Introduction: Communication between Health Care Workers (HCWs) and patients is critical in vaccination decisions, particularly for the underutilized Human Papillomavirus (HPV) vaccination. Evidence-based training can enhance communication, especially when tailored to HCWs' and patients' needs.
Purpose: This study aimed to identify these needs using a taxonomy of anti-vaccination arguments - the attitude roots (Fasce et al., 2023) - alongside other psychological constructs.
Methods: In 2023, we conducted two representative nationwide telephone surveys with parents of children aged 9-14 (n=1508) and HCWs in paediatric practices (n=503) in Germany. The surveys assessed vaccination/recommendation behaviour, psychological determinants, HPV-related knowledge, and communication behaviours. Additionally, ten anti-vaccination statements representing the most relevant attitude roots regarding HPV vaccination were included. We used t-tests/ANOVA for group differences and linear regression models to analyze associations between attitude roots and HPV vaccination attitudes. A follow-up parent survey is planned for 2026 to assess possible changes at population-level.
Findings: Parents were more willing to vaccinate daughters than sons (t=-4.70, p=<.001), and perceived HPV vaccination as more important for girls (t=-5.76, p<.001). HCWs showed a similar pattern, expressing more positive attitudes toward vaccinating girls (t=4.54, p≤ .001). Among parents, the most prevalent attitude roots were unwarranted beliefs, distrust, and fears/phobia. Distorted risk perception showed the strongest association with parental vaccination attitudes (ß=-0.30, t=-9.90, p<.001). The attitude roots HCW found most difficult to address were unwarranted beliefs and fears/phobia. Both groups demonstrated notable knowledge gaps and uncertainties regarding HPV and the vaccination.
Conclusion: Survey results informed two training interventions conducted in 2024 in Germany. These emphasized, among others aspects, that HPV vaccination is equally important for all children and that parental fears must be addressed. The identified attitude roots will also be used to assess training impact, providing insights into how a demand-driven approach can improve HCWs' ability to counter anti-vaccination arguments.