title: Intent to participate in future cervical cancer screenings is lower when satisfaction with the decision to be vaccinated is neutral.
abstract: BACKGROUND
  HPV vaccination programs have adversely affected participation in future cervical cancer screening. The purpose of this study is to determine the influence of decision satisfaction with accepting/rejecting the HPV vaccine, as well as traditional clinical factors, on the intent to participate in future screening.
  
  
  RESULTS
  From January 2011 through August 2012 women 18-26 years old presenting for health care in an urban college student health and wellness clinic in the US Midwest were asked to complete a descriptive and medical history survey including a six element decisional satisfaction survey scored on 5-point Likert scales, where the intent to participate in future cervical cancer screening was measured. Of the 568 women who completed the decisional satisfaction survey, 17% of those <21 years and 7% ≥ 21 years indicated no intent to participate in future cervical cancer screenings. Among women of current screening age, the univariate risk factors of race/ethnicity, contraceptive use, number of lifetime sexual partners, and receipt of HPV vaccine were not predictors of intent for future cervical cancer screening. Instead, only a history of a prior Pap test was a significant positive predictor and only a decisional satisfaction of 'neutral' (Likert score = 3) for any of the four decisional satisfaction elements was a significant negative predictor. For the decisional satisfaction element "best for me personally", there was a 78% decreased likelihood of intending to participate in future screening if the satisfaction was neutral rather than firm (aOR = 0.22, 95% CI: 0.05-0.91) and a 26 fold increased likelihood if she had had a prior Pap test (aOR = 26, 95% CI: 5-133).
  
  
  CONCLUSIONS
  HPV vaccination implementation programs must help women be the owner of their decision around HPV vaccination and understand the importance of future participation in cervical cancer screening.
authors.affiliation: Department of Community and Family Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States of America; Department of Family Medicine, Kansas City University of Medicine and Biosciences, Kansas City, Missouri, United States of America.
authors.forename: Natalie Marya
authors.initials: NM
authors.lastname: Alexander
authors.affiliation: Department of Community and Family Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States of America; Department of Obstetrics and Gynecology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States of America; Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States of America; University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Diane Medved
authors.initials: DM
authors.lastname: Harper
authors.affiliation: University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Johanna Claire
authors.initials: JC
authors.lastname: Comes
authors.affiliation: University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Melissa Smith
authors.initials: MS
authors.lastname: Smith
authors.affiliation: University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Melinda Ann
authors.initials: MA
authors.lastname: Heutinck
authors.affiliation: University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Sandra Martin
authors.initials: SM
authors.lastname: Handley
authors.affiliation: Department of Community and Family Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States of America; University of Missouri-Kansas City Student Health and Wellness, University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: Debra Ann
authors.initials: DA
authors.lastname: Ahern
mesh_terms: D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs; D033182:Intention; D015146:Midwestern United States / Q000453:epidemiology; D016017:Odds Ratio; D053918:Papillomavirus Vaccines / Q000276:immunology; D010342:Patient Acceptance of Health Care; D010549:Personal Satisfaction; D011446:Prospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines