Objective:Motivation is theorized to be a key determinant of behavior but has not been applied to human papillomavirus (HPV) vaccination. Autonomous motivation is hypothesized to be the most "self-determined" type of motivation and may contribute to parents' decisions to initiate and complete the HPV vaccine series. I examined patterns of association between motivation types and HPV vaccination as well as the pathways linking autonomous motivation with intentions to vaccinate.

Methods:As part of a larger project, parents (N=177) of unvaccinated adolescents completed a survey including a measure of parental motivation for adolescent vaccination. After 12 months, I reviewed electronic medical records to obtain HPV vaccination coverage data. I used logistic regression models to determine which motivation types—autonomous, introjected, or external—were associated with one- and three-dose coverage. I examined ordinal regression models to assess the overall effect of motivation on HPV vaccine coverage. Additionally, I tested competing models of the direct effect of autonomous motivation and the indirect effect through other psychosocial variables to determine which pathway(s) best explain the relationship between autonomous motivation and intentions to vaccinate.

Results:Results indicate autonomous motivation is a significant predictor of 1-dose coverage (OR= 2.47; 95%CI: [1.202, 5.079], p= .01) and of 3-dose coverage (OR= 2.68; 95%CI: [1. 00, 7.18], p = .05). Ordinal regression models confirmed greater autonomous motivation is associated with increased likelihood of pursuing HPV vaccine coverage (OR= 2.452, 95% CI = 1.257 - 4.786, p= .009).There were no significant effects of introjected or external motivation on one- or three-dose coverage (ps > .142). Moreover, a model with both direct effects of autonomous motivation on intentions and indirect effects via attitudes best fit the data.

Conclusions: Findings support the utility of distinguishing the type of underlying motivation for adolescent HPV vaccination. Autonomous motivation, rather than introjected and external motivation, was positively associated with one- and three-dose coverage. Thus, autonomy-supportive interventions to promote parents’ beliefs that the HPV vaccine is important and beneficial to their child's health may be a useful mechanism for increasing rates of completion of the vaccine series.

Degree Date

Summer 8-7-2018

Document Type





Austin S. Baldwin

Number of Pages




Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Available for download on Saturday, May 11, 2019