Predictors of Human Papillomavirus (HPV) vaccine uptake among young rural women

Purpose: To identify referent normative influences predicting uptake of free Gardasil offered to rural Appalachian women ages 18 to 26. Methods: Young women (N=495) were recruited from health clinics and community colleges in rural Southeastern, Kentucky. After completing a brief questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for the initial dose of vaccine served as the study outcome variable. Hierarchical logistic regression was used to estimate the influence of four normative referents (healthcare providers, friends, mothers, and fathers) on the outcome variable. Results: One-quarter of the sample (25.9%) received dose 1. In controlled analyses, 3 of the 4 referent norms retained significance. Women indicating their healthcare provider suggested taking the vaccine were about 1.64 times more likely to be vaccinated. Similarly, women indicating their friends would "definitely" want them to be vaccinated and their fathers would “definitely” want them to be vaccinated were 1.64 times and 1.61 times, respectively, more likely to be vaccinated. The influence of mothers as a normative referent did not retain significance (P = .46) in the regression model. Interaction effects occurred between recruitment site (clinic vs. college) and all three of the referent norms retaining multivariate significance with uptake. Each effect indicated that the obtained association only applied to women recruited from clinics. Conclusion: Uptake of free HPV vaccination in this rural population was quite low. Interventions may benefit by targeting 3 referent sources: fathers, healthcare providers, and by favorably altering peer norms.