title: Uptake of the human papillomavirus vaccine in Kenya: testing the health belief model through pathway modeling on cohort data.
abstract: Many studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. This study investigated the utility of the Health Belief Model (HBM) in predicting HPV vaccine uptake in Kenya, focusing on the importance of promotion, probing willingness to vaccinate as precursor of uptake and exploring the added value of personal characteristics.
  
  
  
  Longitudinal data were collected before and after a pilot HPV vaccination program in Eldoret among mothers of eligible girls (N = 255). Through pathway modeling, associations between vaccine uptake and the HBM constructs, willingness to vaccinate and adequate promotion were examined. Adequate promotion was defined as a personal evaluation of promotional information received. Finally, baseline cervical cancer awareness and socio-demographic variables were added to the model verifying their direct, mediating or moderating effects on the predictive value of the HBM.
  
  
  
  Perceiving yourself as adequately informed at follow-up was the strongest determinant of vaccine uptake. HBM constructs (susceptibility, self-efficacy and foreseeing father's refusal as barrier) only influenced willingness to vaccinate, which was not correlated with vaccination. Baseline awareness of cervical cancer predicted uptake.
  
  
  
  The association between adequate promotion and vaccination reveals the importance of triggers beyond personal control. Adoption of new health behaviors might be more determined by organizational variables, such as promotion, than by prior personal beliefs. Assessing users' and non-users' perspectives during and after implementing a vaccination program can help identifying stronger determinants of vaccination behavior.
authors.affiliation: International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000, Ghent, Belgium. heleen.vermandere@ugent.be.
authors.forename: Heleen
authors.initials: H
authors.lastname: Vermandere
authors.affiliation: University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: van Stam
authors.affiliation: Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000, Ghent, Belgium.
authors.forename: Kristien
authors.initials: K
authors.lastname: Michielsen
authors.affiliation: International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000, Ghent, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Degomme
authors.affiliation: Department of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Oort
mesh_terms: D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity; D053918:Papillomavirus Vaccines / Q000494:pharmacology* / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010865:Pilot Projects; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cohort; HPV vaccination; Health Belief Model; Kenya; Pathway modeling