Self-Reported HPV Vaccine Knowledge, Perceptions, and Behaviors among Parents from Schools Participating in a School-Based HPV Vaccine Program during the COVID-19 Pandemic in the Lower Rio Grande Valley, Texas
Introduction
Through our CPRIT-funded school-based human papillomavirus (HPV) vaccination program, school-based vaccination has shown to be successful in increasing HPV vaccine access and uptake among middle-school students. An additional and crucial tier of the program is the robust education campaign targeting parents and community members that emphasized the cancer prevention benefits of the HPV vaccine. As part of our program in Pharr-San Juan-Alamo Independent School District (PSJAISD), we conducted pre- and post-intervention surveys among parents to assess HPV vaccine knowledge, perceptions, and behaviors.
Methods
The iteration of the program being studied began 3/1/2019 and ended 2/28/23. We conducted pre- (n=200) and post- (n=196) intervention surveys among a random sample of parents of children aged ≥ 9 years who were enrolled in one of the participating schools. Surveys were conducted ending 12/2/2019 and 04/10/2023, respectively. The parent survey included: demographic information; an assessment of parental knowledge about the HPV vaccine; and information about their children and HPV vaccine experience, including reasons for not receiving the HPV vaccine, having children who graduated high school that received the HPV vaccine, and their children’s current enrollment status in the Texas Immunization Registry (ImmTrac). Knowledge was assessed through five questions: (1) "Are you aware that the HPV vaccine can prevent certain types of cancer?" "Do you think HPV can cause (2) cancer of the cervix, (3) anal cancer, (4) penile cancer, and (5) oral cancer?" An answer of “yes” was evaluated as correct. Additionally, the question “Have your children received the HPV vaccine?” was asked. Finally, the post intervention survey asked, “Did the COVID-19 pandemic affect how you think of the vaccine?” Pre- and post-intervention survey responses were described using proportions and compared using chi-square tests.
Results
Demographic characteristics were similar in pre- and post-intervention survey participants. There was lower knowledge of HPV among post survey parents. Namely, there were significant differences in the proportion who know that the vaccine prevents cancer (80.5% versus 57.14%, P < 0.0001) and who knew that HPV causes oral cancer (38.0% versus 25.51%, P < 0.01). Differences in percentages of correct responses for the other knowledge assessment questions were not statistically significant. There was a significantly higher proportion of parents in the post-intervention survey compared to the pre-intervention survey who reported that they had vaccinated their children (65.8% versus 51.0%, p<0.001). Additionally, there was an over 9-fold increase in the proportion of parents who reported that they attended school-based vaccination events (7.0% pre-intervention versus 64.8% post-intervention, p<0.0001). Finally, the COVID-19 pandemic did not affect how respondents thought of the HPV vaccine (98.98% versus 0.51%) as measured in the post survey.
Conclusion
Although there was a marked increase in respondents that mentioned attending vaccination events and vaccinating their child with the HPV vaccine, lower knowledge about HPV and the HPV vaccine was reported. One reason for this may be that the pandemic restricted in-person meeting events where the team could effectively communicate the information to the public. Decreased interaction and a higher focus on vaccination could explain the discrepancy. Additionally, information oversaturation due to the flood of COVID-19 news may have had a confusing effect on an individual’s perception of other vaccines including the HPV vaccine. Lessons learned will guide current practices though as restrictions are lifted, normal interaction and information dissemination may be continued to pre-pandemic levels.