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

Abstract

Background The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents’ and guardians’ views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement. Methods During April through November 2019, we conducted three focus groups (n = 12) and eight in-depth semi-structured interviews with parents of children aged 11 and 12 who had not yet initiated the HPV vaccine series. The interview topics addressed were: perception of vaccination, HPV vaccine and it is inclusion as new school entry requirement practice, procedure of the sources of information, influencers, and willingness to change. The interviews were recorded and transcribed by our staff members. We identified emergent themes through thematic analysis. Results The participants’ perspective on the HPV vaccine school requirement was mixed. Lack of information of the HPV vaccines and lack of communication about the school-entry requirement were the themes most mentioned in the interviews. Moreover, previous negative experiences from friends or family members and adverse effects deterred some participants from vaccinating their kids. We discussed barriers in the process of soliciting an exemption. Conclusion Most barriers mentioned by study participants are modifiable. Information about the HPV vaccine mandate’s implementation and educational materials regarding HPV vaccine safety need to be provided to address parents’ concerns related to the vaccine’s side effects. Schools (teachers, principal directors, and administrative staff), the government, and parent organizations need to be part of these efforts. This multilevel approach will help to improve disseminating information about HPV vaccination to clarify doubts and misinformation among parents.

The adoption of the HPV vaccine school-entry requirement in Puerto Rico: How practical lessons can inform future vaccine policies

“…For instance, Hispanics show higher odds of support for HPV vaccine school-entry requirements compared to non-Hispanic Whites in the US ( Calo et al, 2016 ). In the case of PR, perspectives about the implementation of the HPV vaccine school-entry requirement from parents of unvaccinated children were reported as mixed ( Colón-López et al, 2021a ). Half of the parents supported the policy, while those who were uncertain mentioned concerns related to the early age of vaccine administration, vaccine safety, and parental autonomy ( Colón-López et al, 2021a ).…”

“…In the case of PR, perspectives about the implementation of the HPV vaccine school-entry requirement from parents of unvaccinated children were reported as mixed ( Colón-López et al, 2021a ). Half of the parents supported the policy, while those who were uncertain mentioned concerns related to the early age of vaccine administration, vaccine safety, and parental autonomy ( Colón-López et al, 2021a ). Therefore, it is important for individuals and organizations involved in vaccination efforts, such as local health departments, to adapt and tailor to context, including the politico-cultural context ( Attwell et al, 2018 ), when considering vaccine policies and educational interventions.…”

Indiana Parental Perceptions of the Acceptability of General and HPV-Specific State Vaccine Requirements

“…Importantly, recent studies indicate that the degree of support is related to the inclusion of opt-out provisions [ 4 , 13 , 16 ]; when opt-out provisions are included, parental support for HPV vaccine requirements increase [ 17 ]. Overall, these studies indicate that the inclusion of opt-out provisions is essential to the support of school-entry requirements, as are perceptions that a given vaccine is safe and effective [ 14 ]. However, stronger support for easily accessible opt-out provisions is problematic because they are associated with higher non-vaccination and infection rates [ 18 ].…”

The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being

“…This is linked to a lack of trust in the government ( 58 , 59 ), the pharmaceutical industries ( 60 , 61 ), and health providers ( 62 , 63 ) as many presume there are motives behind promoting vaccinations ( 63 , 64 ). These are often associated with newer vaccines ( 17 ) or the dissemination of vaccine misinformation from health care providers ( 59 , 65 ) and the media ( 66 , 67 ). Interestingly, studies have indicated that fathers, parents who are not vaccinated ( 68 , 69 ), and negative vaccination experiences ( 70 ) play major roles in parents being hesitant about vaccinating their children.…”