Social Cognitive and Clinical Factors Associated with HPV Vaccine Initiation Among Urban, Economically Disadvantaged Women


  • Disclosure: The authors report no conflict of interest or relevant financial relationships.


Anne Teitelman, PhD, CRNP, FAANP, Center for Health Equities Research, School of Nursing, University of Pennsylvania Fagin Hall, 2L (Rm. 244), 418 Curie Blvd., Philadelphia, PA 19194-4217



To learn more about human papilloma virus (HPV) knowledge and vaccination among teens and young women age 13 to 26 years from an economically disadvantaged, urban community. Our aim was to identify common beliefs about HPV vaccine initiation and describe the relationship between attitudes, norms, perceived control, and intention to receive HPV vaccine, drawing from the theory of planned behavior (TPB).


Mixed method, descriptive design. Guided by the TPB, HPV vaccine beliefs were assessed through focus groups. Intention to receive the vaccine, demographic and clinical factors, and theoretical predictor variables (attitudes, norms, and control) were assessed through questionnaires.


After recruitment, focus groups were held at a convenient date and time for our participants in a small university conference room.


Participants were economically disadvantaged young women, age 13 to 26 (N = 34).


Specific behavioral, normative, and control beliefs were elicited in focus groups and analyzed using content analysis. Simple and multivariate general linear modeling with adjustment for prognostic demographic and clinical factors was completed to assess the influence of the theoretical predictor variables on the outcome of HPV vaccine initiation.


Influential beliefs toward vaccination were identified. Analysis indicated attitudes, norms, and perceived control toward HPV vaccine initiation were highly significant predictors of intent, as was tobacco use; all p's < .001.


Barriers to HPV vaccine initiation were identified, and strong preliminary evidence supports use of the TPB to guide programs to promote urban, economically disadvantaged young women's intent to begin the HPV vaccine.