TITLE:
Disease prevention without relapse: Processes of change for HPV vaccination
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, James O. Prochaska
KEYWORDS:
Human Papillomavirus; Transtheoretical Model; Processes of Change; Vaccine
JOURNAL NAME:
Open Journal of Preventive Medicine,
Vol.3 No.3,
June
10,
2013
ABSTRACT: Background: Human
papillomavirus is the most prevalent sexually transmitted infection in the
United States and is associated with 70% of cervical cancers as well as over
90% of genital warts. Although the HPV vaccine appears in the US immunization
schedule during adolescence, a large percentage of women reach adulthood
without being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change
(POC) construct provides an assessment of participants’ experiences with HPV
vaccination and is a central component of computer-tailored interventions
designed to increase compliance with medical recommendations, such as vaccination.
This study describes development and validation of a POC measure for
increasing HPV vaccination among young adult women. Methods: Cross-sectional
measurement development was conducted using an online survey to reach a sample
of 340 female college students representing vaccinated and unvaccinated
women. Factor analytic structural equation modeling as well as evaluations of
the stage by POC were used to evaluate the validity of the POC measure.
Results: Confirmatory analyses supported the theoretically expected ten-factor,
fully correlated model as the best fit for the data. Expected Stage of Change
to POC relationships were also confirmed insofar as each POC was significantly
associated with Stage of Change, with the exception of dramatic relief.
Follow-up analyses suggested that individuals in the Precontemplation stage
used all POC less frequently than individuals in all other stages. Conclusions: The POC measure was found
to be internally and externally valid in a sample of college-attending women.
The POC measure developed may be used to tailor stage-matched interventions
that increase use of experiential and behavioral strategies important for
increasing HPV vaccination in this high-risk population.