A Systematic Review of
Measures to Assess Factors
associated with Acceptability of
the HPV Vaccine
Jennifer Allen, DFCI/Harvard
Gloria Coronado, University of Washington
Cam Escoffery, Emory University
Maria Fernandez, University of Texas
Beth Glenn, University of California, LA
Pat Mullen, University of Texas
Raegan Tuff, Morehouse School of Medicine
Rebecca Williams, University of North Carolina
Kathi Wilson, Centers for Disease Control & Prevention
Background & Rationale
• Causal association between HPV &
cervical cancer known since ~1995
• First vaccine approved for use in U.S.
June 2006
• Proliferation of studies examining vaccine
acceptability or intention to vaccinate
• Extent to which use of standardized,
validated measures is unknown
Goals of Review
1. Review measures used in published
studies of knowledge, attitudes and
behaviors related to HPV vaccine;
2. Describe characteristics & performance of
measures;
3. Provide recommendations for
measurement that may improve quality of
future studies.
Methods
• Database search
– PubMed, PsychINFO, CINAHL (1995 through January 2008)
• Inclusion criteria
– English language
– Primary source
– Developed country
• Exclusion criteria
– Provider studies
– Qualitative studies
• Data extraction
– Standardized on-line coding form
– Two independent coders
– Discrepancies resolved by group consensus
• 1741 titles/abstracts reviewed; 80 eligible
Characteristics of Studies (n=80)
Study Design
RCT
Pre/post one group
Cross-sectional
%
5
8
86
U.S.
Non-U.S.
51
45
Population-based
Health care
Community/school
21
41
52
U.S.
Non-U.S.
51
45
Location
Setting
Location
Characteristics of Studies (n=80)
Sample
Parents
Adult women
%
21
58
Adolescent girls (<18)
Men
Women & men
28
5
18
<100
101-500
501-1000
>1000
13
58
15
15
Random
Convenience
Other
24
64
13
Sample Size
Sampling Method
Constructs Measured & Frequency
Intention (dtr)
Perceived Susceptibility HPV (dtr)
Intention (self)
Social Norms
Subjective Norms
Perceived Vaccine Risks
Perceived Severity HPV
Perceived Benefits
Perceived Barriers
Vaccine Acceptability (dtr)
Perceived Susceptibility HPV (self)
Vaccine Acceptability (dtr)
Knowledge
0
10
20
30
40
50
60
70
80
Conclusions & Recommendations
Psychometric properties of
measures used in most
studies unknown or not
reported
Theoretical or conceptual
frameworks used in most
studies unknown or not
reported
Few measures developed for
population subgroups
Development & use of
validated measures
Greater use & application of
theoretical or conceptual
frameworks
Testing of measures across
age, gender, literacy level,
cultural groups