Alberts Catharina J, van der Loeff Maarten F Schim, Hazeveld Yvonne, de Melker Hester E, van der Wal Marcel F, Nielen Astrid, El Fakiri Fatima, Prins Maria, Paulussen Theo G W M
Department of Infectious Diseases, Research and Prevention, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
BMC Public Health. 2017 Feb 21;17(1):220. doi: 10.1186/s12889-017-4091-4.
Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter that is invited for the HPV vaccination.
In February 2014, parents/guardians living in Amsterdam were invited to complete a questionnaire about social-psychological determinants of their decision making process regarding the HPV vaccination of their daughter and socio-demographic characteristics. This questionnaire was sent approximately one month before the daughter was scheduled to receive her first HPV vaccine dose. Their daughters' HPV vaccination status was retrieved from the national vaccination database. We distinguished four ethnic groups: Dutch (NL), Surinamese, Netherlands Antillean, and Aruban (SNA), Middle-Eastern and North-African (MENA), and Other. To assess the impact of determinants on both intention and uptake, linear and logistic regression analyses were used respectively. Missing data were imputed using multiple imputation by chained equation.
In total 1,309 parents/guardians participated (33% participation rate). In all groups we found the mothers' intention to be the strongest predictor of their daughters' HPV vaccination uptake. Explained variance of uptake was highest in the NL-group (pseudo-R:0.56) and lower in the other ethnic groups (pseudo-R varied between 0.23 and 0.29). The lower explained variance can be attributed to the relative large proportion of participants with a positive intention that finally did not go for vaccination in the SNA-group (11%) and MENA-group (30%). Explained variance (R) of intention varied between 0.66 and 0.77 across ethnic groups, and was best explained by the proximal social-psychological determinants. The strength of association of these determinants with both intention and uptake were largely similar across ethnic groups.
We conclude that the same determinants should be targeted in the different ethnic groups, although the mode of delivery of the intervention needs to be tailored to the different cultural backgrounds. Further research is needed to explain the observed discrepancy between intention and uptake, especially among parents/guardians in the non-Dutch groups.
与其他儿童疫苗接种率（>90%）相比，荷兰人乳头瘤病毒（HPV）疫苗接种率较低（约60%），在少数族裔中更低。本研究的目的是探讨种族对受邀为女儿接种HPV疫苗的父母/监护人的HPV疫苗接种意愿及接种情况的决定因素可能产生的影响。
2014年2月，邀请居住在阿姆斯特丹的父母/监护人填写一份关于其女儿HPV疫苗接种决策过程的社会心理决定因素及社会人口学特征的问卷。该问卷在女儿预定接种第一剂HPV疫苗前约一个月发送。从国家疫苗接种数据库中获取其女儿的HPV疫苗接种状况。我们区分了四个种族群体：荷兰人（NL）、苏里南人、荷属安的列斯人和阿鲁巴人（SNA）、中东和北非（MENA）以及其他。为评估决定因素对意愿和接种情况的影响，分别使用线性回归和逻辑回归分析。缺失数据采用链式方程多重插补法进行插补。
共有1309名父母/监护人参与（参与率为33%）。在所有群体中，我们发现母亲的意愿是其女儿HPV疫苗接种情况的最强预测因素。接种情况的解释方差在荷兰人群体中最高（伪R：0.56），在其他种族群体中较低（伪R在0.23至0.29之间）。解释方差较低可归因于SNA群体（11%）和MENA群体（30%）中最终未接种疫苗但有积极意愿的参与者比例相对较高。意愿的解释方差（R）在不同种族群体中在0.66至0.77之间变化，并且最好由近端社会心理决定因素来解释。这些决定因素与意愿和接种情况的关联强度在不同种族群体中基本相似。
我们得出结论，尽管干预的实施方式需要根据不同文化背景进行调整，但不同种族群体应针对相同的决定因素。需要进一步研究来解释观察到的意愿和接种情况之间的差异，尤其是在非荷兰群体的父母/监护人中。
