Fu Linda Y, Zimet Gregory D, Latkin Carl A, Joseph Jill G
General and Community Pediatrics, Children's National Health System, 111 Michigan Ave, NW, Washington, DC 20010, United States.
Department of Pediatrics, Indiana University, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States.
Vaccine. 2017 Feb 1;35(5):802-807. doi: 10.1016/j.vaccine.2016.12.045. Epub 2017 Jan 4.
Healthcare providers (HCPs) are advised to give all parents a strong recommendation for HPV vaccination. However, it is possible that strong recommendations could be less effective at promoting vaccination among African Americans who on average have greater mistrust in the healthcare system. This study examines the associations of parental trust in HCPs and strength of HCP vaccination recommendation on HPV vaccine acceptance among African American parents.
Participants were recruited from an urban, academic medical center between July 2012 and July 2014. We surveyed 400 African American parents of children ages 10-12years who were offered HPV vaccine by their HCPs to assess sociodemographic factors, vaccine beliefs, trust in HCPs, and the HPV vaccine recommendation received. Medical records were reviewed to determine vaccination receipt.
In multivariable analysis, children whose parents were "very strongly" recommended the HPV vaccine had over four times higher odds of vaccine receipt compared with those whose parents were "not very strongly" recommended the vaccine. Having a parent with "a lot of" versus "none" or only "some" trust in HCPs was associated with over twice the odds of receiving HPV vaccine. Very strong HCP recommendations were associated with higher odds of vaccination among all subgroups, including those with more negative baseline attitudes toward HPV vaccine and those with lower levels of trust. Adding the variables strength of HCP recommendation and parental trust in HCPs to a multivariable model already adjusted for sociodemographic factors and parental vaccine beliefs improved the pseudo R from 0.52 to 0.55.
Among participants, receiving a strong vaccine recommendation and having a higher level of trust in HCPs were associated with higher odds of HPV vaccination, but did not add much to the predictive value of a model that already adjusted for baseline personal beliefs and sociodemographic factors.
建议医疗保健提供者（HCPs）向所有父母大力推荐人乳头瘤病毒（HPV）疫苗接种。然而，对于平均而言对医疗保健系统不信任程度更高的非裔美国人，大力推荐可能在促进疫苗接种方面效果较差。本研究探讨非裔美国父母对HCPs的信任以及HCPs疫苗推荐力度与人乳头瘤病毒疫苗接受度之间的关联。
2012年7月至2014年7月期间，从一家城市学术医疗中心招募参与者。我们对400名年龄在10至12岁、其HCPs已为其提供HPV疫苗的非裔美国儿童的父母进行了调查，以评估社会人口学因素、疫苗信念、对HCPs的信任以及所收到的HPV疫苗推荐情况。查阅医疗记录以确定疫苗接种情况。
在多变量分析中，父母“非常强烈”推荐HPV疫苗的儿童接种疫苗的几率比父母“不是非常强烈”推荐疫苗的儿童高出四倍多。父母对HCPs“非常信任”与“完全不信任”或“只是有些信任”相比，其子女接受HPV疫苗的几率高出两倍多。HCPs的非常强烈推荐与所有亚组中较高的接种几率相关，包括那些对HPV疫苗基线态度较为负面以及信任程度较低的亚组。将HCPs推荐力度和父母对HCPs的信任这两个变量添加到一个已经针对社会人口学因素和父母疫苗信念进行调整的多变量模型中，伪R值从0.52提高到了0.55。
在参与者中，收到强烈的疫苗推荐以及对HCPs有更高的信任程度与更高的HPV疫苗接种几率相关，但对于一个已经针对基线个人信念和社会人口学因素进行调整的模型，其预测价值增加不多。
