ReviewA systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability☆
Introduction
The recent availability of human papillomavirus (HPV) vaccines provides the potential for a major step forward in reducing the public health burden of the most common sexually transmitted infection in the United States (U.S.). Yet, this will only occur if there is widespread uptake of the vaccine. Behavioral interventions to ensure broad population coverage require an understanding of vaccine acceptability and the factors that predict it. Recently, there has been a proliferation of studies of this type. Several comprehensive reviews have summarized findings from published studies [1], [2], [3], [4]. Across studies involving women, adolescents and parents, ratings of vaccine acceptability have generally been high. Nevertheless, numerous studies document concerns regarding issues of vaccine safety [5], [6], [7], efficacy [6], [7], [8], cost [9], [10], [11], [12], [13], and among parents, the potential impact of vaccination on adolescent sexual behaviors [14], [15], [16]. Findings regarding other potential salient factors in decision-making about vaccination, such as perceived severity and susceptibility to HPV infection, have been inconsistent [1], [17].
Existing reviews cite difficulties in cross-comparison of study findings due to differences in study designs, sampling methods and populations, and in addition, differences in methods for assessing constructs related to vaccine acceptability [1], [2], [3], [4]. In particular, the lack of standardized theoretical and operational definitions of constructs hypothesized to influence vaccine uptake creates concern about use of available data to guide interventions. In the absence of standardized methods for defining and measuring theoretical constructs, it is not possible to know if inconsistent findings are the result of differences in measurement or true variability across study populations. A high degree of measurement error could lead to erroneous findings, leading researchers either to abandon a line of inquiry that is worthy of further study, or to accept associations where none exist.
Given the early stage of this field and the rapid pace of new research, this is an opportune time to evaluate measures of HPV vaccine acceptability and to consider next steps to strengthen them. Thus, the aims of this paper are to: (1) systematically review measures used in published studies of HPV-vaccine knowledge, attitudes and behaviors; (2) describe their characteristics and psychometric properties; and (3) provide recommendations to improve the measurement of constructs in future studies.
Section snippets
Methods
We sought primary reports that presented quantitative data of HPV and HPV-vaccine related knowledge, attitudes, beliefs and acceptability. Studies included were those conducted in the English language and that sampled parents, other young adults or adolescents in an industrialized country. Qualitative studies, case reports, reviews, presentations of clinical guidelines and studies of health care providers were excluded.
A trained health services librarian with experience in conducting and
Results
All citations (N = 1052) were reviewed for eligibility based on titles and abstracts. Of these 367 required full-text reviews, 79 studies met inclusion criteria.
Conclusions
We believe this to be the first systematic review of measurement instruments used in published studies to assess knowledge, attitudes and beliefs, and behaviors regarding the HPV vaccine. In a prior review, Tiro et al. [68] examined items used to measure vaccine behaviors in national surveillance programs. Other reviews [1], [3] have synthesized findings of studies addressing HPV knowledge and attitudes or beliefs about the HPV vaccine. The existing body of literature on HPV vaccine
Recommendations
We offer several recommendations about development and reporting of measures, in hopes of motivating efforts toward the development and use of standardized measures with demonstrated validity and reliability. We begin with recommendations that are applicable to measurement of any study topic, then address some of the unique challenges of measuring acceptability and uptake of a new vaccine for a sexually transmitted disease.
As this field of research advances, it is critical that increased
Acknowledgements
Research for this publication was supported by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) cooperative agreements for the Cancer Prevention and Control Research Networks (CPCRN) at Emory University School of Public Health (1-U48-DP00043); Harvard School of Public Health/Boston School of Public Health (1-U48-DP000064); Morehouse School of Medicine, Prevention Research Center (1-U48-DP000056); University of California at Los Angeles School of
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The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.