Health Care Decisions for Female Adolescents: The Role of Mothers and Daughters in Decision Making
Preventing cervical cancer is a public health concern. Since 2006 a quadrivalent vaccine
for young women nine to twenty six years of age has been available to protect against the
human papillomavirus (HPV) and to prevent some types of cervical cancer (Gardasil). The
vaccine is an important health promotion tool to address the widespread prevalence of HPV
and cervical cancer, but not all eligible young women receive the vaccine. The vaccine is
most effective when administered to young women before their sexual debut. When the vaccine
is given to young women less than 18 years of age, parental permission is required. This
permission is usually provided by the young woman's mother. Understanding predictors of a
mother's decision for her minor daughter to receive the HPV vaccine will inform
interventions that seek to increase the number of young women who receive the vaccine.
Health behavior theories, such as the Theory of Planned Behavior (TPB), indicate the factors
and mechanisms that predict health promotion decisions and activities. TPB provides a direct
statistical model through which variables related to health behaviors can be measured and
evaluated, and will be used to guide the proposed study.
The study will focus on mothers and their adolescent daughters between 13-17 years of age.
The normative changes and realignments in the parent child relationship that arrive with the
onset of adolescence, coincide with greater adolescence behavioral autonomy, and influence
over parental decisions related to the adolescent. Thus, we expanded the TPB to include the
influence of the adolescent on the mother's decision for her daughter to receive the HPV
Hypothesis: We hypothesize that the Expanded Theory of Planned Behavior will explain a
mother's decision to choose the HPV vaccine for her daughter.
RSQ1: What TPB variables predict a mother's decision to choose HPV vaccine for her
RSQ2: What variables predict the strength of a daughter's influence on the mother's
decision to choose HPV vaccine for her daughter?
RSQ3: What are the relationships between the mothers' and daughters' scores on the
variables related to the decision to choose HPV vaccine?
RSQ4: How do the mothers and daughters who chose to receive the HPV vaccine differ
descriptively from those mothers and daughters who do not choose to receive the HPV vaccine?
Data will be analyzed using path analysis, multiple regression, and analysis of variance.
The model demonstrates multiple potential influences on the mother's decision to choose the
HPV vaccine for her daughter, and all influences are potential targets for family teaching
interventions and tailored social marketing. Further study will be needed to determine how
well the model applies to various family types and diverse cultures and nationalities.
Observational Model: Case-Only, Time Perspective: Cross-Sectional
Mimia C Logsdon, DNS, ARNP, FAAN
University of Louisville School of Nursing
United States: Institutional Review Board
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