Shenzhen Longhua District Maternity and Child Healthcare Hospital, Shenzhen, China.
Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
BMC Med. 2024 Aug 13;22(1):328. doi: 10.1186/s12916-024-03538-1.
Mothers play a crucial role in influencing their daughters' HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels.
From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9-17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data.
Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02-1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake.
These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls.
母亲在影响女儿 HPV 疫苗接种决策方面发挥着关键作用。解决母亲群体中 HPV 疫苗接种的障碍可能会一举两得：既提高母亲自身，也提高其女儿的 HPV 疫苗接种率。本研究旨在从个体和人际两个层面，探讨中国女童母亲 HPV 疫苗接种率及其决定因素。
2023 年 7 月至 10 月，采用横断面在线研究方法，对中国深圳 11678 名 9-17 岁女童的母亲进行 HPV 疫苗拒绝为女儿接种的调查。采用随机抽样方法，选取深圳市 13 所中学和 11 所小学。研究团队邀请女童母亲参与匿名在线调查。采用多水平逻辑回归模型（水平 1：学校；水平 2：个体参与者）分析数据。
在 11678 名母亲中，41.1%的人自述至少接种过一剂 HPV 疫苗。通过多水平逻辑回归分析，8 项 HPV 疾病观念测量指标（指人们对 HPV 的看法）与 HPV 疫苗接种率较高相关（比值比 1.02-1.14）。这些指标包括身份（识别 HPV 的症状）、时间线（HPV 是急性/慢性）、负面后果、个人和治疗控制（HPV 是否在自愿控制下）、关注、负面情绪和一致性（对 HPV 的整体理解）。此外，拒绝为其女儿接种 HPV 疫苗的母亲（比值比 0.82，95%CI：0.76，0.89）接种率较低。个体层面认为接种 9 价疫苗难度较大（比值比 1.06，95%CI：1.04，1.08）和对疫苗相关宣传材料满意度较高（比值比 1.50，95%CI：1.46，1.54）与 HPV 疫苗接种率较高相关。人际因素中，社交媒体上他人对 HPV 疫苗接种证词的曝光频率较高（比值比 1.19，95%CI：1.14，1.25）和对信息真实性的深思熟虑程度较高（比值比 1.11，95%CI：1.07，1.16）与 HPV 疫苗接种率较高相关。
这些发现为改变 HPV 疾病观念、解决 9 价 HPV 疫苗接种困难以及加强健康传播需求以提高女童母亲 HPV 疫苗接种率提供了重要启示。
