基于创新扩散理论的人乳头瘤病毒疫苗接种行为分析

Analysis of HPV vaccination behavior based on diffusion of innovation

目的基于创新扩散理论分析人乳头瘤病毒(HPV)疫苗接种行为,为提高HPV疫苗接种意愿提供依据。方法采用方便抽样法从杭州市2家社区卫生服务中心选择已预约或接种HPV疫苗至少1剂次的女性为调查对象,参考宫颈癌危险因素、HPV疫苗知识和接种时间设计问卷进行调查,基于创新扩散理论分析HPV疫苗接种扩散规律,分析不同扩散阶段的接种者的特征。结果共纳入448人,年龄18~45岁,中位数为30.5岁。2017年4月以前为起步阶段,领头者8人,占1.79%;2017年10月-2018年2月为缓慢上升阶段,早期接种者59人,占13.17%;2018年4月-2019年4月为较快上升阶段,早期多数接种者160人,占35.71%;2019年5-8月为迅速上升阶段,后期多数接种者170人,占37.95%;2019年9月至调查结束日为滞缓阶段,落后者51人,占11.38%。领头者均接受宫颈癌筛查,均为自愿接种,均知晓宫颈癌易感人群、疫苗预防HPV型别和疫苗适用人群,妊娠3次6人,首次妊娠年龄中位数为27岁。早期接种者和早期多数接种者多因医生或朋友推荐而接种HPV疫苗,首次妊娠年龄中位数分别为26岁和28岁,其他特征与领头者基本相似。后期多数接种者和落后者特征相似,以学生,因朋友推荐而接种HPV疫苗,未接受宫颈癌筛查,不知晓宫颈癌易感人群、疫苗预防HPV型别和疫苗适用人群者居多。结论暴露风险高、关注宫颈癌相关知识及接受筛查的人群早期接种HPV疫苗的可能性大。加强HPV疫苗接种健康教育,充分利用医生和早期接种者的意见领袖作用,有助于提高适龄人群HPV疫苗接种率。

Objective To understand the behavioral characteristics of vaccination of human papillomavirus(HPV) vaccine based on diffusion of innovation theory,and to put forward suggestions for improving the vaccination willingness.Methods The women who had made an appointment or received at least one dose of HPV vaccine in two community health service centers with HPV vaccination qualification in Hangzhou were recruited by convenience sampling method.A questionnaire survey was conducted according to cervical cancer risk factors,HPV vaccine knowledge and the time of vaccination.The diffusion of HPV vaccination and the characteristics of vaccinees in different stages was analyzed.Results A total of 448 women,aged from 18 to 45 years old,with a median of 30.5 years old,were investigated.The spread of HPV vaccine were divided into five stages:April 2017 and before was the initial stage,with 8 leaders,accounting for 1.79%;October 2017 to February 2018 was the slowly rising stage,with 59 early vaccinees,accounting for 13.17%;April 2018 to April 2019 was the rising stage,with 160 most early vaccinees,accounting for 35.71%;May to August 2019 was the rapidly rising stage,with 170 most late vaccinees,accounting for 37.95%;September 2019 to the end of the survey was the standstill stage,with 51 laggards,accounting for 11.38%.All of the leaders had participated in cervical cancer screening,voluntarily vaccinated,and knew the susceptible population of cervical cancer,the targeted HPV types and the suitable population of vaccine.The median age of the first pregnancy was 27 years old.Six of them had three pregnancies.The early vaccinees and the most early vaccinees were recommended by doctors or friends to get HPV vaccine.The median age of first pregnancy was 26 and 28 years old,respectively.Their other characteristics were similar to those of the leaders.The characteristics of most late vaccinees were similar to those of the laggards.They were were mainly students who were recommended by their friends to receive HPV vaccination,did not participate in cervical cancer screening,did not know the susceptible population of cervical cancer,the targeted HPV types and the suitable population of vaccine.Conclusions People with high risk of HPV exposure,awareness of cervical cancer and screening are more likely to receive HPV vaccination at the early stage.It is necessary to strengthen the health education of HPV vaccination,and make full use of the influence of doctors and early vaccinees,which is helpful to promote the early vaccination of HPV vaccine among the right age population.