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Globalization and Health

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Open Access 01-12-2016 | Research

Uptake of the human papillomavirus vaccine in Kenya: testing the health belief model through pathway modeling on cohort data

Authors: Heleen Vermandere, Marie-Anne van Stam, Violet Naanyu, Kristien Michielsen, Olivier Degomme, Frans Oort

Published in: Globalization and Health | Issue 1/2016

Abstract

Background

Many studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. This study investigated the utility of the Health Belief Model (HBM) in predicting HPV vaccine uptake in Kenya, focusing on the importance of promotion, probing willingness to vaccinate as precursor of uptake and exploring the added value of personal characteristics.

Methods

Longitudinal data were collected before and after a pilot HPV vaccination program in Eldoret among mothers of eligible girls (N = 255). Through pathway modeling, associations between vaccine uptake and the HBM constructs, willingness to vaccinate and adequate promotion were examined. Adequate promotion was defined as a personal evaluation of promotional information received. Finally, baseline cervical cancer awareness and socio-demographic variables were added to the model verifying their direct, mediating or moderating effects on the predictive value of the HBM.

Results

Perceiving yourself as adequately informed at follow-up was the strongest determinant of vaccine uptake. HBM constructs (susceptibility, self-efficacy and foreseeing father’s refusal as barrier) only influenced willingness to vaccinate, which was not correlated with vaccination. Baseline awareness of cervical cancer predicted uptake.

Conclusions

The association between adequate promotion and vaccination reveals the importance of triggers beyond personal control. Adoption of new health behaviors might be more determined by organizational variables, such as promotion, than by prior personal beliefs. Assessing users’ and non-users’ perspectives during and after implementing a vaccination program can help identifying stronger determinants of vaccination behavior.

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WHO ICO. Human Papillomavirus and Related Cancers. Kenya. Summary Report Update. 2015.

Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009;374(9686):301–14. doi:10.1016/s0140-6736(09)61248-4.CrossRefPubMed

The Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;256(19):1915–27.

Chatterjee A. The next generation of HPV vaccines: nonavalent vaccine V503 on the horizon. Expert Rev Vaccines. 2014;13(11):1279–90. doi:10.1586/14760584.2014.963561.CrossRefPubMed

Wigle J, Coast E, Watson-Jones D. Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects. Vaccine. 2013;31:3811–7. doi:10.1016/j.vaccine.2013.06.016.CrossRefPubMedPubMedCentral

Graham JE, Mishra A. Global challenges of implementing human papillomavirus vaccines. Int J Equity Health. 2011;10(1):27. doi:10.1186/1475-9276-10-27.CrossRefPubMedPubMedCentral

Becker-Dreps S, Otieno WA, Brewer NT, Agot K, Smith JS. HPV vaccine acceptability among Kenyan women. Vaccine. 2010;28(31):4864–7. doi:10.1016/j.vaccine.2010.05.034.CrossRefPubMedPubMedCentral

Rositch AF, Gatuguta A, Choi RY, Guthrie BL, Mackelprang RD, Bosire R, et al. Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya. PLoS One. 2012;7(7):e40766. doi:10.1371/journal.pone.0040766.CrossRefPubMedPubMedCentral

Perlman S, Wamai RG, Bain PA, Welty T, Welty E, Ogembo JG. Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review. PLoS One. 2014;9(3):e90912. doi:10.1371/journal.pone.0090912.CrossRefPubMedPubMedCentral

10.

Dempsey AF. Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV. Pediatrics. 2006;117(5):1486–93. doi:10.1542/peds.2005-1381.CrossRefPubMed

11.

Reiter PL, Brewer NT, Gottlieb SL, McRee AL, Smith JS. Parents’ health beliefs and HPV vaccination of their adolescent daughters☆. Soc Sci Med. 2009;69(3):475–80. doi:10.1016/j.socscimed.2009.05.024.CrossRefPubMed

12.

Ratanasiripong NT. Human papillomavirus vaccine increases high-risk sexual behaviors: a myth or valid concern. J Sch Nurs. 2014. doi:10.1177/1059840513520042.PubMed

13.

Forster AS, Marlow LA, Stephenson J, Wardle J, Waller J. Human papillomavirus vaccination and sexual behaviour: cross-sectional and longitudinal surveys conducted in England. Vaccine. 2012;30(33):4939–44. doi:10.1016/j.vaccine.2012.05.053.CrossRefPubMed

14.

Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Prev Med. 2007;45(2–3):107–14. doi:10.1016/j.ypmed.2007.05.013.CrossRefPubMed

15.

Allen JD, Coronado GD, Williams RS, Glenn B, Escoffery C, Fernandez M, et al. A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability. Vaccine. 2010;28(24):4027–37. doi:10.1016/j.vaccine.2010.03.063.CrossRefPubMedPubMedCentral

16.

Gerend MA, Shepherd JE. Predicting human papillomavirus vaccine uptake in young adult women: comparing the health belief model and theory of planned behavior. Ann Behav Med. 2012;44(2):171–80. doi:10.1007/s12160-012-9366-5.CrossRefPubMedPubMedCentral

17.

Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974;2(4):354–86.CrossRef

18.

Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the Health Belief Model. Health Educ Q. 1988;15(2):175–83.CrossRefPubMed

19.

Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1–47.CrossRefPubMed

20.

Champion VL, Skinner SR. The health belief model. Health behavior and health education: theory, research and practice. Fourthth ed. 2008.

21.

Cunningham MS, Davison C, Aronson KJ. HPV vaccine acceptability in Africa: a systematic review. Prev Med. 2014;69c:274–9. doi:10.1016/j.ypmed.2014.08.035.CrossRef

22.

DiAngi YT, Panozzo CA, Ramogola-Masire D, Steenhoff AP, Brewer NT. A cross-sectional study of HPV vaccine acceptability in Gaborone, Botswana. PLoS One. 2011;6(10):25481. doi:10.1371/journal.pone.0025481.CrossRef

23.

Coleman MA, Levison J, Sangi-Haghpeykar H. HPV vaccine acceptability in Ghana, West Africa. Vaccine. 2011;29(23):3945–50. doi:10.1016/j.vaccine.2011.03.093.CrossRefPubMed

24.

Weinstein ND. Misleading tests of health behavior theories. Ann Behav Med. 2007;33(1):1–10. doi:10.1207/s15324796abm3301_1.CrossRefPubMed

25.

Noar SM, Mehrotra P. Toward a new methodological paradigm for testing theories of health behavior and health behavior change. Patient Educ Couns. 2011;82(3):468–74. doi:10.1016/j.pec.2010.11.016.CrossRefPubMed

26.

Steptoe A, Freedland KE, Jennings JR, Llabre MM, Manuck SB, Susman EJ. Handbook of Behavioral Medicine. 2010. doi:10.1007/978-0-387-09488-5.CrossRef

27.

Sheeran P. Intention-Behavior relations: a conceptual and emperical review. Eur Rev Soc Psychol. 2011;12(1):1–36. doi:10.1080/14792772143000003.CrossRef

28.

Vermandere H, Naanyu V, Mabeya H, Vanden Broeck D, Michielsen K, Degomme O. Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya. PLoS One. 2014;9(10):e109353. doi:10.1371/journal.pone.0109353.CrossRefPubMedPubMedCentral

29.

Vermandere H, Naanyu V, Degomme O, Michielsen K. Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders. BMC Public Health. 2015;15(1):875. doi:10.1186/s12889-015-2219-y.CrossRefPubMedPubMedCentral

30.

Marlow LA. HPV vaccination among ethnic minorities in the UK: knowledge, acceptability and attitudes. Br J Cancer. 2011;105(4):486–92. doi:10.1038/bjc.2011.272.CrossRefPubMedPubMedCentral

31.

Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy E, et al. Constructing questionnaires based on the Theory of Planned Behaviour. A manual for health services researchers. 2004. ISBN: 0-9540161-5-7.

32.

Peterson RA. A meta-analysis of cronbach’s coefficient alpha. J Consum Res. 1994;21:381–91.CrossRef

33.

Muthén B. A general structural equation model with dichotomous, ordered categorical, and continuous latent variable indicators. Psychometrika. 1984;49:115–32.CrossRef

34.

Kline RB. Principles and Practice of Structural Equation Modeling. 3rd ed. New York: The Guilford Press; 2011.

35.

Newsom J. Practical approaches to dealing with nonnormal and categorical variables. 2005.

36.

Brewer NT, Gottlieb SL, Reiter PL, McRee AL, Liddon N, Markowitz L, et al. Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area. Sex Transm Dis. 2011;38(3):197–204. doi:10.1097/OLQ.0b013e3181f12dbf.CrossRefPubMedPubMedCentral

37.

Reiter PL, McRee AL, Pepper JK, Gilkey MB, Galbraith KV, Brewer NT. Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males. Am J Public Health. 2013;103(8):1419–27. doi:10.2105/ajph.2012.301189.CrossRefPubMedPubMedCentral

38.

Conroy K, Rosenthal SL, Zimet GD, Jin Y, Bernstein DI, Glynn S, et al. Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. J Womens Health (Larchmt). 2009;18(10):1679–86. doi:10.1089/jwh.2008.1329.CrossRef

39.

Brewer NT. A meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. 2005.

40.

Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun. 2010;25(8):661–9. doi:10.1080/10410236.2010.521906.CrossRefPubMed

41.

Brewer NT, Gilkey MB. Comparing theories of health behavior using data from longitudinal studies: a comment on Gerend and Shepherd. Ann Behav Med. 2012;44(2):147–8. doi:10.1007/s12160-012-9396-z.CrossRefPubMedPubMedCentral

42.

Sturm LA, Mays RM, Zimet GD. Parental beliefs and decision making about child and adolescent immunization: from polio to sexually transmitted infections. J Dev Behav Pediatr. 2005;26(6):441–52.CrossRefPubMed

43.

Sheeran P, Abraham C. Mediator of moderators: temporal stability of intention and the intention-behavior relation. Pers Soc Psychol Bull. 2003;29(2):205–15. doi:10.1177/0146167202239046.CrossRefPubMed

44.

Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165–75. doi:10.1016/j.vaccine.2015.04.037.CrossRefPubMed

45.

Bowyer HL, Forster AS, Marlow LA, Waller J. Predicting human papillomavirus vaccination behaviour among adolescent girls in England: results from a prospective survey. J Fam Plann Reprod Health Care. 2014;40(1):14–22. doi:10.1136/jfprhc-2013-100583.CrossRefPubMed

46.

Kumar S, Quinn SC, Kim KH, Musa D, Hilyard KM, Freimuth VS. The social ecological model as a framework for determinants of 2009 H1N1 influenza vaccine uptake in the United States. Health Educ Behav. 2012;39(2):229–43. doi:10.1177/1090198111415105.CrossRefPubMed

Title: Uptake of the human papillomavirus vaccine in Kenya: testing the health belief model through pathway modeling on cohort data
Authors: Heleen Vermandere
Marie-Anne van Stam
Violet Naanyu
Kristien Michielsen
Olivier Degomme
Frans Oort
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Globalization and Health / Issue 1/2016
Electronic ISSN: 1744-8603
DOI: https://doi.org/10.1186/s12992-016-0211-7

At a glance: The STEP trials

Springer Medicine

Uptake of the human papillomavirus vaccine in Kenya: testing the health belief model through pathway modeling on cohort data

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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