Infectious Disease
Demographic disparities in suboptimal uptake of human papillomavirus (HPV) vaccine among female schoolteachers in a middle eastern country: A generalized structural equation modeling approach Saeed Akhtar* Saeed Akhtar Juman Rezqalla Danah Omar Mariam Alshatti Houda Al-Failakawi Sarah AlGhurair Shamayel AlHaqqan Amna Ibraheem
Background: Suboptimal human papillomavirus (HPV) vaccine uptake among females is associated with several knowledge and behavioural factors. However, the complex mechanisms causing poor HPV vaccine uptake are not yet fully understood. Using generalized structural equation modeling (GSEM) with bootstrapping estimation, we sought to disentangle the direct, indirect, and total effects (DE, IDE, TE) of age, family history of cervical cancer and unawareness of HPV causal role in cervical cancer on the poor uptake of HPV vaccine among female schoolteachers in Kuwait.
Methods: A cross-sectional study was conducted among female schoolteachers employed in public and private-sector high schools in Hawalli governorate. Data were collected using a self-administered questionnaire during January 2018. Prevalence of HPV vaccine uptake was computed. The effects of age (years) (≥ 30 vs. < 30), and family history of cervical cancer (yes/no), through mediator (i.e., unawareness of HPV causal role in cervical cancer) on to HPV vaccine uptake (no vs. yes) were examined in GSEM framework. The DE, IDE, TE were estimated as log odds and their SEs.
Results: Of 1341 participants, 60% were unaware of HPV causal role in cervical cancer. The prevalence of HPV vaccine uptake was 1.9%. There was evidence of a significant IDE of age on HPV vaccine uptake status through the mediator (mediated proportion 36%; IDE aOR: 0.54, p = 0.004; DE aOR: 1.96; p = 0.108; TE aOR: 1.07; p < 0.001). Moreover, a positive family history of cervical cancer mediated a significant protective effect through the mediator to the poor HPV vaccine uptake status (IDE aOR 0.42, p = 0.006; DE aOR = 0.21, p < 0.001; TE aOR 0.08, p < 0.001).
Conclusion: Health education intervention tailored to enhance the awareness about HPV causal role in cervical cancer, and benefits of HPV vaccine may augment the HPV vaccine uptake in this and other similar populations. If implemented future studies may look at the impact of such efforts.
