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Int J Environ Res Public Health. 2020 Jan 16;17(2). pii: E571. doi: 10.3390/ijerph17020571.

Multi-Theory Model and Predictors of Likelihood of Accepting the Series of HPV Vaccination: A Cross-Sectional Study among Ghanaian Adolescents.

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Department of Public Health, Robbins College of Health and Human Sciences Baylor University, One Bear Place, Waco, TX 97343, USA.
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Geography and Resource Development, University of Ghana, Legon, Ghana.
Ghana Health Services, Non-Communicable Disease Control, Accra, Ghana.
Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA.
Department of Pediatrics and Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
Department of Internal Medicine, Division of Cancer Prevention and Control in the College of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA.


HPV vaccines are efficacious in preventing HPV related cancers. However, the vaccination uptake in Ghana is very low. Studies that utilize theoretical frameworks to identify contributory factors to HPV vaccination uptake in Ghana are understudied. We used multi-theory model (MTM) constructs to predict initiation and completion of HPV vaccination series in Ghanaian adolescents. Adolescents (n = 285) between the ages of 12 and 17 years old were recruited from four selected schools in Ghana to participate in the cross-sectional study. Linear regressions were used to analyze the data. Most participants were female (91.2%) and senior high school students (60.0%). Many of the participants had neither heard about HPV (92.3%) nor HPV vaccinations (95.4%). Significant predictors of adolescents' likelihood of getting the first dose of HPV vaccination were perceived beliefs and change in a physical environment (p < 0.001), with each variable accounting for 6.1%and 8.8% of the variance respectively. Significant predictors of adolescents' likelihood of completing HPV vaccination recommended series were perceived beliefs, practice for change, and emotional transformation (p < 0.001), with each variable accounting for 7.8%, 8.1%, and 1.1% of the variance respectively. Findings underscore important opportunities for developing educational interventions for adolescents in Ghana to increase the HPV vaccination uptake.


HPV vaccination; adolescents; multi-theory model

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