Ahmad Abuzoor

Using the Health Belief Model to Examine Parental Knowledge and Health Beliefs About Human Papilloma Virus (HPV) and iHPV Vaccine in Kuwait: Cross-Sectional Survey Study

Abstract Background Cervical cancer (CC) is a major public health issue, accounting for approximately 350,000 deaths, around 7.5% of all female cancer deaths worldwide, in 2018. Human papillomavirus (HPV) is the most common virus infecting the reproductive system. Despite the high number of diagnosed cases of CC globally, prevention is possible. Vaccination against HPV is considered to be a primary prevention strategy, while cervical screening can also play a secondary prevention role. Objective This study aimed to examine the knowledge and health beliefs of parents in Kuwait towards HPV and HPV vaccination in order to prepare for the development of a national policy on CC. Methods A cross-sectional survey was conducted among a representative multistage sample of 538 parents and guardians of eligible children aged 12–17 years in Kuwait, yielding a response rate of 89%. The survey was structured using the health belief model. Analysis showed statistically significant links between knowledge, health beliefs, concepts, and vaccination intention. Results Knowledge of HPV and HPV vaccination was low in our study population: 55.6% (n=297), 24.9% (n=133), and 19.5% (n=104) for poor, fair, and good knowledge, respectively. Parents of daughters scored lower on perceived susceptibility to HPV and were more likely to have a higher perception of barriers to HPV vaccination, even though fathers were more likely to believe their daughters were at risk. HPV vaccination has the stigma of promiscuity attached, even though half of the parents are willing to accept HPV vaccination if that recommendation comes from Uhealth officials or relatives. A greater proportion of parents with female children had a low perception of the severity of HPV infection compared to those with male children (n=154, 58.6% vs n=134, 49.4%; P =.043). Around 52% (n=278) of parents perceived a high benefit of HPV vaccination. Parents with a female child had a lower perception of HPV vaccine benefits compared to parents with a male child. The findings demonstrated that parents with higher levels of education were better informed about the use of HPV vaccines in controlling the illness. Parents with female children were 1.34 times more likely to act on the recommendation for HPV vaccination compared to parents with male children after a recommendation from an official source, such as doctors or healthcare professionals. Conclusions Recommendations for a Kuwaiti vaccination policy for HPV must take into consideration different knowledge levels of parents for groups with different educational levels, as well as the stigma of promiscuity and other barriers, and various health beliefs regarding susceptibility for daughters and sons, respectively.

Health Beliefs and Perspectives of Parents Regarding Human Papillomavirus Vaccination in Kuwait: Qualitative Study

Background After breast cancer, cervical cancer (CC) is one of the leading causes of female mortality. CC accounts for more than 7.5% of female cancer deaths worldwide. Human papillomavirus (HPV) is the most common sexually transmitted disease in women and the leading cause of CC in almost 99% of all CC cases. HPV vaccination could prevent up to 70% of HPV-related CC and 90% of genital warts. HPV vaccination is the bedrock of primary prevention and helps reduce the incidence and death rates of HPV-associated CC. Objective The study aimed to understand the knowledge, health beliefs, and perspectives of Kuwaiti parents regarding HPV vaccination, with the goal of developing a health promotion policy and introducing a national immunization program in Kuwait. Methods A total of 37 participants were evaluated using purposive sampling to select 20 (54%) participants for one-on-one semistructured interviews. We wanted to include both participants (male and female parents) with primary education (diploma or below) or secondary and higher education (bachelor’s degree and above). We had four categories (male parents/guardians with a diploma or below, male parents/guardians with a bachelor’s degree or above, female parents/guardians with a diploma or below, and female parents/guardians with a bachelor’s degree or above) with at least 5 participants in each category, which gave us 20 participants. Semistructured interviews were based on the Health Belief Model (HBM). The data were thematically analyzed using an inductive approach, generating themes through the theoretical framework of the HBM, and theme extraction analyses were managed on a semantic level. Results We identified 7 main themes containing 20 subthemes. The seven themes were (1) knowledge and awareness about HPV infection and vaccination (3 subthemes); (2) perceived susceptibility, which is explained by the HPV infection effect based on sex (2 subthemes); (3) perceived barriers to HPV vaccination (8 subthemes); (4) perceived benefits (1 subtheme); (5) perceived severity (2 subthemes); (6) perceived efficacy (2 subthemes); and (7) cues to action (2 subthemes). Conclusions The HBM framework is beneficial for Kuwait’s HPV vaccination campaign. The correlation between sexual intercourse and the HPV vaccine frequently adds complexity to the decision-making process about immunization. This study demonstrates that positive cues to action from health care practitioners and educational vaccination benefits can overcome perceived barriers among parents related to stigma and religion. It is essential to conduct more such research to guide the development of interventions aimed at promoting adoption of the HPV vaccine.