# Socio-demographic, provider-related and attitudinal determinants towards HPV vaccination in a French Caribbean territory

Frédérique Dorléans, Gwladys Nadia Gbaguidi, Lucie Léon, Jocelyn Raude, Jacques Rosine, Judith Mueller

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Frédérique Dorléans, Gwladys Nadia Gbaguidi, Lucie Léon, Jocelyn Raude, Jacques Rosine, et al. "Socio-demographic, provider-related and attitudinal determinants towards HPV vaccination in a French Caribbean territory." 2026. hal-05477538

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# Title: Socio-demographic, provider-related and attitudinal determinants towards HPV vaccination in a French Caribbean territory.

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## Authors and affiliations:

1. Frédérique G.E. DORLEANS*, Santé publique France Antilles, Fort-de-France, Martinique, France

Institut Pasteur, Paris, France Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 7572 Paris, France

2. Gwladys Nadia GBAGUIDI, Santé publique France Antilles, Fort-de-France, Martinique, France

3. Lucie LEON, Santé publique France Antilles, Gourbeyre, Guadeloupe, France

4. Jocelyn RAUDE, EHESP, Rennes, France, France

5. Jacques ROSINE, Santé publique France Antilles, Fort-de-France, France

6. Judith E. MUELLER, Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 7572 Paris, France

Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 – 35000 Rennes]

*Corresponding author: Frédérique G. E. DORLEANS

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Email: frederique.dorleans@santepubliquefrance.fr and frederique.dorleans@gmail.com

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Postal address: Santé publique France Antilles

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C/o ARS de Martinique, Centre d'affaires AGORA Zac de l'Etang Z'abricot, Pointe des grives

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CS 80 656 - 97263 Fort de France Cedex

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# 1 Introduction

Human papillomavirus vaccination (HPVV) was introduced in the French National Vaccination Programme in 2007 for girls and in 2021 for boys and is recommended on the basis of a two-doses schedule (1). Despite this national recommendation, HPVV uptakes in Guadeloupe (GuaP) and in Martinique (MQ), two French Caribbean territories where the French public health policy applies, have remained far below the 60% and 90% respective national and 2030 World Health Organization (WHO) HPVV uptake targets. As of 31st of December 2023, 31.5% (GuaP) and 21.9% (MQ) of girls aged 15 years (born in 2008) and 6.8% (GuaP) and 6.3% (MQ) of the same age boys had received at least one dose of HPV vaccine (2). In Continental France, HPVV coverage at age 15-years was 55.6% in girls and 26.6% in boys. This HPVV uptake disparity between the French Caribbean and mainland France raises concerns on current and future health inequalities towards HPV-infections-associated diseases occurrence. In Latin American countries and in the Caribbean, the rates of cervical cancer incidence and mortality have decreased over time, however, they remain above the WHO elimination threshold of 4 per 100,000 (3). Specifically in those two French Caribbean islands of Guadeloupe and Martinique, cancer surveillance reports that cervical cancer standardized incidence rates were 8.7 and 7.2 per 100.000 persons-years respectively, compared to 6.6 per 100.000 persons-years in mainland France.

Several studies have underscored that this higher incidence would be avoidable by higher HPVV uptake and increased adherence to screening (4-6). Social inequalities and determinants in vaccination uptake has gained increased awareness and interest (7). Specifically, research findings on socio-economic, educational and political determinants of HPVV highlighted common features in different countries and settings.
(8-10). A 2021 nationwide survey identified that in Continental France, HPVV status was higher in children's parents with higher education compared to others. Although crucial, such data on a HPVV uptake's social gradient are not available for the French Caribbean islands where socio-economic indicators reflect a more deprived situation than in Continental France. In 2022, 26.7% in Martinique and 34.5% in Guadeloupe are reported to live below the poverty threshold whereas they account for 14.8% in Continental France and the unemployment rates were estimated to reach 18.6% of the active population in Guadeloupe, 15.0% in Martinique whereas 7.3% in Continental France (11, 12). Despite strong evidence demonstrating poorer economic and social outcomes in the French Caribbean as compared to Continental France, we lack evidence on the determinants of health inequalities within these populations specifically targeting HPVV uptake socio-demographic and educational determinants.

In the international literature, there is substantial evidence that vaccine uptake is also related to knowledge, believes and individual psychological determinants, towards vaccination in general or HPVV (13). Socio-demographic and educational factors may impact uptake not only via vaccine accessibility, but also via acceptability. A deeper understanding of low vaccine coverage therefore requires the evaluation of socio-demographic, educational, health-care-related and attitudinal factors.

In our survey, we therefore aimed at investigating socio-demographic and educational determinants of HPVV awareness, uptake and intention in a French Caribbean population (Guadeloupe) as well as exploring knowledge, attitudes and beliefs underlying HPVV.

## 47 Materials and methods

## 48 Study implementation
We conducted a cross-sectional survey in the fifty-two public and private middle schools in Guadeloupe, using an internet-based anonymous questionnaire among parents or legal tutors with at least one child enrolled in one of the school at the time of the survey. According to annual statistics published by the Education Administration, a total of 23,184 pupils were enrolled in middle-age schools in Guadeloupe in 2022-2023. Invitations to participate in the online survey were sent on June 7, 2023, by the central level school administration via the educational online platform (Pronote), followed by two additional reminders on June 14 and June 21, 2023. The invitation included a description of the survey objectives, methods, inclusion criteria and confidentiality regulations along with a web-based link to access the Limesurvey online questionnaire.

The participating parents completed the questionnaire for their eldest child enrolled in middle school. Two of the three-part survey questionnaire included socio-demographic and educational characteristics of the parents or legal tutors, as well as vaccination status, awareness, knowledge, perceptions and behaviour around HPVV safety, accessibility, reputation and benefits.

## Data collection and management

Socio-educational characteristics were assessed through three binary variables : the educational level ("below or equal to high school" and "above high school"), the employment status ("active" for those self-reporting an occupation, students or being on training and "inactive" for those without) and the socio-professional situation ("low-CSP level" and "high-CSP level" according to the INSEE classification). To explore the socio-demographic and economic determinants of HPVV, we defined three outcomes. First, we defined HPVV awareness: respondents answering « Yes » to the
73 question "Have you ever heard about HPV vaccination?" were considered « aware »,
74 while those answering "No" or "I am not sure" were considered as « not aware ».

75 Secondly, we defined HPVV uptake : parents self-reporting that their child had
76 received at least one dose of HPVV were considered « vaccinated », while all others
77 including those answering « I do not know » were considered « unvaccinated ». Third,
78 we defined intention to vaccinate against HPV: parents, aware of HPVV, reporting
79 unvaccinated children were asked whether they intended to vaccinate them. Those
80 answering "I made an appointment to vaccinate my child against HPV" or "I will soon
81 schedule an appointment for my child to be vaccinated against HPV" were considered
82 as intending to vaccinate against HPV, while all others, including those answering « I
83 do not know » were considered as not intending to vaccinate against HPV (Figure 1).

84 We also assessed whether their child has had a medical consultation with the general
85 practitioner over the previous 12 months and whether he/she had offered HPVV. We
86 grouped the parents who self-declared that the child did not see a general practitioner
87 during the past 12 months and the ones who were unsure about it in a "no" modality
88 and we grouped the other parents 'responses as "yes". We collected data on other
89 aspects such as information and vaccination accessibility, vaccination safety and
90 effectiveness, time opportunity, opinion on recommended age, reputation and
91 easiness to talk with the child or a health professional about HPVV and participating
92 parents were asked to indicate their responses on a 5-point-Likert scale (cf. Appendix
93 1).

94 **Data analysis**

95 We performed descriptive analyses on outcomes as well as sociodemographic,
96 educational characteristics, attitudes and practice providing frequencies and
proportions. We developed multivariable logistic regression models for the three outcomes HPVV awareness, HPVV status (among the persons aware of HPVV) and HPVV intention (among the persons aware of HPVV and with an unvaccinated child), using sociodemographic and educational variables as independent variables. In bivariable models we identified independent variables that were associated with outcome variables at a p-value <0.2, and we included these variables in full multivariable models. During stepwise backward procedure, we then selected independent variables contributing at p-value <0.05 to the outcome. For the model on sociodemographic and educational determinants, in a last step, we explored the potential mediation by physician contact and HPVV offer to the HPVV outcomes, by including these variables into the models if they had a p-value <0.2 in bivariable analysis.

We developed two separate models to explore the respective associations of attitudes on HPVV uptake and intention. As we were interested in evaluating global associations between attitudes and outcomes, we did not adjust for sociodemographic factors. We explored the hypothesis that attitudes and HPVV outcomes may both depend on medical offer, by adjusting for this variable in alternative analyses.

## Results

A total of 504 persons connected to the web-based questionnaire and 306 completed the questionnaire on vaccine status, and intention, socio-educational and attitudinal characteristics. Given that there are 23,184 pupils in grades 5th in Guadeloupe, we estimated a participation rate of 1.3%. Almost all participants (93.1%) were mothers, 65.4% self-reported a higher educational level, 85.3% self-declared being professionally active and 52.9% reported belonging to an upper CSP-level. According
to the participants, 52.9% of the children were girls and 81.7% were born between 2009 and 2012 (Table 1). A majority (88.9%) declared that their child had a medical consultation during the previous 12 months. HPVV was offered by the general practitioner to 40.5% of children of whom almost three out of four were girls. Of all participants, 261 (85.3%) reported being aware of HPVV and 77 (25.2%) reported that their oldest HPVV-eligible child (on which the questionnaire focused) had received at least one dose of HPVV. This proportion was 35.8% among girls and 13.2% among boys. Amongst parents aware of HPVV and with an unvaccinated child, 57 (31.2%) intended to vaccinate their child. Three quarters (73.2%) of parents were in favor of vaccination in general and 51.3% declared being informed of vaccination for teenagers. The proportions of parents aware of HPV infections and of HPVV were respectively 87.3% and 85.3% (Figure 1).

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## 134 Socio-educational determinants

HPVV awareness was positively associated with the level of education in the multivariable model. Parents having more than a high-school level degree were 2.4 (95%CI: [1.3 – 4.6]) times more likely to be aware of HPVV compared to others (Table 2). HPVV uptake was associated only with being a girl (OR= 3.6;95%CI: [2.0 – 6.5]) (Table 3). This association was mediated by medical HPVV offer, as it substantially decreased when adjusting for this variable (OR=1.2;95%CI: [0.5–2.7]), which was itself a strong determinant of HPVV uptake (OR=28.8;95%-CI: [11.2–73.7]). We could not identify any significant (P<0.05) sociodemographic or educational determinants of HPVV intention among parents of unvaccinated children, but reporting a medical HPVV offer was associated with HPVV intention (OR=2.7,95% CI: [1.4 – 5.3]) (Table 4).
145 Attitudinal factors

146 Positive attitudes on HPVV benefits, safety and accessibility were expressed by the
147 majority (≥70%) of parents, both with and without medical HPVV offer. By contrast, the
148 frequent belief that the child was too young for HPVV was substantially more common
149 among parents without than with HPVV offer (49% vs 27%) and impacted negatively
150 vaccine uptake regardless of medical vaccination offer (OR=0.1;95%CI: [0.1– 0.2])
151 (Tables 5 and 6). Nonetheless, HPVV intention was enhanced in parents who believed
152 that their child was too young to be vaccinated and who also received a medical
153 vaccination offer (OR=0.2;95%CI: [0.1–0.9]) compared to those who were not offered
154 any HPVV (OR=0.4;95%CI: [0.1–1.2]) (Table 7). HPVV intention for unvaccinated
155 children was associated with perceiving a favorable benefit-risk balance
156 (OR=33.5;95%CI: [3.3-339.1]).

158 Discussion

159 In this survey among parents of middle-school pupils in Guadeloupe, we found that
160 HPVV offer during a medical consultation was the most prominent determinant of
161 HPVV awareness, uptake and intention, and explained the significant difference in
162 vaccination status between girls and boys. Beside this, only higher education level was
163 associated with HPVV awareness. The belief that the child was considered too young
164 to be vaccinated against HPV was a barrier for vaccine uptake as well as for vaccine
165 intention, while favorable perceptions of the benefit-risk balance influenced positively
166 HPVV intention.

167 The pivotal role of HPVV offer during a medical consultation is coherent with the
168 organization of vaccine access in France, where general practitioners play a
fundamental gatekeeper role in the health system. This finding is also in line with evidence from continental France as well as other countries where healthcare providers are the most trusted source of prevention practice. In fact, numerous studies identified that consulting a general practitioner or a gynecologist increased HPVV uptake and in continental France, a similar study identified that the physician advising during consultation was associated with increased HPVV awareness and intention and most strongly with child's vaccination status (14).

In addition, HPVV awareness was more frequent among higher educated parents in our Guadeloupean study, but we did not identify any other social inequalities. This contrasts with other studies identifying inequalities in HPVV uptake inequalities between socio-educational categories. Several ecological and individual-level studies in mainland France reported that less deprived socio-economic environment, higher income and educational level were determinants of higher HPVV uptake (15-17). Furthermore, Rivera et al. described in a survey among parents of middle-school pupils an interaction between a multilingual family context and lower educational attainment towards lower likelihood of being aware of HPVV and of intending it, if the child was unvaccinated (18). Finally, Moffroid et al. found lower likelihood of HPVV uptake among adolescents reporting lower parental educational attainment, and this effect was stronger among adolescents reporting no recent physician visits (19).

The absence of identification of such a gradient in our study results in Guadeloupe could reflect a selection bias in our survey with a poor representation of lower-income and lower-diploma population groups; but it also could be related to a generally poor access to HPVV, or generally low acceptance, regardless of socio-educational
characteristics. Given the general practitioners' role in HPVV promotion, suboptimal and non-systematic HPVV medical advising targeting eligible children unfavorably impacts vaccination uptake. Although our participants reported higher educational attainment than the general population in Guadeloupe, we found that 14.7% of parents were not aware of HPVV, highlighting the need for enhanced communication and promotion towards parents, as well as children. We also identified that merely 50% of parents had received an HPVV offer from the physician during a medical consultation.

Among many publications pointing to the prominent role of primary health care doctors in vaccination adhesion, a systematic review on barriers to HPVV uptake among racial and ethnic minorities found that low HPVV initiation and completion rates were associated with a lack of providers' HPVV offer, inadequate knowledge on HPV and low HPVV awareness (20). A qualitative study in Martinique recently explored HPVV levers and barriers among parents of 11- to 17-year-old children. Parents here emphasized that general practitioners were either reluctant or did not offer HPVV (21).

Based on a quantitative survey among family physicians in Martinique, Saint-Ange had suggested that failure to promote HPVV may vary with the General Practitioner's socio-demographic profile (22).

Three quarter of parents thought that HPVV was not well known and more than 80% reported difficulties in speaking about the vaccination with the general practitioner or with their child. At the same time, favorable attitudes about vaccine safety, collective protection, benefits in relation to risks, and accessibility were expressed by about two thirds of participants. These findings clearly call for reinforced information on HPVV and promotion activities, even more so as our sample overrepresented parents with higher educational attainment. Such communication can be performed by healthcare professionals and within the educational system, and should address the widespread
218 belief about ideal age of HPVV, and doubts about its benefit-risk balance.
219 Misunderstanding the recommendation of early HPVV raises concerns among many
220 parents as underlined in other studies in France and elsewhere. Through a phone
221 survey, Dib et al. identified in a sample of vaccine-eligible children that the strongest
222 factor negatively associated with HPVV uptake was the recommended age for
223 vaccination (23). Another survey described that the recommended age often
224 discouraged parents from vaccinating their children against HPV and one discrete-
225 choice experiment among parents in France found that specifically among parents with
226 lower educational attainment speaking exclusively French at home, justifying the early
227 age of vaccination by the sexual debut dissuaded from vaccination (24). This barrier is
228 the result of promotion of HPVV as vaccination against a sexually transmittable
229 disease, which was justified in earlier strategies, when this vaccination targeted young
230 women and effectiveness depended on vaccination before age 17, as seen in Sweden
231 (25). However, given global strategies targeting pre- or early adolescents, the
232 justification of stronger immunogenicity before age 14 years is an argument, as well
233 (26). In a discrete choice experiment conducted along with the current survey, the
234 argument of a better immune response before the age of 14 years old had a motivating
235 effect on parents (27). These elements suggest that communication around early HPV
236 vaccination in Guadeloupe can be adapted to expectations and preferences of families
237 and communication focusing on age should be carefully tailored.

238 It should also be noted that HPVV gender inequalities slow down the process of HPV
239 infections and cervical cancer elimination. In fact, girls are more likely to be vaccinated
240 as compared to boys and this finding appears exacerbated by the practice of
241 healthcare professionals, who may continue to focus HPVV offer on girls, despite a
242 gender-neutral policy adopted in France since 2021. The 2021 National HPVV
recommendation made this HPV vaccination universal in a period where medical attention was diverted to two simultaneous major dengue and COVID-19 epidemics in the French Caribbean. The lack of awareness in recent HPVV recommendations extension to boys might explain the gender gradient seen in our study (28).

Given the prominent role taken by medical doctors in both HPVV uptake and intention, the systematic vaccine offer by healthcare professionals may need to be monitored and encouraged. Professional training needs to provide aids for information and shared decision making, strengthening professionals' confidence in addressing vaccine benefits and safety. Preventative consultations at adolescent age and the use of motivational interviewing techniques should also be promoted. In the French system since recently, other professionals, such as midwives, nurses and pharmacists, also can take these roles, and require such training, as well.

Evidence from interventional research suggests that the implementation of multi-component interventions targeting simultaneously pupils, parents and health professionals could have the greatest effect on HPVV uptake (29), with a central role of school-based vaccination campaigns implementation (30). Results from the PrevHPV trial in mainland France suggested that a global coverage increase of at least 5% can be expected by such policy with an increase of 15% in participating schools (31). Furthermore, the trial showed the positive impact of carefully designed in-class HPVV education and motivation not only on adolescents' HPVV-related knowledge, but also on attitudes, including the perceived benefit-risk balance (32). While HPV vaccination requires parental consent in France, such positive effects from school-based education on vaccine attitudes may help addressing on the long term relatively low vaccine acceptance in the French Caribbean, a problem that has been
exacerbated by the Covid-19 vaccine campaigns and the reinforced circulation of misinformation via digital social networks (33).

Our study has several limitations. Despite support from the regional school authority and communication of the survey invitation by middle schools in Guadeloupe, only 1% of the eligible population participated. The small sample size limits the statistical power, with risk of not recognizing relevant associations, and hinders stratified analyses. This low response rate may be related to poor access to electronic school platforms but can also reflect the perceived low interest in vaccination within the population of the French Caribbean, since the major protests against COVID-19 mandatory vaccination that gave rise to an unprecedented refusal towards vaccination (34). In addition, the recruitment method based on volunteering and electronic invitation and data collection has resulted in the over-representation of highly educated (56.2% versus 24.4% in the Guadeloupean population), occupationally active persons (85.3% versus 70.0%) and higher socio-professional categories (50.8% versus 28.7%). As in any cross-sectional study with selected sample, exact prevalence estimates should not be interpreted, while identifying determinants may be of greater validity. Similarly, the extrapolation to other Caribbean populations with similar cancer epidemiology, such as Martinique, should be done carefully, based on shared sociodemographic, economic, cultural, historical, and political characteristics.

## Conclusion

Considering these limits and given that evidence on HPV vaccine acceptance and improved vaccine promotion is scarce for Caribbean territories, our results underpin the need for larger studies with substantial recruitment efforts. The results point to a lack of HPVV awareness among parents with lower educational attainment and to the
291 central role of health practitioners' vaccine offer in fostering HPVV uptake and intention. In France, a national school-based HPVV campaign has been implemented for the first time from September 2023 onwards, including Guadeloupe and Martinique.
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294 The results from our study, conducted prior to the first campaign, suggest the need of active involvement of family doctors and other frontline healthcare workers in such campaigns. Communication should insist on pre- and early adolescence as the ideal age for better immunogenicity, aiming at disconnecting parental HPVV perception from the idea of sexual activity. Stakeholders should join forces to enhance HPVV uptake and reach public health goals of eliminating cervical cancer and other HPV-associated-diseases.
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311 Acknowledgements : Dr. Frank Assogba, Mrs. Anne-Sophie Barret, Dr. Isabelle

312 Bonmarin, Dr. Florelle Bradamantis, Dr. Didier Che, Dr. Armelle Ezelin, M. Arnaud

313 Gauthier, Mrs. Clothilde Hachin, Mrs. Valérie Henry, Mrs. Diana Ledreck, Dr.

314 Mathilde Melin, Dr. Jérôme Naud, Dr. Christophe Perret, Mrs. Sandrine

315 Randriamampianina, Mrs. Cindy Thelise, Dr. Stéphanie Vandentorren, Dr. Ami

316 Yamada.

317 Funding source: This research did not receive any specific grant from funding

agencies in the public, commercial, or not-for-profit sectors.

319 Conflict of interest statement: I declare that the authors have no competing interests

320 or other interests that might be perceived to influence the results and/or discussion

321 reported in this paper.

322 Ethics approval: The study protocol was approved by the Institut Pasteur IRB. The

323 survey protocol received clearance by the Pasteur Institute on November 8, 2022

324 under the following reference: IRB reference: IRB2022-L-Exemp. The database was

325 registered by Sante publique France according to the General Data Protection

326 Regulation (GRDP).

327 Informed consent: Not applicable. Because the data collection was observational,

328 anonymous without any risk of indirect identification and collected no sensitive and

329 only self-declared biomedical information, no informed consent was required according

330 to the French regulation: https://www.cnil.fr/fr/lanonymisation-des-donnees-un-

331 traitement-cle-pour-lopen-data

332 Declaration of generative AI in scientific writing : none.

333 Data statement: The data that support the findings of this study are available upon

334 reasonable request and with permission of the French National Public Health
Agency, Sante publique France). The reuse of data is subject to compliance with the

General Data Protection Regulation (GDPR) and French regulations.

Authors' contributions: FGED and JEM : conceptualization, methodology; FGED :

Data curation, Formal analysis, Visualization; Writing - original draft, review & editing.

GB, LL : Formal analysis and interpretation of data ; JEM, JRau, JRo : Supervision,

Validation and final approval ; All authors: Review.

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<table><caption>Table 1. Socio-demographic and educational characteristics of participating parents of adolescents in Guadeloupe, 7-30 June 2023 (N=306)</caption><thead><tr><th>Characteristics</th><th>Total (N=306)<br>N (%)</th></tr></thead><tbody><tr><td><strong>Age</strong></td><td></td></tr><tr><td>Less than 35 years</td><td>18 (5.9)</td></tr><tr><td>Between 35 and 44 years</td><td>156 (51.0)</td></tr><tr><td>Between 45 and 54 years</td><td>120 (39.2)</td></tr><tr><td>More than 55 years</td><td>12 (3.9)</td></tr><tr><td><strong>Parents' gender</strong></td><td></td></tr><tr><td>Mother</td><td>285 (93.1)</td></tr><tr><td>Father</td><td>21 (6.9)</td></tr><tr><td><strong>Graduation level</strong></td><td></td></tr><tr><td>Less than final high-school diploma</td><td>38 (13.1)</td></tr><tr><td>Final high-school diploma</td><td>62 (21.5)</td></tr><tr><td>More than high-school diploma</td><td>189 (65.4)</td></tr><tr><td><strong>Occupation situation</strong></td><td></td></tr><tr><td>Occupied or involved in a professional training</td><td>244 (85.3)</td></tr><tr><td>Unoccupied</td><td>30 (10.5)</td></tr><tr><td>Retired or unable to work</td><td>12 (4.2)</td></tr><tr><td><strong>Occupation</strong></td><td></td></tr><tr><td>Farmers/small business owners</td><td>27 (10.3)</td></tr><tr><td>Executives and professionals/students/large business owners</td><td>74 (28.2)</td></tr><tr><td>Technicians/service workers</td><td>155 (59.2)</td></tr><tr><td>Factory workers</td><td>6 (2.3)</td></tr><tr><td><strong>Child's sex</strong></td><td></td></tr><tr><td>Female</td><td>162 (52.9)</td></tr><tr><td>Male</td><td>144 (47.1)</td></tr><tr><td><strong>Child's birth cohort</strong></td><td></td></tr><tr><td>2007-2008</td><td>56 (18.4)</td></tr><tr><td>2009</td><td>89 (29.2)</td></tr><tr><td>2010</td><td>77 (25.3)</td></tr><tr><td>2011-2012</td><td>83 (27.2)</td></tr></tbody></table>

<footnote>* Number of participants responding to the last section of the questionnaire is N=306</footnote>
<table><caption>Table 2. Socio-demographic and educational determinants of HPV vaccine awareness, participating parents of adolescents in Guadeloupe, 7-30 June 2023 (N=306)</caption><thead><tr><th rowspan="2"></th><th colspan="2">Yes</th><th colspan="2">Bivariable analysis</th><th colspan="2">Multivariable analysis</th></tr><tr><th>N</th><th>%</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th></tr></thead><tbody><tr><td>Total</td><td>261</td><td>85.3</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Age</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Less than 35 years</td><td>16</td><td>88.9</td><td>Ref.</td><td>-</td><td></td><td></td></tr><tr><td>Between 35 and 44 years</td><td>131</td><td>84.0</td><td>0.7</td><td>[0.1 - 3.0]</td><td></td><td></td></tr><tr><td>Between 45 and 54 years</td><td>103</td><td>85.8</td><td>0.8</td><td>[0.2 - 3.6]</td><td></td><td></td></tr><tr><td>More than 55 years</td><td>11</td><td>91.7</td><td>1.4</td><td>[0.1 - 17.1]</td><td></td><td></td></tr><tr><td>Sex</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>246</td><td>86.3</td><td>2.5</td><td>[0.9 - 6.9]*</td><td>2.4</td><td>[0.7 - 9.0]</td></tr><tr><td>Male</td><td>15</td><td>71.4</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Graduation level</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Final high-school diploma or less</td><td>77</td><td>77.0</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>More than high-school diploma</td><td>168</td><td>88.9</td><td><strong>2.4</strong></td><td><strong>[1.3 - 4.6]*</strong></td><td><strong>2.8</strong></td><td><strong>[1.2 - 6.6]</strong></td></tr><tr><td>Occupation situation</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Occupied or involved in a professional training</td><td>212</td><td>86.9</td><td>1.8</td><td>[0.8 - 4.1]*</td><td>2.3</td><td>[0.7 - 7.8]</td></tr><tr><td>Unoccupied/retired/unable to work</td><td>83</td><td>78.6</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Occupation</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Upper occupational level</td><td>120</td><td>90.2</td><td>1.9</td><td>[0.9 - 4.0]*</td><td>1.3</td><td>[0.5 - 3.0]</td></tr><tr><td>Lower occupational level</td><td>107</td><td>83.0</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Child's sex</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>145</td><td>89.5</td><td>2.1</td><td>[0.1 - 3.9]*</td><td>1.8</td><td>[0.8 - 3.9]</td></tr><tr><td>Male</td><td>116</td><td>80.6</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Child's birth cohort</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2007-2008</td><td>49</td><td>87.5</td><td>Ref.</td><td>-</td><td>-</td><td>-</td></tr><tr><td>2009</td><td>77</td><td>86.5</td><td>0.9</td><td>[0.3 - 2.5]</td><td>-</td><td>-</td></tr><tr><td>2010</td><td>63</td><td>81.8</td><td>0.6</td><td>[0.2 - 1.7]</td><td>-</td><td>-</td></tr><tr><td>2011-2012</td><td>71</td><td>85.5</td><td>0.9</td><td>[0.3 - 2.3]</td><td>-</td><td>-</td></tr><tr><td>HPV vaccination medical offer</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>137</td><td>75.7</td><td>Ref.</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<table><tr><td>Yes</td><td>123</td><td>99.2</td><td>39.5</td><td>[5.4 – 291.0]*</td><td>-</td><td>-</td></tr></table>

Results obtained from bivariable and multivariable logistic regression models. OR (95%-CI), odds ratio and 95% confidence interval
Statistically significant determinants (P<0.05) in bold. Variables with a p-value <0.2 in the bivariable model are included in the multivariable model.
* Bivariable analysis with a p-value <0.2 **Model without HPVV medical offer.
<table><caption>Table 3. Socio-demographic and educational determinants of HPV vaccination status, participating parents of adolescents in Guadeloupe, 7-30 June 2023 (N=303)</caption><thead><tr><th rowspan="3"></th><th colspan="8">HPV vaccination status<br>N=303</th></tr><tr><th colspan="2">Yes</th><th colspan="2">Bivariable analysis</th><th colspan="2">Multivariable analysis**</th><th colspan="2">Multivariable analysis***<br>adjusted for medical HPVV offer</th></tr><tr><th>n</th><th>%</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th></tr></thead><tbody><tr><td>Total</td><td>77</td><td>25.4</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Age</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Less than 35 years</td><td>4</td><td>23.5</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Between 35 and 44 years</td><td>42</td><td>27.1</td><td>1.2</td><td>[0.4 - 3.9]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Between 45 and 54 years</td><td>29</td><td>24.4</td><td>1.0</td><td>[0.3 - 3.5]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>More than 55 years</td><td>2</td><td>16.7</td><td>0.7</td><td>[0.1 - 4.3]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Parent's Sex</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>76</td><td>27.0</td><td>7.6</td><td>[1.0 - 55.9]*</td><td>4.4</td><td>[0.6 - 35.4]</td><td>5.4</td><td>[0.5 - 55.3]</td></tr><tr><td>Male</td><td>1</td><td>4.8</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Graduation level</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Final high-school diploma or less</td><td>24</td><td>24.5</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>More than high-school diploma</td><td>47</td><td>25.0</td><td>1.0</td><td>[0.6 - 1.8]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Occupation situation</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Occupied or involved in a professional training</td><td>58</td><td>24.1</td><td>0.6</td><td>[0.3 - 1.3]*</td><td>0.7</td><td>[0.3 - 1.6]</td><td>0.6</td><td>[0.2 - 1.7]</td></tr><tr><td>Unoccupied/retired/unable to work</td><td>14</td><td>33.3</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Occupation</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Upper occupational level</td><td>31</td><td>23.5</td><td>0.8</td><td>[0.5 - 1.5]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Lower occupational level</td><td>34</td><td>26.8</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Child's sex</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>58</td><td>36.0</td><td>3.6</td><td>[2.0 - 6.5]*</td><td>3.7</td><td>[2.0 - 7.0]</td><td>1.2</td><td>[0.5 - 2.7]</td></tr><tr><td>Male</td><td>19</td><td>13.4</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Child's birth cohort</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2007-2008</td><td>19</td><td>35.2</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>2009</td><td>34</td><td>38.2</td><td>1.1</td><td>[0.6 - 2.3]*</td><td>1.2</td><td>[0.5 - 2.6]</td><td>1.8</td><td>[0.7 - 4.8]</td></tr><tr><td>2010</td><td>13</td><td>17.1</td><td>0.4</td><td>[0.2 - 0.9]*</td><td>0.5</td><td>[0.2 - 1.2]</td><td>0.5</td><td>[0.2 - 1.4]</td></tr></tbody></table>
<table><thead><tr><th>2011-2012</th><th>11</th><th>13.3</th><th>0.3</th><th>[0.1-0.7]*</th><th>0.2</th><th>[0.1-0.5]</th><th>0.3</th><th>[0.1-1.0]</th></tr></thead><tbody><tr><td><strong>HPV vaccination medical offer</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>7</td><td>3.9</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Yes</td><td>70</td><td>56.9</td><td><strong>32.5</strong></td><td><strong>[14.1-74.9]*</strong></td><td>-</td><td>-</td><td><strong>28.8</strong></td><td><strong>[11.2-73.7]</strong></td></tr></tbody></table>

Results obtained from bivariable and multivariable logistic regression models. OR (95%-CI), odds ratio and 95% confidence interval.

Statistically significant determinants (P<0.05) in bold. Variables with a p-value <0.2 in the bivariable model will be included in the multivariable model.

* Bivariable analysis with a p-value <0.2 **Model without HPVV medical offer. ***Model including HPVV medical offer. Includes all parents, regardless of HPVV awareness.
<table><caption>Table 4. Socio-demographic and educational determinants of HPV vaccination intention among parents of unvaccinated adolescents who are aware of HPVV. Guadeloupe, 7-30 June 2023 (N=183)</caption><thead><tr><th rowspan="3"></th><th colspan="8">HPV vaccination intention</th></tr><tr><th colspan="8">N=183</th></tr><tr><th colspan="2">Yes</th><th colspan="2">Bivariable analysis</th><th colspan="2">Multivariable analysis**</th><th colspan="2">Multivariable analysis***<br>Adjusting for medical HPVV offer)</th></tr><tr><th>n</th><th>%</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th></tr></thead><tbody><tr><td>Total</td><td>57</td><td>31.2</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Age</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Less than 35 years</td><td>0</td><td>0</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Between 35 and 44 years</td><td>26</td><td>29.2</td><td>0.5</td><td>[0.1-2.1]*</td><td>0.8</td><td>[0.2-3.7]</td><td>1.1</td><td>[0.2-5.4]</td></tr><tr><td>Between 45 and 54 years</td><td>27</td><td>37.0</td><td>0.7</td><td>[0.2-3.0]*</td><td>1.3</td><td>[0.3-6.1]</td><td>1.7</td><td>[0.3-8.5]</td></tr><tr><td>More than 55 years</td><td>4</td><td>44.4</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Sex</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>50</td><td>29.6</td><td>0.4</td><td>[0.1-1.2]*</td><td>0.4</td><td>[0.1-1.4]</td><td>0.4</td><td>[0.1-1.3]</td></tr><tr><td>Male</td><td>7</td><td>50.0</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Graduation level</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Final high-school diploma or less</td><td>16</td><td>30.2</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>More than high-school diploma</td><td>36</td><td>30.0</td><td>1.0</td><td>[0.5-2.0]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Occupation situation</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Occupied or involved in a professional training</td><td>49</td><td>32.0</td><td>1.8</td><td>[0.6-5.6]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Unoccupied/retired/unable to work</td><td>4</td><td>21.1</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Occupation</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Upper occupational level</td><td>31</td><td>35.7</td><td>0.9</td><td>[0.6-1.3]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Lower occupational level</td><td>20</td><td>27.4</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Child's sex</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>32</td><td>36.8</td><td>1.7</td><td>[0.9-3.1]*</td><td>1.9</td><td>[0.9-3.7]</td><td>1.5</td><td>[0.7-3.1]</td></tr><tr><td>Male</td><td>25</td><td>26.0</td><td>Ref.</td><td>-</td><td>Ref.</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Child's birth cohort</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2007-2008</td><td>8</td><td>27.6</td><td>Ref.</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>2009</td><td>18</td><td>41.9</td><td>1.9</td><td>[0.7-5.2]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>2010</td><td>11</td><td>22.0</td><td>0.7</td><td>[0.3-2.1]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<table><tr><td>2011-2012</td><td>20</td><td>33.3</td><td>1.3</td><td>[0.5-3.5]</td><td>-</td><td>-</td><td>-</td></tr><tr><td colspan="8">HPV vaccination medical offer</td></tr><tr><td>No</td><td>32</td><td>24.8</td><td>Ref.</td><td>-</td><td>-</td><td>Ref.</td><td>-</td></tr><tr><td>Yes</td><td>25</td><td>47.2</td><td>2.7</td><td>[1.4-5.3]*</td><td>-</td><td>2.3</td><td>[1.1-4.8]</td></tr></table>

Results obtained from bivariable and multivariable logistic regression models. OR (95%-CI), odds ratio and 95% confidence interval.

Statistically significant determinants (P<0.05) in bold. Variables with a p-value <0.2 in the bivariable model will be included in the multivariable model.

* Bivariable analysis with a p-value <0.2 **Model without HPVV medical offer. ***Model including HPVV medical offer. Includes all parents, regardless of HPVV awareness
<table><caption>Table 5. Attitudes towards HPV vaccination among parents of adolescents aware of HPVV with and without medical offer, Guadeloupe, 7-30 June 2023 (N=260)</caption><thead><tr><th></th><th>N (%)<br>Without medical advising</th><th>N (%)<br>With medical advising</th></tr></thead><tbody><tr><td>Easiness to find information on HPV vaccination</td><td></td><td></td></tr><tr><td>Yes</td><td>77 (70.6)</td><td>93 (78.8)</td></tr><tr><td>HPV vaccination safe</td><td></td><td></td></tr><tr><td>Yes</td><td>56 (74.7)</td><td>84 (85.7)</td></tr><tr><td>Having my child vaccinated against HPV is easy</td><td></td><td></td></tr><tr><td>Yes</td><td>70 (72.2)</td><td>94 (82.5)</td></tr><tr><td>Preventing HPV transmission is important</td><td></td><td></td></tr><tr><td>Yes</td><td>98 (89.9)</td><td>110 (93.2)</td></tr><tr><td>It is difficult to talk about HPV vaccination with my child</td><td></td><td></td></tr><tr><td>Yes</td><td>101 (85.6)</td><td>109 (90.8)</td></tr><tr><td>It is difficult to talk about HPV vaccination with my general practitioner</td><td></td><td></td></tr><tr><td>Yes</td><td>9 (7.4)</td><td>5 (4.2)</td></tr><tr><td>It is difficult to find time to vaccinate my child against HPV</td><td></td><td></td></tr><tr><td>Yes</td><td>25 (21.4)</td><td>17 (14.2)</td></tr><tr><td>My child is too young to be vaccinated against HPV**</td><td></td><td></td></tr><tr><td>Yes</td><td>54 (49.1)</td><td>32 (26.7)</td></tr><tr><td>Vaccinating my child against HPV will have more benefits than risks**</td><td></td><td></td></tr><tr><td>Yes</td><td>59 (67.8)</td><td>87 (79.1)</td></tr><tr><td>I think that HPV vaccination is not well known</td><td></td><td></td></tr><tr><td>Yes</td><td>96 (86.5)</td><td>98 (87.5)</td></tr></tbody></table>

<footnote>*The options “I am not sure” and “I do not Know” are grouped into the modality “No” of the variable of interest. Results obtained from bivariable analysis and statistically significant determinants (P<0.05) are in bold. The results are calculated only among parents who are aware of HPVV.</footnote>
<table><caption>Table 6. Beliefs, knowledge and attitudinal determinants of HPV vaccination uptake, participating parents of adolescents in Guadeloupe, 7-30 June 2023 (N=260)</caption><thead><tr><th rowspan="3"></th><th colspan="4">HPV Vaccination uptake (N=260)</th></tr><tr><th colspan="2">Bivariable analysis</th><th colspan="2">Multivariable analysis*</th><th colspan="2">Multivariable analysis**<br>(HPVV medical offer)</th></tr><tr><th>OR</th><th>p-value</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th></tr></thead><tbody><tr><td>Easiness to find information on HPV vaccination (Yes/No*)</td><td>1.9</td><td>0.059</td><td>1.0</td><td>[0.4 – 2.9]</td><td>0.9</td><td>[0.2 – 3.5]</td></tr><tr><td>HPV vaccination is safe (Yes/No*)</td><td><strong>3.8</strong></td><td><strong>0.006</strong></td><td>2.6</td><td>[0.6 – 12.6]</td><td>2.8</td><td>[0.4 – 19.2]</td></tr><tr><td>Having my child vaccinated against HPV is easy (Yes/No*)</td><td><strong>35.8</strong></td><td><strong>&lt; 0.001</strong></td><td><strong>12.3</strong></td><td><strong>[1.4 – 107.5]</strong></td><td><strong>16.5</strong></td><td><strong>[1.6 – 173.5]</strong></td></tr><tr><td>Preventing HPV transmission is important (Yes/No*)***</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>It is difficult to talk about HPV vaccination with my child (Yes*/No)</td><td>0.4</td><td>0.09</td><td>1.1</td><td>[0.2 – 7.2]</td><td>1.3</td><td>[0.1 – 12.3]</td></tr><tr><td>It is difficult to talk about HPV vaccination with a health professional (Yes*/No)</td><td>0.4</td><td>0.197</td><td>4.2</td><td>[0.2 – 74.7]</td><td>6.3</td><td>[0.4 – 95.4]</td></tr><tr><td>It is difficult to find time to vaccinate my child against HPV (Yes/No*)</td><td><strong>0.4</strong></td><td><strong>0.019</strong></td><td><strong>0.3</strong></td><td><strong>[0.1 – 0.7]</strong></td><td>0.4</td><td>[0.1 – 1.4]</td></tr><tr><td>My child is too young to be vaccinated against HPV (Yes/No*)</td><td><strong>0.1</strong></td><td><strong>&lt;0.001</strong></td><td><strong>0.1</strong></td><td><strong>[0.1 – 0.2]</strong></td><td><strong>0.1</strong></td><td><strong>[0.1 – 0.2]</strong></td></tr><tr><td>Vaccinating my child against HPV will have more benefits than risks (Yes/No*)</td><td><strong>2.7</strong></td><td><strong>0.009</strong></td><td>1.1</td><td>[0.3 – 3.8]</td><td>0.8</td><td>[0.2 – 4.1]</td></tr><tr><td>I think that HPV vaccination is not well known (Yes/No*)</td><td>1.7</td><td>0.261</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>

Results obtained from bivariable and multivariable logistic regression models. OR (95%-CI), odds ratio and p-value.

Statistically significant determinants (P<0.05) in bold. Variables with a p-value <0.2 in the bivariable model are included in the multivariable model.

*Model without HPVV medical offer. **Model including HPVV medical offer. Includes only parents who report being aware of HPVV and whose children are vaccinated or not against HPV.

*** No parent declaring a vaccinated child reported that HPVV transmission prevention was not important. The OR cannot be calculated for this variable.
<table><caption>Table 7. Beliefs, knowledge and attitudinal determinants of HPV vaccination intention among parents of unvaccinated adolescents who are aware of HPVV, Guadeloupe, 7-30 June 2023 (N=183)</caption><thead><tr><th rowspan="3"></th><th colspan="6">HPV vaccination intention (N=183)</th></tr><tr><th colspan="2">Bivariate analysis</th><th colspan="3">Multivariable analysis*</th><th colspan="1">Multivariable analysis<br>(HPVV medical offer)</th></tr><tr><th>OR</th><th>p-value</th><th>OR</th><th>95% CI</th><th>OR</th><th>95% CI</th></tr></thead><tbody><tr><td>Easiness to find information on HPV vaccination (Yes/No*)</td><td>0.7</td><td>0.341</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>HPV vaccination is safe (Yes/No*)</td><td><strong>46.6</strong></td><td><strong>&lt;0.001</strong></td><td>8.7</td><td>[0.8 - 9]</td><td>4.3</td><td>[0.4 - 46.6]</td></tr><tr><td>Having my child vaccinated against HPV is easy (Yes/No*)</td><td><strong>5.0</strong></td><td><strong>&lt;0.001</strong></td><td>1.8</td><td>[0. - 7.8]</td><td>1.9</td><td>[0.4 - 9.3]</td></tr><tr><td>Preventing HPV transmission is important (Yes/No*)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>It is difficult to talk about HPV vaccination with my child (Yes*/No)</td><td>0.9</td><td>0.968</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>It is difficult to talk about HPV vaccination with a health professional (Yes*/No)</td><td>1.1</td><td>0.918</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>It is difficult to find time to vaccinate my child against HPV (Yes/No*)</td><td><strong>2.5</strong></td><td><strong>0.015</strong></td><td>1.6</td><td>[0.4 - 5.8]</td><td>2.0</td><td>[0.5 - 7.9]</td></tr><tr><td>My child is too young to be vaccinated against HPV (Yes/No*)</td><td><strong>0.2</strong></td><td><strong>&lt;0.001</strong></td><td>0.4</td><td>[0.1 - 1.2]</td><td><strong>0.2</strong></td><td><strong>[0.1 - 0.9]</strong></td></tr><tr><td>Vaccinating my child against HPV will have more benefits than risks (Yes/No*)</td><td><strong>29.1</strong></td><td><strong>&lt;0.001</strong></td><td><strong>30.4</strong></td><td><strong>[3.2 - 207.5]</strong></td><td><strong>33.5</strong></td><td><strong>[3.3 - 339.1]</strong></td></tr><tr><td>I think that HPV vaccination is not well known (Yes/No*)</td><td>2.4</td><td>0.107</td><td>2.3</td><td>[0.3 - 18.6]</td><td>2.5</td><td>[0.3 - 24.8]</td></tr></tbody></table>

Results obtained from bivariable and multivariable logistic regression models. OR (95%-CI), odds ratio and p-value.

Statistically significant determinants (P<0.05) in bold. Variables with a p-value <0.2 in the bivariable model are included in the multivariable model.

*Model without HPVV medical offer. **Model including HPVV medical offer. Includes only parents who report being aware of HPVV and whose children are not vaccinated against HPV
<figure><img src="image_2.png" /><figcaption>**Figure 1.** Flow chart representing the parents participating to the survey questionnaire: HPV vaccination awareness (N=306, top), HPV vaccination uptake (N=303, longdash lifestyle) and HPV vaccination intention (N=183, dashdotdotted lifestyle) amongst parents aware of HPVV with the child not vaccinated against HPV, 7 to 30 June 2023, Guadeloupe</figcaption></figure>