Human papillomavirus (HPV) vaccination completion rates in Asian-American populations are substantially lower than most White Americans. Our objective was to identify the knowledge, perceptions, and decision-making processes about HPV vaccinations in the Hmong population, an Asian-American group with increased risks of HPV-related cancers. We conducted eight focus groups with Hmong adolescents (n = 12) and parents (n = 13) to learn about barriers, facilitators, and decision-making processes regarding general vaccinations and the HPV vaccine. The focus group results were analyzed using thematic analysis, informed by the socioecological model and asset lens. Findings showed that at the individual level, Hmong adolescents and parents had low HPV and HPV vaccine awareness levels (barrier) and strong desires to learn about HPV and the HPV vaccine (facilitator). Community-level barriers included salient narratives about traumatic experiences with vaccines and vaccine research, while facilitators included strong community connections. At the institutional level, barriers included structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision-making. Additionally, a range of decision-making processes between parents, adolescents, and providers were present, with parents expressing a strong appeal to engage in more shared decision-making with providers. A linguistically and culturally specific HPV educational program for Hmong adolescents and parents could address the barriers and build on facilitators and assets to promote HPV vaccine uptake in this growing Asian-American community.

Background Healthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores. Methods A Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified. Results Listening sessions produced three major themes, with recommended actions for primary care clinics. #1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity. #2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion. #3: Funding Based on Current Quality Measures Perpetuates Health Inequities. Conclusion Community leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare.

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Background: Human papillomavirus (HPV) vaccination rates in Asian-American/Pacific- Islander (AAPI) populations are substantially lower than majority Americans. No studies have assessed HPV vaccine rates in the Hmong population, an AAPI group with increased risks of cervical and nasopharyngeal cancer. In 2015, the HPV vaccinations rates for Hmong girls and boys ages 9-17 at a Minnesota community health center (CHC) were 32% and 20%, lower than national 2017 HPV rates of 47% and 53%. This qualitative community-based participatory action research study identified multilevel barriers, facilitators, and decision-making processes about HPV vaccinations among Hmong adolescents and parents. Methods: Bilingual community researchers recruited Hmong adolescents and their parents from a community health center, conducted eight focus groups with 12 adolescents and 13 parents. Participants also completed demographic and HPV knowledge surveys. The research team analyzed transcripts using participatory thematic analysis and identified themes using a multilevel socioecological model combined with an assets lens. Results: Both survey and focus group results showed that Hmong adolescents and parents had low levels of HPV and HPV vaccine awareness. At the individual-level, both adolescents and parents reported concerns about side-effects and cost as reasons for not getting any type of vaccination, however they also expressed a strong desire to learn about HPV and the HPV vaccine. Community-level barriers identified included community narratives around traumatic experiences with vaccines, and facilitators included family and community connections and communications. At the institutional-level, barriers included structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision-making. Finally, there was a range of decision-making processes between parents and adolescents and between parents and providers. Conclusion: A linguistically and culturally-specific HPV educational program for Hmong adolescents and parents could address barriers and build on facilitators and assets to promote HPV vaccine uptake. These findings have informed the development of an eHealth application to increase HPV vaccinations in Hmong adolescents. Future research will test the feasibility, acceptability, and efficacy of culturally-tailored, multilevel HPV vaccination interventions that may provide evidence about the efficacy of culturally-appropriate education in comprehensive vaccine strategies.