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Table 1 Overview of social-psychological scale measures 1

From: Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study

Measure Item Answer options Scale (minimum to maximum value) Number of items Cronbach’s alpha (α) Reference
Knowledge about the HPV vaccinationa ־ HPV is sexually transmittable; −1 = incorrect −8 = incorrect 8 n/a  
־ HPV is a virus; 0 = don’t know 8 = correct
־ The HPV vaccination in the Netherlands consists of three injections; 1 = correct
־ My daughter is/I am obliged to get the HPV vaccination when she is/I am invited;
־ You will always notice when you are infected by HPV;
־ Only women can get infected by HPV;
־ Women who received the HPV vaccination are still advised to participate in the cervical cancer screening in the Netherlands;
־ The HPV vaccination fully protects against cervical cancer.
Risk perception (having received no HPV vaccination) Imagine that your daughter was/you were not vaccinated against HPV. The chance that my daughter will get/I will get cervical cancer is… −3 = very small to 3 = very large n/a 1 n/a [20, 31]
Risk perception (having received the HPV vaccination) Imagine that your daughter was/you were vaccinated against HPV. The chance that my daughter will get/I will get cervical cancer is… −3 = very small to 3 = very large n/a 1 n/a [20, 31]
Attitude towards the HPV vaccination Vaccinating my daughter/myself against HPV is… −3 = very undesirable to 3 = very desirable; −12 = negative to 12 = positive 4 M = .98 [31]
D = .94
−3 = very bad to 3 = very good;
−3 = very negative to 3 = very positive;
−3 = very unimportant to 3 = very important
Negative outcome expectations of the HPV vaccination If my daughter gets/I get the HPV vaccination… −3 = completely agree to 3 = completely disagree −15 = completely agree to 15 = completely disagree 5 M = .60 [20, 27, 32]
D = .49
־ she/I will become infertile;
־ she/I will get unpleasant side effects shortly after the injection, such as head ache, fever or pain at the injection spot;
־ she/I will be afraid of the injection with a needle;
־ she/I will have unsafe sex in the future;
־ her/my natural immune system against illnesses will be disturbed.
Positive outcome expectations of the HPV vaccination If my daughter gets/I get the HPV vaccination… −3 = completely disagree to 3 = completely agree −9 = completely disagree to 9 = completely agree 3 M = .76 [33, 34]
D = .77
־ she/I will not contract cervical cancer;
־ she/I will not have to worry about cervical cancer;
־ she/I will not be infected with HPV.
Anticipated regret about rejecting the HPV vaccination Imagine your daughter has not received the HPV vaccination and she gets cervical cancer in the future. How much would you regret your decision to let her receive no vaccination? 1 = no regret and 5 = very much regret n/a 1 n/a  
Anticipated regret about receiving the HPV vaccination Imagine your daughter has received the HPV vaccination and she gets a serious illness as a result of the vaccine. How much would you regret your decision to let her receive the vaccination? 1 = no regret and 5 = very much regret n/a 1 n/a  
Beliefs about the HPV vaccination ־ If the government offers the vaccination, I assume it will be safe; −3 = completely disagree to 3 = completely agree −18 = negative to 18 = positive 9 M = .80 [19, 20]
D = .70
־ Our government shows responsibility for the health of the Dutch population by introducing the HPV vaccination; −3 = completely agree to 3 = completely disagree
־ The HPV vaccination was only introduced because the pharmaceutical industry will earn a lot of money from it;
־ There is too little known about whether      
the HPV vaccination effectively protects against cervical cancer;  
־ There is too little known about the detrimental side effects of the HPV vaccination;
־ My daughter is/I am too young to receive the HPV vaccination;
־ My daughter does/I do not need to get the HPV vaccination if she is/I am already sexually active;
־ My daughter does/I do not need the vaccination because she is/I am not yet sexually active;
־ It is inappropriate that my daughter has/I have to pay for the HPV vaccination if she decides/I decide to get the vaccination at a higher age.
Relative effectiveness of the HPV vaccinationb How would you rate the effectiveness of the following methods of preventing cervical cancer: 1 = not at all effective to 10 = very effective n/a 5 n/a  
־ having safe sex  
־ having sex with only one person in a lifetime
־ participating in the cervical cancer screening
־ having a healthy lifestyle (e.g. not smoking)
־ the HPV vaccination
Participants rated the effectiveness of each method
Ambivalence towards the HPV vaccination decision During my decision making about my daughter’s/my HPV vaccination… −3 = completely disagree to 3 = completely agree −9 = completely disagree to 9 = completely agree 3 M = .93  
D = .85
־ I felt torn between the pros and cons of vaccination;  
־ I experienced positive as well as negative feelings;
־ I was torn between the pros and cons of vaccination.
Confidence in authorities involved in the HPV vaccination As regards the HPV vaccination, how much confidence do you have in… −3 = very little to 3 = very much confidence −9 = very little to 9 = very much confidence 3 M = .91  
D = .88
־ science
־ health care
־ the Ministry of Public Health
Participants rated their confidence in each authority
Subjective norms towards the HPV vaccinationc Normative beliefs −2 = certainly not vaccinating to 2 = certainly vaccinating, −70 =negative to 70 = positive (M); M = 7 M = .85 [31]
What is your expectation on the opinion of … about the HPV vaccination of your daughter? D = 6 D = .77
3 = not applicable; −60 =negative to 60 = positive (D)
Not applicable was recoded into ‘0’
Social referents: partner (M), parents (M), daughter (M), father (D), mother (D), best friends (M/D), general practitioner (M/D), doctor/nurse from the municipal health service (M/D), the Ministry of Public Health (M/D)
  Motivation to comply 1 = not at all to 5 = very much M = 7   [31]
How motivated are you to comply with the opinion of …? D = 6
Descriptive norms towards the HPV vaccination How many parents/girls do you know who will decide to let their daughter/themselves be vaccinated against HPV if they receive the invitation? 1 = none of the parents/girls I know, to 7 = all the parents/girls I know n/a 1 n/a [31]
Self-efficacy expectations towards the HPV vaccination To what extent would you succeed in dealing with the following situations: −3 = I would certainly not succeed to 3 = I would certainly succeed −18 = I would certainly not succeed to 18 = I would certainly succeed 6 M = .82  
D = .66
־ Finding reliable information about the HPV vaccination;
־ Understanding information about the HPV vaccination;      
־ Making a different decision about the HPV vaccination of my daughter/myself than most parents/girls among my acquaintances;
־ Having a good talk with my daughter about the HPV vaccination (M);
־ Having a good talk with my partner about the HPV vaccination (M);
־ Having a good talk with my father about the HPV vaccination (D);
־ Having a good talk with my mother about the HPV vaccination (D);
־ Having a good talk with my general practitioner about the HPV vaccination.
HPV vaccination information processing Before I finally decided about my (daughter’s) vaccination, I…   −6 = completely disagree to 6 = completely agree 2 M = .84 [31]
D = .75
־ gathered a lot of information about the HPV vaccine
־ thoroughly considered the HPV vaccination −3 = completely disagree to 3 = completely agree
Participants rated their agreement on both items separately
Habit strength towards the HPV vaccination Letting my daughter receive the HPV vaccination/Receiving the HPV vaccination is something I do… −3 = completely disagree to 3 = completely agree −6 = completely disagree to 6 = completely agree 2 M = .78 [35]
D = .65
־ automatically
־ without thinking
Participants rated their agreement on both items separately
Decisional conflict about the HPV vaccination - value clarity As regards the HPV vaccination… −3 = completely disagree to 3 = completely agree −9 = completely disagree to 9 = completely agree 3 M = .89 [36]
־ I was clear about which benefits were most important to me; D = .85
־ I was clear about which risks were most important to me;
־ I was clear about which was more important to me, the benefits or the risks.
Decisional conflict about the HPV vaccination - certainty As regards the HPV vaccination… −3 = completely disagree to 3 = completely agree −9 = completely disagree to 9 = completely agree 3 M = .89 [36]
D = .87
־ I felt sure about what to choose;
־ the decision was relatively easy to make;
־ I was clear about the best choice for me/my daughter.
Opinion about alternative medicine In what way do you agree with the view of… −3 = completely disagree to 3 = completely agree −9 = completely disagree to 9 = completely agree 3 M = .81  
־ anthroposophy D = .76
־ homeopathy
־ other alternative medicine
Past cancer experienced Have you/has your mother had experience with… 1 = no, 2 = yes, 3 = I do not want to answer this question n/a 6 n/a [19, 27]
Do you know someone from your close environment who has/has had…
־ cervical cancer
־ other cancers
־ abnormal pap smear
  1. Notes M = Mother; D = Daughter; n/a = not applicable; 1Scores on scaled item that showed sufficient internal consistency were summed into one scale; Mothers received questions about the HPV vaccination of their daughter, whereas daughters answered questions about the HPV vaccination of themselves; a) Knowledge is not a scale because the answer on one item does not predict the answer on the other items; the items were summed up to present a sum score of knowledge; b) The difference between the rated effectiveness of the HPV vaccination and the most effective alternative represented the relative effectiveness score (−9 = HPV vaccination least effective to 9 = HPV vaccination most effective); c) The subjective norms score was first computed by multiplying normative beliefs and motivation to comply for each social referent, and then by summing up the multiplications of the social referents; d) Past cancer experience is not a scale because the answer on one item does not predict the answer on the other items.
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