Intervention-amenable factors associated with lack of HPV vaccination in Kenya: Results from a large national phone survey.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly perceptions of what other parents are doing (descriptive norms) and the extent of social interaction around vaccination—play a critical role in HPV vaccine uptake. The study highlights that when caregivers believe that other parents are vaccinating their daughters, and when they engage in conversations about vaccination within their social networks, they are significantly more likely to vaccinate their own daughters. These findings underscore that norms operate through visibility and communication: limited discussion about HPV vaccination constrains the formation of strong pro-vaccination norms, while perceived peer behavior reinforces uptake. The discussion further emphasizes that activating social networks and leveraging trusted messengers (health workers, religious leaders, and peer caregivers) can shift norms and improve vaccination coverage.
Objectives The study aimed to identify intervention-amenable factors associated with HPV vaccination uptake among pre-adolescent girls in Kenya, using a theory-informed framework to assess behavioral and social drivers of vaccination among parents and caregivers.
Methods A cross-sectional, nationally distributed phone survey was conducted with approximately 1,400 parents and caregivers of girls aged 10–16 years in Kenya. Guided by the WHO Behavioral and Social Drivers (BeSD) framework, the study measured multiple domains including vaccine hesitancy, knowledge, perceived disease risk, social norms, trust in institutions, and access barriers. Social norms were assessed through measures of perceived peer behavior (whether others vaccinate), communication about vaccination, and influence from health workers and social networks. Multivariable logistic regression models were used to examine associations between these factors and whether daughters had received any HPV vaccine doses.
Results Only 38.2% of respondents reported that their daughters had received any HPV vaccine doses. Lower vaccine hesitancy, greater knowledge about HPV and the vaccine, and knowing someone affected by cervical cancer were all significantly associated with higher uptake. Social norms were strongly associated with vaccination: caregivers who had discussed HPV vaccination with others or perceived that other parents vaccinate their daughters had substantially higher odds of vaccinating their own daughters (aOR≈2–4). Trust in health systems and institutions also increased uptake, while perceived or anticipated access barriers significantly reduced the likelihood of vaccination.
Conclusions HPV vaccination uptake in Kenya is shaped by a combination of cognitive, social, and structural factors, with social norms emerging as a key leverage point for intervention. Programs should prioritize increasing knowledge, addressing safety concerns, fostering peer-to-peer communication, and leveraging trusted community and health system actors to strengthen pro-vaccination norms and improve coverage.
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