Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers

Authors: Ingrid T. Katz, Laura M. Bogart, Chong Min Fu, Yingna Liu, Joanne E. Cox, Ronald C. Samuels, Tami Chase, Pamela Schubert, Mark A. Schuster

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates.

Methods

We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion.

Results

Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, “newer” vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections.

Conclusions

Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families’ concerns about vaccine safety and efficacy.
Literature
1.
CDC. Human papillomavirus (HPV)-associated cancers. 2013.
2.
Dunne EF, Markowitz LE, Saraiya M, Stokley S, Middleman A, Unger ER, et al. CDC grand rounds: reducing the burden of HPV-associated cancer and disease. MMWR Morb Mortal Wkly Rep. 2014;63(4):69–72.PubMed
3.
Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, et al. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst. 2013;105(3):175–201.CrossRefPubMedPubMedCentral
4.
Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56(Rr-2):1–24.PubMed
5.
Centers for Disease Control and Prevention. FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010;59(20):626–9.
6.
Centers for Disease Control and Prevention. Recommendations on the use of quadrivalent human papillomavirus vaccine in males--Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2011;60(50):1705–8.
7.
Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356(19):1915–27.CrossRef
8.
Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009;374(9686):301–14.CrossRefPubMed
9.
Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, et al. A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high-grade cervical and external genital lesions. Cancer Prev Res (Phila). 2009;2(10):868–78.CrossRef
10.
Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;369(9574):1693–702.CrossRefPubMed
11.
Palefsky JM, Giuliano AR, Goldstone S, Moreira Jr ED, Aranda C, Jessen H, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011;365(17):1576–85.CrossRefPubMed
12.
Dillner L, Kemetli L, Elfgren K, Bogdanovic G, Andersson P, Carlsten-Thor A, et al. Randomized healthservices study of human papillomavirus-based management of low-grade cytological abnormalities. Int J Cancer. 2011;129(1):151–9.CrossRefPubMed
13.
Elam-Evans LD, Yankey D, Jeyarajah J, Singleton JA, Curtis RC, MacNeil J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years--United States, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(29):625–33.PubMed
14.
Perkins RB, Clark JA, Apte G, Vercruysse JL, Sumner JJ, Wall-Haas CL, et al. Missed opportunities for HPV vaccination in adolescent girls: a qualitative study. Pediatrics. 2014;134(3):e666–674.CrossRefPubMed
15.
Bynum SA, Staras SA, Malo TL, Giuliano AR, Shenkman E, Vadaparampil ST. Factors associated With Medicaid providers' recommendation of the HPV vaccine to low-income adolescent girls. J Adolesc Health. 2014;54(2):190–6.CrossRefPubMed
16.
Ferrer HB, Trotter C, Hickman M, Audrey S. Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis. BMC Public Health. 2014;14:700.CrossRefPubMedPubMedCentral
17.
Friedman AL, Shepeard H. Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: findings from CDC focus group research and implications for practice. Health Educ Behav. 2007;34(3):471–85.CrossRefPubMed
18.
Shui I, Kennedy A, Wooten K, Schwartz B, Gust D. Factors influencing African-American mothers' concerns about immunization safety: a summary of focus group findings. J Natl Med Assoc. 2005;97(5):657–66.PubMedPubMedCentral
19.
Hofman R, van Empelen P, Vogel I, Raat H, van Ballegooijen M, Korfage IJ. Parental decisional strategies regarding HPV vaccination before media debates: a focus group study. J Health Commun. 2013;18(7):866–80.CrossRefPubMed
20.
Perkins RB, Zisblatt L, Legler A, Trucks E, Hanchate A, Gorin SS. Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine. 2015;33(9):1223–9.CrossRefPubMed
21.
Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr. 2014;168(1):76–82.CrossRefPubMedPubMedCentral
22.
US Department of Health and Human Services: Healthy People 2020. In., vol. 2015. Washington, DC: Office of Disease Prevention and Health Promotion; 2012.
23.
Creswell JW. Qualitative inquiry and research design: choosing among five approaches: SAGE Publications. 2012.
24.
Katz IT, Ware NC, Gray G, Haberer JE, Mellins CA, Bangsberg DR. Scaling up human papillomavirus vaccination: a conceptual framework of vaccine adherence. Sex Health. 2010;7(3):279–86.CrossRefPubMedPubMedCentral
25.
Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory: Sage publications. 2014.
26.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.CrossRef
27.
Bissell P, May CR, Noyce PR. From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions. Soc Sci Med. 2004;58(4):851–62.CrossRefPubMed
28.
Bogart LM, Cowgill BO, Sharma AJ, Uyeda K, Sticklor LA, Alijewicz KE, et al. Parental and home environmental facilitators of sugar-sweetened beverage consumption among overweight and obese Latino youth. Acad Pediatr. 2013;13(4):348–55.CrossRefPubMedPubMedCentral
29.
Shelton RC, Goldman RE, Emmons KM, Sorensen G, Allen JD. An investigation into the social context of low-income, urban Black and Latina women: implications for adherence to recommended health behaviors. Health Educ Behav. 2011;38(5):471–81.CrossRefPubMed
30.
Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol. 2016;21(7):1311-21. doi:10.​1177/​1359105314551950​. Epub 2014 Oct 7.
31.
LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44(6):2093–105.CrossRefPubMedPubMedCentral
32.
Bogart LM, Wagner G, Galvan FH, Banks D. Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among african american men with HIV. J Acquir Immune Defic Syndr. 2010;53(5):648–55.PubMedPubMedCentral
33.
Bogart LM, Galvan FH, Wagner GJ, Klein DJ. Longitudinal association of HIV conspiracy beliefs with sexual risk among black males living with HIV. AIDS Behav. 2011;15(6):1180–6.CrossRefPubMedPubMedCentral
34.
Kolar SK, Wheldon C, Hernandez ND, Young L, Romero-Daza N, Daley EM. Human papillomavirus vaccine knowledge and attitudes, preventative health behaviors, and medical mistrust among a racially and ethnically diverse sample of college women. J Racial Ethn Health Disparities. 2015;2(1):77–85.CrossRefPubMed
35.
Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health And Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566–73.CrossRefPubMed
36.
Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2012, National Cancer Institute. Bethesda, http://​seer.​cancer.​gov/​csr/​1975_​2012/​. 2014. SEER data submission, posted to the SEER web site, April 2015.
37.
Pierre Joseph N, Clark JA, Mercilus G, Wilbur M, Figaro J, Perkins R. Racial and ethnic differences in HPV knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina, and Caucasian young adult women. J Pediatr Adolesc Gynecol. 2014;27(2):83–92.CrossRefPubMed
38.
Gilkey MB, Moss JL, Coyne-Beasley T, Hall ME, Shah PD, Brewer NT. Physician communication about adolescent vaccination: how is human papillomavirus vaccine different? Prev Med. 2015;77:181–5.CrossRefPubMedPubMedCentral
39.
Niccolai LM, Hansen CE. Practice- and community-based interventions to increase human papillomavirus vaccine coverage: a systematic review. JAMA Pediatr. 2015;169(7):686–92.CrossRefPubMedPubMedCentral
40.
Jena AB, Goldman DP, Seabury SA. Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females. JAMA Intern Med. 2015;175(4):617–23.CrossRefPubMedPubMedCentral
Metadata
Title
Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers
Authors
Ingrid T. Katz
Laura M. Bogart
Chong Min Fu
Yingna Liu
Joanne E. Cox
Ronald C. Samuels
Tami Chase
Pamela Schubert
Mark A. Schuster
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3529-4

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Research article

Resilience, tipping, and hydra effects in public health: emergent collective behavior in two agent-based models

Research article

Under-five mortality rate variation between the Health and Demographic Surveillance System (HDSS) and Demographic and Health Survey (DHS) approaches

Research article

Developing a mHealth intervention to promote uptake of HIV testing among African communities in the UK: a qualitative study

Study protocol

Development and evaluation of the efficacy of a web-based ‘social norms’-intervention for the prevention and reduction of substance use in a cluster-controlled trial conducted at eight German universities

Research article

Socioeconomic disparities in lung cancer mortality in Belgian men and women (2001-2011): does it matter who you live with?

Research article

Comparing the mortality risks of nursing professionals with diabetes and general patients with diabetes: a nationwide matched cohort study