Exploring Variation in Parent Worries about HPV Vaccination

Background. Parental vaccine hesitancy contributes to suboptimal uptake of human papillomavirus (HPV) vaccine among adolescents. Effectively communicating with parents to address hesitancy necessitates nuanced understanding of their concerns. Prior research documents the diverse worries that parents have about HPV vaccination, but little is known about the relative importance of worries or how they co-occur which could be useful to inform targeted communication campaigns.

Methods. We developed a best-worst scaling (BWS) instrument that presented repeated subsets of 11 common worries about HPV vaccination identified in the literature. We administered the BWS instrument via a national, online survey to parents of adolescents ages 11-17 who reported never having talked with their child’s healthcare provider about HPV vaccination (n=443). We used conditional logistic regression to prioritize parents’ HPV vaccination worries and then constructed scale-adjusted latent class models with 1-10 classes to identify patterns of worry.

Results. About one-third of parents (36%) ranked long-term side effects of HPV vaccination as their top worry. Other common top-ranked worries were how new the vaccine is (12%), motives of drug companies (12%), short-term side effects (10%), and that it may be unnecessary (10%). In latent class analyses, the statistical fit of the model improved with each additional class (BIC: 22557 and 20962 for 1- and 10-class model, respectively). Across models, many classes were characterized by a worry about long-term side effects, either alone or in combination with other worries. For example, in the 5-class model, Vaccine Harm Worriers (Class 1, 28%) were primarily concerned about long-term side effects while most other classes—including Industry Worriers (Class 2, 29%), Novelty Worriers (Class 3, 23%), and General Risk Worriers (Class 4, 15%)—prioritized other concerns in tandem with worry about side effects. The smallest class, Sexual Activity Worriers (Class 5, 5%), was characterized by concern about encouraging sexual activity.

Discussion. This national study provides novel data for understanding how parents prioritize their worries about HPV vaccination, which can inform ongoing efforts to better support parental decision making about HPV. We also found that parents’ HPV vaccination worries are difficult to segment into clinically meaningful groups. Providers should be prepared to address concerns about long-term side effects, as this was common across classes in our analyses. However, a tailored, rather than targeted, communication approach may be needed.