Decision-Making about the HPV Vaccine among Ethnically Diverse Parents: Implications for Health Communications

Abstract

Objective: To describe parents' knowledge, attitudes, and decision-making with regard to obtaining the HPV vaccine for their daughters. Methods: White, Black, and Hispanic parents of daughters who were age eligible to receive the HPV vaccine (9–17 years) were recruited from community settings to participate in focus groups. Parents were asked about knowledge and awareness of HPV, decision-making about HPV vaccine, as well as preferred and actual sources of HPV information. Results: Seven focus groups (n = 64 participants) were conducted. Groups were segmented by gender (women = 72%) and race/ethnicity (Black = 59%; White = 23%; Hispanic = 19%). Prevalent themes included: insufficient information to make informed decisions; varied preferences for involvement in decision-making; concerns about vaccine safety; mistrust of medical providers and pharmaceutical companies; and mismatch between actual and preferred sources of information. Discussion: Improving communication between providers and caregivers and helping parents to access information necessary for informed decision-making, while alleviating concerns about vaccine safety, may help to improve vaccine acceptance.

Provider communication about HPV vaccination: A systematic review

“…7,64,[66][67][68][69][70] This pattern of findings is concerning given that both quantitative and qualitative studies suggested that provider recommendations were especially influential among parents from racial/ethnic minority backgrounds. 19,69,[71][72][73] Providers more often recommended HPV vaccination for patients they perceived to be at higher risk for HPV infection. Studies found that providers prioritized HPV vaccination for subpopulations including sexually active adolescents, males who might have same sex partners, and adolescents of lower socioeconomic status.…”

“…4,[18][19][20]71,74,[76][77][78] However, the extent to which parents communicated about HPV vaccination beyond giving consent varied, with qualitative studies suggesting that parents from racial/ethnic minorities or with lower socioeconomic status were less likely to be engaged by providers and more likely than parents from more socially privileged backgrounds to defer to providers' advice. 19,71,73,74,77 Parents were also more likely to follow providers' advice without question when they received a strong, unambiguous recommendation. 38,74,77 Findings on adolescents' role in clinical communication about HPV vaccination were also mixed.…”

“…18,80 In contrast, other studies found that adolescents did play a role in communication and decision-making in clinical settings, one which increased with age, maturity, and social privilege. 18,27,71,73,76,80 For some parents, the desire to maximize adolescents' role was even a reason for delaying HPV vaccination. 80 Studies suggested that parent-adolescent decisions were largely concordant and that most dyads ultimately reached agreement about the vaccination decision, but they sometimes looked to providers for guidance in the case of initial disagreement.…”

“…84 In contrast, qualitative studies with parents from racial/ethnic minority backgrounds suggested some degree of dissatisfaction with HPV vaccine communication, with some parents reporting too little information, limited opportunities to ask questions, or ambiguous recommendations. 61,71,77,78,98,99 For these parents, the perception that providers were withholding information was a source of confusion that introduced doubt about the value of HPV vaccination, discouraged vaccine acceptance, and in some cases undercut parents' trust in providers. 61,71,77,78,98,99 Parents emphasized their desire for clear, unambiguous messages from providers about the importance of HPV vaccination.…”

“…61,71,77,78,98,99 For these parents, the perception that providers were withholding information was a source of confusion that introduced doubt about the value of HPV vaccination, discouraged vaccine acceptance, and in some cases undercut parents' trust in providers. 61,71,77,78,98,99 Parents emphasized their desire for clear, unambiguous messages from providers about the importance of HPV vaccination. 38,71,77,99 Channel Relatively few studies assessed modes of clinical communication about HPV vaccination beyond provider dialog, but those that did focused primarily on written materials.…”