Biopsychosocial Determinants of Human Papilloma Virus Immunization in Women of Reproductive Age in Surakarta, Central Java


  • Gabriela Advitri Febriani Masters Program in Public Health, Universitas Sebelas Maret
  • Setyo Sri Rahardjo Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret


Background: Cervical cancer ranks second as the cause of death in women worldwide. Cervical cancer is preventable by Human Papilloma Virus (HPV) immunization. It was hypothesized that use of HPV immunization is determined by biopsychosocial factors as involved in the Health Belief Model and Social Learning Theory. This study aimed to analyze the determinants of HPV immunization use in women of reproductive age.

Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at Permata Harapan Clinic and Budi Sehat Laboratory Clinic, Surakarta, Central Java. The data were collected from February to March 2018. A sample of 200 women was selected by random sampling, consisting of 50 women undertaking screening and 150 women not undertaking screening. The dependent variable was HPV immunization. The independent variables were perceptions of susceptibility, seriousness, benefit, barrier, respectively, and self-efficacy, education, family income, employment status, family support, social environment, and cervical cancer screening. Data on HPV vaccine use were taken from medical record. The data were collected by questionnaire and analyzed by path analysis.

Results: Use of HPV immunization was directly associated with perceived susceptibility (b= 2.01; 95% CI= 1.03 to 3.00; p<0.001), perceived seriousness (b= 1.52; 95% CI 95%= -0.08 to 3.13; p=0.063), self efficacy (b= 1.55; 95% CI= 0.05 to 3.05; p=0.043), and perceived barrier (b= -2.25; 95% CI= -3.22 to -1.28; p<0.001). It was indirectly associated with perceived benefit, education, family income, employment status, family support, social environment, and cervical cancer screening.

Conclusion: Use of HPV immunization is directly associated with perceived susceptibility, perceived seriousness, self-efficacy, and perceived barrier. It is indirectly associated with perceived benefit, education, family income, employment status, family support, social environment, and cervical cancer screening.


Alberts CJ, Loeff MFC, Hazeveld Y, Melker HE, Wal MF, Nielen A, Fakiri FE, Prins M, Pulussen TGWM (2017). A Longitudinal Study on Determinants of HPV Vaccination Uptake in Parents/Guardians from Different Ethnic Background in Amsterdams the Netherlands. BMC Public Health. 17: 220.

Barroeta JE, Guragain DA, Grotkowski CE (2016). Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology. Wiley Periodicals.

Baumesiter RF, Vohs KD (2008). SelfRegulation, Ego Depletion, and Motivation. Social and Personality Psychology Compass.

Beavis AL, Levinson KL (2016). Preventing Cervical Cancer in the United States: Barriers and Resolutions for HPV Vaccination. Front. Oncol.

Brunni L, Barrionuevo Rosas L, Albero G, Serrano B, Mena M, G

Cipriano JJ, Scoloveno R, Kelly A (2017). Increasing Parental Knowledge Related to the Human Papillomavirus Vaccine (HPV). National Association of Pediatric Nurse Practitioners.

Cox DS, Cox AD, Sturm L, Zimet G (2010). Behavioral Interventions to Increase HPV Acceptability Vaccination Among Young Mothers Girls. American Psychological Association: health psychology.

Cunningham MS, Skrastins E, Fitzpatrick R, Jindal P, Oneko O, Yeates K, Booth CM, Carpenter J, Aronson K (2017). Cervical Cancer Screening and HPV Vaccine Acceptability among Rural and Urban Women in Kilimanjaro Region Tanzania. BMJ Open. 5: e005828.

Dairo MD, Adeleke MO, Salawu AT, Adewole AD (2016). Parental support for human papilloma virus vaccination by adolescents in Ibadan North Local Government Area, Ibadan, Nigeria. Adolescent Medicine and Health.

Fernandez ME, YenChi, Espada NF, Calo WA, Savas LS, Velez C, Aragon AP, Lopez VC (2014). Knowledge, Attitudes and Beliefs About Human Papillomavirus (HPV) Vaccination among Puerto Rican Mothers and Daughters. Center for Disease Control and Prevention. 11 E212.

Forster AS, McBride KA, Davies C, Stoney T, Marshall H, McGeechan K, Cooper SC, Skinner SR (2017). Development and Validation of Measures to Evaluate Adolescent Knowledge about Human Papillomavirus (HPV) involvement in HPV Vaccine decision making, selfefficacy to receive the Vaccine and fear and anxiety. The Royal Society for Public Health.

Hoffmann RL, Rohrer WM, Paul JES, Burdett R, Watziaf VJM (2008). The Effects of Barriers on Health Related Quality of Life (HRQL) and Compliance in Adult Asthmatics who are Followed in an Urban Community Health Care Facility. J Community Health.

HPV Information Center (2017). Human Papillomavirus and Related Disease Report. ICO HPV Information Center.

Infodatin (2015). Stop Kanker. Pusat Data dan Informasi Kementrian Kesehatan RI: 2-4.

Karafillakis E, Larson HJ (2017). The Benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vacinnes in European populations. Vaccine.

Kyoung J, Jeong BY, Yun EH, Lim MK (2017). Awareness of and Attitudes toward Human Papillomavirus Vaccination among Adults in Korea: 9-Year Changes in Nationwide Surveys. Cancer Research and Treatment: Official Journal of Korean Cancer Association.

Lim H, Kimm H, Song IH (2014). The Relationship between Employment Status and Self rated Health among Wage Workers in South Korea: The Moderating Role of Household Income. Health and Social Works.

Mc Bride KR, Singh S (2017). Predictors of Adults

Nan X, Madden K, Richards A, Holt C, Wang MQ, Tracy K (2015). Message Framing, Perceived Susceptibility, and Intentions to Vaccinate Children Against HPV Among African American Parents. Health Communication.

Ndejjo R, Mukama T, Kiguli J, Musoke D (2017). Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: a qualitative study. BMJ Journals.

Rey D, Fressard L, Cortaredona S, Bocquier A, Gautier A, Watel PP, Verger P (2018). Vaccine hesitancy in the French population in 2016, and its association with vaccine uptake and perceived vaccine risk

Roberts ME, Gerrard M, Reimer R, Gibbons FX (2015). Mother Daughter Communication and Human Papillomavirus Vaccine Uptake by College Students. Pediatrics.

Saqer A, Ghazal S, Barqawi H, Babi JA, Alkhafaji R, Elmekresh MM (2017). Knowledge and Awareness about Cervical Cancer Vaccine (HPV) Among Parents in Sharjah. Asian Pacific Journal of Cancer Prevention.

Sari HE, Mudigdo A, Dermatoto A (2016). Multilevel Analysis on the Social Determinants of Cervical Cancer in Yogyakarta. Journal of Epidemiology and Public Health.

Senicato C, Lima MG, Barros MB (2016). Are there differences between paid women workers and housewives in healthrelated quality of life?. SciELO: Cadernos de Saude Publica.

Tan TQ, Melvin V, Gerbie MD (2017). Perception, Awareness, and Acceptance of Human Papillomavirus Disease and Vaccine Among Parents of Boys Aged 9 to 18 Years. Clinical Pediatrics.

Thomas TL, Strickland OL, Higgins M (2017). Mothers, Fathers, Sons, and Human Papillomavirus Immunization Practices. Family and Community Health.

Wang B, He M, Chao A, Engelgau MM, Saraiya M, Wang L, Wang L (2015). Cervical Cancer Screening Among Adult Women in China. The Oncologist.

WHO (2017). Immunization, Vaccines and Biologicals Human Papillomavirus. Geneva: World Health Organization.

Wiebe E, Denny L, Thomas G (2012). Cancer of The Cervix Uteri. International Journal of Gynecology and Obstetrics.




How to Cite

Febriani, G. A., Rahardjo, S. S., & Murti, B. (2018). Biopsychosocial Determinants of Human Papilloma Virus Immunization in Women of Reproductive Age in Surakarta, Central Java. Journal of Health Promotion and Behavior, 3(1), 66–77. Retrieved from




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