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Processes of Change for HPV Vaccination Anne C University of Rhode Island DigitalCommons@URI Cancer Prevention Research Center Faculty Cancer Prevention Research Center Publications 2013 Disease Prevention without Relapse: Processes of Change for HPV Vaccination Anne C. Fernandez University of Rhode Island Andrea L. Paiva University of Rhode Island, [email protected] See next page for additional authors Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 License. Follow this and additional works at: https://digitalcommons.uri.edu/cprc_facpubs Citation/Publisher Attribution Fernandez, A. , Paiva, A. , Lipschitz, J. , Larson, H. , Amoyal, N. , Blaney, C. , Sillice, M. , Redding, C. and Prochaska, J. (2013) Disease prevention without relapse: Processes of change for HPV vaccination. Open Journal of Preventive Medicine, 3, 301-309. doi: 10.4236/ ojpm.2013.33041. Available at: http://dx.doi.org/10.4236/ojpm.2013.33041 This Article is brought to you for free and open access by the Cancer Prevention Research Center at DigitalCommons@URI. It has been accepted for inclusion in Cancer Prevention Research Center Faculty Publications by an authorized administrator of DigitalCommons@URI. For more information, please contact [email protected]. Authors Anne C. Fernandez, Andrea L. Paiva, Jessica M. Lipschitz, H. Elsa Larson, Nicole R. Amoyal, Cerissa L. Blaney, Marie A. Sillice, Colleen A. Redding, and James O. Prochaska This article is available at DigitalCommons@URI: https://digitalcommons.uri.edu/cprc_facpubs/1 Vol.3, No.3, 301-309 (2013) Open Journal of Preventive Medicine http://dx.doi.org/10.4236/ojpm.2013.33041 Disease prevention without relapse: Processes of change for HPV vaccination Anne C. Fernandez1,2*, Andrea L. Paiva1,2, Jessica M. Lipschitz1,2, H. Elsa Larson1,2, Nicole R. Amoyal1,2, Cerissa L. Blaney1,2, Marie A. Sillice1,2, Colleen A. Redding1,2, James O. Prochaska1,2 1Department of Psychology, University of Rhode Island, Kingston, USA; *Corresponding Author: [email protected] 2Cancer Prevention Research Center, University of Rhode Island, Kingston, USA Received 8 April 2013; revised 12 May 2013; accepted 21 May 2013 Copyright © 2013 Anne C. Fernandez et al. This is an open access article distributed under the Creative Commons Attribution Li- cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT externally valid in a sample of college-attending women. The POC measure developed may be Background: Human papillomavirus is the most used to tailor stage-matched interventions that prevalent sexually transmitted infection in the increase use of experiential and behavioral stra- United States and is associated with 70% of tegies important for increasing HPV vaccination cervical cancers as well as over 90% of genital in this high-risk population. warts. Although the HPV vaccine appears in the US immunization schedule during adolescence, Keywords: Human Papillomavirus; a large percentage of women reach adulthood Transtheoretical Model; Processes of Change; without being vaccinated. The Transtheoretical Vaccine Model’s (TTM) Processes of Change (POC) con- struct provides an assessment of participants’ experiences with HPV vaccination and is a cen- 1. INTRODUCTION tral component of computer-tailored interven- Human papillomavirus (HPV) is the most common tions designed to increase compliance with me- sexually transmitted infection in the United States [1]. dical recommendations, such as vaccination. High-risk types of HPV (specifically 16 and 18) are as- This study describes development and valida- sociated with 70% of cervical cancers diagnosed world- tion of a POC measure for increasing HPV vac- wide and low risk-types of HPV, such as types 6 and 11, cination among young adult women. Methods: Cross-sectional measurement development was are associated with 90% of genital warts cases [2]. It is conducted using an online survey to reach a estimated that 80% of sexually active females will be sample of 340 female college students repre- exposed to HPV before they reach 50 years of age [3]. senting vaccinated and unvaccinated women. Sexually active young women under 25 are at greatest Factor analytic structural equation modeling as risk for HPV infection and US prevalence of HPV has well as evaluations of the stage by POC were been shown to be highest among women aged 20 - 24 used to evaluate the validity of the POC measure. [4-6]. Female college students have been identified as a Results: Confirmatory analyses supported the high-risk population for HPV infection [7,8]. theoretically expected ten-factor, fully correlated In June 2006, the Food and Drug Administration ap- model as the best fit for the data. Expected proved GARDASIL®, a highly efficacious quadrivalent Stage of Change to POC relationships were also vaccine protective against HPV types 6, 11, 16, and 18 confirmed insofar as each POC was significantly [9]. GARDASIL® is a three dose vaccine series adminis- associated with Stage of Change, with the ex- tered over six months. The American Committee on Im- ception of dramatic relief. Follow-up analyses munization Practices has recommended routine vaccina- suggested that individuals in the Precontempla- tion of girls aged 11 - 12 and catches up vaccination of tion stage used all POC less frequently than in- females aged 13 - 26 [10]. Routine vaccination of girls dividuals in all other stages. Conclusions: The before sexual debut optimizes the protective benefit of POC measure was found to be internally and the vaccine, but vaccinating girls and women older than Copyright © 2013 SciRes. OPEN ACCESS 302 A. C. Fernandez et al. / Open Journal of Preventive Medicine 3 (2013) 301-309 12 years of age may also help to reduce cervical cancer Table 1. Processes of change. rates [11]. As of 2009, 44% of girls aged 13 - 17 reported receiving at least one dose of the vaccine series and 27% Process Name Description Mean SD reported receipt of all three doses [12]. Data describing Experiential Processes vaccine uptake levels among women over 17 years of Efforts by the individual to age are limited, but the 2009 National Immunization Sur- Consciousness gain awareness, gather 11.31 3.74 vey found 17% of women aged 19 - 26 had received at Raising information, or get feedback least one dose of the HPV vaccine series [13]. Low vac- regarding the target behavior. cine uptake among college-aged females requires further Expression and experience of Dramatic affect related to the target examination of variables that may influence vaccine 12.31 4.40 acquisition and completion. Relief behavior (e.g. fear, hope, empowerment). One behavior change model particularly well-suited to examining motivation and decision-making related to Consideration of how the Environmental target behavior influences the 11.48 4.85 HPV vaccination is the Transtheoretical Model of Change Reevaluation physical and social (TTM). The TTM is an integrative model of behavior environment. change that has been applied to over 48 health behaviors Cognitive and emotional Self [14]. It is organized around the Stages of Change and reappraisal of one’s values 12.36 4.50 Reevaluation uses ten Processes of Change (POC) to represent activi- related to the target behavior. ties and experiences that are applied when engaging in Considering the social Social intentional behavior change [15,16]. Stage of Change is climate and norms related to 12.58 4.15 Liberation comprised of five stages: Precontemplation (not intend- the target behavior. ing to change), Contemplation (considering change), and Behavioral Processes Preparation (preparing to make a change), Action (ac- tively engaged in behavior change), and Maintenance Applying new ways of Counter thinking and behaving to 10.34 4.51 (sustaining change). Additional TTM constructs include Conditioning Decisional Balance and Self-efficacy. Decisional Balance promote behavior change. reflects the individual’s weighing of the pros and cons of Strategic control of Stimulus situations/triggers that may changing their behavior [17]. Self-efficacy describes the 9.32 4.32 Control interfere with or promote individual’s situation specific confidence that they can behavior change. sustain their behavior change despite high-risk or tempt- Commitment to change and Self ing situations to relapse to their unhealthy behavior [18- belief in one’s ability to 12.5 4.32 Liberation 20]. change. Application of behavioral The POC represent the functional dimension of the Reinforcement contingencies to promote 10.85 4.45 TTM, outlining the experiential and behavioral ways in Management behavior change. which people change [16,21,22]. There are ten POC, Use and availability of other comprised of covert and overt activities representing two Helping people for social and 12.27 4.55 broad correlated experiential and behavioral domains. Relationships emotional support while The experiential POC represent more covert cognitive making a behavioral change. and affective experiences/activities, and the behavioral POC represent more overt strategies, like substituting testing when applying the TTM to new behaviors. healthy alternatives, finding social support, and re- HPV vaccination is unique relative to other health be- organizing the environment to promote behavior change haviors because it lacks a traditional behavioral Main- (see Table 1). Unlike Decisional Balance which shows a tenance stage and requires relatively little overt beha- high level of consistency across Stage of Change for
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