Purdue University Purdue e-Pubs Open Access Theses Theses and Dissertations Summer 2014 Parental Acceptance of the Human Papillomavirus Vaccination Among South Asian Immigrants Living in the Midwest USA Samina Shams Khan Purdue University Follow this and additional works at:https://docs.lib.purdue.edu/open_access_theses Part of theHealth Policy Commons Recommended Citation Khan, Samina Shams, "Parental Acceptance of the Human Papillomavirus Vaccination Among South Asian Immigrants Living in the Midwest USA" (2014).Open Access Theses. 446. https://docs.lib.purdue.edu/open_access_theses/446 This document has been made available through Purdue e-Pubs, a service of the Purdue University Libraries. Please contact [email protected] for additional information. 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Shamsur Rahman Khan and Tahera Khan, and my dearest son and husband Nawaf Rayan Bhuiyan and Aizaz Bhuiyan iii ACKNOWLEDGEMENTS I am thankful to my academic advisors Dr. Titilayo Okoror and Dr. Gerald Hyner for their endless guidance and support to make this research a success. My gratitude goes to them for being accommodating and easily accessible at several times when their support was necessary. Their positive attitude always kept me motivated and without their astute thoughts and constructive suggestions this work would not have been possible. I also express my sincere gratitude to Dr. Roseann Lyle for her valuable time and important suggestions to make this thesis complete. I thankfully acknowledge the people and organizations that were behind the main driving force of this research, the data collection. I am grateful to my wonderful friends who disseminated the survey links to the potential participants. I am equally thankful to the members of the South Asian organizations who completed the surveys and provided data for my research. Special thanks go to Bithi Islam and Pooja Sharma, for working so hard for getting the survey participants for this study. My deepest gratitude goes to the people of the graduate Health and Kinesiology Department for their support. I appreciate my wonderful friend Haijuan Gao and Tahira Yeasmin for extending helpful hands on several occasions. I specially appreciate the service of Lisa Duncan from the very first day of my graduate school. It is for the department staffs my journey was so smooth. iv I am indebted to my parents, Md. Shamsur Rahman Khan and Mrs. Tahera Khan for their continuous inspiration in any academic work of my entire life. The sacrifice they have made for my graduate work is unsurpassable. I feel proud to have such supportive and cooperative parents. I am also grateful to my husband, Dr. Aizaz Bhuiyan for his constant love, support, and care. Finally, a true inspiration of my graduate studies was my son’s glowing smile. My all source of energy for this degree was this heavenly kid. A million thanks to Nawaf for the priceless moments you shared with me throughout the whole journey. v TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................ vii  LIST OF FIGURES ........................................................................................................... ix  ABSTRACT……….. .......................................................................................................... x  CHAPTER 1.  INTRODUCTION ................................................................................. 1  1.1  Introduction ............................................................................................... 1  1.2  Background ............................................................................................... 2  1.3  Research Questions ................................................................................... 4  1.4  Significance of the study ........................................................................... 4  CHAPTER 2.  LITERATURE REVIEW ...................................................................... 6  2.1  Burden of HPV Infection in South Asia.................................................... 6  2.2  Prevention strategy .................................................................................... 8  2.3  HPV vaccine and South Asian Parents ..................................................... 9  2.4  South Asian Immigrants and Cancer Prevention Strategy ...................... 12  CHAPTER 3.  RESEARCH METHOD ...................................................................... 16  3.1  Participants .............................................................................................. 16  3.2  Research Procedure ................................................................................. 17  3.3  Measures .................................................................................................. 17  3.3.1  Dependent Variables .........................................................................17  3.3.2  Independent Variables .......................................................................18  3.4  Statistical Analysis .................................................................................. 19  3.5  Socio-ecological Model ........................................................................... 20  CHAPTER 4.  RESULTS ............................................................................................ 22  4.1  Socio-demographic Information ............................................................. 22 vi Page 4.2  Awareness of HPV, Cervical Cancer, Genital Warts, and HPV Vaccination…. .............................................................................................................. 26  4.3  HPV Knowledge ..................................................................................... 33  4.4  Source of Information ............................................................................. 38  4.5  Attitude Toward Vaccination In General ................................................ 39  4.6  Parental Willingness to HPV Vaccination .............................................. 42  4.7  Reasons in Support of and Against Vaccination ..................................... 47  CHAPTER 5.  DISCUSSION ...................................................................................... 55  5.1  Introduction ............................................................................................. 55  5.2  Awareness and Knowledge of HPV ........................................................ 55  5.3  Willingness .............................................................................................. 58  5.3.1  Difference in Acceptance Across Sex of the Children ......................59  5.3.2  Difference in Acceptance Across the Sex of the Parents ..................60  5.3.3  Other Factors .....................................................................................60  5.4  Supporting Factors and Barriers Toward HPV Vaccination Decision .... 61  5.5  Physicians’ Role in Parental Vaccine Decision ...................................... 62  5.6  Strengths of the Study ............................................................................. 63  5.7  Limitations of the Study .......................................................................... 63  5.8  Future Research ....................................................................................... 64  5.9  Conclusion ............................................................................................... 64  LIST OF REFERENCES .................................................................................................. 67 APPENDICES Appendix A  Email Invitation ....................................................................................... 72  Appendix B  Online Participant Information Sheet ...................................................... 73  Appendix C  Survey Questionnaire .............................................................................. 75  Appendix D  Email Reminder ....................................................................................... 88 vii LIST OF TABLES Table .............................................................................................................................. Page Table 4.1: Socio-demographic information of the study population (n=136). ................. 23  Table 4.2: Awareness of HPV, cervical cancer, genital warts, and HPV vaccination. ..... 26  Table 4.3: Awareness of HPV across different socio-demographic variables. ................. 27  Table 4.4: Awareness of cervical cancer across different socio-demographic variables. 28  Table 4.5: Awareness of genital warts across different socio-demographic variables. .... 29  Table 4.6: Awareness of HPV vaccine across different socio-demographic variables. ... 30  Table 4.7: Regression analysis of HPV, cervical cancer, genital warts, and HPV vaccination awareness ....................................................................................................... 32  Table 4.8: Individual knowledge on HPV. ....................................................................... 34  Table 4.9: Average score on knowledge questions. .......................................................... 35  Table 4.10: Frequency distribution of knowledge scores. ................................................ 35  Table 4.11: Variation of knowledge across socio demographic variables. ....................... 37  Table 4.12: Logistic regression analysis of knowledge. ................................................... 38  Table 4.13: Source of information (n=136). ..................................................................... 39  Table 4.14: Attitude towards vaccination in general in valid percentages. ...................... 41  Table 4.15: Variation of parents’ willingness to vaccinate daughters across different socio-demographic variables. ........................................................................................... 43 viii Table .............................................................................................................................. Page Table 4.16: Variation of parents’ willingness to vaccinate sons across different socio- demographic variables. ..................................................................................................... 44  Table 4.17: Logistic regression analysis of parents’ willingness to vaccinate daughters. 46  Table 4.18: Logistic regression analysis of parents’ willingness to vaccinate sons. ........ 47  Table 4.19: Reason for accepting HPV vaccination. ........................................................ 50  Table 4.20: Reasons for not accepting HPV vaccination. ................................................ 51