title: A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands.
abstract: Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter that is invited for the HPV vaccination.
  
  
  
  In February 2014, parents/guardians living in Amsterdam were invited to complete a questionnaire about social-psychological determinants of their decision making process regarding the HPV vaccination of their daughter and socio-demographic characteristics. This questionnaire was sent approximately one month before the daughter was scheduled to receive her first HPV vaccine dose. Their daughters' HPV vaccination status was retrieved from the national vaccination database. We distinguished four ethnic groups: Dutch (NL), Surinamese, Netherlands Antillean, and Aruban (SNA), Middle-Eastern and North-African (MENA), and Other. To assess the impact of determinants on both intention and uptake, linear and logistic regression analyses were used respectively. Missing data were imputed using multiple imputation by chained equation.
  
  
  
  In total 1,309 parents/guardians participated (33% participation rate). In all groups we found the mothers' intention to be the strongest predictor of their daughters' HPV vaccination uptake. Explained variance of uptake was highest in the NL-group (pseudo-R2:0.56) and lower in the other ethnic groups (pseudo-R2varied between 0.23 and 0.29). The lower explained variance can be attributed to the relative large proportion of participants with a positive intention that finally did not go for vaccination in the SNA-group (11%) and MENA-group (30%). Explained variance (R2) of intention varied between 0.66 and 0.77 across ethnic groups, and was best explained by the proximal social-psychological determinants. The strength of association of these determinants with both intention and uptake were largely similar across ethnic groups.
  
  
  
  We conclude that the same determinants should be targeted in the different ethnic groups, although the mode of delivery of the intervention needs to be tailored to the different cultural backgrounds. Further research is needed to explain the observed discrepancy between intention and uptake, especially among parents/guardians in the non-Dutch groups.
authors.affiliation: Department of Infectious Diseases, Research and Prevention, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands. nalberts@ggd.amsterdam.nl.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands. nalberts@ggd.amsterdam.nl.
authors.forename: Catharina J
authors.initials: CJ
authors.lastname: Alberts
authors.affiliation: Department of Infectious Diseases, Research and Prevention, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Maarten F Schim
authors.initials: MF
authors.lastname: van der Loeff
authors.affiliation: Department of Youth Health Service, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hazeveld
authors.affiliation: Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
authors.affiliation: Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: van der Wal
authors.affiliation: Department of Youth Health Service, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Nielen
authors.affiliation: Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: Fatima
authors.initials: F
authors.lastname: El Fakiri
authors.affiliation: Department of Infectious Diseases, Research and Prevention, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.affiliation: TNO (Netherlands Organization for Applied Scientific Research), Expertise Centre Child Health, Leiden, The Netherlands.
authors.forename: Theo G W M
authors.initials: TG
authors.lastname: Paulussen
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008137:Longitudinal Studies; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Ethnicity; HPV; Population-based; Vaccination acceptability; Vaccination uptake; the Netherlands