Parental intentions to vaccinate their daughters for HPV. A cross-sectional nationwide study in Greece using the COM-B model

Manuscript
Published: Dec 20, 2024
DOI: https://doi.org/10.12681/psy_hps.39611
Keywords:
human papillomarivus (HPV), HPV vaccination, intention, COM-B model, capability, opportunity, motivation, behaviour
Apostolos Efkarpidis
University of West Attica; General Hospital of Syros
https://orcid.org/0000-0003-1828-9650
George Koulierakis
General Hospital of Syros
https://orcid.org/0000-0003-3705-1007
Anastasia Papastilianou
National Centre for Public Administration and Local Government
Abstract

Human papillomavirus (HPV) infection is a common sexually transmitted disease in men and women worldwide. It accounts for the appearance of benign papillomatous or precancerous lesions, which sometimes can be evolved into cancer, especially in the anogenital area. For prevention, a vaccine is available worldwide including Greece, for girls and boys aged 9-18 years. The responsibility for the vaccination usually lies with parents/guardians. This study aimed to measure parental intention to vaccinate their daughters against HPV and identify the determinants that affect it. From September 2021 to March 2022, a cross-sectional nationwide study was carried out among a representative sample of students, and through them their parents/guardians, using multistage stratified sampling. 46 schools in the territory participated, with a representative sample of 3,203 parents/guardians of female students aged 11-18 years, who completed an anonymous questionnaire created based on the Capability, Opportunity, Motivation - Behavior (COM-B) and Theoretical Domain Framework (TDF) models. 905 parents out of the 1358 who hadn’t vaccinated their daughters (66.6%) mentioned that they intended to do so or complete vaccination. Knowledge about the vaccine (p < .001), fear of possible side effects (p < .001), relief that serious diseases could be avoided (p <.001), expert influence (p < .001), and reminders through email (p = .048) were the significant determinates of parents' intention to vaccinate their daughters. The interconnected COM-B and TDF models are suitable frameworks for targeted interventions to foster HPV vaccination.

Article Details
  • Section
  • SPECIAL SECTION
Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The journal PSYCHOLOGY adopts a Platinum open-access policy. Submission, processing or publication costs are waived by the Hellenic Psychological Society. Papers published in the journal PSYCHOLOGY are licensed under a 'Creative Commons Attribution-ShareAlike 4.0 International' licence. The authors reserve the copyright of their work and grant the journal the right of its first publication. Third-party licensees are allowed to use the published paper immediately after publication as they wish, provided they retain the defined by the license copyright formalities, regarding the reference to its author(s) and its initial publication in the journal PSYCHOLOGY. Moreover, any adjusted work should be shared under the same reuse rights, so with the same CC license.

Downloads
Download data is not yet available.
References
Ajzen, I. (1991). The theory of planned behavior. Theories of Cognitive Self-Regulation, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
Alhusayn, K. O., Alkhenizan, A., Abdulkarim, A., Sultana, H., Alsulaiman, T., & Alendijani, Y. (2022). Attitude and hesitancy of human papillomavirus vaccine among Saudi parents. Journal of Family Medicine and Primary Care, 11(6). https://journals.lww.com/jfmpc/fulltext/2022/06000/attitude_and_hesitancy_of_human_papillomavirus.104.aspx
Alshehri, M. A., Fahim, W. A., & Alsaigh, R. R. (2023). The Association Between Parents’ Knowledge About Human Papillomavirus and Their Intention to Vaccinate Their Daughters: A Cross-Sectional Study. Cureus. https://doi.org/10.7759/cureus.48600
American Psychological Association. (2015). APA Dictionary of Psychology (2nd ed.).
Arbyn, M., Gultekin, M., Morice, P., Nieminen, P., Cruickshank, M., Poortmans, P., Kelly, D., Poljak, M., Bergeron, C., Ritchie, D., Schmidt, D., Kyrgiou, M., Van Den Bruel, A., Bruni, L., Basu, P., Bray, F., & Weiderpass, E. (2021). The European response to the WHO call to eliminate cervical cancer as a public health problem. International Journal of Cancer, 148(2), Article 2. https://doi.org/10.1002/ijc.33189
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., Grimshaw, J. M., Lawton, R., & Michie, S. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 77. https://doi.org/10.1186/s13012-017-0605-9
Balogun, F. M., & Omotade, O. O. (2022). Parental intention to vaccinate adolescents with HPV vaccine in selected communities in Ibadan, Southwest Nigeria: An application of Integrated Behavioral Model. Human Vaccines & Immunotherapeutics, 18(5), 2069959. https://doi.org/10.1080/21645515.2022.2069959
Bandura, A. (1986). Social Foundations of Thought and Action. https://api.semanticscholar.org/CorpusID:142519016
Blebil, A. Q., Saw, P. S., Dujaili, J. A., Bhuvan, K. C., Mohammed, A. H., Ahmed, A., Houssenaly, F. Z., Hassan, B. A. R., Kaur, A., & Roien, R. (2022). Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: A qualitative study. BMC Health Services Research, 22(1), 929. https://doi.org/10.1186/s12913-022-08297-4
Bobadilla, M. L., Villagra, V., Castro, H., von Horoch, M., Araya, S., Deluca, G., & de Paula, V. S. (2024). Human Papillomavirus (HPV) Infection and Risk Behavior in Vaccinated and Non-Vaccinated Paraguayan Young Women. Pathogens, 13(3). https://doi.org/10.3390/pathogens13030209
Bogka, E., Naoum, P., Pavi, E., & Athanasakis, K. (2024). What Influences Parents on Their Decision to Vaccinate Their Daughters Against HPV? Journal of Pediatric and Adolescent Gynecology, S1083318824001827. https://doi.org/10.1016/j.jpag.2024.02.001
Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting Psychological science into action. Psychological Science in the Public Interest, 18(3), 149–207. https://doi.org/10.1177/1529100618760521
Brouwer, A. F., Delinger, R. L., Eisenberg, M. C., Campredon, L. P., Walline, H. M., Carey, T. E., & Meza, R. (2019). HPV vaccination has not increased sexual activity or accelerated sexual debut in a college-aged cohort of men and women. BMC Public Health, 19(1), 821. https://doi.org/10.1186/s12889-019-7134-1
Brown, B., Gabra, M. I., & Pellman, H. (2017). Reasons for acceptance or refusal of Human Papillomavirus Vaccine in a California pediatric practice. Papillomavirus Research, 3, 42–45. https://doi.org/10.1016/j.pvr.2017.01.002
Bruni, L., Albero G., Serrano B., Mena M., Collado JJ., Gόmez D., Munoz J., Bosch FX., & de Sanjose S. (2023). Human Papilloma Virus and Related Disease Report - Europe. ICO/IARC HPV Information Centre. https://hpvcentre.net/statistics/reports/XEX.pdf
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37. https://doi.org/10.1186/1748-5908-7-37
Caskey, R., Sherman, E. G., Beskin, K., Rapport, R., Xia, Y., & Schwartz, A. (2017). A behavioral economic approach to improving human papillomavirus vaccination. Journal of Adolescent Health, 61(6), 755–760. https://doi.org/10.1016/j.jadohealth.2017.07.020
Centers for Disease Control and Prevention - CDC. (2022). Genital HPV Infection – Basic Fact Sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm
Chan, D. N. S., Li, C., Law, B. M. H., Choi, K. C., Lee, P. P. K., & So, W. K. W. (2023). Factors affecting HPV vaccine uptake among ethnic minority adolescent girls: A systematic review and meta-analysis. Asia-Pacific Journal of Oncology Nursing, 10(9), 100279. https://doi.org/10.1016/j.apjon.2023.100279
Conner, M., & Norman, P. (2022). Understanding the intention-behavior gap: The role of intention strength. Frontiers in Psychology, 13. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.923464
Costantino, C., Tabacchi, G., Sannasardo, C. E., Scarpitta, F., Vella, C., Vitale, F., Casuccio, A., & Restivo, V. (2020). Systematic review and meta-analysis of determinants associated with HPV vaccination uptake in Europe. European Journal of Public Health, 30(Supplement_5), ckaa166.1438. https://doi.org/10.1093/eurpub/ckaa166.1438
Cui, M., Wang, Y., Liu, Z., Liu, C., Niu, T., Zhou, D., Zhao, M., Zhang, M., Jia, J., & Luo, L. (2023). The awareness and acceptance of HPV vaccines among parents of primary and junior high school students in China: A meta-analysis. Infectious Medicine, 2(4), 273–282. https://doi.org/10.1016/j.imj.2023.11.003
Dang, J. H. T., Gori, A., Rios, L., Rolon, A. M., Zhang, J., & Chen, M. S. (2024). “You Don’t Know If It’s the Truth or a Lie”: Exploring human papillomavirus (HPV) vaccine hesitancy among communities with low HPV vaccine uptake in Northern California. Vaccines, 12(4). https://doi.org/10.3390/vaccines12040372
Darabi, A., Tahmasebi, R., Vahdat, K., & Noroozi, A. (2022). Predictive factors of COVID-19 vaccine acceptance based on COM-B model. Mdrsjrns, 10(4), 711–718. http://hehp.modares.ac.ir/article-5-61593-en.html
Deci, E. L., & Ryan, R. M. (2000). The “What” and “Why” of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J. A. (2013). Vaccine hesitancy: An overview. Human Vaccines & Immunotherapeutics, 9(8), 1763–1773. https://doi.org/10.4161/hv.24657
ECDC. (2018). Factsheet about human papillomavirus. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/human-papillomavirus/factsheet
eClinicalMedicine. (2023). Global strategy to eliminate cervical cancer as a public health problem: Are we on track? eClinicalMedicine, 55, 101842. https://doi.org/10.1016/j.eclinm.2023.101842
Efua Sackey, M., Markey, K., & Grealish, A. (2022). Healthcare professional’s promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine, 40(19), 2656–2666. https://doi.org/10.1016/j.vaccine.2022.03.054
European Cancer Information System -ECIS. (2022). Estimated incidence and mortality by country—Comparison with EU-27. https://ecis.jrc.ec.europa.eu/explorer.php?$0-0$1-All$2-All$4-2$3-30$6-0,85$5-2022,2022$7-7,8$CEstByCountry$X0_8-3$X0_19-AE27$X0_20-No$CEstBySexByCountry$X1 _8-3$X1_19-AE27$X1_-1-1$CEstByIndiByCountry$X2_8-3$X2_19-AE27$X2_20-No$CEstRelative$X3 _8-3$X3_9-AE27$X3_19-AE27$CEstByCountryTable$X4_19-AE27
Flood, T., McLaughlin, M., Hughes, C. M., & Wilson, I. M. (2023). Applying the COM-B behaviour model to understand factors which impact school immunisation nurses’ attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15–17 year old students in Northern Ireland, UK. Vaccine, 41(38), 5630–5639. https://doi.org/10.1016/j.vaccine.2023.07.066
Garbutt, J. M., Dodd, S., Walling, E., Lee, A. A., Kulka, K., & Lobb, R. (2018). Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices. Implementation Science, 13(1), 45. https://doi.org/10.1186/s13012-018-0729-6
Garner, B. A. (Ed.). (2022). Black’s Law Dictionary (9th ed.). Admin. https://archive.org/details/blacks-law-9th-edition/page/n1/mode/2up
Geoghegan, S., & Feemster, K. (2020). Optimizing Human Papillomavirus Immunization: The Role of Centralized Reminder and Recall Systems. Pediatrics, 145(5), Article e20193596. https://doi.org/10.1542/peds.2019-3596
Glenn, B. A., Crespi, C. M., Herrmann, A. K., Nonzee, N. J., Rosen, D. L., Park, C. L., Johnson, G., Chang, L. C., Singhal, R., Taylor, V. M., & Bastani, R. (2023). Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination. Preventive Medicine, 169, 107448. https://doi.org/10.1016/j.ypmed.2023.107448
Gomes, J. M., Silva, B. M., Santos, E. F. D. S., Kelly, P. J., Costa, A. D. S., Takiuti, A. D., De Abreu, L. C., Soares Júnior, J. M., Baracat, E. C., & Sorpreso, I. C. E. (2020). Human Papillomavirus (HPV) and the quadrivalent HPV Vaccine among Brazilian adolescents and parents: Factors associated with and divergences in knowledge and acceptance. PLOS ONE, 15(11), Article e0241674. https://doi.org/10.1371/journal.pone.0241674
Hanley, K., Chung, T. H., Nguyen, L. K., Amadi, T., Stansberry, S., Yetman, R. J., Foxhall, L. E., Bello, R., Diallo, T., & Le, Y.-C. L. (2023). Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients. Vaccines, 11(4), 872. https://doi.org/10.3390/vaccines11040872
Hussein, I., Vänskä, S., Sivelä, J., Leino, T., & Nohynek, H. (2024). Factors associated with parental Human Papillomavirus (HPV) vaccination intention of daughter: A national survey in Finland. Vaccine, 42(3), Article 3. https://doi.org/10.1016/j.vaccine.2023.12.026
Kanellopoulou, A., Giannakopoulos, I., Fouzas, S., Papachatzi, E., Nasikas, S., Papakonstantinopoulou, A., Dimitriou, G., & Gkentzi, D. (2021). Vaccination coverage among school children in Western Greece from 2016 to 2019. Human Vaccines & Immunotherapeutics, 17(11), 4535–4541. https://doi.org/10.1080/21645515.2021.1967040
Kolek, C. O., Opanga, S. A., Okalebo, F., Birichi, A., Kurdi, A., Godman, B., & Meyer, J. C. (2022). Impact of Parental Knowledge and Beliefs on HPV Vaccine Hesitancy in Kenya—Findings and Implications. Vaccines, 10(8). https://doi.org/10.3390/vaccines10081185
Lelliott, M., Sahker, E., & Poudyal, H. (2023). A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan. Journal of Clinical Medicine, 12(5). https://doi.org/10.3390/jcm12052004
Lin, Z., Chen, S., Su, L., Chen, H., Fang, Y., Liang, X., Chan, K., Chen, J., Luo, B., Wu, C., Wang, Z. (2024). Exploring mother-daughter communication and social media influence on HPV vaccine refusal for daughters aged 9-17 years in a cross-sectional survey of 11,728 mothers in China. Human Vaccines & Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2333111
Liu, S., & Liu, J. (2021). Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets. Journal of Medical Internet Research, 23(5), e28118. https://doi.org/10.2196/28118
López, N., Garcés-Sánchez, M., Panizo, M. B., de la Cueva, I. S., Artés, M. T., Ramos, B., & Cotarelo, M. (2020). HPV knowledge and vaccine acceptance among European adolescents and their parents: A systematic literature review. Public Health Reviews, 41(1), 10. https://doi.org/10.1186/s40985-020-00126-5
McDonagh, L. K., Saunders, J. M., Cassell, J., Curtis, T., Bastaki, H., Hartney, T., & Rait, G. (2018). Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: A systematic review. Implementation Science, 13(1), 130. https://doi.org/10.1186/s13012-018-0821-y
Mekonnen, A. G., & Mittiku, Y. M. (2023). Early-onset of sexual activity as a potential risk of cervical cancer in Africa: A review of literature. PLOS Global Public Health, 3(3), Article e0000941. https://doi.org/10.1371/journal.pgph.0000941
Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. Silverback.
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence-based practice: A consensus approach. Quality and Safety in Health Care, 14(1), 26. https://doi.org/10.1136/qshc.2004.011155
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42
Naoum, P., Athanasakis, K., Zavras, D., Kyriopoulos, J., & Pavi, E. (2022). Knowledge, Perceptions and Attitudes Toward HPV Vaccination: A Survey on Parents of Girls Aged 11–18 Years Old in Greece. Frontiers in Global Women’s Health, 3, 871090. https://doi.org/10.3389/fgwh.2022.871090
Nguyen, K. H., Santibanez, T. A., Stokley, S., Lindley, M. C., Fisher, A., Kim, D., Greby, S., Srivastav, A., & Singleton, J. (2021). Parental vaccine hesitancy and its association with adolescent HPV vaccination. Vaccine, 39(17), 2416–2423. https://doi.org/10.1016/j.vaccine.2021.03.048
Nuwarda, R. F., Ramzan, I., Weekes, L., & Kayser, V. (2022). Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines, 10(10). https://doi.org/10.3390/vaccines10101595
Nyengidiki, T. K., Bassey, G., Durugbo, I., Serdaroglu, S., & Kutlubay, Z. (Eds.). (2017). Cervical Cancer, a Sequela of a Sexually Transmitted Infection: The Human Papillomavirus Infection. In Fundamentals of Sexually Transmitted Infections (p. Ch. 3). IntechOpen. https://doi.org/10.5772/intechopen.69259
Paraskevaidis, E., Athanasiou, A., Paraskevaidi, M., Bilirakis, E., Galazios, G., Kontomanolis, E., Dinas, K., Loufopoulos, A., Nasioutziki, M., Kalogiannidis, I., Athanasiadis, A., Papanikolaou, A., Vatopoulou, A., Grimbizis, G., Tsolakidis, D., Daponte, A., Valasoulis, G., Gritzeli, S., Michail, G., … the HeCPA (Hellenic Cervical Pathology Academic) Group. (2020). Cervical Pathology Following HPV Vaccination in Greece: A 10-year HeCPA Observational Cohort Study. In Vivo, 34(3), 1445–1449. https://doi.org/10.21873/invivo.11927
Patterson, L., Berry, E., Parsons, C., Clarke, B., Little, A., Beggs, J., Chuter, A., Jackson, T., Hsia, Y., McGrath, H., Millman, C., Murphy, S., Bradley, D. T., & Milligan, S. (2023). Using the COM-B framework to elucidate facilitators and barriers to COVID-19 vaccine uptake in pregnant women: A qualitative study. BMC Pregnancy and Childbirth, 23(1), 640. https://doi.org/10.1186/s12884-023-05958-y
Santhanes, D., Yong, C. P., Yap, Y. Y., Saw, P. S., Chaiyakunapruk, N., & Khan, T. M. (2018). Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis. Scientific Reports, 8(1), 3640. https://doi.org/10.1038/s41598-018-21912-x
Sheeran, P. (2002). Intention—Behavior Relations: A Conceptual and Empirical Review. European Review of Social Psychology, 12(1), 1–36. https://doi.org/10.1080/14792772143000003
Si, M., Jiang, Y., Su, X., Wang, W., Zhang, X., Gu, X., Ma, L., Li, J., Zhang, S., Ren, Z., Liu, Y., & Qiao, Y. (2021). Willingness to Accept Human Papillomavirus Vaccination and its Influencing Factors Using Information–Motivation–Behavior Skills Model: A Cross-Sectional Study of Female College Freshmen in Mainland China. Cancer Control, 28, 10732748211032899. https://doi.org/10.1177/10732748211032899
Sidiropoulou, M., Gerogianni, G., Kourti, F. E., Pappa, D., Zartaloudi, A., Koutelekos, I., Dousis, E., Margari, N., Mangoulia, P., Ferentinou, E., Giga, A., Zografakis-Sfakianakis, M., & Dafogianni, C. (2022). Perceptions, knowledge and attitudes among young adults about prevention of HPV infection and immunization. Healthcare, 10(9), 1721. https://doi.org/10.3390/healthcare10091721
Sonawane, K., Zhu, Y., Damgacioglu, H., Garg, A., Graboyes, E. M., Montealegre, J. R., Brownstein, N. C., Ford, M. E., Roberts, J. R., Sterba, K. R., Giuliano, A. R., & Deshmukh, A. A. (2024). Factors associated with parental human papillomavirus vaccination intentions among adolescents from socioeconomically advantaged versus deprived households: A nationwide, cross-sectional survey. The Lancet Regional Health – Americas, 31. https://doi.org/10.1016/j.lana.2024.100694
Suzuki, T., Ota, Y., Sakata, N., Fujita, N., Kamatsuka, M., Nagashima, K., Hirayama, J., Fujita, N., Shiga, K., Oyama, N., Terada, Y., & Nomura, K. (2022). HPV vaccine intention among university students during suspension of active recommendation in Japan. Human Vaccines & Immunotherapeutics, 18(6), 2116900. https://doi.org/10.1080/21645515.2022.2116900
Suzuki, Y., Sukegawa, A., Ueda, Y., Sekine, M., Enomoto, T., & Miyagi, E. (2021). Effect of a brief web-based educational intervention on willingness to consider human papillomavirus vaccination for children in japan: Randomized controlled trial. Journal of Medical Internet Research, 23(9), Article e28355. https://doi.org/10.2196/28355
Timlin, D., McCormack, J. M., & Simpson, E. E. (2021). Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet). Public Health Nutrition, 24(7), 1657–1670. Cambridge Core. https://doi.org/10.1017/S1368980020001445
Valasoulis, G., Pouliakis, A., Michail, G., Kottaridi, C., Spathis, A., Kyrgiou, M., Paraskevaidis, E., & Daponte, A. (2020). Alterations of HPV-Related Biomarkers after Prophylactic HPV Vaccination. A Prospective Pilot Observational Study in Greek Women. Cancers, 12(5), 1164. https://doi.org/10.3390/cancers12051164
Vasudevan, L., Ostermann, J., Wang, Y., Harrison, S. E., Yelverton, V., Fish, L. J., Williams, C., & Walter, E. B. (2022). Association of caregiver attitudes with adolescent HPV vaccination in 13 southern US states. Vaccine: X, 11, 100181. https://doi.org/10.1016/j.jvacx.2022.100181
Vatopoulou, A., Ntanika, A., Vatopoulou, A., Gkrozou, F., Tsonis, O., & Paschopoulos, M. (2023). HPV vaccination: Does it increase teen sex? Journal of Pediatric and Adolescent Gynecology, 36(2), 233. https://doi.org/10.1016/j.jpag.2023.01.164
Walker, K. K., Owens, H., & Zimet, G. (2020). “We fear the unknown”: Emergence, route, and transfer of hesitancy and misinformation among HPV vaccine accepting mothers. Preventive Medicine Reports, 20, 101240. https://doi.org/10.1016/j.pmedr.2020.101240
Wang, Y., Chen, Y., & Bao, S. (2023). The impact of exposure to HPV related information and injunctive norms on young women’s intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory. Frontiers in Public Health, 10, 1102590. https://doi.org/10.3389/fpubh.2022.1102590
Warsi, S. K., Nielsen, S. M., Franklin, B. A. K., Abdullaev, S., Ruzmetova, D., Raimjanov, R., Nagiyeva, K., & Safaeva, K. (2023). Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan. Vaccines, 11(4). https://doi.org/10.3390/vaccines11040754
Waser, M., Heiss, R., & Borena, W. (2022). Factors affecting children’s HPV vaccination in Austria: Evidence from a parent survey. Human Vaccines & Immunotherapeutics, 18(6), 2126251. https://doi.org/10.1080/21645515.2022.2126251
Wassie, M., Zegeye, A. F., Worku, W., Sisay, T., Eyob, T., & Gebeyehu, D. A. (2023). Willingness to accept human papilloma virus vaccination and its associated factors among parents with eligible daughters in Addis Zemen town, Northwest Ethiopia. Infectious Agents and Cancer, 18(1), 84. https://doi.org/10.1186/s13027-023-00551-6
West, R., & Michie, S. (2020). A brief introduction to the COM-B Model of behaviour and the PRIME Theory of motivation. Qeios. https://doi.org/10.32388/WW04E6.2
Whittal, A., Störk, S., Riegel, B., & Herber, O. R. (2021). Applying the COM-B behaviour model to overcome barriers to heart failure self-care: A practical application of a conceptual framework for the development of complex interventions (ACHIEVE study). European Journal of Cardiovascular Nursing, 20(3), 261–267. https://doi.org/10.1177/1474515120957292
Willmott, T. J., Pang, B., & Rundle-Thiele, S. (2021). Capability, opportunity, and motivation: An across contexts empirical examination of the COM-B model. BMC Public Health, 21(1), 1014. https://doi.org/10.1186/s12889-021-11019-w
Wolrd Health Organization - WHO. (2014). Report of the SAGE working group on vaccine hesitancy. WHO. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598046/pdf/pone.0258462.pdf
Wolrd Health Organization - WHO. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
Wolrd Health Organization - WHO. (2024). Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
Zastawna, B., Milewska, A., Załuska, R., Kozłowski, R., Zastawna, M., & Marczak, M. (2023). Analysis of Parents’ Attitudes and Knowledge toward Immunization and How These Factors Influence Their Decisions to Vaccinate Their Children against Human Papilloma Virus (HPV). Medicina, 59(10), Article 10. https://doi.org/10.3390/medicina59101755
Zhu, X., Jacobson, R. M., MacLaughlin, K. L., Sauver, J. St., Griffin, J. M., & Finney Rutten, L. J. (2023). Parent-reported barriers and parental beliefs associated with intentions to obtain HPV vaccination for children in a primary care patient population in Minnesota, USA. Journal of Community Health, 48(4), 678–686. https://doi.org/10.1007/s10900-023-01205-9
Most read articles by the same author(s)