Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study

Abstract

Background Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. However, uptake remains far below the Healthy People 2020 targets for the US. Given the barriers to population-level vaccination policies and challenges to incorporating additional action items during clinical visits, we sought to explore alternative delivery mechanisms, specifically delivery of the vaccine in community settings. Methods We conducted six focus groups (three with adolescents aged 11–14 who had not received the HPV vaccine and three with caregivers of adolescents meeting those criteria) from Black, Latino, and Brazilian communities in Massachusetts. We utilized a framework analysis approach that involved a multi-stage coding process employing both prefigured and emergent codes. Initial interpretations were refined through consultation with an advisory board. Results Adolescents and caregivers expressed a range of concerns about the HPV vaccine and also described interest in learning more about the vaccine, emphasizing the importance of a relationship with a trusted provider as a facilitator of vaccine acceptance. Regarding community-based delivery of the vaccine, reactions were mainly negative. However, adolescents and caregivers noted that receiving information in community settings that could seed a conversation with a trusted provider would be welcome. Interestingly, the notion of a trusted provider seemed to extend broadly to practitioners linked to the trusted main provider. Conclusions The study highlights an opportunity for increasing HPV vaccination among some racial and ethnic minority populations by leveraging trusted community organizations to provide information and seed conversations with a potentially broad group of trusted providers. A task-shifting approach, or reliance on staff with fewer formal credentials, may offer opportunities to support vaccination in resource-constrained settings.

Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

“…Similar to our studies 33,34 , parents have recommended workshops in a school setting given the accessibility and confidence. Since the HPV vaccine is a school requirement, it is of the utmost importance that the schools have trained school personnel and, likewise, integrate parents and students in the process to enhance the engagement 35 .…”

“…Most of the barriers discussed in our study are modifiable with the implementation of educational programs, health communication strategies across agencies responsible for the implementation, public acceptability, and political acceptability to support this policy. 33,[38][39][40] According to an unpublished preliminary results using data of 2010 through 2019 provided by the Puerto Rico Immunization Registry from our research team, a subtle but significant increase in HPV vaccination (initiation, not completion against HPV) has been observed after implementing the requirement. However, at this time, we are unaware if the COVID-19 pandemic has made an impact on parental perception to the school required vaccines.…”

Understanding parents’ views toward the newly enacted HPV vaccine school entry policy in Puerto Rico: a qualitative study

“…The lack of communication between the parents and guardians with the school and health providers was the main barrier to the HPV vaccine school entry policy. Similar to our studies [ 21 , 30 , 31 ] , parents have recommended workshops in a school setting given the accessibility. Having trained school personnel and integrate parents and students, the school could improve the engagement with the HPV vaccine policy [ 32 ].…”

“…We conducted this study in a timely opportunity to understand the parental perceptions regarding the implementation of this recent HPV vaccine requirement. Most of the barriers identified could be modifiable addressing with targeted educational programs with parents, school staff and providers, health communication strategies across agencies responsible for the implementation, public acceptability, and political acceptability to support this policy [ 29 , 31 , 45 ]. According to unpublished preliminary results using data of 2010 through 2019 provided by the Puerto Rico Immunization Registry and our research team, an increase of 54% was observed in HPV vaccination initiation rate (not completion) for 11–12 years old children after implementing the requirement [ 46 ].…”

Adolescent girls’ recommendations for the design of a human papillomavirus vaccination program in Sindh, Pakistan: a qualitative study

“…School-based vaccination has proven a successful strategy to achieve high HPV vaccine coverage in many countries, 17 , 18 and was previously indicated as the most acceptable approach by adolescents in the United States. 19 However, our study participants consistently argued that community-based vaccination delivery would be preferable in the local setting, because it may improve accessibility and promote vaccination uptake among those who do not trust healthcare facilities. In November 2019, Pakistan introduced typhoid conjugate vaccine administration through schools and hospitals.…”