Abstract
Human Papillomavirus (HPV) prevalence among African
American adolescents is disproportionately high in comparison with
other age and ethnic groups. HPV vaccination series initiation and
completion rates remain low among this population, despite the
availability of a safe and effective vaccine. Previous theoretical
frameworks have been unable to successfully integrate all factors
involved in HPV vaccine uptake. Innovative theoretically grounded
strategies are needed to enhance overall understanding and
intervention design for those at highest risk of infection. This
purpose of this research was to examine correlates of HPV and
cancer knowledge and intent to vaccinate against HPV among African
American adolescent females using Everett Rogers' Diffusion of
Innovations Theory
. This research tested the
explanatory power of the DOI Innovation-Decision Process model and
the DOI model for preventative innovations as applied to HPV
vaccine decision-making. Using ACASI, 216 surveys were completed
with African American females 14-18 years of age. The items
measured in the ACASI were mapped to the DOI Innovation-Decision
Process model. A cross-sectional analysis was conducted to examine
correlates of HPV knowledge and intention to vaccinate against HPV
within the context of DOI. While DOI has never been used to explain
HPV vaccine decision-making, application of this model accounts for
all variables that influence HPV vaccine uptake. The results of
this research demonstrate that DOI is an appropriate model to
conceptualize and analyze HPV vaccine decision-making. The DOI
Innovation-Decision Process model successfully integrates all
correlates of HPV vaccination and provides an optimal framework
through which to explain HPV knowledge and intent to vaccinate
among African American adolescent females. Subsequent research must
be conducted to test the application of DOI to predict HPV vaccine
series initiation and completion among African American
adolescents. DOI should be used to frame future HPV vaccine uptake
intervention strategies to increase the diffusion of the vaccine
among this at-risk population.
Table of Contents
INTRODUCTION 1
Human Papillomavirus 1
HPV Epidemiology 2
Risk Factors 3
HPV Prevention 4
HPV Vaccine Efficacy and Safety 5
HPV Vaccine Uptake 5
Theoretical Foundation 7
Diffusion of Innovations Theory 7
Diffusion of Innovations Theory and Vaccine Uptake 10
Purpose of study 11
LITERATURE REVIEW 13
HPV Vaccination Coverage 13
HPV Vaccine Acceptability and Uptake 15
Sociodemographic factors 15
Behavioral factors 17
Attitudinal factors 17
Knowledge factors 19
Limitations of the Literature 20
Diffusion of Innovations Theory 23
Diffusion of Innovations Theory and Vaccination Uptake 25
Research Questions 26
METHODS 28
Primary Study Design 28
Sample 28
Setting 29
DeKalb County Board of Health 29
Fulton County Department of Health and Wellness 30
Planned Parenthood Southeast 31
Clayton County Board of Health 32
Carroll County Board of Health 33
Recruitment 33
Procedures 34
Secondary Study Design 35
Measures 36
Primary Study Measures 36
Sociodemographics 37
Sexual history 37
Knowledge of HPV and cervical cancer 38
Perceived susceptibility and severity of HPV and cervical cancer
38
Perceptions about vaccines in general and the HPV vaccine. 38
HPV vaccine acceptability 39
Normative beliefs 39
Medical record abstraction to assess HPV vaccination and STI
incidence 40
Secondary Study Measures 40
Prior conditions 41
HPV and cervical cancer knowledge 42
Characteristics of the decision-making unit 42
Perceived characteristics of the innovation 42
Intent to vaccinate against HPV 43
Analyses 43
1) DOI correlates of HPV and cervical cancer knowledge 44
2) DOI correlates of intent to vaccinate today 45
3) DOI Correlates of intent to vaccinate in the next 12 months with
a provider recommendation 46
Suggested Analyses for Future Studies 48
RESULTS 49
Description of the Sample 49
Correlates of HPV and cervical cancer knowledge 54
Prior conditions and HPV and cervical cancer knowledge 54
Characteristics of the decision making unit and HPV and cervical
cancer knowledge 55
Perceived characteristics of the innovation and HPV and cervical
knowledge 55
Intent to vaccinate and HPV and cervical cancer knowledge 56
Correlates of intent to vaccinate today 57
Prior conditions and intent to vaccinate today 57
Characteristics of the decision-making unit and intent to vaccinate
today 58
Perceived characteristics of the innovation and intent to vaccinate
today 59
HPV and cervical cancer knowledge and intent to vaccinate today
59
HPV and cervical cancer knowledge, characteristics of the
innovation and intent to vaccinate today 60
Correlates of intent to vaccinate in the next 12 months with a
provider recommendation 61
Prior conditions and future intent to vaccinate 61
Characteristics of the decision-making unit and future intent to
vaccinate 62
Perceived characteristics of the innovation and future intent to
vaccinate 63
HPV and cervical cancer knowledge and future intent to vaccinate
63
HPV and cervical cancer knowledge, perceived characteristics of the
innovation, and future intent to vaccinate 64
DISCUSSION 66
Summary 66
Research Question 1: What are correlates of HPV knowledge and
intention to vaccinate against HPV among African American
adolescent females? 67
HPV and cervical cancer knowledge. 67
Intent to vaccinate today 69
Intent to vaccinate in the next 12 months with a provider
recommendation 71
Research Question 2: Can components of the DOI Innovation-Decision
Process model explain HPV knowledge and intention to vaccinate
against HPV among African American adolescent females? 74
Research Question 3: Can components of the DOI model for
preventative innovations explain HPV knowledge and intention to
vaccinate against HPV among African American adolescent females?
76
Strengths and Limitations 77
Strengths 77
Limitations 79
Implications for Public Health Practice 81
Recommendations for Future Research 84
REFERENCES 87
APPENDICES 93
Appendix A: Girls OnGuard Informed Consent Form 93
Appendix B: Girls OnGuard HIPPA Authorization 96
Appendix C: Girls OnGuard IRB Approval 99
Appendix D: Codebook of Measures 101
Appendix E: Additional Figures 122
About this Master's Thesis
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