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Unravelling parental decision-making for adolescent HPV vaccination in China by COM-B framework: a discrete choice
Naiyang Shi1,2, Shixin Xiu3, Jiayu Wang4
1Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
Background:
The paper provides a novel perspective beyond existing theoretical frameworks by integrating the COM-B model with discrete choice experiments (DCEs) to quantify parental decision-making dynamics for adolescent HPV vaccination.
Research Design And Methods:
Two cross-sectional surveys were conducted in Wuxi, China, before and after the introduction of free domestic bivalent vaccines. Multinomial logistic regression identified COM-B predictors of vaccination intention, whereas DCEs quantified parental preferences. Latent class analysis (LCA) linked preference heterogeneity to COM-B domains with policy simulations comparing 20 vaccination scenarios.
Results:
Health benefit perception (motivation), financial/temporal self-efficacy (motivation), and social influence (opportunity) are key predictors. Generally, parents prioritized HPV vaccines with low cost, high efficacy, and low side effect risks, while hesitant and refusing parents showed less concern with appointment difficulties but preference for imported producers. Five distinct HPV vaccination preference groups are identified: domestic-affordable, cost-sensitive, efficacy-focused, safety-oriented, and accessibility-driven. Hesitant and refusing parents were representative in cost-sensitive and accessibility-driven, which were sensitive in simulated incentives or convenience-enhancing scenarios. Free domestic 2-valent vaccine maintained its dominance in choice probability across simulated scenarios, except for the National Immunization Program.
Conclusions:
Findings support stratified interventions targeting motivation (education, persuasion) and opportunity (cost subsidies, accessibility) based on the free domestic 2-valent vaccine policy.
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