Abstract
Objective and MethodCervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance.ResultsWe found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine’s newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations–including hearing the girl’s voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance.ConclusionsHealth personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns.
Highlights
Cancer of the cervis is the third most common cancer affecting women worldwide
We found a nonlinear human papillomavirus (HPV) decision-making process that evolved over time
Vaccines against the two most common HPV types, 16 and 18, have proven safe and efficacious [6,7] in preventing precancerous lesions in HPV-naive girls and women. Prophylactic vaccination targeting these genotypes is expected to result in significant reductions in the burden of cervical cancer and other cancers associated with these genotypes, provided that these vaccination programs can achieve significant coverage of the target population [8]
Summary
Dynamic Decision-making Process for HPV Vaccine We observed a nonlinear decision-making process among parents that evolved over time. In coastal urban and rural zones in particular, parents mentioned in interviews that the decision-making process was influenced by news stories related to cases of vaccine-related death due to yellow fever or measles/ rubella vaccines and by news of expired vaccines in the area’s health facilities These reports generated a general fear of vaccinating their daughters, and increasing distrust of the HPV vaccine among parents. In just one family interviewed, one parent argued that the HPV vaccine would encourage their daughter to have sexual relations and would have a negative effect on her health Her dad didn’t want to authorize it because he said it encourages having sexual relations with anyone. This was noted more commonly in urban than in rural settings
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