Dissertation
Effect of health beliefs and acculturation on HPV vaccine acceptance among Asian Indian parents
Doctor of Nursing Practice (D.N.P.), Drexel University
Jan 2016
DOI:
https://doi.org/10.17918/etd-6686
Abstract
Background: Asian Indians are considered the third largest Asian community in the United States numbering 3.2 million per records from the U.S. census bureau for the year 2010, but little is known about Asian Indian parents' acceptance of the HPV vaccine for their children. Human Papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Even though HPV vaccination is highly effective in preventing HPV infection, many studies have proposed that the vaccination rates in general are low. According to the teen vaccination coverage report by Center for Disease Control in 2014, only 37.6% of girls and 13.9% of boys between the age group of 13 - 17 years received all three doses of HPV vaccination. The key determinant of HPV vaccination rates is parental acceptance. The major factors affecting parental acceptance of HPV vaccination include health beliefs, educational level, religion, child's gender, subjective norms, (peer, family, and social pressure), and personal experience of the disease. While there are several studies in the U. S that have examined parental acceptance of HPV vaccination in general, to date there were no studies specifically focusing on Asian Indian parents living in the U. S, nor any that had assessed the effects of acculturation (cultural identity) on HPV acceptance in the commonly available databases. Therefore, because the factors affecting HPV vaccination acceptance of Asian Indian parents are unknown, the purpose of this study was to determine the effects of health beliefs (perceived seriousness, perceived susceptibility, perceived barriers, perceived benefits) and acculturation (cultural identity) and to explore the effects of educational level, religion, child's gender, subjective norms, and personal experience of the disease on Asian Indian parental acceptance of the HPV vaccine. Methods: A comparative descriptive cross-sectional design based on a theoretical framework of Health Belief Model was used for the study. The sample, Asian Indian parents, who have children between the ages of 9-16 years, were recruited from various places of worship and community organizations from the Houston Metropolitan area and all over the U.S. Participants were recruited directly, with the help of formal and informal leaders of these organizations and through email. Participants were provided with a web-link for the research survey to assess the effect of health beliefs, acculturation, and demographic factors on HPV vaccine acceptance. As established by previous research on non-Asian Indian parents, the acceptance of at least one dose of HPV vaccination was expected to be 45% and the acceptance of Hepatitis B vaccination to be 90%. Using the above estimates, a sample size of 160 participants was deemed sufficient to achieve 81% power to detect a difference between group proportions of 0.45 with a significance level (alpha) of 0.05 using a two-sided two dependent group McNemar test. The same sample size is sufficient for hierarchical logistic regression analysis to achieve 81% power, 0.05 alpha, and a 1.65 Odds Ratio. The expected survey response rate was about 50%, based on previous research conducted to examine variations in response rates to email surveys. Data Analysis: The obtained data was directly entered into SPSS and then cleaned, coded, and checked for shape of distribution and outliers, and then analyzed using descriptive statistics. The rates of HPV vaccination acceptance was compared to Hepatitis B vaccination acceptance using a two-sided two dependent group McNemar Chi square test. The effect of health beliefs and acculturation on vaccination acceptance was carried out using hierarchical logistic regression models. Educational level, religion, and child's gender were added as covariates in the first step; subjective norms, and personal experience of the disease were added as co-variates in the second step; and health beliefs and acculturation were added in the third step of the logistic regression model. Results: The findings suggested that Asian Indian parents were significantly more likely to accept Hepatitis B vaccination than HPV vaccination (OR = 27.7, P = <0.0001). Among health beliefs, parents who expressed higher levels of perceived barriers were less than half as likely to accept HPV vaccination acceptance (OR = 0.47, P = 0.02). Subjective norms excluding spousal opinion positively predicted HPV vaccination acceptance where parents were more than one and half times more likely to accept the vaccination (OR = 1.7, P = 0.05). However, among the subjective norms variables, spousal opinion predicted a negative effect on vaccination where parents were slightly more than half as likely to accept the vaccination (OR = 0.59, P = 0.01). Implications: Knowledge from the findings of this study may inform educational programs to improve Asian Indian parental vaccination acceptance rates and reduce the prevalence of HPV and its sequelae among their children. Likely factors influencing HPV vaccination acceptance among Asian Indian parents became evident through this study conforming to the modified HBM theoretical framework used, displaying the effect of perceived barriers and subjective norms on vaccination acceptance. Educational interventions targeting perceived barriers, spousal opinion, pediatric providers, and other significant people who have an influential effect on parents may positively affect HPV vaccination rates among this population. Moreover, educating healthcare personnel, including providers and nurses about these specific factors may help to modify their approach in promoting HPV vaccination.
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Details
- Title
- Effect of health beliefs and acculturation on HPV vaccine acceptance among Asian Indian parents
- Creators
- Daisy George Mullassery - DU
- Contributors
- Bobbie Posmontier (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Nursing Practice (D.N.P.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Doctoral Nursing; Nursing (Graduate); College of Nursing and Health Professions; Drexel University
- Other Identifier
- 6686; 991014632152204721