Mother-Daughter Joint Decision Making to Obtain the HPV Vaccine

描述（由申请人提供）：人乳头瘤病毒（HPV）是宫颈癌和生殖器疣的前体。人类乳头瘤病毒16和18株被认为是70%宫颈癌的前体。HPV毒株6和11与90%的生殖器疣有关。2006年，美国食品和药物管理局（FDA）批准了一种预防这四种HPV类型的疫苗。最近的估计表明，在美国，只有18%的少女接受了三剂系列疫苗。子宫颈癌对少数民族的影响尤为严重。与非拉丁裔白人妇女相比，拉丁裔妇女的宫颈癌发病率是后者的2至4倍。研究还表明，HPV在少数民族妇女中的患病率更高。我们的调查将以预防行为的信息-动机-行为技能（IMB）模型（Fisher & Fisher, 1992; Fisher, Fisher, & Shuper, 2009）和文化因素的结合为指导。我们建议的调查将包括三个顺序进行的研究：两个定性和一个定量。定性研究1将包括半结构化访谈，分别对30名母亲和30名未接种疫苗的女儿进行访谈。定性研究1的目的是确定：a)在今后的干预中，向母亲和女儿提供关于人乳头瘤病毒和疫苗的信息的格式和沟通来源，同时考虑到卫生素养和计算能力；b)在考虑文化因素的同时，阻止和鼓励接受疫苗接种；(c)母亲和女儿认为她们需要的技能和资源，以便在性问题和采取与性有关的健康预防措施（如接种疫苗）方面相互有效沟通。定性研究2的目的是证实和扩展我们在定性研究1中的发现。定性研究2将包括与30名母亲和30名接种疫苗的女儿分别进行的半结构化访谈。定性研究2的目的是阐明：a)关于HPV病因学和疫苗接种的知识，b)如何做出接种疫苗的决定，以及c)母亲和女儿在讨论与性有关的预防行为时的舒适程度。最后，定量研究的目的将是建立与疫苗接种决策有关的领域——信息、动机、行为技能——预测150名拉丁裔母亲（50%的母亲给女儿接种了疫苗）的疫苗接种决策。拟议研究的结果将用于进行R01，以开发和试点测试未来的干预措施，以促进拉丁裔社区采用HPV疫苗。我们的目标的实现将为基于明确定义的潜在决策机制的干预措施的发展提供信息，这对于采取疾病预防行为至关重要，这种行为有可能大大减少癌症的种族健康差异。此外，我们在研究中收集的信息可以翻译成

DESCRIPTION (provided by applicant): The Human Papillomavirus (HPV) is a precursor of cervical cancer and genital warts. HPV strains, 16 and 18, are recognized as precursors of 70% of cervical cancers. HPV strains, 6 and 11, are associated with 90% of genital warts. In 2006, the U.S. Food and Drug Administration (FDA) licensed a vaccine to protect against these four HPV types. Recent estimates indicate that only 18% of teenage girls have received the three-dose series in the U.S. Cervical cancer affects ethnic minorities disproportionately. Cervical cancer incidence is two to fourfold in Latina women when compared to non-Latina white women. Research also suggests that the prevalence of HPV is greater in ethnic minority women. Our inquiry will be guided by a combination of the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior (Fisher & Fisher, 1992; Fisher, Fisher, & Shuper, 2009) and cultural factors. Our proposed investigation will consist of three studies conducted in sequence: two qualitative and one quantitative. Qualitative study 1 will consist of semi-structured interview conducted separately with 30 mothers and 30 non-vaccinated daughters. The purpose of qualitative study 1 will be to identify: a) format and communication source to provide information, in a future intervention, to mothers and daughters about HPV and the vaccine while considering health literacy and numeracy, b) deterrents and motivators of vaccination acceptance while considering cultural factors, and c) the skills and resources that mothers and daughters perceive they need to be self-efficacious in communicating effectively with one another regarding sexuality and the adoption of sexuality-related health preventive measures such as vaccination. The objective of qualitative study 2 will be to corroborate and expand our findings from qualitative study 1. Qualitative study 2 will consist of semi-structured interviews conducted separately with 30 mothers and 30 vaccinated daughters. The purpose of qualitative study 2 will be to elucidate: a) knowledge about HPV etiology and vaccination, b) how the decision to vaccinate was made, and c) mother and daughter level of comfort in discussing sexuality- related preventive behaviors. Lastly, the purpose of the quantitative study will be to establish that the domains pertaining to the decision to vaccinate- information, motivation, behavioral skills-predict vaccination decisions in a sample of 150 Latina mothers (50% who have vaccinated their daughters). The findings from the proposed study will be used to pursue an R01 to develop and pilot test a future intervention to promote adoption of the HPV vaccine in the Latino community. The accomplishment of our aims will inform the development of an intervention based on well-defined underlying decision-making mechanisms critical to the adoption of a disease preventive behavior that has the potential to considerably reduce ethnic health disparities in cancer. In addition, information gathered in our studies can be translated to promote uptake of the HPV vaccine by health care practitioners impacting directly the field of nursing science. PUBLIC HEALTH RELEVANCE: The findings from this research will be used to inform the development of an intervention to promote vaccination in the Latino community. In addition, the findings will inform health care practitioners of the information that can be provided to Latinas, n the patient-provider encounter, to motivate vaccination.