The Multidimensional Nature of Perceived Barriers: Global Versus Practical Barriers to HPV Vaccination

Health Psychology (Impact Factor: 3.95). 11/2011; 32(4). DOI: 10.1037/a0026248
Source: PubMed

ABSTRACT Objective: Perceived barriers are one of the strongest determinants of health behavior. The current study presents a novel conceptualization of perceived barriers by testing the following hypotheses: (a) perceived barriers are multidimensional and thus should cluster into distinct factors; (b) practical barriers should be salient for individuals intending to engage in a particular health behavior, whereas global barriers should be salient for individuals not intending to enact the behavior; and (c) whereas global barriers should be negatively associated with behavioral intentions, practical barriers should be positively related to intentions. Methods: The context for this investigation was young adult women's perceived barriers to human papillomavirus (HPV) vaccination. Two months after viewing an educational video about HPV vaccination, women (aged 18-26) who had not received any doses of the HPV vaccine (n = 703) reported their perceived barriers to HPV vaccination and intentions to receive the vaccine. Results: Relative to the conventional single-factor approach, a five-factor model provided a better fit to the data and accounted for a larger proportion of variance in vaccination intentions. The relative salience of different perceived barriers varied as a function of women's intentions. Participants who were not intending to get vaccinated cited global concerns about vaccine safety and low perceived need for the vaccine. In contrast, participants intending to get vaccinated cited practical concerns (cost, logistical barriers) related to carrying out their intentions. Moreover, whereas global perceived barriers were associated with lower intentions, practical barriers were associated with higher intentions. Conclusions: Perceived barriers are multidimensional and vary systematically as a function of people's behavioral intentions. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

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    • "In line with the psychological saying " past behavior is the best predictor of future behavior " (Mischel, 1968, p. 139) past vaccinations (e.g., against influenza) predict future vaccination behavior very well (e.g., Nowalk et al., 2010; Lin et al., 2010). Lastly, even if an individual is generally willing to vaccinate, structural barriers can hinder eventual implementation of the vaccination (Rosenstock, 1974, Gerend, Shepherd & Shepherd, 2013). Greater barriers are therefore associated with less behavioral change (Abraham & Sheeran, 2005; Harrison, Mullen, & Green, 1992) and less vaccination (Kimmel, Burns, Wolfe & Zimmerman, 2007). "
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    ABSTRACT: Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, i.e., a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions in order to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should therefore be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals while interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.
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    • "Although a financial incentive was offered, the GPs in our study volunteered to participate and, therefore, may represent a subgroup of GPs who have a higher level of interest in HPV vaccination compared with GPs who were randomly selected. This potential bias may limit the generalisability of our findings; however, we found that some of the barriers reported in our study were also reported in similar studies from other countries [26,35-37], which supports the relevance of our study results to other countries even in the context of differing health systems. "
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    ABSTRACT: Background Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners’ (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine. Methods Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change. Results According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs’ and patients’ beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field. Conclusions Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine.
    BMC Women's Health 07/2014; 14(1):91. DOI:10.1186/1472-6874-14-91 · 1.66 Impact Factor
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    • "In nations such as the United States, with abundant resources, only half of those who initiate the vaccine ultimately complete the series [21], [22]. Research focused on the multi-dimensional nature of perceived barriers, including vaccine expense, concerns about adverse effects, discomfort from the injection, and low perceived need for the vaccine [23], has provided a framework to understand why vaccine efficacy does not always translate into vaccine effectiveness, even in settings where the vaccine is broadly available [24]. "
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    ABSTRACT: In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto. The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis. Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV. In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine's target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.
    PLoS ONE 08/2013; 8(8):e72094. DOI:10.1371/journal.pone.0072094 · 3.23 Impact Factor
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