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

doi:10.1186/s12889-016-3529-4

. 2016 Aug 25;16(1):874.

doi: 10.1186/s12889-016-3529-4.

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

Ingrid T Katz^{1

2

3

4}, Laura M Bogart^{5

6

7}, Chong Min Fu⁶, Yingna Liu⁶, Joanne E Cox^{5

6}, Ronald C Samuels^{5

6}, Tami Chase⁶, Pamela Schubert⁶, Mark A Schuster^{5

6}

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. ikatz2@partners.org.
² Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA. ikatz2@partners.org.
³ Harvard Medical School, Boston, Massachusetts, USA. ikatz2@partners.org.
⁴ Division of Women's Health, 1620 Tremont Street, 3rd Floor BWH, Boston, MA, 02120, USA. ikatz2@partners.org.
⁵ Harvard Medical School, Boston, Massachusetts, USA.
⁶ Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
⁷ RAND Corporation, Santa Monica, California, USA.

PMID: 27558506
PMCID: PMC4997748
DOI: 10.1186/s12889-016-3529-4

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

Ingrid T Katz et al. BMC Public Health. 2016.

. 2016 Aug 25;16(1):874.

doi: 10.1186/s12889-016-3529-4.

Authors

Ingrid T Katz^{1

2

3

4}, Laura M Bogart^{5

6

7}, Chong Min Fu⁶, Yingna Liu⁶, Joanne E Cox^{5

6}, Ronald C Samuels^{5

6}, Tami Chase⁶, Pamela Schubert⁶, Mark A Schuster^{5

6}

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. ikatz2@partners.org.
² Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA. ikatz2@partners.org.
³ Harvard Medical School, Boston, Massachusetts, USA. ikatz2@partners.org.
⁴ Division of Women's Health, 1620 Tremont Street, 3rd Floor BWH, Boston, MA, 02120, USA. ikatz2@partners.org.
⁵ Harvard Medical School, Boston, Massachusetts, USA.
⁶ Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
⁷ RAND Corporation, Santa Monica, California, USA.

PMID: 27558506
PMCID: PMC4997748
DOI: 10.1186/s12889-016-3529-4

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.

Keywords: Adolescents; HPV immunization; Parental preferences; Provider preferences; Qualitative methods.

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References

1. CDC . Human papillomavirus (HPV)-associated cancers. 2013.
1. 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. - PMC - PubMed
1. 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. doi: 10.1093/jnci/djs491. - DOI - PMC - PubMed
1. 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
1. 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):626–629. - PubMed

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[1] CDC . Human papillomavirus (HPV)-associated cancers. 2013.

[2] CDC . Human papillomavirus (HPV)-associated cancers. 2013.

[3] 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. - PMC - PubMed

[4] 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. - PMC - PubMed

[5] 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. doi: 10.1093/jnci/djs491. - DOI - PMC - PubMed

[6] 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. doi: 10.1093/jnci/djs491. - DOI - PMC - PubMed

[7] 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

[8] 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

[9] 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):626–629. - PubMed

[10] 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):626–629. - PubMed

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

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

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