What influences parents to vaccinate (or not) their sons with the Human Papillomavirus (HPV) vaccine: an examination of HPV vaccine decision-making changes over time

Abstract Background: Most sexually active adults are infected with the Human Papillomavirus (HPV) in their lifetime and about 3800 Canadians are diagnosed each year with a HPV attributable cancer. Although highly effective HPV vaccines exist, the HPV is responsible for 4.5% of all cancers worldwide, that include cervical, anal, vaginal/vulvar, penile, and oropharyngeal cancers. The present HPV vaccine uptake rate for boys in Canada is well below the target set by the Canadian government. This study aimed to analyze the motives that influence a change in parents’ HPV vaccine-decision-making status for their sons over time. Methods: Data were collected using a web-based survey that measured knowledge, attitudes, beliefs, and behaviors regarding HPV vaccination. Canadian parents of boys aged 9 to 12 completed the survey at baseline (T1) and in a follow-up survey 9 months later (T2). Parents’ decision stage regarding their son receiving the HPV vaccine was categorized using the Precaution Adoption Process Model: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate, or vaccinated. Parents who moved stages from T1 to T2 responded to open-ended questions, and we used qualitative deductive and inductive methods to analyses data. In parallel, we used quantitative methods to analyses parents’ knowledge, attitudes, and beliefs. Results of quantitative and qualitative analyses were compared and interpreted. Results: Of the 1427 parents who completed the survey at both T1 and T2, 118 parents moved to decided not to vaccinate, 125 moved to decided to vaccinate, and 9 to vaccinated. Qualitative analyses revealed that parents who moved to decided not to vaccinate their son indicated harms, knowledge, and general anti-vaccination attitudes as the top categories for vaccine nonacceptability. These parents also scored lower on HPV and HPV vaccine knowledge scales. Benefits, knowledge, and hearing positive opinions from health care professionals (HCPs) were the most commonly assigned categories for parents who moved to decided to vaccinate their sons. Conclusions: Highlighting the benefits of the vaccine, countering negative stories about the vaccine, and having HCPs provide strong recommendations are critical to increase HPV vaccine uptake in boys.