Sense & sensibility: Decision-making and sources of information in mothers who decline HPV vaccination of their adolescent daughters

Background: Vaccination against human papillomavirus (HPV) has been part of the Danish Childhood Vaccination Programme (CVP) since 2009 and initially had a high uptake. Following an intense public debate on the alleged side-effects to the vaccine in 2015, coverage rates declined dramatically leaving the current coverage at 54%.The main aim of this study was to identify differences in the sources of information and factors of importance in mothers' decision to have or not to have their adolescent daughters vaccinated against HPV.

Methods: This cross-sectional study was based on survey and register data from 3,558 mothers of daughters born in 2003 living in the Central Denmark Region. The survey examined, among others, sources of information and factors of value in the decision-making process. Socioeconomic register data were retrieved from Statistics Denmark.Pearson's chi-squared test was used to determine differences in socioeconomic distribution between both respondents and non-respondents, and mothers who had their daughters vaccinated versus those who did not. Associations between vaccination status and various events were estimated using logistic regression.

Results: A strong association was found between vaccine uptake and general practitioner (GP) recommendation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.10; 0.30), seeking GP guidance (OR 0.63, 95% CI 0.50; 0.78) and agreeing with the daughter's father to vaccinate (OR 0.60, 95% CI 0.37; 0.96). Inversely, vaccination decline was associated with a negative first impression of HPV vaccination (OR 4.05, 95% CI 3.28; 5.00), valuing media stories (OR 3.57, 95% CI 2.63; 4.85) and distrusting the first source of information (OR 2.49, 95% CI 1.92; 3.23).

Conclusions: The results indicate that the impression left behind by information sources is more important in determining vaccination status than the information sources themselves, indicating that mothers are liable to make healthcare decisions based on sensibility rather than sense.