Parents' Stigmatizing Beliefs about the HPV Vaccine and Their Association with Information Seeking Behavior and Vaccination Communication Behaviors

"...findings illustrate how stigmatizing beliefs about the HPV vaccine are associated with parents' communication and information-seeking processes."

Research has established that stigmas that associate the human papillomavirus (HPV) vaccine with sexual activity and promiscuity are prevalent among parents of vaccine-eligible children, especially those in cultural contexts that value sexual purity. This study explores the associations between stigmatising beliefs about the HPV vaccine and variables that might underlie stigma's negative impact on vaccine uptake - namely, variables related to information-seeking and communicating about the vaccine. The hope is to shed light on potential leverage points where health promotion efforts could potentially mitigate the effects of stigmatising beliefs on vaccine uptake.

The framework for the study is the model of stigma management communication (SMC Model), which predicts that people who accept that a public stigma perception exists but who do not accept that the stigma applies to themselves will engage in avoidance behaviours to distance themselves from the stigma. Applied to HPV vaccination, the SMC Model predicts that parents who perceive an association between the HPV vaccine and sex-related stigma will avoid conversations about the HPV vaccine with their child's healthcare provider. Parents with stigmatising beliefs may instead turn to alternative means of seeking health information, such as friends, family members, or the internet. Because doctor recommendations have been identified as important facilitators of HPV vaccine uptake, preference for alternative sources of information may contribute to missed opportunities for doctors to persuade parents to have their child vaccinated and subsequently lower vaccination intentions. These theorised relationships are summarised in the figure above.

Parents of vaccine-eligible children (n = 512) were surveyed in a large urban clinical network in the United States. Most parents had positive attitudes toward vaccination in general, responding that they would either definitely or probably plan have their child receive the HPV vaccine. That said, a notable portion of parents reported stigmatising beliefs about the HPV vaccine, such as "My child is too young". Such cognitions help parents distance their children and themselves from sex-related stigma associated with the HPV vaccine, a common response to stigma outlined in the SMC model.

Four of the five stigmatising beliefs measured were associated with lowered intentions to vaccinate; only "My child is too young" was associated with higher intentions to vaccinate. Among the other findings: Parents who agreed or strongly agreed with the belief "My child is too young to get a vaccine for a sexually transmitted infection" were significantly more likely than parents who disagreed with the belief to report lower self-efficacy scores in speaking with their doctor. "Parents who hold this stigmatizing belief may especially benefit from educational materials that they can consult independently from a doctor. Interventions that deliver educational materials to parents should be theoretically- and empirically-based, with methods designed to enhance parent communication self-efficacy and mitigate stigma-related barriers to vaccination."

Notably, parents who reported the stigmatising belief "It [the HPV vaccine] might make my child think it's okay to have sex" had significantly higher odds of reporting social media as a source of information than parents who did not report this belief. ("[S]ocial media may serve as a place where uneasy parents feel more comfortable seeking information about the HPV vaccine, but it also may reinforce, rather than refute, stigmatizing beliefs...") However, parents who endorsed the other stigmatising beliefs did not seek out alternative information sources; "these findings suggest that stigmatizing beliefs might instead shut down parents' interest in information-seeking behaviors - perhaps because they feel uncomfortable thinking about the possibility of their child's future sexual initiation and ensuing HPV risk..."

Based on their analysis, the researchers argue that studies that only measure stigma in terms of parents' perception that the vaccine would promote adolescent sexual activity or make their child more likely to have sex fail to capture the broader range of stigmatising beliefs held by parents that act as a barrier to communicating with providers. Also: "Future research should continue to investigate feasible methods for supporting providers in assessing and remediating stigma-associated beliefs of parents."

In conclusion, this study highlights the importance of doctor recommendations to all patients at recommended ages, noting that doctor visits represent a key opportunity to normalise HPV vaccination and address parents' stigmatising beliefs about the HPV vaccine.