Bridging the gap: tackling general and HPV vaccine hesitancy in rural and low-vaccination areas to improve HPV vaccine uptake.

Background: Despite strong efforts, HPV vaccine uptake remains low, especially in rural areas. This study examined general and HPV vaccine hesitancy among parents of children aged 9-17 in rural, low-vaccination areas, its link to HPV vaccination rates, and key factors influencing hesitancy. Methods: We surveyed parents from three counties in Virginia and collected information about their beliefs and opinions regarding adolescent vaccines, particularly the HPV vaccine, and their child's HPV vaccination status. General and HPV vaccine hesitancy were assessed using validated scales. Bayesian index logistic regression models were used to examine the relationship between each index and the child's HPV vaccination status, and also to identify the most important factor within each index. Results: The final analytical sample included 249 complete responses. The average reported child age was 12.4 years; 62.0% of parents reported that their child had received the HPV vaccine. In the adjusted general vaccine hesitancy model, hesitancy was significantly associated with a lower likelihood of a child's HPV vaccination (OR = 0.43, 95% CI: 0.26, 0.73), with perceived vaccine safety (weight = 0.363) the most influential factor estimated within the index. Similarly, in the adjusted HPV vaccine hesitancy model, hesitancy was significantly associated with a child's HPV vaccination (OR = 0.39, 95% CI: 0.20-0.72), with provider recommendation (weight = 0.198) the dominant estimated factor. Conclusion: Vaccine hesitancy remains a substantial challenge for HPV vaccination. Engaging providers to give strong vaccine recommendations and sharing information about vaccine safety, among other strategies, could help improve HPV vaccine uptake in rural and low-vaccination areas.