A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java, Indonesia: Understanding Community Readiness for Prevention Interventions.

Belinda Rina Marie Spagnoletti,Amirah Ellyza Wahdi,Siswanto Agus Wilopo,Linda Rae Bennett,Christina Alexandra Keenan

doi:10.31557/apjcp.2019.20.8.2429

Abstract

Background:Cervical cancer (CC) is a leading cause of cancer deaths among Indonesian women. Pilot prevention programs, including human papillomavirus (HPV) vaccination for young adolescent girls, and cervical screening for women, have been implemented. However, many communities are yet to receive these interventions, nor targeted education regarding CC prevention. This study explored community readiness and acceptance of HPV vaccination and CC screening, as well as knowledge and perceptions of HPV and CC, to determine facilitators and barriers to upscaling CC prevention in rural Central Java. Methods:Qualitative data collection in October 2015 consisted of four focus group discussions with married women and men, and 22 semi-structured interviews with married women. All 57 participants, 39 women and 15 men, lived in Purworejo Regency in rural Central Java. Results:Most participants had no knowledge of HPV or the causal link between HPV and CC. However, most participants were supportive of vaccinating their children against HPV. Most participants had heard of cervical cancer, although understandings of symptoms and causes were very poor. Less than half of the women interviewed had undergone CC screening. Multiple barriers to screening were reported, including: a dislike of pelvic exams; embarrassment at being screened by a male doctor; anxiety over the cost; fearing a positive result; and being asymptomatic and thus not perceiving the need for screening.Conclusions:Extensive community education about HPV and CC, targeting women and men, adolescents, health workers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling of CC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free within the National Immunization Program, and for CC screening to be free at primary health clinics.

Highlights

Cancers are the cause of 13% of all mortalities in Indonesia, and cervical cancer (CC) is one of the leading causes of cancer-related deaths among Indonesian women (WHO, 2014; Bruni et al, 2016)
Low incomes among rural families underline the need for the human papillomavirus (HPV) vaccine to be provided free within the National Immunization Program, and for CC screening to be free at primary health clinics
The key differences between the pilot evaluation in Karawang and our research is that we looked at HPV vaccination as well as CC screening, and the women and men in our study had not been part of a large-scale CC screening program

Summary

Introduction

Cancers are the cause of 13% of all mortalities in Indonesia, and cervical cancer (CC) is one of the leading causes of cancer-related deaths among Indonesian women (WHO, 2014; Bruni et al, 2016). The imperative of adding HPV vaccination to the National Immunization Program and improving access to CC screening is unanimously recognised by the Indonesian Government (GOI), the medical profession, and nation-wide cancer advocacy groups (Kosen et al, 2017; Bennett and Spagnoletti, 2019). Progress towards these endeavours includes the development of an HPV Demonstration. Conclusions: Extensive community education about HPV and CC, targeting women and men, adolescents, health workers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling of CC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free within the National Immunization Program, and for CC screening to be free at primary health clinics

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