PREVALENCE AND DETERMINANTS OF VACCINE HESITANCY TOWARDS HUMAN PAPILLOMAVIRUS VACCINE AMONG CAREGIVERS OF GIRL CHILDREN AGED 9–14 YEARS ATTENDING THE OUTPATIENT CLINIC IN ANAKAPUTHUR, CHENGALPATTU DISTRICT, TAMIL NADU

Abstract

Background: Human papillomavirus (HPV) vaccination is an important strategy for preventing HPV-related diseases, including cervical cancer. However, vaccine hesitancy among parents and caregivers may limit vaccination uptake. This study assessed the prevalence and determinants of HPV vaccine hesitancy among caregivers of girls aged 9–14 years. Methods: A facility-based cross-sectional study was conducted among 250 parents or primary caregivers of girls aged 9 14 years attending the outpatient department of Anakaputhur Primary Health Centre, Chengalpattu district, Tamil Nadu. Participants were recruited using consecutive sampling. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire covering sociodemographic characteristics, knowledge regarding HPV and HPV vaccination, sources of information, vaccination willingness, reasons for hesitancy and the five domains of the 5C psychological antecedents of vaccination. Vaccine hesitancy was defined as being hesitant or refusing vaccination. Associations were assessed using the chi-square test, independent-samples t-test and multivariable binary logistic regression. Results: Among 250 caregivers, 179 (71.6%) were willing to vaccinate their daughters, 51 (20.4%) were hesitant and 20 (8.0%) refused vaccination, resulting in an overall vaccine hesitancy prevalence of 28.4%. Good knowledge was observed in 87 (34.8%) participants, moderate knowledge in 131 (52.4%) and poor knowledge in 32 (12.8%). Educational status, knowledge level and source of information were significantly associated with hesitancy on bivariate analysis. Healthcare providers were the most commonly reported source of information (36.0%). Insufficient information was the leading reason for hesitancy (28.2%), followed by safety concerns and cost concerns (16.9% each). Compared with non-hesitant caregivers, hesitant caregivers had significantly lower confidence and collective responsibility scores and higher complacency, constraints and calculation scores (all p<0.001). In multivariable analysis, absence of prior information (adjusted odds ratio [AOR] 7.62; 95% confidence interval [CI] 1.52–38.29), higher complacency (AOR 7.91; 95% CI 3.70–16.89) and greater perceived constraints (AOR 6.33; 95% CI 3.05–13.16) were independently associated with higher odds of hesitancy, whereas higher confidence was associated with lower odds (AOR 0.14; 95% CI 0.06–0.30). Knowledge score did not reach statistical significance after adjustment (p=0.053). Conclusion: HPV vaccine hesitancy affected more than one-fourth of caregivers and was associated with information gaps and psychological determinants of vaccination. Healthcare-provider-led counselling, reliable vaccine information, communication addressing vaccine safety and perceived necessity, and measures to reduce practical barriers may help improve caregiver acceptance of HPV vaccination.