Identity-based motivation in HPV vaccine decision-making: Role of healthcare provider trust, communication and response efficacy

Human papillomavirus (HPV), the most common newly acquired sexually transmitted infection (STI) in the United States (U.S.), is a well-established and accepted cause of a number of cancers in women and men (Centers for Disease Control and Prevention, 2016). Because of pervasive cervical cancer disparities, a focus has been placed on pushing for adolescent vaccination in low income and ethnic minority populations. As a framework for this study, we drew upon the Identity-Based Motivation Theory (Oyserman, Fryberg, & Yoder, 2007) to explore the potential role of ethnic identity (ID) in HPV vaccine decision-making among Somali and African-American parents. We examined whether the HPV vaccine is viewed as congruent with ethnic-ID, and how this in turn influenced vaccine uptake. In cases of incongruence, we examined how provider trust, health care provider (HCP) communication during the vaccine offer, and perceptions of the vaccines efficacy interact with ethnic-ID to influence parental decision-making.;A cross-sectional survey was administered to 211 parents (100 African American and 111 Somali) of children who had been previously offered the vaccine. Participants self-labeled and rated the importance of their ethnic-ID, rated the frequency of general health behaviors, and indicated their current HPV vaccine decision. Participants then indicated the degree to which HPV vaccination and general health behaviors are typical (congruent) of people who share their ethnic-ID. Finally, parents were asked about the degree to which they trust their child's HCP, their perceptions of the vaccine's response efficacy and provider communication about the vaccine. In addition, a small sub-set (n = 5) of in-depth interviews were conducted with Somali mothers to explore alternate identities that were salient during HPV vaccine decision-making.;Results showed moderate HPV vaccine uptake and vaccine series completion rates among African American and Somalis. Completion rates were higher among African Americans compared to Somalis. African Americans and Somalis had strong ethnic-ID, and Somalis had significantly stronger ethnic-ID than African Americans. Ethnic-ID incongruence decreased the likelihood of HPV vaccination. However, incongruence did not mediate the relationship between ethnic-ID strength and behavior. The effect of incongruence on ethnic-ID strength was not moderated by HCP trust, response efficacy or HCP communication. Ethnic-ID congruence increased the likelihood of HPV vaccination. The effect of congruence was moderated by response efficacy. Theoretical and applied implications of the results are discussed.