Facilitators and barriers of human papillomavirus vaccine uptake in young females 18–26 years old in Singapore: A qualitative study

Abstract

BackgroundAround 70% of cervical cancers are caused by Types 16 and 18 of human papillomavirus (HPV). Vaccines against HPV have been shown to be safe and effective in preventing HPV and cervical cancer. ObjectiveTo explore the facilitators and barriers of HPV vaccination in young females aged 18–26 years in Singapore, and to describe their recommended strategies to improve the uptake of HPV vaccination. DesignQualitative, descriptive design guided by the socio-ecological model. ParticipantsYoung women studying in National University of Singapore (NUS), aged 18–26 (N = 40). Purposive sampling was used to recruit participants from various socio-economic levels and faculties, both vaccinated against HPV and unvaccinated. MethodsIn-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with the participants. IDIs and FGDs were transcribed and coded using NVIVO software. Thematic data analysis was performed using an inductive approach. ResultsBarriers to HPV vaccination included lack of awareness, lack of perceived risk for cervical cancer, cost, lack of parental support, inconvenience of getting the vaccination, stigma associated with connection with sexual activity, and concern regarding safety. Facilitators include parental encouragement, protection of one’s health, lack of logistical barriers, and perceived safety and efficacy of the vaccine. Participants recommended increasing awareness of HPV vaccination and cervical cancer, reducing cost of vaccination and making the vaccine compulsory to increase vaccine uptake. ConclusionBarriers and facilitators exist at different levels to influence vaccine uptake. Public education on cervical cancer and the vaccine should be stepped up to increase public awareness. A school-based national vaccination programme was proposed by the target group to increase the rate of uptake of HPV vaccination in Singapore.