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Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study

Hilde M van Keulen1*, Wilma Otten1, Robert AC Ruiter2, Minne Fekkes1, Jim van Steenbergen34, Elise Dusseldorp1 and Theo WGM Paulussen1

Author Affiliations

1 TNO (Netherlands Organization for Applied Scientific Research), Expertise Center Life Style, PO Box 2215, Leiden, 2301 CE, the Netherlands

2 Department of Work and Social Psychology, Maastricht University, PO Box 616, Maastricht, 6200 MD, the Netherlands

3 National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, PO Box 1, Bilthoven, 3720 BA, the Netherlands

4 Leiden University Medical Center, Center for Infectious Diseases, PO Box 9600, Leiden, 2300 RC, the Netherlands

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BMC Public Health 2013, 13:111  doi:10.1186/1471-2458-13-111

Published: 6 February 2013



The Dutch government recently added universal Human Papilloma Virus (HPV) vaccination for 12-year-old girls to the existing national immunization program. The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower (47%) than expected (70%). To inform future HPV information campaigns, this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009.


A random sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate (n = 5,998 mothers and daughters). In addition, a random sample was recruited via an online panel by a marketing research company (n = 650 mothers; n = 350 daughters). Both groups were asked to complete a web-based questionnaire with questions on social demographic characteristics, social-psychological factors and HPV vaccination intention. Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention.


Data from 952 mothers (14%) and 642 daughters (10%) were available for the intended analyses. The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers (ΔR2 = .01; p = .007), but not significant for daughters (ΔR2 = .02; p = .17) after controlling for HPV vaccination uptake and the sample. In addition, social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers (ΔR2 = .35; p < .001) and daughters (ΔR2 = .34; p < .001). Attitudes, beliefs, subjective norms and habit strength were significantly associated with participants’ HPV vaccination intentions.


Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters, future communication strategies targeting HPV vaccination uptake should address attitudes, beliefs, subjective norms and habit strength. There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study.

HPV; Vaccination intention; Screening; Cancer; Social-psychological determinants