SHARED DECISION MAKING? EXAMINING MOTHER AND DAUGHTER INFLUENCE ON THE CHOICE TO VACCINATE AGAINST THE HUMAN PAPILLOMAVIRUS

Purpose:    The human papillomavirus (HPV) is a common infection that has been linked to several cancers. A vaccine has been developed for adolescents. This study measures the influences of the attitudes of daughter and mother on the decision to immunize the daughter.  

Methods:    The Theory of Planned Behavior guided the development and analysis of survey data collected from 72 mother-and-daughter dyads. Additional information was collected regarding the relationship between mother and daughter.  Two structural equation models (SEM) were created; one to relate the mother’s behavioral attitude, subjective norms, and perceived behavioral control with her intention and decision whether to vaccinate the daughter. The second expanded the model to include variables related to the dyad. Additional analyses compared whether the daughter shared similar attitudes and beliefs to her mother.

Results:    Mothers (average age = 44 years) were mainly Caucasian (73%), at least high school educated (62%), and married (64%). Their daughters (average age = 15 years) were mainly in grade 9 or lower (69%) and only 35% reported being in a dating relationship.    The mother’s intention to vaccinate was predicted by her behavioral attitude (B=.39, p<.001), normative beliefs (B=.31, p<.001), and perceived behavioral control (B=.31, p<.001); intention predicted her vaccine decision (B=.31, p<.001). The basic SEM was a good fitting model (RMSEA=.001, PCLOSE=.52). The three variables strongly predicted intention (r-square = .68, p<.001); regressing perceived behavioral control and intention on the decision (yes or no) to vaccinate resulted in an odds ratio = .33 (p<.001). The addition of variables related to the mother’s relationship to her daughter and her parenting style did not significantly improve the model’s predictability. The mother and daughter did not always hold the same attitudes toward vaccination; only their normative beliefs were correlated (r=.42, p<.001).

Conclusion:    In the decision to vaccinate an adolescent female against different cancer-causing strains of HPV, there appears to be little shared decision making. Mainly, the attitudes and beliefs of the mother dictate whether the daughter receives the vaccine. Efforts to increase the HPV vaccine acceptance rates should focus on educating mothers about the benefits and risks associated with her decision.