Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

Abstract

Background Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles. Methods We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9–17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination. Results Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels. Conclusion Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.

Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination

“…Prior evidence highlighted the value of elaboration on vaccine safety and efficacy in the communication strategies aiming to promote vaccination [ 93 , 94 ]. Additionally, previous studies in the context of different types of vaccines, including those for COVID-19, seasonal influenza, and human papillomavirus (HPV), have highlighted the importance of vaccine confidence, including trust in health institutions and professionals as a valuable tool to address vaccination hesitancy [ 95 , 96 , 97 ]. Furthermore, the role of collective responsibility appears to be of notable importance among health professionals, serving as a driving factor for vaccine acceptance [ 98 ].…”

Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings

“…Additionally, future research should examine the dynamic of interactions between providers, payers, and policy representatives and how providers can partner with payers and policy representatives to increase HPV vaccine uptake among safety-net populations. Lastly, given parental hesitancy and concern about HPV vaccination promoting sexual activity among adolescents remains a barrier ( 33 , 44 ), future research should also explore the extent that policy and payer strategies (e.g., incentives, minor consent) can overcome parental hesitancy and other barriers to vaccination.…”

“…PCM domains guided the thematic analysis and interpretation, which was further informed by study team members (LAP, SVH, BFC, JCC). Given the complex, multilevel factors that impact promotion and delivery of HPV vaccination ( 33 ), safety-net medical providers face a multitude of reasons for why HPV vaccination does not get systematically delivered to adolescent patients. The focus of this analysis was on policy and payer participants, who were viewed as part of the setting external to safety-net clinics, in order to provide a more comprehensive picture of the external factors that influence defining incentives for delivering HPV vaccination.…”

Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics

“…Furthermore, equitable implementation requires explicit attention to the culture, history, values, and needs of the community and integration of these factors to optimize fit, inform adaptation, and ensure sustainability [ 27 ]. For example, our prior work with American Indian/Alaska Native, Hispanic/Latino and Chinese parents of unvaccinated children identified relationships with adolescent children, exposure to misinformation through community channels, and historical community experiences that contribute to medical mistrust vary across communities and impact how communities engage with primary care providers and prefer to receive vaccine information recommendation, and decision-making [ 28 , 29 ]. These community and setting specific factors can influence the prioritization of specific EBS over others.…”