• Linda D L Wang, Wendy W T Lam, and Richard Fielding.
• Division of Behavioural Sciences, School of Public Health, The University of Hong Kong, Hong Kong, China. Electronic address: lindawdl@connect.hku.hk.
• Lancet. 2016 Oct 1; 388 Suppl 1: S78.

BackgroundUptake of vaccination against human papilloma virus (HPV) remains low among adolescent girls in Hong Kong, China, despite long-standing vaccine availability. We examined predictors of Chinese parents' decision-making regarding their adolescent daughters' vaccination using an extensively modified Theory of Planned Behaviour.MethodsDuring 2014 we did a population-based random sample of Chinese parents in Hong Kong who were aware of HPV vaccine and had at least one unvaccinated daughter aged 12-17 years. Participants gave informed consent and completed baseline telephone interviews to measure knowledge, attitudes, perceived self-efficacy, social norm beliefs, and intentions regarding daughters' HPV vaccination. Participants were followed up at 6 and 12 months to obtain daughters' HPV vaccination status. Vaccination uptake predictors were identified using logistic regression. All analyses were performed using SPSS version 22.0 and p<0·05 was considered statistically significant. Verbal consent was obtained from each participant prior to telephone interview. Ethical approval was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 13-397).FindingsThe study included 1996 participants at baseline (response rate 60%), 1255 at 6 months, and 979 at 12 months. At baseline, 82·6% (1649/1996) of participating parents would accept HPV vaccination for daughters if the government provided it free-of-charge. Otherwise, only 37·7% (752/1996) of parents expressed vaccination intentions. By 12 months of follow-up 9·8% (97/988) had vaccinated their daughters against HPV; of these, 75·3% (73/97) had intended to vaccinate and 24·7% (24/97) had not intended to vaccinate at baseline. Factors predictive of greater uptake were perception of cervical cancer as difficult to prevent (OR 2·86; 95%CI 1·42-5·76), trust in government (2·35; 1·11-4·95), and perception of daughter as susceptible to cervical cancer (1·89; 1·02-3·49). Factors predictive of lower vaccination uptake were older age (0·31; 0·16-0·61), employment as healthcare workers (0·27; 0·08-0·89), belief of vaccines weakening immune systems (0·33; 0·17-0·66), anticipation of regret about vaccination (0·49; 0·24-0·99), or influence by peer-parents (0·43; 0·20-0·88).InterpretationLack of government endorsement and subsidy instills doubt about efficacy and importance of vaccination against HPV in this community. Despite intention to vaccinate, parental vaccination decision-making for daughters was modified by cost, trust in government information, social norm beliefs, and anticipated regret. To improve uptake of vaccination against HPV, the Chinese government should encourage vaccination more strongly, publicise key opinion-leaders' vaccination of their daughters, and ideally subsidize this valuable preventive strategy. Self-reported vaccination status potentially limits this study. A robust theory-based prospective cohort study design strengthens it.FundingHong Kong Government's Health and Medical Research Fund (HMRF 11121501).Copyright © 2016 Elsevier Ltd. All rights reserved.

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