Factors associated with primary care providers' recommendation of HPV vaccination for adolescent males in China: A mixed-methods study

Abstract

Background: The Chinese government has not yet included male population for HPV vaccination but there are increasingly more discussions about including them. Primary care providers' (PCPs) recommendation is an important driver for increasing vaccine uptake but understanding of PCPs' recommendation of HPV vaccine for adolescent males in China is limited. This study examined multidimensional factors associated with PCPs' recommendation of HPV vaccine for male adolescents, aiming to inform future HPV vaccination programs targeting adolescent males in China.

Methods: A sequential explanatory mixed-methods was used. In the quantitative phase, we conducted an online survey with PCPs in Eastern China. Multivariable logistic regression analysis identified individual, interpersonal, community, organizational, and policy factors associated with their recommendation of HPV vaccines for adolescent males. Specialty, job title, and income were adjusted as potential confounding factors. The qualitative phase involved thematic analysis to explore these findings further.

Results: Among the 605 PCPs recruited, only 16.4 % recommended HPV vaccines to adolescent males in the past 12 months. Multivariable logistic regression analysis showed that institutional support for HPV vaccination policies for adolescent males (AOR = 3.05, 95 % CI: 1.65-5.64), frequent institutional vaccine promotion activities (AOR = 1.82, 95 % CI: 1.12-2.96), and institutional incentives for vaccine promotion (AOR = 2.12, 95 % CI: 1.18-3.83) were associated with their recommendation behaviors. Additionally, those who perceived a community norm that HPV vaccines are only for females were less likely to recommend HPV vaccines to adolescent males (AOR = 0.54, 95 % CI: 0.33-0.87). Qualitative research further explained these findings, highlighting the role of organizational factors in PCPs' recommendation of HPV vaccination for adolescent males.

Conclusions: A low proportion of PCPs recently recommended HPV vaccines to adolescent males. Organizational-level factors were found to be significantly associated with their recommendation behaviors, and these may help inform future vaccination programs targeting adolescent males.

Keywords: Adolescent males; HPV vaccine; Primary care providers; Recommendation behavior; Social ecological model.