title: General practitioners' attitudes and behaviors toward HPV vaccination: A French national survey.
abstract: OBJECTIVE
  General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.
  
  
  METHODS
  Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.
  
  
  RESULTS
  Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03).
  
  
  CONCLUSIONS
  Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.
authors.affiliation: Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, 13005 Marseille, France; INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Collange
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fressard
authors.affiliation: CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Lorraine University, Paris Descartes University, EA 4360 Apemac, 54505 Vandœuvre-lès-Nancy cedex, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
authors.affiliation: Regional Unions of Healthcare Professionals (Southeastern Region) - Self-employed Physicians (URPS-ML PACA), 13006 Marseille, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Sebbah
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France; INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 75014 Paris, France. Electronic address: pierre.verger@inserm.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D053918:Papillomavirus Vaccines
keywords: General practice; Health personnel attitudes; Papillomavirus vaccines; Risk perception; Vaccine hesitancy