Danyu Li,1,2 Jennifer Stinson,3,4 Wen Zhang,2 Fulei Wu,2 Jingting Wang,5 Biyu Shen,6 Fan Wu,1,* Changrong Yuan2,* 

1Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, People’s Republic of China; 2School of Nursing, Fudan University, Shanghai, People’s Republic of China; 3Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; 4Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 5School of Nursing, Naval Medical University, Shanghai, People’s Republic of China; 6Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Fan Wu, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, 130 Dong’an Road, Shanghai, 200032, People’s Republic of China, Email wufan@shmu.edu.cn Changrong Yuan, School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, People’s Republic of China, Email yuancr@fudan.edu.cn

Purpose: To assess the predictors of Chinese parents of girls’ decision stage about the Human Papillomavirus (HPV) vaccination.
Patients and Methods: Two hundred and seventy-three parents of girls aged 9– 17 with no HPV vaccination history were recruited to complete an online survey between September–December 2023. We assessed factors thought to influence decisions about HPV vaccination, including sociodemographics, HPV general knowledge, HPV vaccination knowledge, attitudes, and decisional conflict. Parents were asked to choose the decision stages among Stage 1 (have not thought), Stage 2 (considering), and Stage 3 (decided). Predictors of the decision stage were assessed with univariate and multivariate multinomial logistic regression.
Results: The parents of the three decision stages accounted for 48.4%, 29.7%, and 22.0%, respectively. Parents of older girls were more likely to be in the “considering” stage (OR = 1.29) than the “haven’t thought” stage. A higher sense of being uninformed was associated with lower odds of being in the “considering” stage (OR = 0.97). Additionally, greater feelings of uncertainty were linked to lower odds of being in the “decided” stage (OR = 0.95) than the “haven’t thought” stage.
Conclusion: This study highlights the importance of understanding the various stages of decision-making in HPV vaccination among Chinese parents. Parents’ subjective feelings of being informed and certainty appear to be significant factors in advancing through the decision-making stages. Future research should develop and explore the impact of specific knowledge and valued based tools and decision aids.

Keywords: decision stage, decisional conflict, human papillomavirus, China, papillomavirus vaccination