HPV Vaccination Willingness And Behavior Among Adult Women: An Application Of The Protection Motivation Theory

ObjectivesTo investigate the cognition of cervical cancer and HPV vaccine and the status of HPV vaccination in adult women,and to analyse the influencing factors of HPV vaccination willingness and behaviors based on the Protective Motivation Theory(PMT)so as to provide reference for targeted intervention development for follow-up application of vaccines and the prevention and control of cervical cancer.MethodsThere were 898 adult women who met the inclusion and exclusion standards recruited from two cities of Hubei Province between Sep.and Dec.in 2018.Data were collected by questionnaires,including basic characteristics,cognition of cervical cancer and HPV vaccine,HPV vaccination behaviors and willingness,and PMT factors.The SPSS 22.0 was used for the data analysis.The frequency,percentage and?x?s were used to describe the general situation,disease and vaccine cognition,vaccination willingness and behaviors,and protective motivation factors;?~2 test was used to analyse the differences of HPV vaccination willingness and behaviors among adult women with different population sociological characteristics,sexual relationship state and gestation situation;t-test was used to compare the difference of knowledge score among different vaccination willingness and behaviors;and logistic regression analysis was used to analyse the influencing factors of HPV vaccination willingness and behaviors in adult women.Results1.The average score of HPV vaccine knowledge in adult women is(13.22?3.61).There was no significant difference in the scores between those who were vaccinated and those who were not,there is also no significant difference between those who were willing to vaccinate and those who were not(P>0.05).About 86.75%of subjects have heard about HPV vaccine from TV/network/newspaper/book(69.19%),healthcare providers(53.02%),and family member/friends(41.34%).2.About 27.39%(n=246)of subjects were vaccinated or scheduled for HPV vaccination,while 57.91%(n=520)expressed willingness for future HPV vaccination.Among the willingness group,43.27%(n=225)of subjects intended to be vaccinated against HPV within the next three years,and 39.04%(n=203)would be vaccinated when recommended by doctors.However,about 14.70%(n=132)of subjects expressed no willingness,mainly because of fear of unsafe vaccine and side effects after vaccination(51.52%),followed by the high price of HPV vaccine(40.91%)and don't know where to vaccinate(34.85%).3.The univariate analysis found that women who were younger,unmarried,1 or 2pregnancies,no child,and advised by doctors were more likely to be vaccinated in the future.Women who were elder,married,had children,with occupation as medical personnel and civil servants/employees of firms and enterprises,advised by doctors,heard about HPV vaccine,with age of first sexual intercourse over 20 years old,and had multiple sexual partners were more likely to report HPV vaccination behavior.4.Logistics regression analysis found that PMT factors significantly influenced HPV vaccination willingness and behaviors.Specifically,the internal incentives(OR=1.197,95%CI:1.053-1.361),response cost(OR=1.096,95%CI:1.014-1.184),and self-efficacy(OR=1.253,95%CI:1.182-1.329)were the influential in HPV vaccination willingness,while response efficiency(OR=1.110,95%CI:1.056-1.168),response cost(OR=1.137,95%CI:1.074-1.204),and self-efficacy(OR=1.119,95%CI:1.065-1.176)were the influential in HPV vaccination behaviors.Conclusions1.The level of knowledge about HPV vaccine and the awareness of vaccine were higher in adult women.2.The vaccination rate of HPV vaccine was low,but the willingness to vaccinate was high among adult women.3.There were statistically significant differences in HPV vaccination willingness among adult women of different ages,marital status,gravidity,number of children,doctor's advice,and heard about HPV vaccine(P<0.05).Compared to the HPV vaccination willingness,there were statistically significant differences in HPV vaccination behaviors among adult women of different ages,marital status,number of children,occupation,average monthly income,age of first sexual intercourse,number of sexual partners,doctor's advice,heard about HPV vaccine,and family history of cancer(P<0.05).4.Factors in PMT had a certain effect on HPV vaccination willingness and behaviors.HPV vaccination willingness was mainly affected by internal incentives,response costs,self-efficacy,while HPV vaccination behaviors was mainly affected by response efficiency,response cost,self-efficacy.