title: Comparatively low attendance during Human Papillomavirus catch-up vaccination among teenage girls in the Netherlands: Insights from a behavioral survey among parents.
abstract: BACKGROUND
  The Dutch Human Papillomavirus (HPV) catch-up vaccination program in 2009 appeared less successful than expected. We aimed to identify the most important determinants of refusing the vaccination.
  
  
  METHODS
  Two thousand parents of girls born in 1996 targeted for HPV vaccination received an invitation letter to participate in a questionnaire study. Two study groups were defined: the first group consisted of parents of girls who had accepted the vaccine and already received the first dose of HPV vaccination. The second group consisted of parents whose daughters were not vaccinated. The questionnaire consisted of a broad spectrum of possible determinants that were revealed after literature search and discussions with the stakeholders.
  
  
  RESULTS
  Four hundred sixty nine questionnaires (24%) were returned, 307 (31%) from those who accepted and 162 (16%) from those who declined the vaccine. The decision not to accept the vaccine was largely determined by: (i) perception that the information provided by the government about the vaccine was limited or biased (OR 13.27); (ii) limited trust, that the government would stop the vaccination program if there were serious side effects (OR 9.95); (iii) lack of knowledge about the effectiveness of the vaccine (OR 7.67); (iv) concerns about the side effects of the vaccine (OR 4.94); (v) lack of conviction that HPV can be extremely harmful (OR 3.78); (vi) perception that the government is strongly influenced by vaccine producers (OR 3.54); and (vii) religious convictions (OR 2.18).
  
  
  CONCLUSIONS
  This study revealed several determinants for HPV vaccination uptake after implementation of the HPV vaccine for adolescent girls. These determinants should be taken into consideration in order to successfully implement HPV vaccination into National Immunization Programs.
authors: Department of Pharmacy, Pharmacoepidemiology & Pharmacoeconomics (PE2), University of Groningen, Groningen, the Netherlands. g.gefenaite@umcg.nl
authors: Giedre
authors: G
authors: Gefenaite
authors: Marieke
authors: M
authors: Smit
authors: Hans W
authors: HW
authors: Nijman
authors: Adriana
authors: A
authors: Tami
authors: Ingrid H
authors: IH
authors: Drijfhout
authors: Astrid
authors: A
authors: Pascal
authors: Maarten J
authors: MJ
authors: Postma
authors: Bert A
authors: BA
authors: Wolters
authors: Johannes J M
authors: JJ
authors: van Delden
authors: Jan C
authors: JC
authors: Wilschut
authors: Eelko
authors: E
authors: Hak
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines