Sense & Sensibility: Decision-making and Sources of Information in Mothers Who Decline HPV Vaccination of Their Adolescent Daughters

"[T]he impression left behind by information sources is more important in determining vaccination status than the information sources themselves..."

Vaccination against human papillomavirus (HPV) has been part of the Danish Childhood Vaccination Programme since 2009 and initially had a high uptake. Following an intense public debate on the alleged side effects of the vaccine in 2015, coverage rates declined dramatically, leaving the current coverage at 54%. In this context, the study sought to identify differences in the sources of information and factors of importance in mothers' decision to have or not to have their adolescent daughters vaccinated against HPV.

As mothers are considered the primary healthcare decision-makers in families, they were chosen to participate. Specifically, the study population was 3,558 mothers of 13-year-old daughters (either vaccinated or not) who were residents of the Central Denmark Region. Individual electronic links to a survey were sent to all participants in March 2018.

Overall, 32.5% (n=1,157) of respondents reported having first heard about HPV vaccination from news media, whereas substantially fewer reported first having heard of it from social media (n=31, 0.87%) or their general practitioner, or GP (n=374, 10.5%). A substantially larger proportion of mothers reported having heard about HPV vaccination from TV programmes (n=2,386, 67.1%), news (n=2,586, 72.2%), and social media (n=1,404, 39.5%) at a later point.

The survey-based cross-sectional study showed factors favourable for accepting vaccination were general practitioner (GP) recommendation, valuing information from the GP and health authorities, and involving the daughter's father. Some communication-related details:

• Mothers who had first heard of HPV vaccination from their GP were more likely to vaccinate than those who had not (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54; 0.99). Strong associations were found between vaccine uptake and GP recommendation (OR 0.17, 95% CI 0.10; 0.30) and seeking GP guidance (OR 0.63, 95% CI 0.50; 0.78).
• A strong association was found between agreeing with the daughter's father to vaccinate (OR 0.60, 95% CI 0.37; 0.96).

Inversely, a less favourable socioeconomic status, a negative first impression of the HPV vaccination, valuing social and news media, and distrust in information sources were strongly associated with a higher probability of not vaccinating one's daughter. Some communication-related details:

• Mothers who had first heard about the vaccine through social media were more likely to decline vaccination than those who had not (OR 2.15, 95% CI 1.00; 4.61).
• Vaccination decline was associated with valuing media stories (OR 3.57, 95% CI 2.63; 4.85) and distrusting the first source of information (OR 2.49, 95% CI 1.92; 3.23).
• There were associations between both a negative first and overall impression and declining vaccination (OR 4.05, 95% CI 3.28; 5.00, and OR 14.9, 95% CI 12.17; 18.16, respectively).

As these results show, mothers turn to the media in search for information when making healthcare decisions, and mothers who decline vaccination value media stories significantly higher than health authorities compared with mothers who accept vaccination. The researchers point out that "Media is rarely transparent, complete or correct when reporting on HPV vaccination..., which may be attributed to the fact that media reports on health topics are rarely written by science specialists....Furthermore, an increase in media debates has been shown to result in a higher level of information seeking and a higher rate of reported side-effects..." The worry is that "Contemporary media reports of alleged side-effects are therefore not only harmful at the time of publication; they leave a lasting impression causing long-term damage to public health."

Despite this analysis, the researchers conclude that personal factors such as distrust in information sources and personal relations (exemplified by the importance of GP recommendation, agreeing with the daughter's father, and valuing stories of vaccinees) were more important determinants of vaccination than the information sources themselves, which indicates that mothers make healthcare decisions based on their own beliefs rather than on knowledge.