Correlates of Parental Consent to Human Papillomavirus Vaccine Uptake by Their Adolescent Daughters in ZAMBIA: Application of the Health Belief Model

Abstract

Parental consent for adolescent human papillomavirus (HPV) vaccine uptake is important; however, refusal is prevalent. Therefore, this study aimed to understand factors associated with parental consent for their adolescent daughter’s HPV vaccination. A cross-sectional study was conducted in Lusaka, Zambia, between September and October 2021. We recruited parents from different social settings. The means and standard deviations or median and interquartile ranges were used as appropriate to summarise continuous variables. Simple and multiple logistic regression models were fitted with robust estimation of standard errors. The odds ratios are presented with 95% CI. Mediation analysis was conducted using a generalised structural equation model. The study enrolled 400 parents, mean age 45.7 years [95% CI, 44.3–47.1]. Two hundred and fifteen (53.8%) parents reported consenting to their daughters’ HPV vaccination, and their daughters received it. None of the health belief model (HBM) construct scores showed an independent association with parental consent. Higher, compared to lower wealth index (AOR; 2.32, 95% CI: 1.29–4.16), knowing someone with genital warts (AOR = 2.23, 95 CI: 1.04–4.76), cervical cancer screening uptake (AOR = 1.93, 95% CI: 1.03–3.62) were associated with increased odds of parental consent. This study highlights factors influencing parental consent for their daughters’ HPV vaccination. Ongoing sensitisation programs are important to improve their decision-making.

Determinants of the Implementation of Human Papillomavirus Vaccination in Zambia: Application of the Consolidated Framework for Implementation Research

“…The study was conducted within health facilities and schools that are located within the six sub-districts of Lusaka. Further details about the study setting and how the HPV vaccination program is implemented in Zambia are reported elsewhere [ 12 ].…”

“…On the other hand, cervical cancer is one of the few preventable cancers, due to HPV vaccination, screening, and early treatment. However, in Zambia, HPV vaccine and cervical cancer screening coverage are low [ 11 , 12 ], just like in many SSA countries [ 2 ], leading to the late presentation of cervical cancer worsened by late diagnosis and delayed treatment at the only national chemoradiation centre [ 13 ].…”

“…HPV vaccination for adolescent girls intended for the primary prevention of cervical cancer was launched in 2019 in Zambia [ 12 ]. The vaccine coverage rates range from 31–76% for both doses 1 and 2, with some regions consistently reporting low figures [ 14 ].…”

“…The vaccine coverage rates range from 31–76% for both doses 1 and 2, with some regions consistently reporting low figures [ 14 ]. The target group for HPV vaccination in Zambia is adolescent girls aged 14 years; the vaccination is delivered through static (health facilities) and outreach points (schools and within the communities) targeting in-school and out-of-school adolescent girls [ 12 ].…”

“…Multiple stakeholders are involved in HPV vaccine delivery, including teachers and healthcare providers. Teachers play a role in recruiting the in-school girls and sending information to parents, as well as in other activities such as ensuring order and filling out vaccination cards [ 12 ]. Primarily, healthcare professionals play a critical role in promoting HPV vaccination.…”