Low Health Literacy and HPV Vaccine Uptake of African American and Hispanic American Women

Low Health Literacy and HPV Vaccine Uptake of African American and Hispanic American Women by Peter Ntiamoah MPH, Walden University, 2011 BA, Baruch College of the City University of New York, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University May 2018 Abstract Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic AmericanCervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18–26, and the low HPV vaccination uptake. The integrated behavioral model, which identifies factors antecedent to behavioral intention, as well as the motivating variables, was the theoretical framework. Secondary data from the 2015 National Health Interview Survey were used to examine the relationships among the variables of interest. A logistic regression (n = 2093) showed that health literacy is a strong determinant of HPV vaccine behavior intention, and that there was a significant relationship between health literacy and HPV vaccine initiation. Health literacy mediated the relationships between the motivating variables and the vaccine uptake, and completely mediated the relationship between ethnicity and HPV vaccine uptake. Health literacy did not independently predict the vaccine initiation. The findings from this study might (a) provide public health practitioners with enough information to guide health promotion activities to increase the vaccination coverage to the level expected in Healthy People 2020, (b) save economic resources through cancer prevention, and (c) improve lives by curbing the excess deaths among racial minority women. Low Health Literacy and HPV Vaccine Uptake of African American and Hispanic American Women by Peter Ntiamoah MPH, Walden University, 2011 BA, Baruch College of the City University of New York, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University May 2018 Dedication This dissertation is dedicated to my wife, Barbara Tallula Ntiamoah, and my three adorable children, Jeremiah, James, and Janyce. Acknowledgments I wish to express my sincere appreciation to special people who contributed in many diverse ways to make my dissertation a success. I stand at the pinnacle only because the Lord Almighty granted me the strength and many people held my hand. Many others selflessly offered their shoulders to carry me through the journey. My first appreciation goes to my dissertation chair, Dr. Frazier B. Beatty, whose guidance, patience, encouragement, prompt responses to all dissertation concerns, deep understanding of methodology, and commitment to academic excellence made it possible for me to complete this study successfully. I also wish to thank my committee member, Dr. Precilla Belin, for her invaluable input into the content and organization of this dissertation. My appreciation also goes to Dr. LaToya Johnson, the URR whose contributions and expertise ensured that this dissertation met Walden University’s highest doctoral standard. I am grateful to Barb Elwert for her awesome edit of my dissertation. I am particularly grateful to my wife, Barbara Tallula Ntiamoah, who has been a true friend and a source of encouragement since our high school days. I thank my children, Jeremiah, James, and Janyce, for their moral support, encouragement, sacrifices, and understanding of the tremendous commitment needed to complete this PhD journey. With a heart full of gratitude, I wish to express sincere appreciation to my brothers, Samuel, Sampson, Benjamin, Richard (Abaa), Adolf, Patrick, and Big Mike; and sisters, Gina (Judith), Beatrice, Rose, Cecilia, Julie, and Naomi for their prayers and moral support. I thank my father, the late Corporal Joseph Atta Kyei, and my mother, Mrs. Comfort Kyei, for sacrificing everything to ensure that I received a high-quality education. I also am grateful to all of my nephews, nieces, family members, distant relatives, and colleagues who encouraged me along the way. Finally, I am grateful to the Lord Almighty for the strength and grace to complete the PhD program. All the glory is ascribed unto Him, making it possible for me to reach this height on the educational ladder.