What a mother believes
Creators: name: Evans, Kiameesha
Publisher: name: No Publisher Supplied
Year: 2021

description: Background. Human papillomavirus (HPV) is the most commonly transmitted infection among men and women in the United States. Gender and racial disparities are present, with Black males disproportionately affected by HPV-related penile, anal, and rectal cancers. Vaccination against HPV during adolescence is an effective way to reduce HPV transmission, and clinical guidelines have recommended HPV vaccination of males since 2011. However, current uptake remains much lower than Healthy People 2030 objectives. During adolescence, mothers are often the decision makers for the health choices of their minor sons. Thus, an understanding of the factors that shape mothers’ decision-making is essential, as they could serve as the gatekeepers for their sons’ HPV vaccination. Using the Theory of Planned Behavior as a framework, this study was an exploration of the topic of HPV vaccination among adolescent Black males through the lens of their female caregivers.Methods. This dissertation had a mixed-methods design that included two phases of data collection and analysis. One phase entailed secondary analysis of a national data set, the 2017 National Immunization Survey-Teen Supplement. Multivariate analyses were conducted to examine the performance of teen and maternal variables as explanatory factors for HPV vaccination initiation and completion. Interaction terms for clinical recommendation and maternal educational level were added to assess their respective moderating effects. The second phase entailed using qualitative research methods via semistructured interviews to explore the knowledge, attitudes, and behaviors regarding HPV vaccination among a sample of mothers of Black adolescent boys 11 to 17 years, primarily from New Jersey.Results. Quantitative and qualitative analyses showed that the relationship between maternal educational attainment and vaccination behavior was not linear. The health care provider’s role was also reaffirmed, with both arms of analysis indicating a greater likelihood of vaccination if mothers received a provider’s recommendation. Awareness and knowledge were also important, although likely insufficient to motivate Black parents to vaccinate their children. Attitudes regarding medical mistrust merit consideration in developing interventions to address HPV vaccination uptake among Black adolescent males. An expanded model that includes constructs regarding perceived susceptibility could be helpful to improve mothers’ knowledge and influence vaccination intention.Conclusions. Future HPV vaccination uptake researchers should examineu nderstanding and attitudes by subgroups within the Black community. Few current evidence-based efforts to increase HPV vaccination uptake have a primary audience of adolescent Black males. This research with the mothers of Black adolescent males showed issues of medical mistrust, mothers’ gaps in understanding, and an emerging role of male partners in HPV vaccination decision-making. The development of future evidence-based HPV vaccination promotion efforts should incorporate these concerns.