Influencing Factors on Intention to Receive Human Papillomavirus Vaccination in Mothers of Elementary School Girls: Focusing on the Mediating Effects of Self-efficacy

Abstract

Purpose: To provide basic data for the development of a nursing intervention program in order to improve intention to receive human papillomavirus (HPV) vaccination intention of mothers of elementary school girls by confirming the mediating effect of self-efficacy in the relationship between knowledge of HPV vaccine, attitude towards vaccination, subjective norm, and intention to receive vaccination.Methods: The subjects of this study are 171 mothers of elementary school students in grades 5–6 in Yangsan city. The health teacher delivered the questionnaire to the mothers via the female elementary school students in the classroom, the mothers filled out the questionnaire by self-filling, and the questionnaires were collected through the health teacher.Results: The fully mediating effect of self-efficacy in the relationship between the knowledge of the HPV vaccine and the intention of the mothers of female elementary school students to receive vaccination. The partial mediating effect of self-efficacy was confirmed in the relationship between attitude towards HPV vaccination and the intention to receive vaccination. The partial mediating effect of self-efficacy was confirmed in the relationship between the subjective norm for HPV vaccination and the intention to receive vaccination.Conclusion: It is necessary to develop an HPV vaccine vaccination promotion program that can enhance the level of knowledge, attitudes towards vaccination, and subjective norm of HPV vaccine for female elementary school mothers and to strengthen their sense of self-efficacy.

An Integrative Review of the Influence on Human Papillomavirus Vaccination Adherence among Adolescents

“…Subthemes for facilitators are personal characteristics and environmental factors. The personal characteristics include attitude [ 12 , 24 , 35 , 36 ], subjective norms [ 12 , 24 , 28 , 36 ], awareness [ 38 ], self-efficacy [ 24 , 37 ], perceived benefits [ 25 , 31 , 34 ], perceived susceptibility [ 39 ], perceived barriers [ 31 , 39 ], and perceived behavior control [ 10 , 28 , 30 , 36 ], Some papers also mentioned a knowledge aspect to increase intention for HPV vaccination, namely education level [ 30 , 38 ] and high level of knowledge about vaccination [ 12 , 23 , 24 , 29 , 34 ]. Environmental factors were described by various descriptions such as family history of cervical cancer [ 38 ], clinician’s recommendation [ 29 , 30 , 39 ], mothers’ experience of pap-test, concerns about their daughters being high-risk subjects without HPV vaccination, mother’s experience with HPV vaccination [ 30 , 35 ], vaccination status of the health teachers [ 30 ] and their children [ 34 ], and the child’s teachers’ experience with pap-test [ 34 ].…”

“…Subthemes for the barriers to HPV vaccination included a lack of awareness and knowledge about HPV, concerns about side effects of the HPV vaccine [ 29 , 31 , 33 , 34 , 35 ], such as death, neurological disorders and thrombosis, mothers were reluctant to vaccinate their children, and the burden of HPV vaccine costs [ 32 , 33 ]. Some studies showed that adolescent mothers did not receive the HPV vaccine for their offspring because they did not know exactly what illness the HPV vaccine was related to [ 24 , 33 , 37 , 38 ] or did not feel the need to vaccinate [ 33 , 38 ]. Unvaccinated people around adolescents and lack of personal recommendations regarding HPV vaccination were also reasons not to vaccinate [ 32 ].…”

“…A total of 12 out of 19 studies reported the relationship between HPV-related knowledge and HPV vaccination [ 12 , 23 , 24 , 25 , 26 , 27 , 29 , 33 , 36 , 37 , 38 , 39 ] and all papers proposed as recommendation of further actions to increase HPV vaccine uptake by promoting knowledge [ 10 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], and coverage of HPV vaccines by public insurance [ 30 , 32 , 33 ].…”

“…However, mothers of elementary school girls often have inaccurate information about the appropriate age for their children’s HPV vaccination [ 24 ]. Some parents have a false belief that vaccination will increase adolescent sexual activity, but it is not associated with increased sexual activity [ 55 ].…”

“…No article was excluded after quality evaluation according to MMAT guidelines, because it might have caused bias [ 22 ]. Two papers were scored as low [ 23 , 24 ], four papers as moderate [ 25 , 26 , 27 , 28 ], and thirteen as very high [ 10 , 12 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Two papers with low scores were retained because despite having participants from limited areas, they investigated important ideas related to this systematic review.…”