communication preferences were based on the perception that physicians were most knowledgeable about vaccines as well as patients' social and medical histories. [17][18][19][20] However, two studies indicated that preferences for talking with a physician about HPV vaccination lessened after initial discussions; respondents were more open to communicating with other providers or office staff for follow-up. 15, 21 The extent to which parent and patient preferences are currently being met is unknown; however, one recent study found that about half of physicians in a national sample did not make the initial HPV vaccine recommendation for patients in their practice, but rather relied on a nurse practitioner, medical assistant, or other provider to do so.…”

“…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.…”

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

“…By giving parents prior notice that their children will be due to receive HPV vaccine, providers may be able to give parents more time to prepare. 9,25 Finally, given the dearth of data on HPV vaccine refusal and delay, additional research is needed to explore topics such as why parents who initially refuse or delay HPV vaccine later go on to get the vaccine. Understanding how parental refusal and delay interact with other key determinants of under-immunization (e.g., absent or low-quality provider recommendations) is also important.…”