Factors influencing HPV knowledge and vaccine acceptability in parents of adolescent children: results from a survey-based study (KAPPAS study)

Figures & data

Figure 1. Child-related factors influencing HPV knowledge and HPV vaccine acceptability. (a) Child gender. (b) Child age. (c) Child vaccination status. Boxplot representations of scores for, from left to right, HPV knowledge (score range: 0 to 40), knowledge and acceptance of vaccines in general (score range: −10 to 10), HPV vaccine knowledge (score range: 0 to 21) and HPV vaccine acceptability (score range: 0 to 5). The line inside the box represents the median. The lower and upper boundaries of each box indicate Q1 and Q3, respectively.

Figure 2. Factors related to family/parental characteristics influencing HPV knowledge and HPV vaccine acceptability. (a) Parent gender. (b) Parental HPV vaccination status. (c) Having at least one daughter. (d) Number of daughters in the family. (e) Having at least one daughter of vaccination age (≥9 y.o.). Boxplot representations of scores for, from left to right, HPV knowledge (score range: 0 to 40), knowledge and acceptance of vaccines in general (score range: −10 to 10), HPV vaccine knowledge (score range: 0 to 21) and HPV vaccine acceptability (score range: 0 to 5). The line inside the box represents the median. The lower and upper boundaries of each box indicate Q1 and Q3, respectively.

Table 1. Multivariate models for HPV knowledge and acceptability of HPV vaccine

Model	HPV knowledge	HPV vaccine acceptability
	Linear regression (p < .001)	Random forest**/importance of each variable in random forest
Independent variables*	Knowledge of HPV vaccine Healthcare source consulted about HPV infection (p < .001)	Child’s vaccination status Total score in knowledge of HPV vaccine Total score in knowledge and acceptability of vaccines in general Healthcare source consulted about HPV vaccine Total score in knowledge of HPV Parent’s vaccination status	498.180 245.713 211.305 186.464 166.057 22.316
R^2	0.511	0.533

*Independent variables are listed in order of importance.

**As the linear regression model has problems with collinearity and link function, a model based on a Random Forest algorithm was developed. The Random Forest model cannot produce regression coefficients, although the order of the variables included is indicative of their relative importance in the model.

Figure 3. Influence of consulting healthcare sources about HPV infection (a) or HPV vaccine (b) on HPV knowledge and HPV vaccine acceptability. Boxplot representations of scores for, from left to right, HPV knowledge (score range: 0 to 40), knowledge and acceptance of vaccines in general (score range: −10 to 10), HPV vaccine knowledge (score range: 0 to 21) and HPV vaccine acceptability (score range: 0 to 5). The line inside the box represents the median. The lower and upper boundaries of each box indicate Q1 and Q3, respectively.

Table 2. Knowledge and acceptability scores according to whether or not respondents had consulted each healthcare source

Type of source and variable	Gave information about	Not consulted mean (SD)	Consulted mean (SD)	p
Pediatrician
HPV knowledge	HPV	29.28 (3.89)	29.98 (3.68)	0.001
	HPV vaccine	28.83 (4.22)	29.71 (3.96)	<0.001
Vaccine knowledge and acceptance	HPV	6.64 (3.20)	6.77 (3.07)	0.487
	HPV vaccine	6.53 (3.20)	6.88 (3.02)	0.045
HPV vaccine knowledge	HPV	15.57 (2.81)	16.17 (2.60)	<0.001
	HPV vaccine	15.39 (2.78)	16.16 (2.53)	<0.001
HPV vaccine acceptance	HPV	3.08 (1.33)	3.86 (1.17)	<0.001
	HPV vaccine	2.86 (1.36)	3.83 (1.11)	<0.001
General Physician
HPV knowledge	HPV	29.60 (3.80)	29.48 (3.88)	0.747
	HPV vaccine	29.26 (4.11)	29.95 (3.87)	0.022
Vaccine knowledge and acceptance	HPV	6.71 (3.17)	6.61 (2.80)	0.755
	HPV vaccine	6.74 (3.11)	6.77 (3.03)	0.916
HPV vaccine knowledge	HPV	15.84 (2.73)	15.79 (2.81)	0.848
	HPV vaccine	15.80 (2.66)	16.20 (2.58)	0.038
HPV vaccine acceptance	HPV	3.40 (1.32)	3.72 (1.20)	0.016
	HPV vaccine	3.38 (1.33)	3.86 (1.07)	<0.001
Gynecologist
HPV knowledge	HPV	29.21 (3.99)	30.49 (3.19)	<0.001
	HPV vaccine	28.99 (4.25)	30.39 (3.41)	<0.001
Vaccine knowledge and acceptance	HPV	6.63 (3.15)	6.85 (3.13)	0.258
	HPV vaccine	6.60 (3.12)	7.12 (2.98)	0.006
HPV vaccine knowledge	HPV	15.58 (2.85)	16.44 (2.33)	<0.001
	HPV vaccine	15.61 (2.72)	16.54 (2.32)	<0.001
HPV vaccine acceptance	HPV	3.31 (1.37)	3.72 (1.12)	<0.001
	HPV vaccine	3.34 (1.36)	3.78 (1.04)	<0.001
Urologist
HPV knowledge	HPV	29.58 (3.82)	31.25 (2.19)	0.069
	HPV vaccine	29.35 (4.08)	31.08 (3.46)	0.023
Vaccine knowledge and acceptance	HPV	6.69 (3.15)	8.00 (2.33)	0.240
	HPV vaccine	6.72 (3.10)	8.50 (2.00)	<0.001
HPV vaccine knowledge	HPV	15.83 (2.73)	17.38 (2.20)	0.087
	HPV vaccine	15.85 (2.66)	16.79 (2.19)	0.047
HPV vaccine acceptance	HPV	3.43 (1.32)	3.25 (0.71)	0.492
	HPV vaccine	3.46 (1.31)	3.71 (0.86)	0.176
Nurse
HPV knowledge	HPV	29.52 (3.82)	30.67 (3.56)	0.008
	HPV vaccine	29.30 (4.11)	30.20 (3.67)	0.021
Vaccine knowledge and acceptance	HPV	6.70 (3.14)	6.73 (3.22)	0.930
	HPV vaccine	6.74 (3.10)	6.86 (3.06)	0.689
HPV vaccine knowledge	HPV	15.79 (2.74)	16.49 (2.48)	0.025
	HPV vaccine	15.82 (2.66)	16.37 (2.51)	0.029
HPV vaccine acceptance	HPV	3.41 (1.32)	3.76 (1.15)	0.020
	HPV vaccine	3.43 (1.32)	3.75 (1.23)	0.011
Pharmacist
HPV knowledge	HPV	29.56 (3.81)	30.75 (3.66)	0.082
	HPV vaccine	29.37 (4.07)	29.84 (4.49)	0.528
Vaccine knowledge and acceptance	HPV	6.76 (3.16)	7.59 (2.35)	0.103
	HPV vaccine	6.73 (3.11)	7.65 (2.29)	0.036
HPV vaccine knowledge	HPV	15.80 (2.74)	17.35 (2.06)	<0.001
	HPV vaccine	15.84 (2.65)	16.80 (2.58)	0.051
HPV vaccine acceptance	HPV	3.43 (1.32)	3.68 (0.98)	0.171
	HPV vaccine	3.46 (1.31)	3.65 (0.98)	0.432
Other healthcare professionals
HPV knowledge	HPV	29.49 (3.79)	30.87 (3.88)	<0.001
	HPV vaccine	29.33 (4.07)	30.16 (4.08)	0.074
Vaccine knowledge and acceptance	HPV	6.69 (3.13)	6.78 (3.26)	0.783
	HPV vaccine	6.74 (3.10)	6.92 (2.91)	0.586
HPV vaccine knowledge	HPV	15.76 (2.73)	16.80 (2.66)	<0.001
	HPV vaccine	15.81 (2.65)	16.67 (2.60)	0.004
HPV vaccine acceptance	HPV	3.42 (1.32)	3.59 (1.19)	0.224
	HPV vaccine	3.45 (1.32)	3.63 (0.98)	0.114

Table 3. Knowledge and acceptability scores according to whether or not respondents had consulted other non-healthcare sources

Type of source and variable	Gave information about	Not consulted mean (SD)	Consulted mean (SD)	p
Internet/social media
HPV knowledge	HPV	29.07 (3.84)	30.39 (3.62)	<0.001
	HPV vaccine	29.11 (4.07)	30.20 (3.98)	<0.001
Vaccine knowledge and acceptance	HPV	6.72 (3.11)	6.66 (3.20)	0.756
	HPV vaccine	6.76 (3.07)	6.73 (3.14)	0.877
HPV vaccine knowledge	HPV	15.91 (2.69)	16.19 (2.77)	<0.001
	HPV vaccine	15.69 (2.65)	16.38 (2.58)	<0.001
HPV vaccine acceptance	HPV	3.49 (1.31)	3.34 (1.32)	0.040
	HPV vaccine	3.53 (1.29)	3.27 (1.31)	0.002
School
HPV knowledge	HPV	29.54 (3.83)	30.24 (3.59)	0.070
	HPV vaccine	29.29 (4.14)	30.32 (3.22)	0.002
Vaccine knowledge and acceptance	HPV	6.72 (3.11)	6.50 (3.53)	0.501
	HPV vaccine	6.73 (3.11)	6.95 (2.94)	0.473
HPV vaccine knowledge	HPV	15.76 (2.74)	16.65 (2.57)	0.002
	HPV vaccine	15.78 (2.67)	16.72 (2.29)	<0.001
HPV vaccine acceptance	HPV	3.40 (1.32)	3.73 (1.27)	0.015
	HPV vaccine	3.44 (1.30)	3.75 (1.24)	0.012
Family/Friends
HPV knowledge	HPV	29.55 (3.89)	29.66 (3.68)	0.587
	HPV vaccine	29.27 (4.15)	29.60 (3.92)	0.161
Vaccine knowledge and acceptance	HPV	6.77 (3.16)	6.60 (3.11)	0.359
	HPV vaccine	6.76 (3.13)	6.70 (3.03)	0.669
HPV vaccine knowledge	HPV	15.89 (2.73)	15.76 (2.74)	0.409
	HPV vaccine	15.79 (2.67)	16.00 (2.61)	0.162
HPV vaccine acceptance	HPV	3.51 (1.32)	3.32 (1.31)	0.016
	HPV vaccine	3.55 (1.29)	3.29 (1.29)	<0.001
Press
HPV knowledge	HPV	29.34 (3.82)	30.23 (3.71)	<0.001
	HPV vaccine	29.25 (4.09)	29.93 (3.97)	0.019
Vaccine knowledge and acceptance	HPV	6.58 (3.13)	6.90 (3.15)	0.035
	HPV vaccine	6.71 (3.09)	6.91 (3.10)	0.370
HPV vaccine knowledge	HPV	15.65 (2.78)	16.31 (2.55)	<0.001
	HPV vaccine	15.78 (2.68)	16.25 (2.63)	0.012
HPV vaccine acceptance	HPV	3.48 (1.31)	3.31 (1.33)	0.033
	HPV vaccine	3.55 (1.26)	3.09 (1.38)	<0.001
Radio/TV
HPV knowledge	HPV	29.52 (3.84)	29.78 (3.73)	0.270
	HPV vaccine	29.37 (4.11)	29.43 (3.96)	0.807
Vaccine knowledge and acceptance	HPV	6.59 (3.18)	6.98 (3.03)	0.048
	HPV vaccine	6.71 (3.09)	6.88 (3.08)	0.415
HPV vaccine knowledge	HPV	15.73 (2.78)	16.10 (2.60)	0.029
	HPV vaccine	15.84 (2.66)	15.97 (2.64)	0.470
HPV vaccine acceptance	HPV	3.51 (1.32)	3.24 (1.29)	0.001
	HPV vaccine	3.58 (1.26)	3.05 (1.34)	<0.001
Other
HPV knowledge	HPV	29.53 (3.76)	30.12 (4.14)	0.079
	HPV vaccine	29.44 (3.96)	28.74 (5.20)	0.185
Vaccine knowledge and acceptance	HPV	6.74 (3.09)	6.39 (3.51)	0.203
	HPV vaccine	6.78 (3.05)	6.37 (3.58)	0.273
HPV vaccine knowledge	HPV	15.81 (2.72)	16.03 (2.83)	0.356
	HPV vaccine	15.92 (2.62)	15.19 (2.97)	0.016
HPV vaccine acceptance	HPV	3.46 (1.30)	3.24 (1.39)	0.071
	HPV vaccine	3.50 (1.28)	3.06 (1.45)	0.004

Table

AEP	Spanish Association of Pediatricians
GNV	Gender-neutral vaccination
HCP	Healthcare professionals
HIC	High-income countries
HPV	Human papillomavirus
HSD	Honest significant difference
IEC	Investigational ethical committee
NIP	National immunization program
SARS-Cov2	Severe acute respiratory syndrome coronavirus 2
VCR	Vaccine coverage rate
WHO	World Health Organization