ASPO Abstracts
A Qualitative Analysis Extending the Health Belief Model to Explain Reasons for Low HPV Vaccine Uptake
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose: HPV vaccine uptake is low, especially in Indiana. The Health Belief Model provides a framework for
understanding how perceived threat, cues-to-action, and male/female differences affect rates of HPV vaccination.
Methods: We surveyed 53 clinic vaccine coordinators from Indiana. Open-ended questions addressed barriers
they face to vaccinating girls and boys in their communities. Data were analyzed using thematic analysis.
Results: All respondents were female, 94% were non-Hispanic White, and 62% were RNs. When asked to
describe barriers to vaccinating their 11-12 year old patients, responses fell into 3 broad categories: perceived
threat (subthemes: lack of perceived threat of HPV-related disease, and perceived threat of the vaccine), cues
(subthemes: cues-to-action, lack of cues-to-action, and cues-to-inaction), and male/female differences.
Participants reported that parents perceived low threat of HPV infection due to the belief that their child is not
sexually active, but there were multiple perceived threats of the vaccine, including beliefs that it is unsafe and that
it will lead to sexual activity. The main cue-to-action was a need for a school mandate to increase vaccine uptake.
More frequently, respondents reported cues-to-inaction such as media misinformation and stigma, resulting in
parents refusing vaccination. Lack of cues-to-action included provider non-recommendation and low knowledge
about the vaccine and HPV-related disease, resulting in parents not vaccinating their children. There were
frequent male/female differences including the belief that the vaccine was not for boys and the fear of increasing
sexual promiscuity, which was only a concern for girls.
Conclusions: Misinformation about HPV vaccine persists, including unwarranted fears of side effects and a belief
that it is not for boys. While there has been extensive research describing barriers to HPV vaccine uptake,
understanding cues-to-action, lack of cues-to-action, and cues-to-inaction is a new way of examining these
barriers. This approach could lead to innovative interventions aimed at increasing cues-to-action (e.g. a school
mandate), addressing the lack of cues-to-action (e.g. provider non-recommendation), and combatting cues to
inaction (e.g. misinformation in the media).
Keywords: HPV vaccination uptake; barriers to vaccination; Health Belief Model; community-based research