Parents’ or Guardians’ Decisions on Human Papillomavirus Vaccine Acceptance for School Children in a Southern Province of Thailand: A Mixed-Method Study

<b>Background:</b> Cervical cancer is associated with Human Papillomavirus (HPV) infection. Besides cervical cancer, oro-pharyngo-laryngeal or uro-genital cancers are also reported. The HPV vaccine has been strongly recommended for school age children. However, the parents' or guardians' hesitancy remains. <b>Methods:</b> This is a mixed-method study in which the parents or guardians of school children, aged 10-18 years, were enrolled voluntarily. Their general demographic data, knowledge, attitudes, and awareness of vaccine accessibility, healthcare cost entitlement of the children, types of school affiliation, education administration areas where the schools were located, and the presence of a healthcare professional in family were analyzed by multiple logistic regression analysis adjusted with all studied variables to define the significant associated factors with the parents' or guardians' HPV vaccine acceptance (<i>p</i> < 0.05). In-depth interviews were subsequently performed with the selected participants until the qualitative data were saturated. Thematic analysis was applied, and the results of the two study methods were integrated to explore the reasons for vaccine acceptance or hesitancy. <b>Results:</b> A total of 943 questionnaire respondents were enrolled, among whom 75.8% were female and 86.4% were parents. A total of 663 (70.3%) participants accepted the HPV vaccine. Parents' or guardians' knowledge and attitudes, awareness of vaccine accessibility, type of school affiliation, the children's healthcare cost entitlement, and the presence of a healthcare professional in the family were significantly associated with vaccine acceptance in the multivariate analysis (<i>p</i> < 0.05). The qualitative study revealed that misunderstanding of the vaccine's safety and benefits combined with inadequate reliable information sources were associated factors with HPV vaccine hesitancy among the parents or guardians. <b>Conclusions:</b> Providing clear-cut knowledge about the HPV vaccine benefit vs. risk and clearing financial barriers for the parents or guardians of school children are advocated.