Parental perspectives: a mixed method study on perceived risk, self-efficacy, vaccine response efficacy, and willingness for adolescent HPV vaccination in Puducherry, South India.

Background: Cervical cancer is the second most common cancer among women in India. To reduce its incidence, the government is set to roll out a Human papillomavirus (HPV) vaccination for adolescent girls.

Objectives: To find the association between risk perception, self-efficacy, vaccine response efficacy and willingness to vaccinate adolescents (9-18 years) against HPV and to explore factors associated with willingness for vaccination among adolescent girls, their parents and healthcare workers.

Methods: A mixed-method study was conducted among parents of adolescent girls aged 9-18 using multistage simple random sampling in Puducherry. After a brief education session, a self-developed and validated questionnaire was used to assess perceived risk, self-efficacy, vaccine response efficacy and willingness for HPV vaccination. Chi-squared and Fisher's exact tests were used for analysis.

Results: Out of 388 participants, majority (78.1 %) had heard of cervical cancer, and 6.2 % were aware of HPV infection. Of the participants, 44.8 % (95 % CI: 39.9-49.8 %) had a high perceived risk, 49 % (95 % CI: 44.0-53.9 %) had low self-efficacy, and 70.9 % (95 % CI: 66.2-75.2 %) believed in high vaccine response efficacy. Additionally, 91.5 % of participants were willing to vaccinate under a universal immunisation schedule, and only 44.1 % from private providers. Participants who were willing to vaccinate had a higher risk perception of HPV infection and cervical cancers, high belief in vaccines and low self-efficacy in their own health (p<0.001) compared to those who were not willing for HPV vaccination.