Determinants of parental demand of human papillomavirus vaccination for adolescent daughters in China: Contingent valuation survey

IF 1.9 4区医学 Q3 HEALTH POLICY & SERVICES

International Journal of Health Planning and Management Pub Date : 2024-07-16 DOI:10.1002/hpm.3818

Jie Chang, Shan Zhu, Yuting Zhang, Natalie Carvalho, Sen Xu, Yunshu Lu, Xin Liu, Yu Fang, Qingyue Meng

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引用次数: 0

Abstract

Background

Several types of human papillomavirus (HPV) vaccines have been approved for use in adolescent girls in China. These vaccines are regulated as non-National Immunisation Program vaccines and are optional and generally fully self-paid by vaccinees.

Objective

To assess parents' demand for HPV vaccination by eliciting their willingness-to-pay for their adolescent daughters to be vaccinated against HPV and to examine the determinants of demand for HPV vaccination in China.

Methods

A contingent valuation survey was conducted across three cities in Shandong Province in eastern China. We selected 11 junior middle schools with different socioeconomic features and randomly selected 6 classes in each school, and questionnaires were distributed to all girls aged 12–16 in the 66 classes for their parents to complete. A payment card approach was used to elicit parental willingness-to-pay for HPV vaccination for their daughters. We also collected a wide array of socioeconomic and psychological variables and interval regressions were applied to examine the determinants of parental willingness-to-pay.

Results

A total of 1074 eligible parents who completed valid questions were included in analyses. Over 85% of parents believed HPV vaccines were, in general, necessary and beneficiary. However, only around 10% believed that their daughters would be infected by HPV. About 8% of parents would not accept HPV vaccine even if the vaccine were free mainly due to concerns about the potential side effects and vaccine safety and quality issues, and 27.37% would only accept the vaccine if it were free. The median willingness-to-pay was 300 CNY (42 USD). Several factors were positively correlated with higher willingness-to-pay: income, urban residence (relative to rural residence), mothers (relative to fathers), parents' beliefs about vaccine benefits, whether they should make decisions for their daughters, and whether their daughters would be susceptible to HPV. Though education-level was not significantly correlated with willingness-to-pay in the main regressions, a subgroup analysis revealed interesting dynamics in the relation between education and willingness-to-pay across different income-levels.

Conclusions

There is a large gap between parents' willingness-to-pay and the market price of HPV vaccine for girls in China. Parents generally believed the HPV vaccines were beneficial and necessary but when asked for their daughters, most parents did not believe their daughters would be infected by HPV despite the high prevalence in China. Future focus should be on ensuring the provision of accurate health information about HPV prevalence, vaccine quality, and safety to promote vaccine uptake, and promotional efforts tailored to different income groups might yield better effects. Government involvement in negotiating more widely acceptable and affordable prices or subsidising may be necessary for protecting high-risk population groups.

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中国父母为青春期女儿接种人类乳头瘤病毒疫苗需求的决定因素：权变估值调查。

背景：在中国，几种类型的人类乳头瘤病毒 (HPV) 疫苗已被批准用于青春期少女。这些疫苗作为非国家免疫规划疫苗进行管理，接种者可自行选择接种，一般完全自费：通过了解家长为其青春期女儿接种人乳头瘤病毒疫苗的支付意愿，评估家长对人乳头瘤病毒疫苗接种的需求，并研究中国人乳头瘤病毒疫苗接种需求的决定因素：我们在中国东部山东省的三个城市开展了或然估值调查。我们选择了 11 所具有不同社会经济特征的初中学校，并在每所学校中随机抽取了 6 个班级，向这 66 个班级中所有 12-16 岁的女生发放问卷，让她们的家长填写。我们采用支付卡的方式来了解家长为女儿接种人乳头瘤病毒疫苗的支付意愿。我们还收集了一系列社会经济和心理变量，并采用区间回归法来研究家长支付意愿的决定因素：共有 1074 位符合条件并填写了有效问题的家长参与了分析。超过 85% 的家长认为，HPV 疫苗总体上是必要的，也是有益的。然而，只有约 10% 的家长认为他们的女儿会感染 HPV。约 8%的家长即使免费接种也不会接受 HPV 疫苗，主要原因是担心潜在的副作用以及疫苗的安全和质量问题；27.37%的家长只有在免费接种的情况下才会接受疫苗。支付意愿中位数为 300 元人民币（42 美元）。有几个因素与较高的支付意愿呈正相关：收入、城市居住地（相对于农村居住地）、母亲（相对于父亲）、父母对疫苗益处的看法、他们是否应为女儿做决定以及他们的女儿是否容易感染人乳头瘤病毒。虽然在主回归中，教育水平与支付意愿并无明显关联，但分组分析显示，在不同收入水平的人群中，教育水平与支付意愿之间的关系存在有趣的动态变化：结论：在中国，家长的支付意愿与女童 HPV 疫苗的市场价格之间存在巨大差距。家长们普遍认为接种 HPV 疫苗是有益且必要的，但当问及女儿时，大多数家长并不认为他们的女儿会感染 HPV，尽管 HPV 在中国的流行率很高。未来的重点应该是确保提供有关 HPV 流行率、疫苗质量和安全性的准确健康信息，以促进疫苗的接种，针对不同收入群体的宣传工作可能会产生更好的效果。为了保护高危人群，政府有必要参与谈判，以获得更广泛接受和可负担的价格或补贴。

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来源期刊

International Journal of Health Planning and Management Multiple-

CiteScore

4.50

自引率

3.70%

发文量

197

期刊介绍： Policy making and implementation, planning and management are widely recognized as central to effective health systems and services and to better health. Globalization, and the economic circumstances facing groups of countries worldwide, meanwhile present a great challenge for health planning and management. The aim of this quarterly journal is to offer a forum for publications which direct attention to major issues in health policy, planning and management. The intention is to maintain a balance between theory and practice, from a variety of disciplines, fields and perspectives. The Journal is explicitly international and multidisciplinary in scope and appeal: articles about policy, planning and management in countries at various stages of political, social, cultural and economic development are welcomed, as are those directed at the different levels (national, regional, local) of the health sector. Manuscripts are invited from a spectrum of different disciplines e.g., (the social sciences, management and medicine) as long as they advance our knowledge and understanding of the health sector. The Journal is therefore global, and eclectic.